Bicycle injuries in children: an analysis based on demographic density.

INTRODUCTION: The purpose of this study was to investigate the characteristics and the outcome of bicycle injuries in paediatric patients according to the living environment, and to create guidelines for injury prevention. PATIENTS: The evaluation was performed in part based on hospital database of 1803 in- and out-patient children treated at the Paediatric Surgical Department of Pécs/Hungary between 2000 and 2006, and at the Department of Paediatric Surgery at the Heim Pal Hospital Budapest between 2004 and 2006. Additionally questionnaires were mailed to the patients' families to gain follow-up information. We analysed three groups according to demographic density (village, midsize town and large town). RESULTS: We found, that poor road quality played an important role as a contributing factor of injuries in villages. The number of bicycle spoke-injuries was higher in villages (13%), than in midsize towns (4.6%) and the large town (9.9%). In villages, 5% of children injured wore a helmet; this rate was 9% in midsize towns and 9.1% in the large town. Head injury was more common in villages, while in midsize towns and the large town arm injuries proved to be predominant. DISCUSSION: Prevention strategies targeting bicycle injuries in children should take into account the population density. This analysis revealed a substantial difference in the use of safety devices, and in the characteristics of injuries occurring in villages, indicating that there is a need for special attention regarding this higher risk population.

Evaluation of 100 laparoscopic varicocele operations with preservation of testicular artery and ligation of collateral vein in children and adolescents.

OBJECTIVES: To introduce a useful technique for identifying any collateral veins during laparoscopic varicocele operation and to evaluate our long-term results with this technique after 100 cases. METHODS: A new method was used to detect an incidental collateral vein. During surgery the patient was placed in anti-Trendelenburg position after introducing laparoscopic instruments until the dilated scrotal varicose filled up with blood. The main spermatic vein was then grasped atraumatically and the blood was pressed out manually from the scrotum. During this manoeuvre any existing collateral vein/veins became dilated and could be easily identified. The dilated spermatic vein and also any collateral vessel were first prepared then clipped. RESULTS: Out of the 100 patients, collateral veins were detected and ligated in 19 cases. In 15 cases a single collateral, in 4 cases two collaterals, and in the remaining 81 children no collateral veins were found. The testicular artery was identified in all operations as a pulsatile vessel. At a mean of 24 months (range 6-60 months) follow-up recurrence occurred in one patient and in five children hydrocele developed postoperatively. Testicular atrophy and severe intra- or postoperative complication did not occur in any patient of this series. CONCLUSION: The identification of incidental collateral vein by this method and preservation of the testicular artery resulted in a very good success rate in children and adolescents treated by laparoscopic varicocele operation.