Retrieval of a penny from the pediatric esophagus: a cost analysis.

OBJECTIVE: As part of the oral phase of development, children commonly ingest foreign bodies. The most common lodged foreign body, requiring operative removal, in the United States is the penny. Valued at 1 cent, comprised of materials valued at less than 1 cent, costing 1.62 cents to manufacture, and being never removed from circulation, pennies are aplenty. But ingestion can lead to mucosal damage, the consequences of which can be esophageal perforation or stricture formation. We hypothesize that the monetary value of the penny is far less than the cost of its ingestion and removal. This quality assurance study examines the effect of the penny on the purse. PATIENTS AND METHODS: This retrospective review identified 180 foreign bodies in children under the age of 18 over a five year period. Eighty-two were pennies. Operative notes revealed degree of injury. Hospital charge assessments revealed the "cost" of each visit. RESULTS: There were no esophageal perforations, and cases were divided evenly among injury grades 0-III. The average total charge for all penny-related injuries was $7164.78. CONCLUSIONS: The purpose was to examine the actual cost of a penny (more than its value in production) and the potential cost of its damage (thousands of dollars in measurable costs, untold immeasurable costs). The goal of this study is to draw healthcare professional and public attention to a potentially serious and yet highly preventable injury in young children.

Dural arteriovenous fistula: diagnosis, treatment, and outcomes.

OBJECTIVES: The objective of this study is to determine the sensitivity of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) compared to the gold standard, conventional carotid angiography, in the diagnosis of a dural arteriovenous fistula (DAVF). Further objectives include identifying outcomes of treatment and complications as a function of pretreatment radiologic classification. STUDY DESIGN: This is a retrospective review of adults diagnosed with a DAVF between 1990 and 2006. METHODS: Data collected included age, gender, presenting clinical symptoms, diagnostic imaging modalities (conventional angiography, CTA, and/or MRA), interventions (self-compression of artery, embolization, craniotomy, or a combination of these), results (symptoms resolved, improved, or same), and complications (embolic or surgical). All DAVFs were classified according to the Cognard classification. RESULTS: There were a total of 46 patients with 51 fistulas, of whom 42 patients (46 fistulas) had complete follow-up data. Using conventional angiography as the gold standard, CTA had a sensitivity of 15.4%, whereas MRA had a sensitivity of 50%. Embolization (either single or multiple treatments) was the most common treatment, being done in 36/46 (78%) fistulas. Presenting symptoms were resolved or improved in 45/46 fistulas (97.8%) regardless of treatment or Cognard classification. There were complications in 12/46 (26%) patients, most of which were transient and resolved without permanent sequelae. CONCLUSIONS: A DAVF is a vascular lesion that is best diagnosed with conventional angiography, but can often be found with MRA. Treatment with endovascular embolization is effective and has few significant complications.

Microtubules and microfilaments coordinate to direct a fountain streaming pattern in elongating conifer pollen tube tips.

This study investigates how microtubules and microfilaments control organelle motility within the tips of conifer pollen tubes. Organelles in the 30-microm-long clear zone at the tip of Picea abies (L.) Karst. (Pinaceae) pollen tubes move in a fountain pattern. Within the center of the tube, organelles move into the tip along clearly defined paths, move randomly at the apex, and then move away from the tip beneath the plasma membrane. This pattern coincides with microtubule and microfilament organization and is the opposite of the reverse fountain seen in angiosperm pollen tubes. Application of latrunculin B, which disrupts microfilaments, completely stops growth and reduces organelle motility to Brownian motion. The clear zone at the tip remains intact but fills with thin tubules of endoplasmic reticulum. Applications of amiprophosmethyl, propyzamide or oryzalin, which all disrupt microtubules, stop growth, alter organelle motility within the tip, and alter the organization of actin microfilaments. Amiprophosmethyl inhibits organelle streaming and collapses the clear zone of vesicles at the extreme tip together with the disruption of microfilaments leading into the tip, leaving the plasma membrane intact. Propyzamide and oryzalin cause the accumulation of membrane tubules or vacuoles in the tip that reverse direction and stream in a reverse fountain. The microtubule disruption caused by propyzamide and oryzalin also reorganizes microfilaments from a fibrillar network into pronounced bundles in the tip cytoplasm. We conclude that microtubules control the positioning of organelles into and within the tip and influence the direction of streaming by mediating microfilament organization.