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May children with otitis media with effusion safely fly?
Hypertonic glucose (2 to 3 M) was infused starting at the onset of decompensation during persisting hypovolemia, into Sprague-Dawley rats that had been bled according to a modified Wiggers shock protocol. Glucose infusion at the rate of 60 to 80 ~mol/min × kg arrested the fall in glucose concentration and significantly slowed or arrested the decompensatory phase. All of the saline-infused control animals died within three hours after achieving their maximum shed blood volume, while two of the eight animals in the glucose infusion group died less than four hours after the same point. Compared with a saline-infused group, glucose-infused animals demonstrated a more moderate acidosis and did not display the hemoconcentration that usually occurs during decompensation. Because plasma osmolality in the glucose-infused animals was less than in the saline-infused controls, the data indicate that intravascular volume was not maintained by an increased transcapillary osmotic gradient. It was concluded that these results are consistent with the role of glucose as an energy substrate that is critical to homeostasis during hemorrhagic shock.
Cynthia Elliott, MD pelvic inflammatory disease, ultrasound, adolescent
The use of pelvic ultrasonography in the evaluation of a d o l e s c e n t s with pelvic i n f l a m m a t o r y disease Golden N, Cohen H, Gennari G, et al Am J Dis Child 141:1235-1238 Nov 1987
Due to the difficulty in interpreting findings of pelvic examination in adolescent females suspected of having pelvic inflammatory disease (PID), these authors studied the usefulness of pelvic ultrasonography in the diagnosis of PID. The study group of 60 patients included all female adolescents (12 to 17 years old) seen between July 1983 and July 1986 and fulfilling the following criteria: 1) a history of lower abdominal pain with lower abdominal tenderness on physical examination; 2) cervical motion tenderness; 3) adnexal tenderness; and 4) fever of more than 38 C, leukocytosis greater than 10,500/mm, elevated erythrocyte sedimentation rate greater than 20 mm/hr, Gram's stain suggestive of gonorrhoea, or positive enzyme immunoassay test from the endocervix for Chlamydia trachomatis. The control group of 40 patients included adolescents who received pelvic ultrasonography for the evaluation of conditions other than PID. Ultrasonography was used to compare adnexal volume, adnexal adherence, uterine size, and the presence of cul-de-sac fluid between the study and control groups. Ultrasound revealed tubo-ovarian abcesses (TOA) in 11 (19%) of the study patients. In seven of these patients, TOA was not suspected before ultrasound. Mean adnexal volume (excluding patients with TOA) was 11 cm 3 in the PID group, as compared with 5.2 cm 3 in the control group. There was no significant difference found in uterine length and adnexal adherence of cul-de-sac fluid between the PID 17:3 March 1988
Annals of
and control groups. It was concluded that adnexal volume determined by pelvic ultrasonography is useful in identifying adolescent patients with PID. In addition, ultrasonography can identify TOA when it is not clinically suspected in adolescents with PID.
Greg Bennett, MD acetaminophen, poisoning; acetylcysteine, charcoal
The e f f e c t of a c t i v a t e d c h a r c o a l on N - a c e t y l c y s t e i n e absorption in normal subjects Ekins BR, Ford DC, Thompson MIB, et al Am J Emerg Med 5:483-487 Nov 1987
A randomized, crossover study was conducted to evaluate the effect of activated charcoal on serum N-acetylcysteine (NAC) levels given in standard therapeutic doses to healthy volunteers. Nineteen patients, serving as their own controls, completed the two-phase study. Phase I consisted of the subjects taking 140 mg/kg of diluted oral NAC. In Phase II subjects were given 100 g of activated charcoal followed one-half hour later by the diluted NAC. Venous blood samples were drawn in both groups at 11 different time intervals from zero to 480 minutes after ingestion of NAC. There was a significant reduction in the peak NAC level (29%) as well as the total NAC absorbed (39%) in the charcoal/NAC group. Based on these results, the authors recommend a 40% increase in the dosage of NAC if charcoal is used concomitantly with NAC in the treatment of acetominophen poisonings./Editor's note: The results of this study support the recent recommendations that activated charcoal m a y be used concomitantly with NAC, particularly in those patients with po]ydrug overdoses. However, the dose of NAC must be increased in such patients. The problem of absorption of NAC by charcoal can be avoided through the IV administration of NAC that is currently available in some centers.]
