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Chest roentgenogram in pulmonary tuberculosis: New data on an old test
The Journal of Emergency Medicine, Vol. 7, pp. 301-307,
Printed in the USA
1989
maximum plasma nifedipine concentration was 71 ng/mL (compared to 10 ng/mL) and was reached earlier. Also it was observed that the median heart rate increased from 60 to 72 bpm after oral administration, compared with no change after sublingual use. The authors conclude that the therapeutic effects of nifedipine can be obtained more quickly by biting and swallowing than by biting and hold[James Boslough, MD] ing the drug in the mouth.
0 PULMONARY COMPLICATIONS OF INTRAVENOUS DRUG ABUSE: EXPERIENCE AT AN INNER CITY HOSPITAL. O’Donnell AB, Pappas LS. Chest 1988; 94:251-3. This retrospective chart review summarizes the pulmonary complications found in patients with a history of intravenous drug abuse (IVDA). In 5 1 drug abusers seen by a pulmonary consulting service over a 22-month period, the pulmonary diagnoses included septic pulmonary emboli in 12 (23.5%), community acquired pneumonia in 10 (19.6%), AIDS in 5 (9.8%), tuberculosis in 5 (9.8%), empyema in 3 (5.8%), ARD (1 heroin-induced pulmonary edema and 3 related to sepsis) in 4 (8%), lung abscess in 1 (1.9%), and miscellaneous pulmonary diseases in the remaining 11 patients (21.4%), including primary respiratory failure. Forty patients (78%) were tested for HIV antibody, with 25 (62.5%) testing positive. However, only 5 (9.8%) had infectious complications meeting criteria for the diagnosis of AIDS. The authors concluded that common bacterial infections and tuberculosis are the most common pulmonary complications found in patients with a history of IVDA. Although a great number of patients were HIV antibody positive, only a small number had AIDS. However, the authors anticipate an increase in the number of AIDS related pulmonary complications in the near future. [Greg Bennett, MD] Editor’s Note: It is interesting (and depressing) that the incidence of HIV positivity was so high. If this cohort could be followed, it would provide useful information about the development of the disease in HIV positive patients. The high-risk gay cohort has a 75% disease development of AIDS or ARC.
0 CHEST ROENTGENOGRAM IN PULMONARY TUBERCULOSIS: NEW DATA ON AN OLD TEST. Barnes PF, Verdegem TD, Vachon LA, Leedom JM, Overturf CD. Chest 1988;94:316-20. This “predominantly prospective” study was designed to evaluate the utility of routine admission chest roentgenograms (CXRs) in detecting pulmonary tuberculosis (TB) and to evaluate the relationship between CXR patterns and the likelihood of finding acid-fast bacilli (AFB) on sputum smears. After identifying 192 patients with culture proven pulmonary TB, 188 were evaluated by obtaining a standardized history, physical exam, and CXR. If any TB symptom (tactile fever, chills, night sweats, fatigue, weight loss, cough, sputum production, hemoptysis, chest pain, shortness of breath, or exacerbation of pre-existing lung disease) was elicited on the standardized history, the chief complaint was then considered related to pulmonary TB. The admission CXR was “positive” for TB in 52 of the 58 patients including all of 9 patients with a chief complaint unrelated to TB by the standardized history. A second study reviewed CXRs of 392 patients admitted for suspected TB. AFB positive sputum smears were obtained in 90% of patients whose CXR showed a typical reactivation pattern, and in 98% if the CXR showed cavitation or an alveolar infiltrate in 3 or more lung zones. The authors conclude that the routine admission CXR is a useful screening test for TB in areas where the prevalence of TB is particularly high. [Jeffery Cox, MD]
0 NEGLIGIBLE SUBLINGUAL ABSORPTION OF NIFEDIPINE. Harten JV, Burggraaf K, Danhof M, et al. Lmcet 1988;2: 1363-4. In a study involving 11 healthy volunteers, capsules containing 10 mg of nifedipine were either bitten and held in the mouth or bitten and swallowed. After biting the capsule and not swallowing for 20 minutes, a median of 89% of the dose was recovered from the mouth, and a median maximum plasma nifedipine concentration of 10 ng/mL was reached 25 minutes after emptying the mouth. On the other hand, after biting and swallowing the capsule the median
=
Copyright 0 1989 Pergamon Press plc
??
INJURY: RESULTS OF INI0 BLUNT URETHRAL TIAL MANAGEMENT. Malangoni MA, Botner BK, Amin EA, Amin M. Amer Surgeon 1988;54:181-4. This study reviewed 14 patients with blunt urethral trauma. Five had blood at the urethral meatus at the time of
Abstracts-designed to keep readers up to date by providing original abstracts of current literature from all fields relating to emergency medicine-are prepared by the Emergency Medicine Residents of the University Hospital of Jacksonville, Jacksonville, Florida; and the Residency in Emergency Medicine in Denver General, St. Anthony’s, St. Joseph’s, Porter Hospital and University of Colorado Health Sciences Center, Denver, Colorado, with editorial notes by Robert Wears, MD, University Hospital of Jacksonville, and Peter Rosen, MD, Editor-in-Chief, JEM. 0736-4679/89 301
$3.00 + .OO
Printed in the USA
1989
maximum plasma nifedipine concentration was 71 ng/mL (compared to 10 ng/mL) and was reached earlier. Also it was observed that the median heart rate increased from 60 to 72 bpm after oral administration, compared with no change after sublingual use. The authors conclude that the therapeutic effects of nifedipine can be obtained more quickly by biting and swallowing than by biting and hold[James Boslough, MD] ing the drug in the mouth.
