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“Extrapolated” creatine kinase-BB isoenzyme activity in assessment of initial brain damage after severe head injury
ABSTRACTS
important. A child who remains lethargic or irritable when afebrile should be of great concern.] Ronald P Ruffing, MD
drowning, incidence of
pendixes were not visualized sonographically in perforating appendicitis as compared with nonperforating appendicitis, but these results did not affect the treatment as peritonitis was clinically evident in all such cases. The results suggest that graded compression ultrasonography can enhance the accuracy of clinical diagnosis and management.
Reuben W Holland III, MD
Drowning in childhood and a d o l e s c e n c e : A population-based study Wintemute GJ, Kraus JF, Teret SP, et al Am J Public Health 77:830-832 Jul 1987
Based on 1983 data, the overall drowning rate for the United States for persons 19 years old or younger is 3/100,000 persons. This study examined the incidence and conditions of all fatal immersions in Sacramento County, California, during the years 1974 to 1984. The results show an average annual drowning rate for persons 19 years old or younger of 5/100,000 with 35% five or younger. Swimming pool drownings accounted for one-third of the total, with 50% of these occurring at the child's own house or apartment complex. An additional 36% of pool drownings occurred at a friend's, neighbor's, or family member's residence. The swimming pool drowning rate over the years studied was positively correlated with the number of pools in the study area. Of bathtub drownings, infants 1 year old or younger accounted for 67% of the total. In boys 15 to 19 years old, 38% of drownings were alcohol related. Suggested methods of decreasing the incidence of drowning deaths included alcohol education and strict pool fencing laws. Current laws allowing fencing to incorporate a yard or building appear to be inadequate because in 80% of the residential pool drownings, the victim gained access directly from the house or yard.
Mark W Elliott, MD appendicitis, ultrasound
A pr o s p e cti ve study of ultrasonography in t h e diagnosis of appendicitis Puylaert JBCM, Rutgers PH, Lalisang RI, et al N Engl J Med 317:666-669 Sep 1987
" E x t r a p o l a t e d " c r e a t i n e kinase-BB i s o e n z y m e activity in a s s e s s m e n t of initial brain d a m a g e after severe head injury Hans P, Born JD, Albert A J Neurosurg 66:714-717 May 1987
Initial assessment of severe brain injury can be measured clinically with neurological testing, as well as with biochemical markers such as the isoenzyme creatine kinase-BB (CK-BB) located in cerebrospinal fluid (CSF) and in brain tissue. Fifty severely brain-injured patients with Glasgow Coma Scale scores of ~ 7 and Glasgow-Liege Coma Scale scores of ~ 12 during the first 15 hours of hospitalization were studied prospectively. Assaying serial samples of CSF revealed an exponential decay in the activity of CK-BB. The half-life of CK-BB released into CSF was determined to be 4.5 hours (95%, range, 4.4 to 4.6 hours). Measured CK-BB then was "extrapolated" (eCK-BB) to Time 0 and both were compared to GCS and GLCS scores, eCK-BB was better than observed CK-BB, GCS, and GLCS at predicting a favorable or unfavorable outcome. Using 330 U/L as a cut-off point, eCK-BB correctly predicted patient outcome in 78% of the population studied. Thus, early measurement of CK-BB activity in CSF in combination with neurological testing can give useful prognostic information in the assessment of head-injured patients. Carlo Musso, MD
aminophylline, chronic obstructive pulmonary disease
Aminophylline for a c u t e e x a c e r b a t i o n s of chronic obstructive pulmonary d i s e a s e
This prospective study attempted to determine the diagnostic accuracy of graded compression ultrasonography and its clinical impact. All patients were studied with ultrasonography concurrent to or shortly after surgical evaluation. The radiologic interpretation then was compared with the clinical decision of operative or conservative management. In 16 patients there was a change from planned conservative management to surgical intervention. In seven patients there was a change from planned surgical intervention to conservative management. A high proportion of ap-
158/100
creatine kinase-BB isoenzyme; Glasgow-Liege coma scale
Rice KL, Leatherman JW, Duane PG, et al Ann Intern Med 107:305-309 Sep 1987
Using a double-blind, randomized, placebo-controlled trial, the efficacy of IV aminophylline in the therapy of acute exacerbations of chronic obstructive pulmonary disease was evaluated. Patients with the diagnosis of asthma or history of reversible episodes of wheezing or dyspnea, pneumonia, or congestive failure were eliminated. Twenty-eight patients completed the three-day study. All received meth-
Annals of EmergencyMedicine
17:1danuary 1988
important. A child who remains lethargic or irritable when afebrile should be of great concern.] Ronald P Ruffing, MD
drowning, incidence of
pendixes were not visualized sonographically in perforating appendicitis as compared with nonperforating appendicitis, but these results did not affect the treatment as peritonitis was clinically evident in all such cases. The results suggest that graded compression ultrasonography can enhance the accuracy of clinical diagnosis and management.