John Riccio, MD
otitis media with effusion, air flight
May children with otitis m e d i a with effusion safely fly? Weiss MH, Frost JO C/in Pediatr 26:567-568 Nov 1987
This is a prospective study to determine if children who fly with otitis media with effusion are at risk for the development of barotitis. Fourteen children 3 to 11 years old with a total of 24 ears with otitis media with effusion prior to flight'were studied prospectively. No patient had evidence
EmergencyMedicine
292/167
ABSTRACTS
of acute otitis media or upper respiratory infection. All underwent commercial air flights and were examined by an otolaryngologist before and after flight. None experienced pain or exacerbation of prior otologic symptoms in an involved ear during or after flight. The middle ear space didnot undergo changes in pressure during ascent and descent because the eustachian tube was functionally closed at the time. Because the middle ear is a fluid-containing space, it does not function under the physical laws for gas-filled spaces. Two patients did develop baratotis in a contralateral "normal" ear. These "normal" ears probably had borderline eustachian tube function that predisposed the patient to developing barotitis. It was concluded that the presence of otitis media with effusion precludes the development of barotitis.
Jeffrey Schaider, MD arrhythmia, ECG
D e t e c t i o n of a r r h y t h m i a s : U s e of a p a t i e n t activated ambulatory electrocardiogram d e v i c e w i t h a s o l i d - s t a t e m e m o r y loop Brown AP, Dawkins KD, Davies JG Br Heart J 58:251-253
Sep 1987
To aid in the identification of cardiac arrhythmias in patients with symptoms of palpitations, syncope, or presyncope, these authors studied the effectiveness of a patient-
168/293
activated ambulatory electrocardiogram device with a 70second preactivation and ten-second postactivation memory. o n e hundred patients (16 to 88 years old; median, 58) with a history of syncope (36 patients), presyncope (38 patients), or palpitations (26 patients) were studied. All patients wore the recorder for three weeks and were instructed to activate the device when they became symptomatic. Sixty-nine patients had rhythm abnormalities at the time of recorder activation. Twenty of these patients had more significant arrhythmias, including atrial fibrillation (ten), supraventricular tachycardia (three), multiform ventricular tachycardia (one), junctional rhythm with a rate of 28 (one), sinus bradycardia with a rate of 25 (one), sinus arrest of two seconds (one), and intermittent atrioventricular dissociation (two). The remainder of abnormal recordings identified less significant arrhythmias, including frequent extrasystoles of one in five or more (12), occasional extrasystoles (27), and sinus tachycardia greater than 120 beats/min (ten). Thirtyone patients had no recorded arrhythmias. In five of the cases of tachyarrhythmias and one case of bradycardia (6% of the study group), the arrhythmia was present only in the pre-event segment of the memory (ie, before the recording was activated by the patient). It was concluded that this recording device with a pre-event memory can identify arrythmias associated with symptoms that may be missed by conventional 24-hour, continuous monitors or patient-activated recorders without a preactivation memory. Because this device only records symptomatic arrhythmias, the authors caution that such a recorder should be used with and not in place of the 24-hour, continuous monitor.
Annals of Emergency Medicine
Greg Bennett, MD
17:3 March 1988
Cynthia Elliott, MD pelvic inflammatory disease, ultrasound, adolescent
The use of pelvic ultrasonography in the evaluation of a d o l e s c e n t s with pelvic i n f l a m m a t o r y disease Golden N, Cohen H, Gennari G, et al Am J Dis Child 141:1235-1238 Nov 1987
Due to the difficulty in interpreting findings of pelvic examination in adolescent females suspected of having pelvic inflammatory disease (PID), these authors studied the usefulness of pelvic ultrasonography in the diagnosis of PID. The study group of 60 patients included all female adolescents (12 to 17 years old) seen between July 1983 and July 1986 and fulfilling the following criteria: 1) a history of lower abdominal pain with lower abdominal tenderness on physical examination; 2) cervical motion tenderness; 3) adnexal tenderness; and 4) fever of more than 38 C, leukocytosis greater than 10,500/mm, elevated erythrocyte sedimentation rate greater than 20 mm/hr, Gram's stain suggestive of gonorrhoea, or positive enzyme immunoassay test from the endocervix for Chlamydia trachomatis. The control group of 40 patients included adolescents who received pelvic ultrasonography for the evaluation of conditions other than PID. Ultrasonography was used to compare adnexal volume, adnexal adherence, uterine size, and the presence of cul-de-sac fluid between the study and control groups. Ultrasound revealed tubo-ovarian abcesses (TOA) in 11 (19%) of the study patients. In seven of these patients, TOA was not suspected before ultrasound. Mean adnexal volume (excluding patients with TOA) was 11 cm 3 in the PID group, as compared with 5.2 cm 3 in the control group. There was no significant difference found in uterine length and adnexal adherence of cul-de-sac fluid between the PID 17:3 March 1988
Annals of
and control groups. It was concluded that adnexal volume determined by pelvic ultrasonography is useful in identifying adolescent patients with PID. In addition, ultrasonography can identify TOA when it is not clinically suspected in adolescents with PID.
