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Comparison of the oral and intravenous routes for treating asthma with methylprednisolone and theophylline
Abstracts in this issue were prepared by residents in the Universityof Arizona Emergency Medicine Residency Program, Richard Dart, MD, on-site co-editor,
ABSTRACTS Vincent J Markovchick, MD, FACEP Co-Editor Emergency Medical Services Denver General Hospital
Harvey W Meislin, MD, FACEP Section Co-Editor Section of Emergency Medicine University of Arizona College of Medicine
myocardial infarction; MM creatine kinase isoenzyme
Prompt detection of myocardial injury by assay of c r e a t i n e kinase isoforms in initial
plasma samples Abendschein D, Seacord LM, Nohara R, et al Clin Cardio! 11:661-664 Oct 1988
It usually takes several hours before creatine kinase (CK)-MB isoenzyme becomes elevated in the setting of acute myocardial infarction (MI). This fact often limits its usefulness in diagnosis. This study evaluated CK-MM isoenzyme and its isoforms as a possible aid in early diagnosis of MI. At the time of emergency department presentation, serum determinations of CK-MB isoenzyme and isoforms of CK-MM isoenzyme were performed in 81 patients with suspected acute MI. Fifty of these patients ultimately had serial elevations in their CK-MB and were diagnosed as having had an acute MI, while in 31 patients infarction was excluded. Patients with renal failure, musculoskeletal disease, or recent muscle trauma were excluded. It was found that the ratio of CK-MM 3 to MM 1 was > 0.5 in patients who ultimately went on to rule in for MI. This was particularly true when the patients were evaluated early in the course of symptoms (when CK-MBs were still negativel. Of the 50 patients who were diagnosed as having had infarcts, 94% had either an elevated MMg/MM 1 ratio or elevated CK-MB. The specificity of these two tests together was 77% for MI. The ability to predict MI with CK MMa/MM 1 ratio and CK-MB may assist clinicians in making therapeutic and triage decisions. Brien Duncan, MD
asthma
Comparison of the oral and intravenous routes for treating a s t h m a with
m e t h y l p r e d n i s o l o n e and t h e o p h y l l i n e Jonsson S, Kjartansson G, Gaslason D, et al Chest 94:723-726 Oct 1988
T h i s prospective study compared intravenously and orally administered corticosteroids and theophylline in the treatment of acute episodes of airway obstruction. Twenty-eight patients more than 20 years old with history of obstructive airway disease were randomized into two 18:4 April 1989
groups prior to hospital admission. The groups were comparable with regard to age, sex distribution, smoking history, and spirometric measurements. Group A received IV methylprednisolone (80 rag/24 hr) and aminophylline (mean dose, 12 mg/kg/24 hr) by continuous IV infusion. Group B received oral sustained-release theophylline and oral methylprednisolone (80 mg in two divided doses). All patients received inhaled B-agonists. Initial studies included spirometric evaluation, arterial blood gases, and theophyltine levels. Assessment of response to treatment was based on peak expiratory flow measurements every eight hours and daily physical examination and spirometry. Blood gases and theophylline levels were repeated on day four (the end of the study). Both groups had a good overall response to therapy as measured by spirometry, degree of dyspnea and wheezing, and arterial blood gases. There were no significant differences, however, in any of these measured parameters between the two groups. The authors conclude that oral administration of steroids and theophylline is as effective as IV use in treating hospitalized patients with moderate exacerbations of airway obstruction. The use of inhaled B-agonists was postulated to improve overall outcome in both groups, although their use was not controlled in this study. Carol Federiuk, MD dexamethasone, bacterial meningitis
D e x a m e t h a s o n e therapy for bacterial meningitis Lebel M, Freij BJ, Syrogiannopoulos GA, et al N Engl J Med 319:964-971
Oct 1988
These investigators, in two prospective, double-blind, placebo-controlled trials, evaluated dexamethasone theraPY in addition to either cefuroxime (study 1) or ceftriaxone (study 2) in the treatment of bacterial meningitis in infants. Dexamethasone 0.15 mg/kg IV every six hours for four days was administered to 102 patients, while 98 patients received placebo (salinel. The administration of dexamethasone was associated with a significantly more rapid resolution of fever (1.6 versus 5.0 days). There were no differences between groups in the resolution of the clinical signs of meningitis or in the duration of hospitalization. Patients underwent lumbar punctures daily until cerebrospinal fluid (CSF) was sterile. All CSF cultures were sterile after 48 hours of therapy. The mean increase in the CSF glucose and the decrease in lactate and protein levels after 24 hours of therapy were significantly greater
