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Combined salbutamol and ipratropium bromide by inhalation in the treatment of severe acute asthma
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0 RECURRENT APPENDICEAL COLIC. Lee AW, Bell RM, Griffen WO, Hagihara PF. Surg Gynecol Obstet 1985; 161:21-24. Over a 21-year period, 1,869 appendectomies were performed at the University of Kentucky Medical Center. Eleven patients (0.6%) had an appendectomy performed for symptoms suggesting recurrent appendiceal colic. All of the patients had intermittent crampy and disabling recurrent abdominal pain in the right lower quadrant unresponsive to conservative therapy. One of 11 patients (9.1’-70)had accompanying pain in the left lower quadrant, and another patient had low back pain. The duration of pain varied from two weeks to eight years. Accompanying symptoms included nausea, vomiting, diarrhea, and weight loss. None of the patients exhibited anorexia, febrile episodes, muscle guarding, or signs associated with acute appendiceal inflammation. Tenderness of the right lower abdominal quadrant on deep palpation was noted in 10 of 11 patients (90.9%). Plain films of the abdomen were normal in the six patients in whom they were obtained. Seven patients had an urgent diagnostic barium enema during an episode of pain; six of the seven were abnormal. All 11 patients exhibited gross abnormality of the appendix consisting of fecalith in 4, torsion of the appendix in 3, fibrotic lumen in 3, and purulent material in the lumen in 1. In a followup study of 10 of the 11 patients for 2 weeks to 20 years, there has been recurrence of abdominal pain in only 1 patient. Although recurrent appendiceal colic is relatively uncommon, it deserves consideration in all patients who present with recurrent intermittent right lower quadrant abdominal pain. The loss of time from work or school and repeated visits to the emergency department with or without subsequent hospitalization presents an important economic issue. [David C. Stastny, DO]
0 IS CHILDHOOD APPENDICITIS FAMILIAL? Brender JD, Marcuse EK, Weiss NS, Koepsell TD. Am J Dis Child 1985; 139:338340. To determine whether a family history of appendectomy for acute appendicits increases a child’s risk for the disease, the authors performed a hospital-based, case-control study of children with appendicitis. A history of appendectomy in first-degree relatives of 135 children with histologically confirmed acute appendicitis
The Journal of Emergency Medicine
was compared with those of 212 control children without appendicitis. Patients with histologically proven appendicitis were 1.2 times more likely to have a positive family history of appendectomy than were comparison children. A positive family history in a sibling increased the risk of appendicitis 9.5 times, whereas a positive history in the parents increased the risk only 1.1 times. It is suggested that a familial predisposition for appendicitis may be explained by environmental [Richard P. Burruss, MD] or genetic factors.
0 COMBINED SALBUTAMOL AND IPRATROPIUM BROMIDE BY INHALATION IN THE TREATMENT OF SEVERE ACUTE ASTHMA. Beck R, Robertson C, Galdes-Sebaldt M, Levison H. J Pediatr 1985; 107:605608. Twenty-five children were entered into a prospective, randomized, double-blind trial to compare the effects of salbutamol alone with those of salbutamol plus ipratropium bromide, a quaternary ammonium derivative of atropine, in the treatment of acute asthma. All patients received nebulized salbutamol in an initial dose of 150 pg/kg to a total dose of 5 mg, followed by six further doses of 50 pg/kg (to a total dose of 1.7 mg) at 20-minute intervals. In 13 patients, 1.OmL (250 pg) of ipratropium bromide respiratory solution was added to the salbutamol at 60 minutes. The control group (12 patients) received an identical volume of normal saline added to the salbutamol. Pulmonary function, determined by forced expiratory volume in one second (FEV,), was assessed at baseline and at 20-minute intervals throughout the study period. All patients had an initial smooth rise in their FEV,, with a peak response at 60 minutes; all had significant residual airway obstruction at this time. During the second phase of the trial (60 to 150 minutes), the control group showed no further improvement in their FEV, despite repeated doses of salbutamol. In contrast, the group that received ipratropium bromide had a further gradual improvement in FEV, starting 40 minutes after the administration of ipratropium and reaching a peak at 60 minutes. FEV, at this point was 20.6% greater than that of the 60-minute level in the ipratropium group v 3.5% in the control group (PcO.05). Ipratropium appears to improve residual airway obstruction found following therapy with the &agonist salbutamol alone, suggesting
