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Essential tremor: treatment with propranolol
Abstracts Peter Rosen,
MD m editor
Professor of Emergency Medicine and Director of the Division of Emergency Medicine, University of Chicago Hospitals and Cli nics
Beverly Fauman, M D -
assistant editor
Assistant Professor of Emergency Medicine and Psychiatry, University of Chicago Hospitals and Clinics Aqueous humor pH changes after experimental alkali burns. Paterson CA, Pfister RR, Levinson RA, Am J Ophthalmol 79:414-419, (March) 1975. Alkali burns of the eye produce injury, the severity of which depends on the pH of the injuring material and the duration of contact. Elevation of the pH of the aqueous humor to 11.0 or greater is necessary to cause injury to the iris, lens and posterior cornea. Anesthetized rabbit and enucleated h u m a n eyes w e r e subject to alkali injury w i t h v a r y i n g a m o u n t s of 2 n o r m a l sodium hydroxide (pH 13) and 8.1 normal ammonium hydroxide (pH 12.4) by drip onto the exposed cornea. The pH of the aqueous humor was measured and response to various t r e a t m e n t modalities evaluated. C o n t i n u o u s f l u s h i n g of the eye w i t h saline, two to three minutes after the burn, failed to lower the peak rise in aqueous pH. Paracentesis and emptying of the anterior chamber at two minutes resulted in a drop in pH. Intracameral injection of .15 ml of phosphate buffer further lowered the pH. Best results, however, were obtained by consecutive p a r a c e n t e s i s of the a n t e r i o r c h a m b e r and r e f o r m a t i o n w i t h sterile phosphate buffer. The latter modality, in addition to external lavage, is recommended for moderately severe and severe alkali b u r n s of the eye even several hours after the insult. (Editor's note: This aggressive form of therapy should be undertaken by emergency physicians only with the recommendation and support of their ophthalmological consultants.)
Robert J. Rothstein, MD chemical burns, alkali, eye; paracentesis, eye Sinusitis of the maxillary antrum. Evans FO, Sydnor JB, Moore WC, et al, N Engl J Med 293:735-739, (Oct) 1975. Maxillary sinusitis, as defined by aspiration and culture, does not correlate with facial pain, purulent nasal discharge or fever. Correlation does exist for both t r a n s i l l u m i n a t i o n and x-ray. T r a n s i l l u m i n a t i o n is performed by observing the roof of the mouth while shining a bright light over the orbital rim in a dark room. Normal transillumination correlates well with normal aspiration and opaque a n t r u m s with infection, but dullness is nonspecific. Improved t r a n s i l l u m i n a t i o n correlates w i t h response to therapy in acute but not in chronic sinusitis. Mucosal thickening of less t h a n 8 m m on Water's view is associated with normal aspiration, whereas those with 8 m m or more are infected. Many different organisms can cause infection and no correlation exists between cultures of aspirates and anterior nasal swabs. Donald Blythe, MD
infection, sinusitis, maxi/lary Central venous pressure and pulmonary wedge pressure in critical surgical illness. Toussaint GP, Burgess JH, Hampson G, Arch Surg 109:265-269, (Aug) 1074. The correlation between central venous pressure (CVP) and pulmonary wedge pressure (PWP) was tested in 27 critically ill, surgical patients. All patients had moderately severe arterial
Page 822 Volume 5 Number 10
hypoxemia. There was a positive correlation between CVP and PWP if there was no previous cardiopulmonary disease. Patients w i t h previous cardiopulmonary disease had poor correlation. Therefore, in the latter group of patients, CVP is not a proper indication of left ventricular function. (Editor's note: It is impor. rant to remember that the trend of CVP rather than isolated measurements, as well as normal cardiopulmonary function, is required to properly use the C V P as an effective monitor.)