Annals of EmergencyMedicine
430/149
ABSTRACTS Vincent J Markovchick, MD, FACEP Co-Editor Emergency Medical Services Denver General Hospital
Harvey W Meislin, MD, FACEP Section Co-Editor Section of Emergency Medicine University of Arizona College of Medicine
myocardial infarction; MM creatine kinase isoenzyme
Prompt detection of myocardial injury by assay of c r e a t i n e kinase isoforms in initial
plasma samples Abendschein D, Seacord LM, Nohara R, et al Clin Cardio! 11:661-664 Oct 1988
It usually takes several hours before creatine kinase (CK)-MB isoenzyme becomes elevated in the setting of acute myocardial infarction (MI). This fact often limits its usefulness in diagnosis. This study evaluated CK-MM isoenzyme and its isoforms as a possible aid in early diagnosis of MI. At the time of emergency department presentation, serum determinations of CK-MB isoenzyme and isoforms of CK-MM isoenzyme were performed in 81 patients with suspected acute MI. Fifty of these patients ultimately had serial elevations in their CK-MB and were diagnosed as having had an acute MI, while in 31 patients infarction was excluded. Patients with renal failure, musculoskeletal disease, or recent muscle trauma were excluded. It was found that the ratio of CK-MM 3 to MM 1 was > 0.5 in patients who ultimately went on to rule in for MI. This was particularly true when the patients were evaluated early in the course of symptoms (when CK-MBs were still negativel. Of the 50 patients who were diagnosed as having had infarcts, 94% had either an elevated MMg/MM 1 ratio or elevated CK-MB. The specificity of these two tests together was 77% for MI. The ability to predict MI with CK MMa/MM 1 ratio and CK-MB may assist clinicians in making therapeutic and triage decisions. Brien Duncan, MD
asthma
Comparison of the oral and intravenous routes for treating a s t h m a with
m e t h y l p r e d n i s o l o n e and t h e o p h y l l i n e Jonsson S, Kjartansson G, Gaslason D, et al Chest 94:723-726 Oct 1988
T h i s prospective study compared intravenously and orally administered corticosteroids and theophylline in the treatment of acute episodes of airway obstruction. Twenty-eight patients more than 20 years old with history of obstructive airway disease were randomized into two 18:4 April 1989
groups prior to hospital admission. The groups were comparable with regard to age, sex distribution, smoking history, and spirometric measurements. Group A received IV methylprednisolone (80 rag/24 hr) and aminophylline (mean dose, 12 mg/kg/24 hr) by continuous IV infusion. Group B received oral sustained-release theophylline and oral methylprednisolone (80 mg in two divided doses). All patients received inhaled B-agonists. Initial studies included spirometric evaluation, arterial blood gases, and theophyltine levels. Assessment of response to treatment was based on peak expiratory flow measurements every eight hours and daily physical examination and spirometry. Blood gases and theophylline levels were repeated on day four (the end of the study). Both groups had a good overall response to therapy as measured by spirometry, degree of dyspnea and wheezing, and arterial blood gases. There were no significant differences, however, in any of these measured parameters between the two groups. The authors conclude that oral administration of steroids and theophylline is as effective as IV use in treating hospitalized patients with moderate exacerbations of airway obstruction. The use of inhaled B-agonists was postulated to improve overall outcome in both groups, although their use was not controlled in this study. Carol Federiuk, MD dexamethasone, bacterial meningitis
D e x a m e t h a s o n e therapy for bacterial meningitis Lebel M, Freij BJ, Syrogiannopoulos GA, et al N Engl J Med 319:964-971
Oct 1988
These investigators, in two prospective, double-blind, placebo-controlled trials, evaluated dexamethasone theraPY in addition to either cefuroxime (study 1) or ceftriaxone (study 2) in the treatment of bacterial meningitis in infants. Dexamethasone 0.15 mg/kg IV every six hours for four days was administered to 102 patients, while 98 patients received placebo (salinel. The administration of dexamethasone was associated with a significantly more rapid resolution of fever (1.6 versus 5.0 days). There were no differences between groups in the resolution of the clinical signs of meningitis or in the duration of hospitalization. Patients underwent lumbar punctures daily until cerebrospinal fluid (CSF) was sterile. All CSF cultures were sterile after 48 hours of therapy. The mean increase in the CSF glucose and the decrease in lactate and protein levels after 24 hours of therapy were significantly greater
Annals of EmergencyMedicine
430/149