Reuben W Holland III, MD
Drowning in childhood and a d o l e s c e n c e : A population-based study Wintemute GJ, Kraus JF, Teret SP, et al Am J Public Health 77:830-832 Jul 1987
Based on 1983 data, the overall drowning rate for the United States for persons 19 years old or younger is 3/100,000 persons. This study examined the incidence and conditions of all fatal immersions in Sacramento County, California, during the years 1974 to 1984. The results show an average annual drowning rate for persons 19 years old or younger of 5/100,000 with 35% five or younger. Swimming pool drownings accounted for one-third of the total, with 50% of these occurring at the child's own house or apartment complex. An additional 36% of pool drownings occurred at a friend's, neighbor's, or family member's residence. The swimming pool drowning rate over the years studied was positively correlated with the number of pools in the study area. Of bathtub drownings, infants 1 year old or younger accounted for 67% of the total. In boys 15 to 19 years old, 38% of drownings were alcohol related. Suggested methods of decreasing the incidence of drowning deaths included alcohol education and strict pool fencing laws. Current laws allowing fencing to incorporate a yard or building appear to be inadequate because in 80% of the residential pool drownings, the victim gained access directly from the house or yard.
Mark W Elliott, MD appendicitis, ultrasound
A pr o s p e cti ve study of ultrasonography in t h e diagnosis of appendicitis Puylaert JBCM, Rutgers PH, Lalisang RI, et al N Engl J Med 317:666-669 Sep 1987
" E x t r a p o l a t e d " c r e a t i n e kinase-BB i s o e n z y m e activity in a s s e s s m e n t of initial brain d a m a g e after severe head injury Hans P, Born JD, Albert A J Neurosurg 66:714-717 May 1987
Initial assessment of severe brain injury can be measured clinically with neurological testing, as well as with biochemical markers such as the isoenzyme creatine kinase-BB (CK-BB) located in cerebrospinal fluid (CSF) and in brain tissue. Fifty severely brain-injured patients with Glasgow Coma Scale scores of ~ 7 and Glasgow-Liege Coma Scale scores of ~ 12 during the first 15 hours of hospitalization were studied prospectively. Assaying serial samples of CSF revealed an exponential decay in the activity of CK-BB. The half-life of CK-BB released into CSF was determined to be 4.5 hours (95%, range, 4.4 to 4.6 hours). Measured CK-BB then was "extrapolated" (eCK-BB) to Time 0 and both were compared to GCS and GLCS scores, eCK-BB was better than observed CK-BB, GCS, and GLCS at predicting a favorable or unfavorable outcome. Using 330 U/L as a cut-off point, eCK-BB correctly predicted patient outcome in 78% of the population studied. Thus, early measurement of CK-BB activity in CSF in combination with neurological testing can give useful prognostic information in the assessment of head-injured patients. Carlo Musso, MD
aminophylline, chronic obstructive pulmonary disease
Aminophylline for a c u t e e x a c e r b a t i o n s of chronic obstructive pulmonary d i s e a s e
This prospective study attempted to determine the diagnostic accuracy of graded compression ultrasonography and its clinical impact. All patients were studied with ultrasonography concurrent to or shortly after surgical evaluation. The radiologic interpretation then was compared with the clinical decision of operative or conservative management. In 16 patients there was a change from planned conservative management to surgical intervention. In seven patients there was a change from planned surgical intervention to conservative management. A high proportion of ap-
158/100
creatine kinase-BB isoenzyme; Glasgow-Liege coma scale
Rice KL, Leatherman JW, Duane PG, et al Ann Intern Med 107:305-309 Sep 1987
Using a double-blind, randomized, placebo-controlled trial, the efficacy of IV aminophylline in the therapy of acute exacerbations of chronic obstructive pulmonary disease was evaluated. Patients with the diagnosis of asthma or history of reversible episodes of wheezing or dyspnea, pneumonia, or congestive failure were eliminated. Twenty-eight patients completed the three-day study. All received meth-
Annals of EmergencyMedicine
17:1danuary 1988