Larry Drury, MD
central venous pressure, correlation with pulmonary wedge pressure Essential tremor: treatment with propranolol. Tolosa E, Loewenson R, Neurology 25:1041-1044, (Nov) 1975. The authors studied 11 patients referred to the neurology dep a r t m e n t of the University of Minnesota for the t r e a t m e n t of tremor. Essential tremor was diagnosed on the basis of chronic postural tremor t h a t involved the upper extremities in all patients and various other body parts. The patients were randomly assigned either to propranolol or to placebo. Propranolol was b e g u n at a dose of 10 mg tid and i n c r e a s e d to 40 mg tid. Follow-up evaluations were done at three and six weeks. Evaluation consisted of grading the intensity of the tremor. Hand tremor was further evaluated by samples of handwriting and by use of a pegboard. The propranolol group had a statistically significant reduction in the severity of the tremors. No side effects in the propranolol group were encountered though pulse rate decreased an average of 17 beats per minute and blood pressure decreased an average of 4_5 m m Hg systolic pressure and 7.8 m m Hg diastolic pressure. Gerald Schwartz, MD tremor, essential; propranolol
Hemopneumothorax following blunt trauma of the thorax. Sturm JT, Points BJ, Perry JF, Surg Gynecol Obstet 141:539-540, (Oct) 1975. The a u t h o r s r e p o r t on 330 p a t i e n t s t r e a t e d for hemopneumothorax following blunt chest t r a u m a for a five year period. 1968 to 1972. Hemopneumothorax, as an isolated injury, had a low mortality rate of 2% and was usually treated with thoracostomy and fluid replacement alone. However, as associated injuries to the patient increased, so did the mortality rate_ There was a mortality rate of 70% in a group of 28 patients who had a head injury, an injury of an abdominal viscus plus a hemopneumothorax_ The overall mortality rate of 20.3% reflects the increase with associated injuries. The associated injury must be vigorously diagnosed and treated if mortality from blunt trauma is to be reduced since isolated blunt t r a u m a to the chest has a low morbidity. (Editor's note: It is unfortunately too easy to tun" nel in on the chest or head injury in blunt trauma and miss a concomitant blunt abdominal injury with ruptured liver or spleen.) Richard Ostendorf, MD
hemopneumothorax, thorax, blunt injury to October 1976 ~ P
MD m editor
Professor of Emergency Medicine and Director of the Division of Emergency Medicine, University of Chicago Hospitals and Cli nics
Beverly Fauman, M D -
assistant editor
Assistant Professor of Emergency Medicine and Psychiatry, University of Chicago Hospitals and Clinics Aqueous humor pH changes after experimental alkali burns. Paterson CA, Pfister RR, Levinson RA, Am J Ophthalmol 79:414-419, (March) 1975. Alkali burns of the eye produce injury, the severity of which depends on the pH of the injuring material and the duration of contact. Elevation of the pH of the aqueous humor to 11.0 or greater is necessary to cause injury to the iris, lens and posterior cornea. Anesthetized rabbit and enucleated h u m a n eyes w e r e subject to alkali injury w i t h v a r y i n g a m o u n t s of 2 n o r m a l sodium hydroxide (pH 13) and 8.1 normal ammonium hydroxide (pH 12.4) by drip onto the exposed cornea. The pH of the aqueous humor was measured and response to various t r e a t m e n t modalities evaluated. C o n t i n u o u s f l u s h i n g of the eye w i t h saline, two to three minutes after the burn, failed to lower the peak rise in aqueous pH. Paracentesis and emptying of the anterior chamber at two minutes resulted in a drop in pH. Intracameral injection of .15 ml of phosphate buffer further lowered the pH. Best results, however, were obtained by consecutive p a r a c e n t e s i s of the a n t e r i o r c h a m b e r and r e f o r m a t i o n w i t h sterile phosphate buffer. The latter modality, in addition to external lavage, is recommended for moderately severe and severe alkali b u r n s of the eye even several hours after the insult. (Editor's note: This aggressive form of therapy should be undertaken by emergency physicians only with the recommendation and support of their ophthalmological consultants.)
