Successful readministration of trastuzumab after severe immune reactions in two breast cancer patients.

Trastuzumab is a standard treatment in breast cancer overexpressing Her2 oncogene. However, its administration carries the risk of severe immune adverse events which often lead to the discontinuation of trastuzumab. There is no clear guideline on how patients experiencing trastuzumab-related reaction should be rechallenged with the monoclonal antibody. Here, we present two case reports of patients who have presented severe anaphylactic reactions during trastuzumab infusion. Both of them have been successfully rechallenged in intensive care units with premedication, lower rate of infusion and vitals monitoring. Thereafter, trastuzumab could be continued without any serious adverse reaction. Given the positive impact of trastuzumab on patients' survival, treatment rechallenge should be carefully considered in patients who presented anaphylactic reactions.

[Meningeal carcinomatosis in breast cancer: from diagnosis to treatment]. / Carcinomatosis meningea en el cancer de mama: del diagnostico al tratamiento.

The appearance of meningeal carcinomatosis in breast cancer is an event that is being reported increasingly more frequently in the literature. It seems to be related with the lengthening of the patients' lives, improved sensitivity to diagnostic imaging and impermeability of the blood-brain barrier to the chemotherapeutic agents. It is an evolutionary form that affirms the metastatic invasion of the subarachnoidal space and is correlated with limited survival. Its diagnosis is difficult, due to the lack of specificity of the clinical signs dominated by headaches, cognitive disorders and possible signs and symptoms of progressive focal lesions. Magnetic resonance imaging of the brain and the spinal cord interpreted by a specialist in neuro-oncology is the preferred examination in this indication, in the search for an increase in meningeal enhancement. Biological analysis of the cerebrospinal fluid is an essential element in the diagnosis. In addition to the biochemical study, the presence of neoplastic cells is in itself enough to confirm the diagnosis. False negatives are very common and represent an important diagnostic problem that entails the need to repeat the lumbar punctures. The therapeutic methods are standard, often invasive, dominated by intrathecal chemotherapy and are based on low-level scientific evidence. This study analyses the epidemiology, the prognostic factors, the diagnostic tools, currently available treatments and the possible future therapies of meningeal carcinomatosis in breast cancer.

TITLE: Carcinomatosis meningea en el cancer de mama: del diagnostico al tratamiento.La aparicion de carcinomatosis meningea en el cancer de mama es un suceso cada vez mas comunicado en la bibliografia. Parece relacionarse con el alargamiento de la vida de las pacientes, la mejor sensibilidad al diagnostico por imagen y la impermeabilidad de la barrera hematoencefalica a los agentes quimioterapicos. Es una forma evolutiva que afirma la invasion metastasica del espacio subaracnoideo y se correlaciona con una supervivencia limitada. El diagnostico es dificil, debido a la inespecificidad de los signos clinicos dominados por cefaleas, trastornos cognitivos, y posibles sintomas y signos de lesiones focales progresivas. La resonancia magnetica del cerebro y de la medula espinal interpretada por un especialista en neurooncologia es el examen de eleccion en esta indicacion, en busqueda de un incremento en la captacion meningea. El analisis biologico del liquido cefalorraquideo es un elemento esencial en el diagnostico. Ademas del estudio bioquimico, la presencia de celulas neoplasicas es por si sola suficiente para confirmar el diagnostico. El numero de falsos negativos es muy comun y representa un gran problema diagnostico que requiere una repeticion de las punciones lumbares. Los metodos terapeuticos son estandares, a menudo invasivos, dominados por la quimioterapia intratecal y se basan sobre una evidencia cientifica de bajo nivel. Se analiza la epidemiologia, los factores pronosticos, las herramientas diagnosticas, los tratamientos disponibles en la actualidad y las posibles terapias futuras de la carcinomatosis meningea en el cancer de mama.

FOLFOX as Perioperative Chemotherapy of localized Gastric Cancer: Efficacy and Tolerance.