0 PULMONARY COMPLICATIONS OF INTRAVENOUS DRUG ABUSE: EXPERIENCE AT AN INNER CITY HOSPITAL. O’Donnell AB, Pappas LS. Chest 1988; 94:251-3. This retrospective chart review summarizes the pulmonary complications found in patients with a history of intravenous drug abuse (IVDA). In 5 1 drug abusers seen by a pulmonary consulting service over a 22-month period, the pulmonary diagnoses included septic pulmonary emboli in 12 (23.5%), community acquired pneumonia in 10 (19.6%), AIDS in 5 (9.8%), tuberculosis in 5 (9.8%), empyema in 3 (5.8%), ARD (1 heroin-induced pulmonary edema and 3 related to sepsis) in 4 (8%), lung abscess in 1 (1.9%), and miscellaneous pulmonary diseases in the remaining 11 patients (21.4%), including primary respiratory failure. Forty patients (78%) were tested for HIV antibody, with 25 (62.5%) testing positive. However, only 5 (9.8%) had infectious complications meeting criteria for the diagnosis of AIDS. The authors concluded that common bacterial infections and tuberculosis are the most common pulmonary complications found in patients with a history of IVDA. Although a great number of patients were HIV antibody positive, only a small number had AIDS. However, the authors anticipate an increase in the number of AIDS related pulmonary complications in the near future. [Greg Bennett, MD] Editor’s Note: It is interesting (and depressing) that the incidence of HIV positivity was so high. If this cohort could be followed, it would provide useful information about the development of the disease in HIV positive patients. The high-risk gay cohort has a 75% disease development of AIDS or ARC.
0 CHEST ROENTGENOGRAM IN PULMONARY TUBERCULOSIS: NEW DATA ON AN OLD TEST. Barnes PF, Verdegem TD, Vachon LA, Leedom JM, Overturf CD. Chest 1988;94:316-20. This “predominantly prospective” study was designed to evaluate the utility of routine admission chest roentgenograms (CXRs) in detecting pulmonary tuberculosis (TB) and to evaluate the relationship between CXR patterns and the likelihood of finding acid-fast bacilli (AFB) on sputum smears. After identifying 192 patients with culture proven pulmonary TB, 188 were evaluated by obtaining a standardized history, physical exam, and CXR. If any TB symptom (tactile fever, chills, night sweats, fatigue, weight loss, cough, sputum production, hemoptysis, chest pain, shortness of breath, or exacerbation of pre-existing lung disease) was elicited on the standardized history, the chief complaint was then considered related to pulmonary TB. The admission CXR was “positive” for TB in 52 of the 58 patients including all of 9 patients with a chief complaint unrelated to TB by the standardized history. A second study reviewed CXRs of 392 patients admitted for suspected TB. AFB positive sputum smears were obtained in 90% of patients whose CXR showed a typical reactivation pattern, and in 98% if the CXR showed cavitation or an alveolar infiltrate in 3 or more lung zones. The authors conclude that the routine admission CXR is a useful screening test for TB in areas where the prevalence of TB is particularly high. [Jeffery Cox, MD]
0 NEGLIGIBLE SUBLINGUAL ABSORPTION OF NIFEDIPINE. Harten JV, Burggraaf K, Danhof M, et al. Lmcet 1988;2: 1363-4. In a study involving 11 healthy volunteers, capsules containing 10 mg of nifedipine were either bitten and held in the mouth or bitten and swallowed. After biting the capsule and not swallowing for 20 minutes, a median of 89% of the dose was recovered from the mouth, and a median maximum plasma nifedipine concentration of 10 ng/mL was reached 25 minutes after emptying the mouth. On the other hand, after biting and swallowing the capsule the median
=
Copyright 0 1989 Pergamon Press plc
??
INJURY: RESULTS OF INI0 BLUNT URETHRAL TIAL MANAGEMENT. Malangoni MA, Botner BK, Amin EA, Amin M. Amer Surgeon 1988;54:181-4. This study reviewed 14 patients with blunt urethral trauma. Five had blood at the urethral meatus at the time of
Abstracts-designed to keep readers up to date by providing original abstracts of current literature from all fields relating to emergency medicine-are prepared by the Emergency Medicine Residents of the University Hospital of Jacksonville, Jacksonville, Florida; and the Residency in Emergency Medicine in Denver General, St. Anthony’s, St. Joseph’s, Porter Hospital and University of Colorado Health Sciences Center, Denver, Colorado, with editorial notes by Robert Wears, MD, University Hospital of Jacksonville, and Peter Rosen, MD, Editor-in-Chief, JEM. 0736-4679/89 301
$3.00 + .OO