Abstracts
that many children have a significant cholinergic component in their bronchoconstriction. [Pamela Downey, MD]
0 TOPICAL SULFACETAMIDE Y ORAL ERYTHROMYCIN FOR NEONATAL CHLAMYDIAL CONJUNCTIVITIS. Heggie AD, Jaffe AC, Stuart LA, et al. Am JDis Child 1985;
139:564-566. Genital infection with Chlamydia trachomatti is the most prevalent venereal disease in western society. Cervical infection in a pregnant mother carries a 10% to 50% risk of transmission to the newborn, with the conjunctivae being the site most commonly infected. If untreated, the conjunctivitis may become chronic, cause some degree of visual impairment, or spread to the respiratory tract and cause chlamydial pneumonia. To assess the efficacy of topical v systemic antibiotics in the treatment of chlamydial conjunctivitis, 5 1 infants < 30 days of age with purulent conjunctivitis were randomly assigned to receive treatment with either topical 10% sulfacetamide solution for 14 days or oral erythromycin estolate 50 mg/kg/day for 14 days. Chlamydial, bacterial, and viral conjunctival cultures were obtained on each patient, and subsequent therapy was modified according to culture results. Chlamydia trachomatis was isolated from the conjunctivae of 37 (73%) of the infants. Of those completing the study, 15 received oral erythromycin and 14 received topical sulfacetamide solution. There was one case (7070) of persistent conjunctival infection in the systemically treated group and eight (57%) cases of persistent infection in the topically treated group (P< .002). Two cases of nasopharyngeal colonization occurred during topical treatment, and persistent nasopharyngeal infection was detected in one infant. It is concluded that oral therapy with erythromycin was clearly more effective in the treatment of chlamydial conjunctivits and that it also prevented nasopharyngeal colonization. [Richard P. Burruss, MD]
0 HUMAN BITES IN CHILDREN. Schweich P, Fleisher G. Pediatr Emerg Care 1985; 1:51-53. The authors retrospectively reviewed the charts of patients with human bites seen over a fourmonth period in a pediatric emergency room and analyzed the incidence of infection in wounds
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treated or not treated with antibiotics. The incidence of visits for human bites during the study period was l/600 visits. Bites were most commonly inflicted by another child, and the most common injury was a superficial abrasion of the face. Most patients were seen within 12 hours of injury. Twenty-nine bites were uninfected when first seen. Sixteen were treated with oral antibiotics, and 13 were not. There was no significant difference in mean patient age, site, or type of wound between the treated and untreated groups. None of the untreated patients and one of the treated patients developed an infection (P=NS). Four patients had infected wounds when first seen; all four were seen > 12 hours after injury. Three were placed on oral antibiotics, and one was admitted for IV therapy. Of the three children treated as outpatients with oral therapy, two subsequently required admission. It is concluded that prophylactic antibiotics offer no advantage in the treatment of uninfected superficial human bites in children seen shortly after injury. Careful follow-up is necessary for all bite wounds, however, since serious infection may develop or an established, seemingly minor infection may worsen, [R. Scott Israel, MD]
? ?NEAR-DEATH EXPERIENCES IN A PEDIATRIC POPULATION. Morse M, Conner D, Tyler D. Am JDis Child 1985; 139:595-600. Numerous accounts of unique psychological states occurring in adults near death have been reported. To determine if this occurs in the pediatric population as well, the records of 42 patients, 3 through 16 years of age, who were in the pediatric ICU were reviewed. Patients were divided into two groups: those surviving a critical condition with a significant mortality, for example, cardiac arrest, severe trauma, neardrowning, or hyperosmolar coma, and those who were just seriously ill. Twenty-four patients were excluded from the study for failure to return to their premorbid level of school functioning. Five of the patients were unavailable for follow-up. The remaining 13 children were interviewed two months after discharge. Four of the seven critical patients interviewed reported neardeath experiences with feelings of peace, entering a tunnel, being out of the physical body, seeing a world of light, entering into that world, meeting others (especially dead relatives), and reaching a border or a limit. None of the seriously ill children reported such experiences. It