BACKGROUND: Use of perioperative chemotherapy had significantly improved prognosis of localized gastric cancer. Two studies have validated this approach using cisplatin based chemotherapy despite important toxicities. We conducted this study with the aim to evaluate efficacy and toxicity of FOLFOX regimen in this setting. MATERIAL AND METHODS: This is a retrospective study including patients followed for gastric cancer in the Oncology Department of the military hospital Mohamed V in Rabat, Morocco over a period of 7 years from 2007 to 2013. Patients received 4 cycles of mFOLFOX as perioperative regimen. Assessment of tumor response after completion of preoperative chemotherapy was granted by comparative CT scan, tumor markers measurements and R0 surgery rate.Adverse events were graded according to classification of the National Cancer Institute Common Toxicity Criteria version 4.0. RESULTS: Thirty-one patients were included in this study. Use of preoperative chemotherapy showed partial response in fourteen patients (45.1%), stabilization in fifteen patients (48.4%). Tumor markers CEA and CA 19- 9 were significantly decreased. R0 resection rate was 83.87%. Only 2 (6.45%) cases of grade 3/4 hematologic toxicity were reported in our study. Achieving programmed postoperative chemotherapy was possible in 72.41% of patients. CONCLUSIONS: Our study is limited by the retrospective design and small sample size but FOLFOX chemotherapy seems effective and well tolerated in this setting and its place deserves to be studied in a larger study.

Reversal of aconitine-induced tachycardia by prostaglandins in the rabbit Langendorff preparation.

The ability of PGA2, E1, E2, and F2alpha to alter: (a) the refractory period (as judged by the maximal driving frequency); (b) the rate of automatically beating aconitine-treated papillary muscles; and (c) the rate of both untreated and aconitine-treated Langendorff preparations, was studied. The addition of PGA2 (3.0 mumol), PGE2 (2.84 mumol), and PGF2alpha (2.1 mumol) to the perfusate returned heart rate to pre-aconitine levels in the Langendorff preparation, but this action was frequently accompanied by atrioventricular dissociation. In contrast, PGE1 (2.82 mumol) was ineffective in antagonising aconitine-induced tachycardia. In the normally beating rabbit Langendorff, PGF2alpha (2.1 mumol) produced a slight but statistically significant negative chronotropic effect. Neither cardiac contractile force nor maximal driving frequency was altered by the addition of prostaglandins. These results suggest that PGA2, PGE2, and especially PGF2alpha may exert antiarrhythmic activity by direct action(s) upon in vitro rabbit myocardial preparations.

Comparison of childhood burns associated with use of microwave ovens and conventional stoves.

To identify the incidence, type, and severity of burns associated with microwave oven (MW) use and to compare MW-associated burns with those associated with use of conventional stoves, we conducted a review of a national data base. Data were obtained from the US Consumer Product Safety Commission Injury Information Clearinghouse for 1986 through 1990 concerning burn injuries to children (0 to 19 years). There were an estimated 5160 burns associated with MW use. The mean age was 7.6 years (median, 6 years); 25% of burns were to children younger than 36 months old. Fifty-eight percent involved females. Most MW burns were scalds (95%); 16% of these scalds were from exploding eggs or other food. No MW burn involved a body surface area greater than 25% and no patient required hospital admission. Microwave oven burns were compared with stove burns. There were an estimated 41198 stove-associated burns to children. The mean age was 5.8 years; the median was 3 years. Forty-five percent of burns were to children younger than 36 months old; 55% were to males. Most stove burns (74%) were thermal; 7% involved a body surface area greater than 25%. Five percent of children with stove burns required hospital admission. We conclude that (1) burns to children associated with MW use are less frequent and less severe than stove burns; (2) MW burns predominantly affect females; and (3) burn prevention efforts should emphasize the hazards of stoves, which vastly exceed those of MWs.

Are toy guns too dangerous?

Toy guns with projectiles may injure young children. A study was undertaken to assess the danger posed by these toys and the regulations governing them. US Consumer Product Safety Commission (CPSC) data indicate that toy guns with projectiles cause relatively few injuries, mostly to young boys. The magnitude of the problem is smaller than that of nonpowder and powder firearms. Most often, toy gun injuries are to the face and eyes. Of the estimated 818 injuries in 1980 and 1981, 2.9% required hospitalization. More than 400 days were lost from school and work, and there were nearly 3,000 days of restricted activity due to these toy gun injuries. The hazard posed by toy guns with projectiles can be reduced through the legitimate regulatory authority of the Consumer Product Safety Commission with minor impact on retail cost, toy industry sales, and the play value of the toys. The yearly cost to consumers from increased regulation would probably be similar to the annual cost of the injuries. Regulation is warranted to protect young children who use these toys.

