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Hypernatremia in elderly patients
ylprednisolone antibiotics (ampicillin, tetracycline, or trimethaprim-sulfsoxazole) and oxygen (as needed). Over a three-day period, there was progressive improvement in the parameters of subjective dyspnea, room air pO2, and respiratory parameters of forced expiratory volume in one second and forced vital capacity measured before and after bronchodilator therapy in both groups. There was no statistically significant difference in the rate of improvement between the 15 patients receiving aminophylline and the 13 given placebo. Gastrointestinal side effects were more common with aminophylline, occurring in 7 of 15 versus 0 of 13 given placebo. No significant arrhythmias were detected. It was concluded in this small study that group treatment with parenteral aminophylline provided no significant additional benefit when added to an otherwise standard treatment regimen in patients with exacerbations of their chronic obstructive pulmonary disease.
Charles A McKay Jr MD
Gardnerella vaginalis from the vaginas of prepubertal girls, the authors studied 256 prepubertal girls who were divided into three groups. Group 1 included 137 girls with known or suspected sexual abuse, Group 2 included 48 girls with s y m p t o m s of vaginitis but no known history of sexual abuse, and Group 3 consisted of 71 girls without a history of genitourinary complaints or sexual abuse. Groups 2 and 3 were considered the control population. Twenty patients (14.6%) from Group 1 had positive cultures for G vaginalis as compared with two patients (4.2%) in Group 2 (P < .05) and three patients (4.2%) in Group 3 (P < .10). There was no statistically significant correlation between symptoms or signs of vaginitis and positive cultures. Victims of multiple episodes of sexual abuse were more likely to have positive cultures than those with a single episode of abuse (P < .025). It was concluded that positive cultures for G vaginalis suggest the possibility of sexual abuse in prepubertal girls and that positive cultures are unrelated to vulvovaginal symptoms. Gregrey E Bennett, MD
hypernatremia, elderly head injury, motor vehicle
Hypernatremia in elderly patients Snyder NA, Feigal DW, Arieff AI Ann Intern Med 107:309-319 Sep 1987
Effects of legislation on motor vehicle injuries to children
Reviewing 162 admissions of patients over 60 years old with hypematremia (serum sodium > 148), these authors analyzed contributing factors, therapy, and outcome. Fortythree percent of the group were hypematremic at admission, with a mean sodium of 156 ~ 7. The leading factors contributing to the development of hypematremia were a febrile illness, infirmity, gastrointestinal bleeding, diabetes mellitus, and iatrogenic causes such as inappropriate fluid replacement with or without surgery in hospitalized patients. Depression of sensorium correlated highly with hypematremia. Despite a somewhat higher serum sodium, patients hypernatremic at admission fared better than those becoming hypematremic in the hospital (mortality of 29% and 42%, respectively]. This was attributed to a more gradual onset and fewer complicating illnesses. The multifactorial etiology of hypematremia in the elderly and the paramount importance of an altered sensorium, diminished thirst, or inability to replace water losses are emphasized.
Charles A McKay Jr, MD Gardnerella vaginalis, sexual assault
Gardnerella vaginalis in prepubertal girls Bartley DL, Morgan L, Rimsza ME Am J Dis Child 141:1014-1017
Sep 1987
To d e t e r m i n e the significance of the i s o l a t i o n of 17:1January 1988
Agran PF, Dunkle DE, Winn DG Am J Dis Child 141:959-964 Sep 1987
To evaluate the effectiveness of recently instituted child safety laws in motor vehicles, a retrospective study was performed comparing the nature and severity of injuries in a pre-law period (1981 to 1982) with a post-law period (1983 to 1984). A comparison was made between those covered by the child safety law (4 years old or younger) with those not covered by the law (4 to 14 years old). The study population included children 14 years old or younger brought from motor vehicle accidents to nine hospital emergency departments in Orange County, California. In the 4 years old or younger group, 246 patients were seen pre-law and 269 postlaw. In the 4- to 14-year old group, 512 patients were seen pre-law and 592 post-law. This increase in post-law patients was attributed to increasing auto accident rates. The percentage of restrained patients (pre- versus post-law) increased from 26% to 50% in the 4-year-old or younger group and from 9% to 18% in the 4- to 14-year-old group. The percentage medically determined to be injured decreased from 70% to 57% in the 4-year-old or younger group and was stable at 91% in the 4- to 14-year-old group. The percentage of fatalities was 0% for both periods in the 4-year-old or younger group but decreased from 5% to 2% in the 4- to 14-year-old group. Severity of injury (based on Maximum Abbreviated Injury Score) changed with uninjured increasing from 30% to 43% in the 4-year-old or younger group but remaining stable at 9% in the 4- to 14year-old group. Head injuries decreased from 65% to 48% in