Robert J. Rothstein, MD chemical burns, alkali, eye; paracentesis, eye Sinusitis of the maxillary antrum. Evans FO, Sydnor JB, Moore WC, et al, N Engl J Med 293:735-739, (Oct) 1975. Maxillary sinusitis, as defined by aspiration and culture, does not correlate with facial pain, purulent nasal discharge or fever. Correlation does exist for both t r a n s i l l u m i n a t i o n and x-ray. T r a n s i l l u m i n a t i o n is performed by observing the roof of the mouth while shining a bright light over the orbital rim in a dark room. Normal transillumination correlates well with normal aspiration and opaque a n t r u m s with infection, but dullness is nonspecific. Improved t r a n s i l l u m i n a t i o n correlates w i t h response to therapy in acute but not in chronic sinusitis. Mucosal thickening of less t h a n 8 m m on Water's view is associated with normal aspiration, whereas those with 8 m m or more are infected. Many different organisms can cause infection and no correlation exists between cultures of aspirates and anterior nasal swabs. Donald Blythe, MD
infection, sinusitis, maxi/lary Central venous pressure and pulmonary wedge pressure in critical surgical illness. Toussaint GP, Burgess JH, Hampson G, Arch Surg 109:265-269, (Aug) 1074. The correlation between central venous pressure (CVP) and pulmonary wedge pressure (PWP) was tested in 27 critically ill, surgical patients. All patients had moderately severe arterial
Page 822 Volume 5 Number 10
hypoxemia. There was a positive correlation between CVP and PWP if there was no previous cardiopulmonary disease. Patients w i t h previous cardiopulmonary disease had poor correlation. Therefore, in the latter group of patients, CVP is not a proper indication of left ventricular function. (Editor's note: It is impor. rant to remember that the trend of CVP rather than isolated measurements, as well as normal cardiopulmonary function, is required to properly use the C V P as an effective monitor.)
Larry Drury, MD
central venous pressure, correlation with pulmonary wedge pressure Essential tremor: treatment with propranolol. Tolosa E, Loewenson R, Neurology 25:1041-1044, (Nov) 1975. The authors studied 11 patients referred to the neurology dep a r t m e n t of the University of Minnesota for the t r e a t m e n t of tremor. Essential tremor was diagnosed on the basis of chronic postural tremor t h a t involved the upper extremities in all patients and various other body parts. The patients were randomly assigned either to propranolol or to placebo. Propranolol was b e g u n at a dose of 10 mg tid and i n c r e a s e d to 40 mg tid. Follow-up evaluations were done at three and six weeks. Evaluation consisted of grading the intensity of the tremor. Hand tremor was further evaluated by samples of handwriting and by use of a pegboard. The propranolol group had a statistically significant reduction in the severity of the tremors. No side effects in the propranolol group were encountered though pulse rate decreased an average of 17 beats per minute and blood pressure decreased an average of 4_5 m m Hg systolic pressure and 7.8 m m Hg diastolic pressure. Gerald Schwartz, MD tremor, essential; propranolol
Hemopneumothorax following blunt trauma of the thorax. Sturm JT, Points BJ, Perry JF, Surg Gynecol Obstet 141:539-540, (Oct) 1975. The a u t h o r s r e p o r t on 330 p a t i e n t s t r e a t e d for hemopneumothorax following blunt chest t r a u m a for a five year period. 1968 to 1972. Hemopneumothorax, as an isolated injury, had a low mortality rate of 2% and was usually treated with thoracostomy and fluid replacement alone. However, as associated injuries to the patient increased, so did the mortality rate_ There was a mortality rate of 70% in a group of 28 patients who had a head injury, an injury of an abdominal viscus plus a hemopneumothorax_ The overall mortality rate of 20.3% reflects the increase with associated injuries. The associated injury must be vigorously diagnosed and treated if mortality from blunt trauma is to be reduced since isolated blunt t r a u m a to the chest has a low morbidity. (Editor's note: It is unfortunately too easy to tun" nel in on the chest or head injury in blunt trauma and miss a concomitant blunt abdominal injury with ruptured liver or spleen.) Richard Ostendorf, MD
hemopneumothorax, thorax, blunt injury to October 1976 ~ P