Potential mechanisms for failure to eradicate group A streptococci from the pharynx.

OBJECTIVE: To investigate the relative efficacy of orally administered cefadroxil and penicillin V in the treatment of group A streptococcal (GABHS) pharyngitis and the mechanism(s) responsible for failure of antimicrobial therapy to eradicate GABHS from the pharynx. STUDY DESIGN: A prospective, randomized clinical trial was conducted in four pediatric offices in which 462 patients with acute pharyngitis and positive culture for GABHS were randomly assigned to receive cefadroxil (n = 232) or penicillin V (n = 230). RESULTS: Bacteriologic treatment success rates for patients in cefadroxil and penicillin groups were 94% and 86%, respectively. However, among patients classified clinically as likely to have bona fide GABHS pharyngitis, there was no difference in bacteriologic treatment success rates in cefadroxil and penicillin groups (95% and 94%, respectively). Among patients classified clinically as likely to be streptococcal carriers, bacteriologic treatment success rates in cefadroxil and penicillin groups were 92% and 73%, respectively. The presence of beta-lactamase and/or bacteriocin-producing pharyngeal flora had no consistent effect on bacteriologic eradication rates among patients in either penicillin or cefadroxil treatment groups or among patients classified as having either GABHS pharyngitis or streptococcal carriage. CONCLUSIONS: Neither beta-lactamase nor bacteriocin produced by normal pharyngeal flora are related to bacteriologic treatment failures in GABHS pharyngitis. Cefadroxil seems to be more effective than penicillin V in eradicating GABHS from patients classified as more likely to be streptococcal carriers. However, among patients we classified as more likely to have bona fide GABHS pharyngitis, the effectiveness of cefadroxil and penicillin V seems to be comparable.

Effect of age and methacholine on the rate and coronary flow of isolated hearts of diabetic rats.

1. Isolated hearts perfused by the method of Langendorff from 6, 12 and 24 week streptozotocin (STZ) diabetic rats displayed a significant bradycardia following 60 min equilibration. The rate of hearts from 12-week diabetic rats (164 +/- 17) displayed the greatest bradycardia compared to age-matched controls (268 +/- 15; P less than 0.001), and diabetics treated with insulin (232 +/- 17; P less than 0.01), but by 52 weeks the heart rate of the 3 groups was similar. With advancing age the effect of STZ diabetes on the rate of rat isolated perfused hearts remained unchanged but the rate of the control and diabetic + insulin groups declined. 2. Hearts from 6-52 week STZ-treated rats were found to be more sensitive to the negative chronotropic effect of methacholine, the greatest difference occurring in hearts from the 12 week animals. Atropine (10(-7) M) did not affect the resting heart rate of age-matched controls or diabetics but blocked methacholine (2.6 x 10(-6) M)-induced bradycardia in both, suggesting that the site of action of diabetic bradycardia is not the muscarinic receptors. 3. At the end of equilibration there was a significant decrease in coronary flow in hearts from 12 week diabetic animals. In spontaneously beating diabetic rat hearts administration of methacholine (2.6 x 10(-6) M) produced a significantly greater decrease in coronary flow in the 12, 24 and 52 week diabetic hearts. When electrically paced (5 Hz) however, there was no difference in response to methacholine between the three groups except at 52 weeks between the age-matched control and diabetic groups. This suggests that the more pronounced reduction induced by methacholine on the coronary flow of diabetic hearts is secondary to its negative chronotropic effect. 4. In general, hearts from diabetic animals treated with insulin respond similarly to their agematched controls in the presence and absence of methacholine.

The role of bone scintigraphy in detecting child abuse.