Greg Bennett, MD acetaminophen, poisoning; acetylcysteine, charcoal
The e f f e c t of a c t i v a t e d c h a r c o a l on N - a c e t y l c y s t e i n e absorption in normal subjects Ekins BR, Ford DC, Thompson MIB, et al Am J Emerg Med 5:483-487 Nov 1987
A randomized, crossover study was conducted to evaluate the effect of activated charcoal on serum N-acetylcysteine (NAC) levels given in standard therapeutic doses to healthy volunteers. Nineteen patients, serving as their own controls, completed the two-phase study. Phase I consisted of the subjects taking 140 mg/kg of diluted oral NAC. In Phase II subjects were given 100 g of activated charcoal followed one-half hour later by the diluted NAC. Venous blood samples were drawn in both groups at 11 different time intervals from zero to 480 minutes after ingestion of NAC. There was a significant reduction in the peak NAC level (29%) as well as the total NAC absorbed (39%) in the charcoal/NAC group. Based on these results, the authors recommend a 40% increase in the dosage of NAC if charcoal is used concomitantly with NAC in the treatment of acetominophen poisonings./Editor's note: The results of this study support the recent recommendations that activated charcoal m a y be used concomitantly with NAC, particularly in those patients with po]ydrug overdoses. However, the dose of NAC must be increased in such patients. The problem of absorption of NAC by charcoal can be avoided through the IV administration of NAC that is currently available in some centers.]
John Riccio, MD
otitis media with effusion, air flight
May children with otitis m e d i a with effusion safely fly? Weiss MH, Frost JO C/in Pediatr 26:567-568 Nov 1987
This is a prospective study to determine if children who fly with otitis media with effusion are at risk for the development of barotitis. Fourteen children 3 to 11 years old with a total of 24 ears with otitis media with effusion prior to flight'were studied prospectively. No patient had evidence
EmergencyMedicine
292/167
ABSTRACTS
of acute otitis media or upper respiratory infection. All underwent commercial air flights and were examined by an otolaryngologist before and after flight. None experienced pain or exacerbation of prior otologic symptoms in an involved ear during or after flight. The middle ear space didnot undergo changes in pressure during ascent and descent because the eustachian tube was functionally closed at the time. Because the middle ear is a fluid-containing space, it does not function under the physical laws for gas-filled spaces. Two patients did develop baratotis in a contralateral "normal" ear. These "normal" ears probably had borderline eustachian tube function that predisposed the patient to developing barotitis. It was concluded that the presence of otitis media with effusion precludes the development of barotitis.
Jeffrey Schaider, MD arrhythmia, ECG
D e t e c t i o n of a r r h y t h m i a s : U s e of a p a t i e n t activated ambulatory electrocardiogram d e v i c e w i t h a s o l i d - s t a t e m e m o r y loop Brown AP, Dawkins KD, Davies JG Br Heart J 58:251-253
Sep 1987
To aid in the identification of cardiac arrhythmias in patients with symptoms of palpitations, syncope, or presyncope, these authors studied the effectiveness of a patient-
168/293
activated ambulatory electrocardiogram device with a 70second preactivation and ten-second postactivation memory. o n e hundred patients (16 to 88 years old; median, 58) with a history of syncope (36 patients), presyncope (38 patients), or palpitations (26 patients) were studied. All patients wore the recorder for three weeks and were instructed to activate the device when they became symptomatic. Sixty-nine patients had rhythm abnormalities at the time of recorder activation. Twenty of these patients had more significant arrhythmias, including atrial fibrillation (ten), supraventricular tachycardia (three), multiform ventricular tachycardia (one), junctional rhythm with a rate of 28 (one), sinus bradycardia with a rate of 25 (one), sinus arrest of two seconds (one), and intermittent atrioventricular dissociation (two). The remainder of abnormal recordings identified less significant arrhythmias, including frequent extrasystoles of one in five or more (12), occasional extrasystoles (27), and sinus tachycardia greater than 120 beats/min (ten). Thirtyone patients had no recorded arrhythmias. In five of the cases of tachyarrhythmias and one case of bradycardia (6% of the study group), the arrhythmia was present only in the pre-event segment of the memory (ie, before the recording was activated by the patient). It was concluded that this recording device with a pre-event memory can identify arrythmias associated with symptoms that may be missed by conventional 24-hour, continuous monitors or patient-activated recorders without a preactivation memory. Because this device only records symptomatic arrhythmias, the authors caution that such a recorder should be used with and not in place of the 24-hour, continuous monitor.
Annals of Emergency Medicine
Greg Bennett, MD
17:3 March 1988