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Air rifle injuries in children
INTERNATIONAL
ABSTRACTS
OF PEDIATRIC
SURGERY
5 times higher among nonwhite patients than among whites. There was an increased mortality among those who developed convulsions. Ninetyseven per cent of these patients did not have a history of immunization. It is concluded that universal immunization is required to eliminate tetanus.-B. M. Hend~rsotz. TETANUS-TOXOID EMERGENCY BOOSTERS.A REAPPRAISAL.T. C. Pcebles, L. Levine, M. C. Eldred, arzd G. Edsnll. New Eng. J. Med. 280:575-581
(March
13).
1969.
Tetanus antibody titers in 143 pediatric patients receiving routine and emergency immunization showed adequate levels in all cases. The period of protection following 4 or more injections of tetanus toxoid was 12 or more years from the last injection in over 99 per cent of the cases. The authors conclude that when there is a history of adequate immunization against tetanus, boosters are not required and should be discontinued to minimize toxoid reactions.-B. M. Henderson. AIR RIFLE INJURIES IN CHILDREN. L. Spifz. S. Afr.
Med. J. 43:557-560
(May
lo),
1969.
Air rifles of the type commonly possessed by children are not controlled by any legislation. The standard pellet in South Africa is 0.177 inch, the average velocity of this pellet varies from 400 to 600 feet per second and at 20 feet the penetrating power varies from 12 to 163/J inch strawboards placed % inch apart. Eighty-five cases of penetrating injuries are reviewed. All were caused by the 0.177 inch pellet and in 30 per cent the injuries were of a serious nature. Seventy patients were male; 15 were female. The greatest age incidence was between 10 and 14 years. Twenty-five per cent of injuries were self-inflicted, all of these being in boys. Most of the remainder occurred in groups of children at play without adult supervision. The lower extremity was involved in 35.3 per cent of cases. Seven cases involved the eye of which 5 resulted in some degree of blindness. Penetration of the peritoneal cavity occurred in 3 cases and penetration of the chest wall occurred 3 times. Pellets were explored where there was damage to a vital structure, penetration of the peritoneal cavity. penetration of a joint, suspected damage to major vessels or nerves, when there was an associated compound fracture, and when there was secondary infection.
575
There were no deaths in the series, but hospital stay varied from one to 25 days. Case reports record penetrating wounds of the chest, of the eye with loss of the organ and of the eye with permanently impaired vision, of the abdomen with significant hemorrhage, and penetration of the right knee joint. The authors feel that the ability of air rifles to penetrate human tissues is no longer in question and make a plea that these weapons be brought under legislation regulating dangerous weapon\. -H.
V. Firor.
EXPERIENCE WITII EXTRACORPOREAL PIG-LIVER PERFUSION IN THE TREATMENT OF HEPATK COMA. G. M. Abozuza. Gut 9:730-731 (December). 1968.
The use of prolonged extracorporeal pig-live1 perfusion with human blood has now been applied clinically to provide temporary hepatic support in four patients in hepatic coma. One of the patients described was a 6-year-old child. Perfusion for 6 to 10 hours was carried out twice with an interval of 48 hours between. In all cases there was :L marked fall in the level of bilirubin. ammonia. and alkaline phosphatase and an appreciable rise in the level of prothrombin and fibrinogen. No antibody reaction could be demonstrated. All patients showed improvement in their general condition with lightening of coma, and one in fJct recovered consciousness completely but died 4 days later from a massive gastrointestinal hemorrhage. -Mnrgaret
J. Mayrll.
ANESTHESIA
AND INHALATION THERAPY
THE PULMONARY EXCHANGE OF NITROUS 0x1~1: AND HALOTHANE IN INFANTS AND CHILDREN. E. Strlarzitre, utzd H. Rackow, Anesthesiology
30:388-394
(April),
1969.
