ABSTRACTS
minocycline, doxycycline,
blunt trauma, ureter, kidney, pelvis
mucopurulent cervicitis
Ureteropelvic junction disruption following blunt abdominal trauma
Minocycline compared with doxycycline in the treatment of nongonococcal urethritis and mucopurulent cervicitis RomanowskiB, Talbot H, Stadnyk M, eta/ Ann Intern Med 119.16-22 Ju11993 This randomized, double-blind trial was designed to compare the efficacy and tolerability of minocycline with that of doxycycline in the treatment of nongonococcal urethritis and mucopurulent cervicitis. The study population consisted of 151 men and 102 women with clinically diagnosed nongonococcal urethritis or mucopurulent cervicitis or whose sexual partner had either clinical condition or was known to have a positive culture for Chlamydia trachomatis. Minocycline (100 mg) was administered once a day for Seven days, or doxycycline (100 mg)was administered twice a day for seven days. Patients had follow-up visits at one, two, and seven weeks. Cultures for C trachomatis, Ureaplasma urealyticum, and Myceplasma hominiswere taken at each visit. These two drugs had similar clinical cure rates (doxycycline, 85%; minocycline, 89%). Adverse effects, primarily gastrointestinal, occurred more frequently in the doxycycline group (men, 43% versus 26 o%, women, 62% versus 35%). The authors conclude that minocycline (100 mg nightly) was as effective as doxycycline, 100 mg twice daily, for nongonococcal urethritis and mucopurulent cervicitis and had fewer side effects.
Kevin F Giblin, MD
16 4/ 19 3 0
Boone TB, Gilling PJ, Husmann OA J Urol 150.33-36 Jul 1993 The purpose of this retrospective review was to determine any common signs or symptoms that could be useful in the diagnosis of ureteropelvic junction disruptions to avoid a delay in the diagnosis of these injuries. The investigators reviewed their experiences in the past ten years (seven patients) and performed an extensive literature review (40 patients). In 95% of the cases reviewed, patients presented with a history of a rapid deceleration injury and the presence of at least one of four associated findings: microscopic hematuria with shock, gross hematuria, direct flank tenderness or ecchymosis, or multisystem trauma. Most delayed diagnoses occurred in patients with multisystem trauma who presented in profound nonresponsive hypovolemic shock. This clinical situation demanded prompt surgical intervention and precluded the use of radiologic evaluation. Despite the absence of perinephric hematoma and palpably normal kidneys, patients had a ureteropelvic junction disruption. Therefore, the authors recommend that if the kidneys are not inspected directly, further radiographic evaIuation should be obtained after surgical stabilization. Delayed diagnoses also occurred in a second much less common presentation involving a patient with no physical signs or symptoms following a deceleration accident. In these cases, there appear to be no obvious guidelines and the judicious clinical experience of the physician must be used. If the historical data are substantial enough to arouse significant suspicion for ureteropelvic junction injury, radiographic evaluation should be obtained. This is important as a delay in diagnosis
and surgical treatment of more than 24 hours results in a significant increase in the urologic morbidity after repair and in the incidence of primary nephrectomy.
Kathy S Kroshus, MB meningitis, bacterial; bacteremia; meta-analysis; infants
Effect of antibiotic therapy and etiologic microorganism on the risk of bacterial meningitis in children with occult bacteremia Baraff LJ, Oslund S, Prather M Pediatrics 92. 140-143 Jul 1993 This study used meta-analysis to combine the results of 22 studies to quantify the effect of antibiotic therapy on the probability of subsequent bacterial meningitis in children with occult bacteremia who were treate d as outpatients. A total of 906 children with occult bacteremia for whom the type of initial antibiotic therapy could be determined were included. Of these children, 472 were untreated, 184 were treated with oral antibiotics, and 250 were treated with parenteral antibiotics. There were 46, 20, and two cases of subsequent meningitis, respectively, in each of these cases. All cases of subsequent bacterial meningitis in children with occult bacteremia treated with oral antibiotics were due to Haemophilus influenzae. Of the 135 children who had Streptococcus pneumoniae bacteremia treated with oral antibiotics, none developed bacterial meningitis. Also, of the 184 children treated with parenteral antibiotics as outpatients, only two developed culture-positive bacterial meningitis; both had been treated with intramuscular penicillin. However, there were no cases of culture-positive
meningitis in children treated with ceftriaxone. The mean probabilities of subsequent bacteremia meningitis in children with occult bacteremia were 9.8% (no antibiotic), 8.2% (oral antibiotics), and 0.3% (parenteral antibiotics). Therefore, this study concludes that oral and parenteral antibiotic therapy effectively reduces the risk of Spneumoniae meningitis in children with occult bacteremia, whereas parenteral antibiotic therapy reduces the risk of H influenzae meningitis.
ThadA Stephen& MD cardiac troponin I, creatine kinase, cardiac injury
Cardiac troponin I: A marker with high specificity for cardiac injury Adams JE, Bodor GS, D~vi/aRom#n VG, et al Circulation 88.101-106 Jul 1993 Although MB-creatine kinase (MB-CK) is used as the usual serum marker for myocardial injury, regenerating skeletal muscle also contains an increased percentage of MB-CK due to re-expression of a gone suppressed during fetal development. This study measured MB-CK and cardiac troponin I, a myocardial regulatory protein, in patients with skeletal muscle disease or rena] failure to assess whether cardiac troponin I couId distinguish myocardial injury in this setting. Patients (215) included 56 with skeletal muscle injury (acute injury [37], chronic myopathy [10], and extreme exertion [9]) and 159 on chronic dialysis. All patients with skeletal muscle injury had an elevated CK level; 27 of the 159 patients on dialysis had elevated CK levels. Of these patients, MB-CK levels were also elevated in four patients with acute muscle injury, nine with chronic myopathy, six with extreme exertion, and seven patients with renal failure. Echocardiography was used as the gold standard for detecting myocardial injury. Regional wall motion abnormalities were
ANNALS OF EMERGENCY MEDICINE
22:12
DECEMBER 1993