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Pediatric emergency room visits: A risk factor for acquiring measles
ABSTRACTS
methods. Gravel foreign bodies were visible by plain film, xerography, and CT but significant streak artifacts made precise identification and localization impossible when studied by MRI. Plastic foreign bodies were detected by CT and MRI but not by plain film or xerography. Wooden foreign bodies were the m o s t difficult group to visualize and could be reliably identified only w i t h CT and MRI. T h e a u t h o r s c o n c l u d e t h a t plain films should be sufficient to identify glass or gravel fragments in soft tissue and that xerography had no benefit over plain films. CT is the preferred imaging method to identify plastic or wooden foreign bodies, with MRI reserved for the most difficult cases. [Editor's note: This study
used relatively large fragments (at least 10 m m maximum dimension). It should be remembered that small size, about 2 m m for glass, will affect the detection rate.] Bryan Wilson, MD measles, transmission
P e d i a t r i c e m e r g e n c y room visits: A risk f a c t o r for acquiring m e a s l e s Farizo KM, Stehr-Green PA, Simpson DM, et al Pediatrics 87:74-79 Jan 1991
A case-control study was undertaken at emergency departments in Los Angeles and Houston to delineate a possible association between ED visits and the subsequent risk of preschool-aged children acquiring measles during measles outbreaks. At each of two sites, selected measles cases were matched to controls for age, time of visit, and ethnic background. The time of potential measles exposure was defined as a period ten to 18 clays prior to the onset of the measles rash. In Los Angeles, 23% of case patients and 5% of controls (odds ratio, 5.2; 95% confidence interval, 1.7, 15.9; P < .01) had an ED visit during the exposure period; in Houston, 41% of case patients and 6% of controls (odds ratio, 8.4; 95% confidence interval, 3.3, 21.2; P < .01) had such visits. These data suggest that visits to inner-city EDs by 178/595
preschool-aged children during community outbreaks of measles may indeed be a risk factor for acquiring this disease. The authors recommend triage and i s o l a t i o n of s u s p e c t e d cases presenting to EDs as well as ED m e a s l e s v a c c i n a t i o n during outbreaks to provide postexposure prophylaxis and increase v a c c i n a t i o n coverage in hard-to-reach low-income groups.
Rickard Dalberg, MD cerebral resuscitation
Effects of t r o m e t h a m i n e and h y p e r v e n t i l a t i o n on brain injury in the c a t Yoshida K, Marmarou A J Neurosurg 74:87-96 Jan 1991
This study was conducted to assess the effect of tromethamine (THAM) and hyperventilation on brain tissue acidosis in a cat m o d e l of head trauma. Twenty-nine cats were assigned to one of four t r e a t m e n t groups (THAM, h y p e r v e n t i l a t i o n , T H A M and h y p e r v e n t i l a t i o n , and control). T h e brain l a c t a t e index (postinjury lactate + preinjury lactate level) in the THAM group had the least rise of 126% as compared with 142% and 157% in the combination and hyperventilation groups, respectively. The index of cerebral energy depletion, the phosphocreatine ratio (PCr:Pi), was reduced to 79% with THAM therapy, to 60% with hyperventilation therapy, and to 66% with c o m b i n a t i o n therapy. In addition, the phosphocreatine ratio returned to a normal level in the T H A M and combination groups by the end of the eight-hour study period. Brain water content was signific a n t l y d e c r e a s e d in the T H A M t r e a t e d and c o m b i n a t i o n - t r e a t e d groups. The authors conclude that in this e x p e r i m e n t a l m o d e l T H A M ameliorates lactate production and reduces energy use and brain edema. In contrast, prolonged hyperventilation results in greater lactate production and depletion of phosphate energy stores, but no decrease in brain edema.
Steve Price, MD Annals of EmergencyMedicine
hemoperitoneum, ultrasound; blunt abdominal trauma
Emergency center u l t r a s o n o g r a p h y in the e v a l u a t i o n of hemoperitoneum: A p r o s p e c t i v e study Kimura A, Otsuka T J Trauma 31:20-23 Jan 1991
A prospective study of 72 patients was conducted to determine the accuracy of emergency department ultrasound for detecting hemop e r i t o n e u m in b l u n t a b d o m i n a l trauma. H e m o p e r i t o n e u m was diagn o s e d if M o r r i s o n ' s (hepatorenal) pouch or Douglas' cul-de-sac showed an echo-free space. Fifteen patients had hemoperitoneum revealed by diagnostic peritoneal lavage (27%) or l a p a r o t o m y (73%), and 13 of these were demonstrated by ultrasound either on initial (61.5%) or repeat exa m i n a t i o n (38.5%). Independent of examining physician, ultrasound had a sensitivity of 86%, a specificity of 100%, and an accuracy of 97%. Because ultrasound is quicker than diagnostic peritoneal lavage and has virtually no associated morbidity, the authors conclude that ultrasound is a useful screening device and may dim i n i s h the role of diagnostic peritoneal lavage for the ED evaluation of blunt abdominal trauma.
