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Pacman neurapraxia
CORRESPONDENCE
I feel this bit of information is worthwhile passing on to other emergency physicians, as this is one of the most effective and readily available chest wound sealing dressings I have yet to find. The defibrillation pads adhere very well to dry skin, but even better when the skin is wet, as is usually
Pacman
the case in people with trauma of this sort.
Charles E. Pexa, MD Assistant Director of Emergency Services North Memorial Medical Center, Minneapolis
Neurapraxia
the Editor: We wish to report a reproducible peripheral neuropathy {Pacman Neurapraxia) of the radial volar digital nerve of the middle finger manifested by hypoesthesia on the radial side of the fingertip. The neuropathy is found among enthusiasts of the video game Pacman. The mechanism of injury is probably the vigorous squeezing of the joystick control that occurs during lefthanded turns of the Pacman, resulting in a traumatic neurapraxia of the digital nerve. This condition is transient, and slowly resolves with abstinence from Pacman. Adequate patient compliance is difficult to achieve due to the addictive nature of the game,
and we recommend individuals change their joystick grip to avoid directly traumatizing the digital nerve. Our observations are based on a sample of two enthusiastic, righthanded intermediate level Pacman players (who happen to be emergency physicians).
Mark Smith, MD Robert Shesser, MD Division of Emergency Medicine The George Washington University Medical Center Washington, DC
Etiologic Agents of Pediatric Otitis Media To the Editor: I am writing to correct a misleading statement by the editor in the abstract section of the November 1981 issue of Annals (page 619). Hemopl~'lus influenzae, while a frequent cause of otitis media, is not the most c o m m o n etiologic agent of this disease. Feigin and Spector 1 recently reviewed eight separate studies of otitis media in children from one to six years of age. S pneumoniae was the etiologic agent in 26% to 50% of cases, while H influenzae was recovered in 14% to 27%. This compares favorably with the 34% incidence of pneumococcal otitis media reported from Finland. Ampicillin or amoxicillin is effective against both organisms in the majority of cases; however, in areas with a high
prevalence of beta-lactamase-producing H mfluenzae, treatm e n t with cefaclor, trimethprimsulfamethoxasole, or an erythromycin-sulfasoxasole combination should be considered. 1. Feigin RD, Cherry JD: Textbook of Pediatric Infectious Disease. WB Saunders Co, 1981, pp 122-238.
Marykay Pasnick, MD Department of Pediatrics Medical Center Hospital of Vermont Burlington
Author's Reply The point that we were trying to make is that H influenzae is of significant concern in otitis media in this country. For example, Schwartz 1 et al reported in their series of 58 cases in children older than 5 years a 36% incidence of H influenzae, while in that same series S pneumoniae was responsible for 24%. Moreover, they cite several series ~4 in which the incidence of H influenzae was responsible for from 19.3% to 42.3% of the cases. It is still current in the literature, especially in the textbooks of pediatrics, s that S pneumoniae is the most comm o n cause of otitis media. There has been enough literature to suggest that one must always consider H influenzae. We have no disagreement with Dr. Pasnick's statements concerning therapy, and were merely trying to re-emphasize the fact that H flu is probably more dangerous since it is not commonly responsive to ordinary penicillin. 84/334
1. Schwartz R: Acute pun,dent otitis media in children older than 5 years. JAMA 238:1032, 1977. 2. Howie V: Natural history of otitis media. Ann OtoI Rhinol Laryngoi 84:67-73, 1975. 3. Coffie JD: Otitis media in the practice of pediatrics. Pediatrics 35:25-32, 1966. 4. Herberts G: Acute otitis media; Pract Otorhinolaryngol 33:191, 1971. 5. Nelson Textbook of Pediatrics. Philadelphia, WB Saunders Co, 1979, p 1185.
Peter Rosen, MD Annals Abstracts Editor
Annals of Emergency Medicine
11:6 June 1982
I feel this bit of information is worthwhile passing on to other emergency physicians, as this is one of the most effective and readily available chest wound sealing dressings I have yet to find. The defibrillation pads adhere very well to dry skin, but even better when the skin is wet, as is usually
Pacman
the case in people with trauma of this sort.
Charles E. Pexa, MD Assistant Director of Emergency Services North Memorial Medical Center, Minneapolis
Neurapraxia
the Editor: We wish to report a reproducible peripheral neuropathy {Pacman Neurapraxia) of the radial volar digital nerve of the middle finger manifested by hypoesthesia on the radial side of the fingertip. The neuropathy is found among enthusiasts of the video game Pacman. The mechanism of injury is probably the vigorous squeezing of the joystick control that occurs during lefthanded turns of the Pacman, resulting in a traumatic neurapraxia of the digital nerve. This condition is transient, and slowly resolves with abstinence from Pacman. Adequate patient compliance is difficult to achieve due to the addictive nature of the game,
and we recommend individuals change their joystick grip to avoid directly traumatizing the digital nerve. Our observations are based on a sample of two enthusiastic, righthanded intermediate level Pacman players (who happen to be emergency physicians).
Mark Smith, MD Robert Shesser, MD Division of Emergency Medicine The George Washington University Medical Center Washington, DC
Etiologic Agents of Pediatric Otitis Media To the Editor: I am writing to correct a misleading statement by the editor in the abstract section of the November 1981 issue of Annals (page 619). Hemopl~'lus influenzae, while a frequent cause of otitis media, is not the most c o m m o n etiologic agent of this disease. Feigin and Spector 1 recently reviewed eight separate studies of otitis media in children from one to six years of age. S pneumoniae was the etiologic agent in 26% to 50% of cases, while H influenzae was recovered in 14% to 27%. This compares favorably with the 34% incidence of pneumococcal otitis media reported from Finland. Ampicillin or amoxicillin is effective against both organisms in the majority of cases; however, in areas with a high
prevalence of beta-lactamase-producing H mfluenzae, treatm e n t with cefaclor, trimethprimsulfamethoxasole, or an erythromycin-sulfasoxasole combination should be considered. 1. Feigin RD, Cherry JD: Textbook of Pediatric Infectious Disease. WB Saunders Co, 1981, pp 122-238.
Marykay Pasnick, MD Department of Pediatrics Medical Center Hospital of Vermont Burlington
Author's Reply The point that we were trying to make is that H influenzae is of significant concern in otitis media in this country. For example, Schwartz 1 et al reported in their series of 58 cases in children older than 5 years a 36% incidence of H influenzae, while in that same series S pneumoniae was responsible for 24%. Moreover, they cite several series ~4 in which the incidence of H influenzae was responsible for from 19.3% to 42.3% of the cases. It is still current in the literature, especially in the textbooks of pediatrics, s that S pneumoniae is the most comm o n cause of otitis media. There has been enough literature to suggest that one must always consider H influenzae. We have no disagreement with Dr. Pasnick's statements concerning therapy, and were merely trying to re-emphasize the fact that H flu is probably more dangerous since it is not commonly responsive to ordinary penicillin. 84/334
1. Schwartz R: Acute pun,dent otitis media in children older than 5 years. JAMA 238:1032, 1977. 2. Howie V: Natural history of otitis media. Ann OtoI Rhinol Laryngoi 84:67-73, 1975. 3. Coffie JD: Otitis media in the practice of pediatrics. Pediatrics 35:25-32, 1966. 4. Herberts G: Acute otitis media; Pract Otorhinolaryngol 33:191, 1971. 5. Nelson Textbook of Pediatrics. Philadelphia, WB Saunders Co, 1979, p 1185.
Peter Rosen, MD Annals Abstracts Editor
Annals of Emergency Medicine
11:6 June 1982