This review of diagnostic imaging in cases of suspected child abuse characterizes the significant differences between bone scintigraphy and x-ray evaluation, describes the advantages and disadvantages of each modality, postulates on the specific mechanisms of injury that produce the characteristic scintigraphic findings, and emphasizes the influences that scintigraphic studies have on the medical, social, and legal aspects of child abuse. The major advantages of bone scintigraphy are its increased sensitivity (25% to 50%) in detecting evidence of soft tissue as well as bone trauma in child abuse. Furthermore, it is postulated that the specific mechanisms of inflicting the trauma relate to the patient's size and are characterized by bone scintigraphy. During fits of anger or frustration, the perpetrator of child abuse grasps the small infant or child by the thorax during the shaking activity. This produces characteristic rib injuries. The older and heavier child is more likely to be grabbed by the extremities, which produces periosteal injuries manifested as characteristic abnormal localizations in the diaphyses of the extremities. The roentgenograms of these injuries are frequently normal. The importance of bone scintigraphy is its complementary nature in defining and characterizing the extent and severity of trauma from child abuse. Such findings have direct bearing on the medical, social, and legal outcomes for the abused child. The quality of scintigraphic imaging is important, requiring the use of magnification techniques in the infant. The interpretation of the scintigraphic images depends on an understanding of the mechanisms by which the radionuclide localizes in bone. The same traumatic incident can lead to decreased, normal, or increased localization at the trauma site. Radionuclide scintigraphy is a complementary rather than competitive imaging modality to X-ray evaluation in the diagnosis and management of physical child abuse.

Convenient schedules and short course treatment of acute streptococcal pharyngitis.

A number of options exist for reducing the frequency of antibiotic dosing and shortening the course of treatment of GAS pharyngitis. All oral agents are more costly than oral penicillin and have a broader spectrum of antimicrobial activity. These issues must be weighed against the convenience of these treatment regimens. At this time penicillin remains the drug of choice for acute streptococcal pharyngitis. Oral penicillin V can be given twice daily for 10 days. Intramuscular benzathine penicillin is inexpensive and obviates any concerns about compliance. For penicillin-allergic patients, twice daily erythromycin for 10 days is preferred but azithromycin once a day for 5 days is a reasonable (but expensive) alternative.

Cycling injuries treated in emergency departments: need for bicycle helmets among preschoolers.

OBJECTIVES: To describe the incidence, circumstances, and severity of bicycle-related injuries among children treated in US emergency departments (EDs) and to compare injuries in children aged 1 to 4 years (young children) with those in children and adolescents aged 5-9 and 10-14 years (intermediate-age and older children, respectively). DESIGN: Emergency department survey from the National Center for Health Statistics National Hospital Ambulatory Medical Care Survey for January 1, 1992, through December 31, 1997. PATIENTS: National probability sample of patients who sought care in EDs; data for children 1 to 14 years old were used. OUTCOME MEASURES: Incidence and description of bicycle-related injuries among children grouped by age treated in US EDs. RESULTS: The 6-year weighted estimate of bicycle-associated injuries was 2,176,173. Young children had 270,098 ED visits; their average annual incidence was 45,016, a rate of 28.8 per 10,000 (95% confidence interval [CI], 19.1-38.5). Children in the intermediate-age and older groups had an incidence of 82.0 (95% CI, 66.6-97.4); and 86.4 (95% CI, 70.4-102.4) per 10,000, respectively. The highest rates of bicycle-related injuries were observed among boys in the intermediate-age (108.3 per 10,000 per year) and older groups (123.8 per 10,000 per year). Few injured children were involved in collisions with motor vehicles (<1% of young and 4% of intermediate-age groups). The annual incidence of head trauma was 4.0 per 10,000 (95% CI, 0.4-7.5) for young children, 9.3 per 10,000 (95% CI, 4.3-14.2) for intermediate-age children, and 8.1 per 10,000 (95% CI, 3.5-12.8) for older children. Children aged 5 to 9 years had the highest rates of face trauma (estimated 29.8 per 10,000). The incidence of extremity fractures (range, 6.9-17.6 per 10,000) was similar for all groups. CONCLUSIONS: Although boys in the intermediate-age and older groups have the highest incidence of bicycle-related injuries, young children are also commonly injured. The anatomic sites of injury among young cyclists (head and face trauma and extremity fractures) are similar to those observed in both other groups. Bicycle helmets are indicated for the youngest children as well.

How rational is the crossmatching of blood in a pediatric emergency department?