0 RECURRENT APPENDICEAL COLIC. Lee AW, Bell RM, Griffen WO, Hagihara PF. Surg Gynecol Obstet 1985; 161:21-24. Over a 21-year period, 1,869 appendectomies were performed at the University of Kentucky Medical Center. Eleven patients (0.6%) had an appendectomy performed for symptoms suggesting recurrent appendiceal colic. All of the patients had intermittent crampy and disabling recurrent abdominal pain in the right lower quadrant unresponsive to conservative therapy. One of 11 patients (9.1’-70)had accompanying pain in the left lower quadrant, and another patient had low back pain. The duration of pain varied from two weeks to eight years. Accompanying symptoms included nausea, vomiting, diarrhea, and weight loss. None of the patients exhibited anorexia, febrile episodes, muscle guarding, or signs associated with acute appendiceal inflammation. Tenderness of the right lower abdominal quadrant on deep palpation was noted in 10 of 11 patients (90.9%). Plain films of the abdomen were normal in the six patients in whom they were obtained. Seven patients had an urgent diagnostic barium enema during an episode of pain; six of the seven were abnormal. All 11 patients exhibited gross abnormality of the appendix consisting of fecalith in 4, torsion of the appendix in 3, fibrotic lumen in 3, and purulent material in the lumen in 1. In a followup study of 10 of the 11 patients for 2 weeks to 20 years, there has been recurrence of abdominal pain in only 1 patient. Although recurrent appendiceal colic is relatively uncommon, it deserves consideration in all patients who present with recurrent intermittent right lower quadrant abdominal pain. The loss of time from work or school and repeated visits to the emergency department with or without subsequent hospitalization presents an important economic issue. [David C. Stastny, DO]
0 IS CHILDHOOD APPENDICITIS FAMILIAL? Brender JD, Marcuse EK, Weiss NS, Koepsell TD. Am J Dis Child 1985; 139:338340. To determine whether a family history of appendectomy for acute appendicits increases a child’s risk for the disease, the authors performed a hospital-based, case-control study of children with appendicitis. A history of appendectomy in first-degree relatives of 135 children with histologically confirmed acute appendicitis
The Journal of Emergency Medicine
was compared with those of 212 control children without appendicitis. Patients with histologically proven appendicitis were 1.2 times more likely to have a positive family history of appendectomy than were comparison children. A positive family history in a sibling increased the risk of appendicitis 9.5 times, whereas a positive history in the parents increased the risk only 1.1 times. It is suggested that a familial predisposition for appendicitis may be explained by environmental [Richard P. Burruss, MD] or genetic factors.
0 COMBINED SALBUTAMOL AND IPRATROPIUM BROMIDE BY INHALATION IN THE TREATMENT OF SEVERE ACUTE ASTHMA. Beck R, Robertson C, Galdes-Sebaldt M, Levison H. J Pediatr 1985; 107:605608. Twenty-five children were entered into a prospective, randomized, double-blind trial to compare the effects of salbutamol alone with those of salbutamol plus ipratropium bromide, a quaternary ammonium derivative of atropine, in the treatment of acute asthma. All patients received nebulized salbutamol in an initial dose of 150 pg/kg to a total dose of 5 mg, followed by six further doses of 50 pg/kg (to a total dose of 1.7 mg) at 20-minute intervals. In 13 patients, 1.OmL (250 pg) of ipratropium bromide respiratory solution was added to the salbutamol at 60 minutes. The control group (12 patients) received an identical volume of normal saline added to the salbutamol. Pulmonary function, determined by forced expiratory volume in one second (FEV,), was assessed at baseline and at 20-minute intervals throughout the study period. All patients had an initial smooth rise in their FEV,, with a peak response at 60 minutes; all had significant residual airway obstruction at this time. During the second phase of the trial (60 to 150 minutes), the control group showed no further improvement in their FEV, despite repeated doses of salbutamol. In contrast, the group that received ipratropium bromide had a further gradual improvement in FEV, starting 40 minutes after the administration of ipratropium and reaching a peak at 60 minutes. FEV, at this point was 20.6% greater than that of the 60-minute level in the ipratropium group v 3.5% in the control group (PcO.05). Ipratropium appears to improve residual airway obstruction found following therapy with the &agonist salbutamol alone, suggesting
