All-Terrain Vehicle(ATV) Injuries - An Institutional Review Over 6 Years.

OBJECTIVE: Quad bike or all-terrain vehicle (ATV) related injuries are a significant cause of trauma and may present with severe or fatal injuries. Most of the literature describing ATV related injuries come from North America and Australasia and data from the United Kingdom is scarce despite a high prevalence of ATV use. The aim of this study was to describe our single centre experience with ATV injuries over a 6-year period from 2010 to 2015. MATERIALS AND METHODS: This is a cohort analysis of 65 patients who presented with ATV related injuries in South West Acute Hospital, UK between 2010 and 2015. RESULTS: 65 patients had ATV injuries. 34 (52%) patients were children between 0 - 17 years of age. 88% (n=57) patients were ejected from the ATV, six got trapped underneath and two had collisions. "Ejection" as a mechanism of injury was significantly more common than the other mechanisms (p<0.0001). Compliance with helmet use was low at 16% (n=10). Extremity (48%) and head and face trauma (43%) were the most common injuries. One (1.5%) patient died while 3 (4.6%) patients had major morbidity. CONCLUSION: ATV injuries are an important cause of trauma admissions and carry a significant risk of morbidity and mortality. Extremity and head trauma are the most common injuries resulting from ATV accidents. More than 50% of the injured are children. Compliance with helmet use is low and calls for legislation and public awareness strategies to reduce the impact of ATV accidents on health care.

Clinical comparison of 180-degree and 360-degree data collection of technetium 99m sestamibi SPECT for detection of coronary artery disease.

BACKGROUND: With multihead gamma cameras both 180- and 360-degree acquisitions of myocardial perfusion are feasible. However, with 99mTC-labeled sestamibi (99mTC-sestamibi) the optimal clinically relevant demonstration of the superiority of 180- versus 360-degree data acquisition has not been performed. METHODS: Seventy-two consecutive patients undergoing 99mTC-sestamibi imaging at rest and stress who had coronary angiography performed within 3 months were enrolled. The results of blinded interpretation of 13 segments per patient for the 180- and 360-degree data were compared for interobserver variability. Sensitivity and specificity of defect localization in the left anterior descending, right coronary, and left circumflex territories for detection of 50% or greater or 70% or greater stenoses by coronary angiography were compared. RESULTS: There was significant segmental agreement of the stress perfusion images between observers for 180-degree (Kappa = 0.63) and 360-degree data (Kappa = 0.58), but the agreement was significantly higher for 180-degree data (p < 0.05). Overall sensitivity for the detection of coronary artery disease as a 50% or greater stenosis in 62 patients was 79% with 180-degree acquisition and 77% with 360-degree acquisition. The specificity for absence of coronary artery disease in 10 patients was also similar at 70% and 80%, respectively. There was no overall difference in detection of individual stenoses with a sensitivity of 54% with 180-degree acquisition and 50% with 360-degree acquisition. Specificity was also similar at 78% and 81%, respectively. CONCLUSION: There is no difference in clinically relevant detection of overall coronary artery disease or individual stenoses using 180- or 360-degree acquisition of 99mTC-sestamibi myocardial perfusion images. However, 180-degree acquisition has superior interobserver reproducibility.

Pros and cons of perfusion balloons in failed angioplasty.

Prolonged inflation with perfusion balloons is commonly used in failed angioplasty. The objective of this study was to determine the angiographic outcome of 59 consecutive patients treated with prolonged inflation with perfusion balloons as the primary treatment for failed angioplasty. Angiographic success (< 50% stenosis and normal flow) was achieved in 41%. Angiographic success was greater in the left anterior descending coronary artery (67% versus 33% for non-left anterior descending involvement, P = .044) and was less in complex dissections (25% versus 75% for no dissection or simple dissections, P = .025). Angiographic deterioration occurred in 37.5% of the successful group and 77% of the unsuccessful group (P = .002) and was more frequent in the right coronary artery (88% versus 50% for non-right coronary involvement, P = .007) and complex dissections (92% versus 38% for no dissection or simple dissections, P = .0001). Thus, in a group of patients with unsuccessful outcome following conventional balloon angioplasty, success with the perfusion balloon was modest. Furthermore, angiographic deterioration was frequently observed following unsuccessful prolonged inflation.