OBJECTIVE: To determine if typed and crossmatched blood ordered in a pediatric emergency department (ED) is actually used for transfusion and if some ordering patterns are not cost-effective. DESIGN: Retrospective medical record review. Emergency department records and blood bank logs were reviewed daily to identify patients who had a type and crossmatch (T&C) ordered; inpatient records were then reviewed. A priori diagnostic and patient care categories were determined. Physicians and nurses providing care were unaware of the study. SETTING: An inner-city, tertiary care, pediatric trauma center ED. PATIENTS: A consecutive sample of ED patients who had a T&C ordered from October 1, 1993, through January 31, 1994. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Outcome measures included age, general category of diagnosis, number of units of blood crossmatched and transfused within 7 days, hemoglobin concentration in the ED, surgical procedures in the operating room, and hospital charges for typed and crossmatched blood. For trauma patients, the Pediatric Trauma Score was recorded. The crossmatch-to-transfusion (C/T) ratio was calculated for each diagnostic category (the typical C/T ratio for US hospitals is 2). We calculated a new ratio, the patient-to-transfusion (P/T) ratio, to correct for the transfusion of numerous units of blood in a few patients. RESULTS: Two hundred eighty-two patients had 468 U of blood typed and crossmatched. Fifty-six patients received a total of 110 U of blood. The mean hemoglobin concentration was 81 g/L for patients who received a transfusion and 117 g/L for patients who did not receive a transfusion (P < .001). The C/T ratio for all patients was 4.3. The P/T ratio for all patients was 5.3. Sixty-four surgery patients had 78 U of blood typed and crossmatched; 1 U of blood was transfused to 1 patient, yielding a C/T ratio of 78 and a P/T ratio of 64. Ninety-one units of blood were typed and crossmatched for 38 major trauma patients; 20 U of blood were transfused to 2 patients, 19 U were transfused to 1 patient with a Pediatric Trauma Score of 4, and 1 U was transfused to a patient with a Pediatric Trauma Score of 7. The C/T ratio for major trauma patients was 4.6, and the P/T ratio was 19. Forty-five children with ventriculoperitoneal shunt problems had 51 U of blood typed and crossmatched, but no blood was transfused. Children with sickle-cell disease had a C/T ratio of 2.2 and a P/T ratio of 3.3; those with cancer diagnoses had a C/T ratio of 1.6 and a P/T ratio of 1.3. During the 4-month study period, the hospital charged $84,726 for these T&Cs. The charge for T&Cs never used for transfusion was $65,643 (77.5%). CONCLUSIONS: Most typed and crossmatched units of blood ordered in our pediatric ED were never used for transfusion. The C/T and P/T ratios were high for many diagnostic categories, suggesting inefficient blood ordering and patient management. Transfusions were uncommon in children with the following problems: ventriculoperitoneal shunt malfunction, virtually all surgical diagnoses, cancer with a hemoglobin concentration greater than 105 g/L, and trauma patients with a Pediatric Trauma Score of greater than 7.

Tykes and bikes: injuries associated with bicycle-towed child trailers and bicycle-mounted child seats.

OBJECTIVES: To describe the incidence, type, and severity of injuries related to the use of bicycle-towed trailers for transporting children and to compare them with injuries associated with the use of child seats mounted on adult bicycles. DESIGN: A retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for 1990 to 1998. RESULTS: There were 49 injuries to children during the 9-year study period (estimated 2338 injuries; 95% confidence interval [CI], 1121-3555): 6 were associated with the use of bicycle-towed trailers (an estimated 322 injuries; 95% CI, 158-486) and 43 were related to the use of bicycle-mounted child seats (an estimated 2015 injuries; 95% CI, 988-3042). The mean age of injured children was 2.4 years and 51% were male. A collision with a motor vehicle accounted for 2 (33%) of the injuries associated with bicycle-towed trailers; 3 (50%) of the injuries were the result of falls. A motor vehicle was involved in 4 injuries (9%) related to the use of bicycle-mounted child seats (Fisher exact test, P<.13 vs bicycle-towed trailers); 31 (72%) were the result of falls (Fisher exact test, P<.26 vs bicycle-towed trailers). Contact with a bicycle wheel or spokes was the mechanism of 1 injury associated with the use of a bicycle-towed trailer (17%) and the mechanism for 8 (19%) of the injuries associated with the use of a bicycle-mounted child seat (Fisher exact test, P<.69). The head or face was the most common site of injury, accounting for 5 (83%) injuries among those riding in bicycle-towed trailers and 21 (49%) injuries among children in bicycle-mounted child seats (Fisher exact test, P<.12). All 6 children injured in bicycle-towed trailers had contusions/ abrasions or lacerations; 22 (51%) children injured using bicycle-mounted child seats had contusions/abrasions or lacerations and 9 (21%) had fractures. Two children (33%) injured in bicycle-towed trailers and 2 (5%) injured in bicycle-mounted child seats were admitted to the hospital (Fisher exact test, P<.06). CONCLUSIONS: When compared with bicycle-mounted child seats, there were fewer reported injuries to children associated with the use of bicycle-towed trailers. Motor vehicle involvement and need for hospital admission were similar among injured children in both groups, and the head or face was the most common site of injury. These data imply that ongoing surveillance efforts to identify injuries associated with use of bicycle-towed child trailers are warranted and that bicycle helmets should be worn by children riding in bicycle-towed child trailers and in bicycle-mounted child seats.