Abstracts
that many children have a significant cholinergic component in their bronchoconstriction. [Pamela Downey, MD]
0 TOPICAL SULFACETAMIDE Y ORAL ERYTHROMYCIN FOR NEONATAL CHLAMYDIAL CONJUNCTIVITIS. Heggie AD, Jaffe AC, Stuart LA, et al. Am JDis Child 1985;
139:564-566. Genital infection with Chlamydia trachomatti is the most prevalent venereal disease in western society. Cervical infection in a pregnant mother carries a 10% to 50% risk of transmission to the newborn, with the conjunctivae being the site most commonly infected. If untreated, the conjunctivitis may become chronic, cause some degree of visual impairment, or spread to the respiratory tract and cause chlamydial pneumonia. To assess the efficacy of topical v systemic antibiotics in the treatment of chlamydial conjunctivitis, 5 1 infants < 30 days of age with purulent conjunctivitis were randomly assigned to receive treatment with either topical 10% sulfacetamide solution for 14 days or oral erythromycin estolate 50 mg/kg/day for 14 days. Chlamydial, bacterial, and viral conjunctival cultures were obtained on each patient, and subsequent therapy was modified according to culture results. Chlamydia trachomatis was isolated from the conjunctivae of 37 (73%) of the infants. Of those completing the study, 15 received oral erythromycin and 14 received topical sulfacetamide solution. There was one case (7070) of persistent conjunctival infection in the systemically treated group and eight (57%) cases of persistent infection in the topically treated group (P< .002). Two cases of nasopharyngeal colonization occurred during topical treatment, and persistent nasopharyngeal infection was detected in one infant. It is concluded that oral therapy with erythromycin was clearly more effective in the treatment of chlamydial conjunctivits and that it also prevented nasopharyngeal colonization. [Richard P. Burruss, MD]
0 HUMAN BITES IN CHILDREN. Schweich P, Fleisher G. Pediatr Emerg Care 1985; 1:51-53. The authors retrospectively reviewed the charts of patients with human bites seen over a fourmonth period in a pediatric emergency room and analyzed the incidence of infection in wounds
a3
treated or not treated with antibiotics. The incidence of visits for human bites during the study period was l/600 visits. Bites were most commonly inflicted by another child, and the most common injury was a superficial abrasion of the face. Most patients were seen within 12 hours of injury. Twenty-nine bites were uninfected when first seen. Sixteen were treated with oral antibiotics, and 13 were not. There was no significant difference in mean patient age, site, or type of wound between the treated and untreated groups. None of the untreated patients and one of the treated patients developed an infection (P=NS). Four patients had infected wounds when first seen; all four were seen > 12 hours after injury. Three were placed on oral antibiotics, and one was admitted for IV therapy. Of the three children treated as outpatients with oral therapy, two subsequently required admission. It is concluded that prophylactic antibiotics offer no advantage in the treatment of uninfected superficial human bites in children seen shortly after injury. Careful follow-up is necessary for all bite wounds, however, since serious infection may develop or an established, seemingly minor infection may worsen, [R. Scott Israel, MD]
? ?NEAR-DEATH EXPERIENCES IN A PEDIATRIC POPULATION. Morse M, Conner D, Tyler D. Am JDis Child 1985; 139:595-600. Numerous accounts of unique psychological states occurring in adults near death have been reported. To determine if this occurs in the pediatric population as well, the records of 42 patients, 3 through 16 years of age, who were in the pediatric ICU were reviewed. Patients were divided into two groups: those surviving a critical condition with a significant mortality, for example, cardiac arrest, severe trauma, neardrowning, or hyperosmolar coma, and those who were just seriously ill. Twenty-four patients were excluded from the study for failure to return to their premorbid level of school functioning. Five of the patients were unavailable for follow-up. The remaining 13 children were interviewed two months after discharge. Four of the seven critical patients interviewed reported neardeath experiences with feelings of peace, entering a tunnel, being out of the physical body, seeing a world of light, entering into that world, meeting others (especially dead relatives), and reaching a border or a limit. None of the seriously ill children reported such experiences. It