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Incidental detection of pituitary metastasis in patients with primary breast carcinoma is not uncommon. However, pituitary metastasis manifesting as bitemporal hemianopia as a presenting manifestation in a patient with silent adenocarcinoma of the lung, that too in a women, is quite uncommon. We report such a case.

OBJECTIVE: To investigate the characteristics of tricycle-related injuries in children presenting to US emergency departments (EDs).METHODS: Data regarding tricycle injuries in children younger than 18 years of age were obtained from the National Electronic Injury Surveillance System for calendar years 2012 and 2013. Data included body regions injured, ED disposition, and demographics.RESULTS: There were an estimated 9340 tricycle-related injuries treated in US EDs from 2012 to 2013. The average age was 3 years. Children 2 years of age had the highest frequency of injuries. Boys accounted for 63.6% of all injuries. Children 1 to 2 years of age represented 51.9% of all injuries. Lacerations were the most common type of injury. Internal organ damage was the most common type of injury in 3-and 5-year-olds. Contusions were the most common type of injury in 1-and 7-year-olds. The head was the most commonly injured region of the body and the most common region to endure internal damage. The elbows were the most commonly fractured body part. The upper extremity was more frequently fractured than the lower extremity. Approximately 2.4% of all injured children were admitted to the hospital. CONCLUSIONS:The upper extremity of children, particularly the elbow, was more frequently fractured than the lower extremity. The head was the most common body part to endure internal damage. By elucidating the characteristics of tricycle-related injuries, preventive measures can be implemented to decrease the incidence of tricycle-related injuries and ED visits. WHAT'S KNOWN ON THIS SUBJECT:Tricycle riding is a common activity in children. In calendar year 2012, tricycle accidents were the most common cause of reported toy-related deaths in children. Little research has been conducted regarding tricycle-related injuries and how to counsel parents appropriately. WHAT THIS STUDY ADDS:This study uses nationally representative data to investigate various characteristics of tricycle-related injuries in children to better counsel parents. This study highlights the importance of helmet and elbow pad use and parental supervision.

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Traumatic amputations in elderly adults were frequently due to saws and lawnmowers. An increase in injury prevention efforts in this patient population is warranted.

INTRODUCTION: Recent studies have underscored the adverse effects of prenatal exposure to bisphenol-A (BPA), pesticides, mercury, and lead. The purpose of this pilot study was to assess the counseling practices and level of comfort discussing prenatal environmental exposures among obstetricians in the state of Georgia. METHODS: We surveyed 100 practicing obstetricians, including Georgia private practice physicians in addition to residents and faculty from the largest residency training program in the state. RESULTS: The majority (72%) of physicians agreed that assessing environmental exposures during prenatal care is important in preventing adverse pregnancy outcomes. While 97.9% felt confident discussing cigarette smoking, few felt confident discussing the impact of other toxin exposures on pregnancy as follows: BPA (48.4%), pesticides (46.2%), mercury (42.1%), and lead (36.8%). Furthermore, less than 1 in 4 obstetricians reported routinely discussing each of these exposures as part of prenatal care: BPA (3.2%), pesticides (16.1%), mercury (22.6%), and lead (8.6%). There was no significant difference in either counseling practices or comfort discussing these topics when stratified by age, years in practice, and percentage of practice dedicated to obstetrics. CONCLUSION: Prenatal exposure to environmental toxins can have a significant impact on reproductive and developmental health, yet many obstetricians are not confident discussing the effect of environmental exposures on health outcomes with their patients. Currently most Georgia obstetricians are only evaluating a fraction of the environmental exposures recommended by the American College of Obstetricians and Gynecologists experts. There is a profound opportunity for improvement in counseling patients and educating reproductive health providers on this topic.

INTRODUCTION: Threatened abortions are one of the most psychologically distressing and frequently occurring complications in the first trimester of pregnancy. Approximately 30% of threatened abortions result in spontaneous abortions. The objective of this study was to investigate the epidemiology of trauma-associated threatened abortions presenting to United States emergency departments (EDs) using nationally representative data. METHODS: A retrospective analysis of the National Electronic Injury Surveillance System (NEISS) database was conducted. The NEISS database is a national probability sample of over 60 US EDs. Inclusion criteria were pregnant women with vaginal bleeding from trauma seen in US EDs from calendar year 2013 to 2015. All injuries were stratified by age, gender, race and disposition. RESULTS: From calendar year 2013 to 2015, there were 1358 trauma-associated threatened abortions that presented to US EDs. The mean age was 27 years old. There were a higher percentage of threatened abortions in whites (43%) than in blacks (27%) and Hispanics (13%). Approximately 18% of races were not recorded. The majority of threatened abortions occurred after slipping down a set of stairs (48%). A high percentage of threatened abortions also occurred after slipping in restrooms at home (19%). The majority of patients were discharged home after being evaluated in the emergency department (76%). Approximately 12% of patients were admitted or observed at the hospital. CONCLUSION: Falls down stairs were the primary mechanism of injury for threatened abortions in this cohort. Further efforts are warranted to explore safety measures to prevent injuries and decrease the frequency of trauma-related threatened abortions.