The uptake of anesthetic concentrations of nitrous oxide and halothane was found to rise faster in infants and children than in adults. The reasons for the more rapid rise of alveolar concentrations of these anesthetics in infants and children seems to be related to physiologic differences that are most pronounced in infancy. such as increased cardiac output, increased alveolar ventilation in relation to metabolism, and a proportionately larger compartment of well-perfused tissues relative to body mass. The more rapid uptake of halothane is of considerable clinical importance and may account in part for the rapid development of arterial hypotension observed in certain
ABSTRACTS
OF PEDIATRIC
SURGERY
5 times higher among nonwhite patients than among whites. There was an increased mortality among those who developed convulsions. Ninetyseven per cent of these patients did not have a history of immunization. It is concluded that universal immunization is required to eliminate tetanus.-B. M. Hend~rsotz. TETANUS-TOXOID EMERGENCY BOOSTERS.A REAPPRAISAL.T. C. Pcebles, L. Levine, M. C. Eldred, arzd G. Edsnll. New Eng. J. Med. 280:575-581
(March
13).
1969.
Tetanus antibody titers in 143 pediatric patients receiving routine and emergency immunization showed adequate levels in all cases. The period of protection following 4 or more injections of tetanus toxoid was 12 or more years from the last injection in over 99 per cent of the cases. The authors conclude that when there is a history of adequate immunization against tetanus, boosters are not required and should be discontinued to minimize toxoid reactions.-B. M. Henderson. AIR RIFLE INJURIES IN CHILDREN. L. Spifz. S. Afr.
Med. J. 43:557-560
(May
lo),
1969.
Air rifles of the type commonly possessed by children are not controlled by any legislation. The standard pellet in South Africa is 0.177 inch, the average velocity of this pellet varies from 400 to 600 feet per second and at 20 feet the penetrating power varies from 12 to 163/J inch strawboards placed % inch apart. Eighty-five cases of penetrating injuries are reviewed. All were caused by the 0.177 inch pellet and in 30 per cent the injuries were of a serious nature. Seventy patients were male; 15 were female. The greatest age incidence was between 10 and 14 years. Twenty-five per cent of injuries were self-inflicted, all of these being in boys. Most of the remainder occurred in groups of children at play without adult supervision. The lower extremity was involved in 35.3 per cent of cases. Seven cases involved the eye of which 5 resulted in some degree of blindness. Penetration of the peritoneal cavity occurred in 3 cases and penetration of the chest wall occurred 3 times. Pellets were explored where there was damage to a vital structure, penetration of the peritoneal cavity. penetration of a joint, suspected damage to major vessels or nerves, when there was an associated compound fracture, and when there was secondary infection.
575
There were no deaths in the series, but hospital stay varied from one to 25 days. Case reports record penetrating wounds of the chest, of the eye with loss of the organ and of the eye with permanently impaired vision, of the abdomen with significant hemorrhage, and penetration of the right knee joint. The authors feel that the ability of air rifles to penetrate human tissues is no longer in question and make a plea that these weapons be brought under legislation regulating dangerous weapon\. -H.
V. Firor.
EXPERIENCE WITII EXTRACORPOREAL PIG-LIVER PERFUSION IN THE TREATMENT OF HEPATK COMA. G. M. Abozuza. Gut 9:730-731 (December). 1968.
The use of prolonged extracorporeal pig-live1 perfusion with human blood has now been applied clinically to provide temporary hepatic support in four patients in hepatic coma. One of the patients described was a 6-year-old child. Perfusion for 6 to 10 hours was carried out twice with an interval of 48 hours between. In all cases there was :L marked fall in the level of bilirubin. ammonia. and alkaline phosphatase and an appreciable rise in the level of prothrombin and fibrinogen. No antibody reaction could be demonstrated. All patients showed improvement in their general condition with lightening of coma, and one in fJct recovered consciousness completely but died 4 days later from a massive gastrointestinal hemorrhage. -Mnrgaret
J. Mayrll.
ANESTHESIA
AND INHALATION THERAPY
THE PULMONARY EXCHANGE OF NITROUS 0x1~1: AND HALOTHANE IN INFANTS AND CHILDREN. E. Strlarzitre, utzd H. Rackow, Anesthesiology
30:388-394
(April),
1969.
The uptake of anesthetic concentrations of nitrous oxide and halothane was found to rise faster in infants and children than in adults. The reasons for the more rapid rise of alveolar concentrations of these anesthetics in infants and children seems to be related to physiologic differences that are most pronounced in infancy. such as increased cardiac output, increased alveolar ventilation in relation to metabolism, and a proportionately larger compartment of well-perfused tissues relative to body mass. The more rapid uptake of halothane is of considerable clinical importance and may account in part for the rapid development of arterial hypotension observed in certain