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Mower Injuries
Studied By U-M

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PARKING AND ENTRANCE IN REAR

ach year, some 100,000
Americans are injured by
lawn mowers and about 75
die. Many of these victims
are children. While most re-
search has focused on the phys-
ical trauma and surgical aspects
of care, a recent University of
Michigan Medical Center study
examines the psychological im-
pact of severe lawn-mower in-
juries in children.
"I think we as a medical com-
munity tend to focus on the in-
jury itself rather than how it
affects the whole person," says
orthopedic surgeon Frances A.
Farley, director of the study. "The
psychological aspects of lawn-
mower injury haven't been in-
vestigated at all, to our know-
ledge, in children."
Dr. Farley and her colleagues
surveyed 24 children (19 boys,
five girls; average age 4.7) who'd
undergone treatment at the U-
M for lower-extremity amputa-
tions by a riding mower. The
children were given an age-ap-
propriate psychological test and
were interviewed about the im-
pact of the accident on their self-
esteem, their relationships with
friends and family, and their
goals for the future. The chil-
dren's mothers also were asked
to complete a standardized psy-
chological test to assess their per-
ception of their child's emotional
adjustment.
The results, presented earlier
this year at the annual meeting
of the American Academy of Or-
thopedic Surgeons, uncovered
significant psychological distress
among these young patients, in-

eluding depression and chronic
nightmares. Four of the children
also showed signs of psychosis —
extreme social isolation and emo-
tional instability, for example.

Four children
showed signs
of psychosis.

"We never expected that so
many of the children would be
dramatically abnormal psycho-
logically," Dr. Farley says. "We're
not sure whether those kids were
somehow more psychologically
prone to such injury in the first
place."
"Ideally, all children with frac-
tures or amputations as a result
of lawn-mower injury should be
evaluated by a psychologist, with
follow-up therapy aimed at ad-
dressing altered activities and
goals, relationships with peers
and self-esteem," Dr. Farley says.
Children outfitted with a pros-
thetic foot or leg are at especial-
ly high risk psychologically, she
adds.
Dr. Farley also emphasizes the
importance of keeping kids out
of the yard while the mower is
running. In nearly all of the cas-
es studied, the child was playing
in the yard at the time. Most ran
up to the mower while it was
moving and more than half were
injured when the mower was in
reverse. "Parents need to make
sure their kids are not in the yard
when they're mowing, period, she
says. "That's the bottom line." ❑

Scientists Discover
Immune On/Off Switch

previously unrecognized
biochemical mechanism
by which the immune sys-
tem reins in the tissue-de-
stroying activities of T
lymphocities— one of the major
types if blood cells involved in au-
toimmune diseases and rejection
of transplanted organs — has
been identified by researchers at
the Weizmann Institute.
Their studies centered on two
key activities associated with T-
een invasion of infected tissues.
One of them, the release of en-
zyme haparanase that punches
holes in the endothelial connec-
tive tissue of blood vessels, en-
ables the T cell to exit the blood
system and squeeze into an in-
flamed area. The other, the re-

lease by T cells of the signal pro-
tein TNF-alpha, sends out a ral-
lying call to bring additional
inflammatory cells into battle.
in a paper published in the
Proceedings of the National Acad-
emy of Sciences in May, Profes-
sor Irun Cohen and Dr. Ofer
Lider of the Institute's depart-
ment of cell biology showed that
these two activities are interre-
lated. They found that small,
specifically modified sugar units
released by the breakdown of
sugar-containing polymers in
connective tissues are picked up
by invading T cells and other va-
rieties of white blood cells. These
sugar molecules, they observed,
quench the ability of the cells to
produce TNF-alpha.