Charles Sweeney, MD bismuth subsalicylate, diarrhea
B i s m u t h s u b s a l i c y l a t e in the t r e a t m e n t of a c u t e d i a r r h e a in children: A clinical study Soriano-Brucher H, Avendano P, O'Ryan M Pediatrics 87:18-27 Jan 1991
Although rehydration remains the treatment of choice for acute childhood diarrhea, rehydration does not change the amount or duration of diarrhea. A randomized, double-blind, placebo-controlled study was conducted in 123 children to evaluate bismuth subsalicylate (BSS) as an adjunct to rehydration therapy in treatment of acute diarrheal illness. BSS 20:5 May 1991
methods. Gravel foreign bodies were visible by plain film, xerography, and CT but significant streak artifacts made precise identification and localization impossible when studied by MRI. Plastic foreign bodies were detected by CT and MRI but not by plain film or xerography. Wooden foreign bodies were the m o s t difficult group to visualize and could be reliably identified only w i t h CT and MRI. T h e a u t h o r s c o n c l u d e t h a t plain films should be sufficient to identify glass or gravel fragments in soft tissue and that xerography had no benefit over plain films. CT is the preferred imaging method to identify plastic or wooden foreign bodies, with MRI reserved for the most difficult cases. [Editor's note: This study
used relatively large fragments (at least 10 m m maximum dimension). It should be remembered that small size, about 2 m m for glass, will affect the detection rate.] Bryan Wilson, MD measles, transmission
P e d i a t r i c e m e r g e n c y room visits: A risk f a c t o r for acquiring m e a s l e s Farizo KM, Stehr-Green PA, Simpson DM, et al Pediatrics 87:74-79 Jan 1991
A case-control study was undertaken at emergency departments in Los Angeles and Houston to delineate a possible association between ED visits and the subsequent risk of preschool-aged children acquiring measles during measles outbreaks. At each of two sites, selected measles cases were matched to controls for age, time of visit, and ethnic background. The time of potential measles exposure was defined as a period ten to 18 clays prior to the onset of the measles rash. In Los Angeles, 23% of case patients and 5% of controls (odds ratio, 5.2; 95% confidence interval, 1.7, 15.9; P < .01) had an ED visit during the exposure period; in Houston, 41% of case patients and 6% of controls (odds ratio, 8.4; 95% confidence interval, 3.3, 21.2; P < .01) had such visits. These data suggest that visits to inner-city EDs by 178/595
preschool-aged children during community outbreaks of measles may indeed be a risk factor for acquiring this disease. The authors recommend triage and i s o l a t i o n of s u s p e c t e d cases presenting to EDs as well as ED m e a s l e s v a c c i n a t i o n during outbreaks to provide postexposure prophylaxis and increase v a c c i n a t i o n coverage in hard-to-reach low-income groups.
Rickard Dalberg, MD cerebral resuscitation
Effects of t r o m e t h a m i n e and h y p e r v e n t i l a t i o n on brain injury in the c a t Yoshida K, Marmarou A J Neurosurg 74:87-96 Jan 1991
This study was conducted to assess the effect of tromethamine (THAM) and hyperventilation on brain tissue acidosis in a cat m o d e l of head trauma. Twenty-nine cats were assigned to one of four t r e a t m e n t groups (THAM, h y p e r v e n t i l a t i o n , T H A M and h y p e r v e n t i l a t i o n , and control). T h e brain l a c t a t e index (postinjury lactate + preinjury lactate level) in the THAM group had the least rise of 126% as compared with 142% and 157% in the combination and hyperventilation groups, respectively. The index of cerebral energy depletion, the phosphocreatine ratio (PCr:Pi), was reduced to 79% with THAM therapy, to 60% with hyperventilation therapy, and to 66% with c o m b i n a t i o n therapy. In addition, the phosphocreatine ratio returned to a normal level in the T H A M and combination groups by the end of the eight-hour study period. Brain water content was signific a n t l y d e c r e a s e d in the T H A M t r e a t e d and c o m b i n a t i o n - t r e a t e d groups. The authors conclude that in this e x p e r i m e n t a l m o d e l T H A M ameliorates lactate production and reduces energy use and brain edema. In contrast, prolonged hyperventilation results in greater lactate production and depletion of phosphate energy stores, but no decrease in brain edema.
Steve Price, MD Annals of EmergencyMedicine
hemoperitoneum, ultrasound; blunt abdominal trauma
Emergency center u l t r a s o n o g r a p h y in the e v a l u a t i o n of hemoperitoneum: A p r o s p e c t i v e study Kimura A, Otsuka T J Trauma 31:20-23 Jan 1991
A prospective study of 72 patients was conducted to determine the accuracy of emergency department ultrasound for detecting hemop e r i t o n e u m in b l u n t a b d o m i n a l trauma. H e m o p e r i t o n e u m was diagn o s e d if M o r r i s o n ' s (hepatorenal) pouch or Douglas' cul-de-sac showed an echo-free space. Fifteen patients had hemoperitoneum revealed by diagnostic peritoneal lavage (27%) or l a p a r o t o m y (73%), and 13 of these were demonstrated by ultrasound either on initial (61.5%) or repeat exa m i n a t i o n (38.5%). Independent of examining physician, ultrasound had a sensitivity of 86%, a specificity of 100%, and an accuracy of 97%. Because ultrasound is quicker than diagnostic peritoneal lavage and has virtually no associated morbidity, the authors conclude that ultrasound is a useful screening device and may dim i n i s h the role of diagnostic peritoneal lavage for the ED evaluation of blunt abdominal trauma.
Charles Sweeney, MD bismuth subsalicylate, diarrhea
B i s m u t h s u b s a l i c y l a t e in the t r e a t m e n t of a c u t e d i a r r h e a in children: A clinical study Soriano-Brucher H, Avendano P, O'Ryan M Pediatrics 87:18-27 Jan 1991
Although rehydration remains the treatment of choice for acute childhood diarrhea, rehydration does not change the amount or duration of diarrhea. A randomized, double-blind, placebo-controlled study was conducted in 123 children to evaluate bismuth subsalicylate (BSS) as an adjunct to rehydration therapy in treatment of acute diarrheal illness. BSS 20:5 May 1991