Strategies for managing group A streptococcal pharyngitis. A survey of board-certified pediatricians.

OBJECTIVE: To assess the management strategies and knowledge of board-certified pediatricians regarding group A beta-hemolytic streptococcal (GABHS) pharyngitis. DESIGN: Survey of 1000 US pediatricians in 1991, chosen randomly from the membership of the American Academy of Pediatrics. The survey included questions related to 2 clinical scenarios, respondent demographics, and knowledge of streptococcal pharyngitis. SUBJECTS: Pediatricians who treated patients with pharyngitis. Of the 690 surveys that were returned, 510 pediatricians treated patients with pharyngitis and were included in the data analysis. DATA ANALYSIS: Data were analyzed using Chi 2 statistics for categorical data and the Student t test for continuous variables. RESULTS: Antigen detection tests (ADTs) were used by 64% of the pediatricians; 85% used throat cultures. Strategies for diagnosing streptococcal pharyngitis were throat culture alone (38%), consider positive ADTs definitive and use throat culture when ADTs are negative (42%), ADT alone (13%), ADT and throat culture for all patients with pharyngitis (5%), and no tests for GABHS performed (2%). Thirty-one percent usually or always treated with antibiotics before test results were available. Only 29% of these "early treaters" always discontinued antibiotics when tests did not confirm the presence of group A streptococci. The drug of choice for treatment was penicillin (73%); another 26% preferred a derivative of penicillin, particularly amoxicillin. Many pediatricians altered their management when a patient had recurrent streptococcal pharyngitis. Nearly half of the respondents would use a different antibiotic than they used for routine acute streptococcal pharyngitis. They most often changed to erythromycin (25%), cefadroxil (23%), or amoxicillin-clavulanate (20%). Follow-up throat culture was obtained by 51% of pediatricians after treatment of recurrent streptococcal pharyngitis. A patient with chronic carriage of GABHS and symptoms of pharyngitis would be treated with an antibiotic by 84%; most (62%) would use a penicillin. Other choices were cephalosporins (19%), erythromycin (12%), clindamycin (3%), or rifampin plus penicillin (3%). Tonsillectomy was recommended for symptomatic carriers by 31% of respondents. Carriers without symptoms were less likely to be treated with antibiotics (23%) or referred for tonsillectomy (21%). CONCLUSIONS: Most surveyed board-certified pediatricians managed acute GABHS pharyngitis appropriately, but 15% to 20% used diagnostic or treatment strategies that are not recommended. There was lack of a consensus about the management of recurrent GABHS pharyngitis and chronic carriage of GABHS.

Incidence and circumstances of nonfatal firearm-related injuries among children and adolescents.