Annals of Emergency Medicine
101/159
Charles A McKay Jr MD
Gardnerella vaginalis from the vaginas of prepubertal girls, the authors studied 256 prepubertal girls who were divided into three groups. Group 1 included 137 girls with known or suspected sexual abuse, Group 2 included 48 girls with s y m p t o m s of vaginitis but no known history of sexual abuse, and Group 3 consisted of 71 girls without a history of genitourinary complaints or sexual abuse. Groups 2 and 3 were considered the control population. Twenty patients (14.6%) from Group 1 had positive cultures for G vaginalis as compared with two patients (4.2%) in Group 2 (P < .05) and three patients (4.2%) in Group 3 (P < .10). There was no statistically significant correlation between symptoms or signs of vaginitis and positive cultures. Victims of multiple episodes of sexual abuse were more likely to have positive cultures than those with a single episode of abuse (P < .025). It was concluded that positive cultures for G vaginalis suggest the possibility of sexual abuse in prepubertal girls and that positive cultures are unrelated to vulvovaginal symptoms. Gregrey E Bennett, MD
hypernatremia, elderly head injury, motor vehicle
Hypernatremia in elderly patients Snyder NA, Feigal DW, Arieff AI Ann Intern Med 107:309-319 Sep 1987
Effects of legislation on motor vehicle injuries to children
Reviewing 162 admissions of patients over 60 years old with hypematremia (serum sodium > 148), these authors analyzed contributing factors, therapy, and outcome. Fortythree percent of the group were hypematremic at admission, with a mean sodium of 156 ~ 7. The leading factors contributing to the development of hypematremia were a febrile illness, infirmity, gastrointestinal bleeding, diabetes mellitus, and iatrogenic causes such as inappropriate fluid replacement with or without surgery in hospitalized patients. Depression of sensorium correlated highly with hypematremia. Despite a somewhat higher serum sodium, patients hypernatremic at admission fared better than those becoming hypematremic in the hospital (mortality of 29% and 42%, respectively]. This was attributed to a more gradual onset and fewer complicating illnesses. The multifactorial etiology of hypematremia in the elderly and the paramount importance of an altered sensorium, diminished thirst, or inability to replace water losses are emphasized.
Charles A McKay Jr, MD Gardnerella vaginalis, sexual assault
Gardnerella vaginalis in prepubertal girls Bartley DL, Morgan L, Rimsza ME Am J Dis Child 141:1014-1017
Sep 1987
To d e t e r m i n e the significance of the i s o l a t i o n of 17:1January 1988
Agran PF, Dunkle DE, Winn DG Am J Dis Child 141:959-964 Sep 1987
To evaluate the effectiveness of recently instituted child safety laws in motor vehicles, a retrospective study was performed comparing the nature and severity of injuries in a pre-law period (1981 to 1982) with a post-law period (1983 to 1984). A comparison was made between those covered by the child safety law (4 years old or younger) with those not covered by the law (4 to 14 years old). The study population included children 14 years old or younger brought from motor vehicle accidents to nine hospital emergency departments in Orange County, California. In the 4 years old or younger group, 246 patients were seen pre-law and 269 postlaw. In the 4- to 14-year old group, 512 patients were seen pre-law and 592 post-law. This increase in post-law patients was attributed to increasing auto accident rates. The percentage of restrained patients (pre- versus post-law) increased from 26% to 50% in the 4-year-old or younger group and from 9% to 18% in the 4- to 14-year-old group. The percentage medically determined to be injured decreased from 70% to 57% in the 4-year-old or younger group and was stable at 91% in the 4- to 14-year-old group. The percentage of fatalities was 0% for both periods in the 4-year-old or younger group but decreased from 5% to 2% in the 4- to 14-year-old group. Severity of injury (based on Maximum Abbreviated Injury Score) changed with uninjured increasing from 30% to 43% in the 4-year-old or younger group but remaining stable at 9% in the 4- to 14year-old group. Head injuries decreased from 65% to 48% in
Annals of Emergency Medicine
101/159