OBJECTIVE: To describe the incidence and circumstances of nonfatal firearm-related injuries among children and adolescents treated in US emergency departments. DESIGN: Data were obtained from the Firearm Injury Surveillance Study, 1993-1997; data were collected through medical record review at hospitals participating in the National Electronic Injury Surveillance System. SETTING: The hospitals participating in National Electronic Injury Surveillance System are a stratified probability sample of all US hospitals. MAIN OUTCOME MEASURES: Numbers and population rates for nonfatal firearm-related injuries among children and adolescents younger than 20 years old. RESULTS: An estimated 115,131 (95% confidence interval, 76,769-153,493) children and adolescents were treated for a nonfatal gunshot wound during the study period. The estimated annual rates of injury (per 100,000) were 2.0 (children 0-4 years old), 2.2 (children 5-9 years old), 15.4 (children 10-14 years old), and 106.5 (adolescents 15-19 years old). The ratios of nonfatal to fatal firearm-related injuries were 4.0 (children 0-4 years old), 4.4 (children 5-9 years old), 5.0 (children 10-14 years old), and 4.4 (adolescents 15-19 years old). An additional estimated 103,814 children (95% confidence interval, 69,223-138,405) were shot with a nonpowder firearm (BB or pellet gun). Boys 5 to 9 and 10 to 14 years old had the highest rates of injury related to nonpowder firearms, an estimated 36.2 and 99.8 per 100,000, respectively. Fifty-six percent of those 15 to 19 years old were assault victims. An estimated 48% of children and adolescents with powder firearm-related gunshot wounds and an estimated 4% with nonpowder firearm injuries were admitted to the hospital. CONCLUSIONS: Nonfatal injuries related to powder firearms and nonpowder firearms (BB or pellet guns) are an important source of injury among US children and adolescents. Ongoing surveillance of nonfatal firearm-related injury among children and adolescents is needed.

Insurmountable antagonism of ouabain-induced coronary constriction by prazosin.

A linear dose-response curve was produced by the addition of ouabain (10(-8)-10(-6) M) to the media bathing segments of porcine right coronary arteries. A concentration of 10(-6) M ouabain produced constriction equal to 47% of that resulting from exposure to 35 mM KCl. The ouabain dose-response curve was competitively displaced one order of magnitude by the previous addition of verapamil (2.2 X 10(-8) M), and non-competitively by the prior exposure to prazosin (6.5 X 10(-7)-6.5 X 10(-13) M). The inhibitory effect of prazosin appears to be unrelated to its alpha 1-adrenergic blocking action.

Childhood pedestrian injury: a pilot study concerning etiology.

For U.S. children of preschool and school age, fatal pedestrian injury is more common than fatal passenger injury, but there is no agreement on preventive approaches and their efficacy. Development of preventive measures requires understanding of how and why such injuries occur, which in turn requires better methods to sort out the many factors which appear to contribute to the problem. In an attempt to develop the broadest possible picture of the dynamics of child pedestrian injury, a multidisciplinary process was developed to collect and interpret medical, traffic, social, psychological and behavioral information concerning specific injury events. In a pilot study, the process was used to study six pedestrian injuries. The pilot study indicated that: the multidisciplinary approach identified possible etiologic factors missed without it; this approach requires the availability of high quality medical information and police accident records; biological, psychological, and social characteristics of victims, victim families and communities appear to affect the occurrence of child pedestrian injuries; and, such victim factors must be considered in development of countermeasures. It is concluded that the technique of multidisciplinary analysis merits further application as a productive way to generate quantitatively testable hypotheses concerning childhood pedestrian injury causality and potential countermeasures.

Exposure corrected risk estimates for childhood product related injuries.

This study assesses the effect of exposure correction on injury risk estimates for children, using Chicago-area survey data on age-specific exposure of children to seven products: amusement park rides, sleds, bunkbeds, skateboards, fireworks, toboggans, and air guns and rifles. National Electronic Injury Surveillance System estimates for 1987 were used as numerators with two denominators: (i) uncorrected age-specific U.S. Census estimates for 1987 and (ii) these estimates corrected for exposure. Except for bunkbeds, skateboards and sleds, corrected injury risk decreased as age increased. Uncorrected population injury rates underestimated the risk posed to product-using children, especially those who are youngest and those who use skateboards.

Child pedestrian injury taxonomy based on visibility and action.

With data from multidisciplinary investigations of child pedestrian injuries in Chicago, a new and simpler four-category taxonomy is presented based on the process that led to the collision. Two dimensions are recognized: the visibility of the child and/or the vehicle immediately prior to the event and the rapidity of action, either movement or change in direction, of the victim or the vehicle. The taxonomy is neutral with respect to responsibility for the collision and accommodates the findings of other researchers. This classification scheme is tested empirically using objective data elements such as child gender and age and event location. It is further tested using the results of a multidisciplinary causal sequence reconstruction of each injury event, based on such factors as child's psychological character, traffic risks, driver behavior, visibility obstructions, whether the child negotiated part of the street before being struck, and child's activities immediately prior to the injury. The results show that events in the categories in this new taxonomy are distinctly different from each other, and that the structure is useful for identifying and organizing interventions.