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Serum dosage levels in nonpancreatic abdominal pain vs acute pancreatitis
earlier arrival including patients whose onset of stroke was at work rather than at home, and if the symptoms were first felt during waking hours rather than sleep. Age was shown not to be a significant characteristic and was dropped from further analysis. A conclusion drawn from this study shows that, if public education is undertaken and EMS emphasized, rapid stroke treatment may be initiated soon on hospital arrival. [Javier Aristimufio, MD] Editor3 Comment: With the increasing use of urgent stroke treatment protocols, early utilization of EMS is identified as a critical component.
C SERUM DOSAGE LEVELS IN NONPANCREATIC ABDOMINAL PAIN VS ACUTE PANCREATITIS. Gunasse VV, Roditis N, Mehta D, et al. Am J Gastroenterol. 1993;88(12):2051-4. Measurement of serum amylase is the most widely used screening test for acute pancreatitis. However, serum amylase levels may be elevated in many other conditions that cause abdominal pain, and levels may be low or normal in acute alcoholic pancreatitis. This study was done to compare serum lipase and serum amylase levels in patients with nonpancreatic abdominal pain and patients with acute pancreatitis. Ninety-five patients with nonpancreatic abdominal pain were placed in group A, and 75 patients with acute pancreatitis were placed in group P. Serum amylase levels in group A ranged from 11 to 416 U/L (mean 58 f 46), and in group P ranged from 124 to 13,000 U/L (mean 1620 f 1976). Twenty-seven percent of the patients in group P had levels that overlapped those found in group A. The serum lipase levels in group A ranged from 3 to 680 U/L (mean 111 f lOl), and in group P ranged from 711 to 3 I, 153 (mean 6705 f 7022). None of the patients in group P had levels that overlapped those in group A. The sensitivity of serum amylase in detecting acute pancreatitis was 75%; the specificity was 99%. The sensitivity of serum lipase was lOO%, and the specificity was 99%. The authors conclude that a serum lipase level of 3 times normal has a better diagnostic accuracy than serum amylase in detecting acute pancreatitis. [Bernard F. Kennerz, Jr .] Editor’s Comment: Serum lipase levels are also more valuable in the setting of chronic pancreatitis than are serum amylase levels.
[I STRIKING PREVALENCE OF OVER-THE-COUNTER NONSTEROIDAL ANTI-INFLAMMATORY DRUG USE IN PATIENTS WITH UPPER GASTROINTESTINAL HEMORRHAGE. Wilcox CM, Shalek KA, Cotsonis G. Arch Intern Med. 1994;154:42-6. Consecutive patients evaluated for upper gastrointestinal hemorrhage (UGIH) at a large inner city hospital were prospectively evaluated for over-the-counter (OTC) and
prescription use of nonsteroidal anti-inflammatory drugs (NSAID). Over a 2-year period, 421 patients were admitted and evaluated for UGIH. Most of these patients were black males with a mean age of 50 years. A standardized team questioned each patient for OTC or prescription NSAID use during the week prior to admission. It was found that 56% of the patients evaluated for UGIH had taken OTC or prescription NSAIDs the week prior to admission. Gastric lesions were much more common than other causes of UGIH in the patients taking any form of NSAID. The authors point out that the link of UGIH and prescription NSAID use has long been recognized, but in the light of this study they feel it is of great importance to inquire about OTC NSAID use in any patient with suspected UGIH. [Kelly Gray-Eurom, MD] Editor’s Comment: This study re-emphasizes the need for physicians to consider alternatives to NSAIDs for patients at risk for UGIH.
•I MAGNESIUM BOLUS OR INFUSION FAILS TO IMPROVE EXPIRATORY FLOW IN ACUTE ASTHMA EXACFBBATIONS. Tiffany B, Berk W, Todd I, et al. Chest. 1993;104(3):831-4. Standard therapy of acute asthma exacerbations has relied on B-agonist, parental steroids and methylxanthines. Controversial evidence exists to magnesium’s efficacy in acute asthma exacerbations. A prospective, randomized, double-blinded, placebo-controlled study was performed to ascertain whether magnesium provides objective evidence of improvement in expiratory flow when combined with standard therapy in acute asthma. Forty-eight patients who presented to the emergency department with acute asthma and initial peak expiratory flow rate (PEFR) < 200 l/m, and failed to improve by greater than 100% or remained c 2OOL/m after two nebulizer treatments were enrolled. Patients were excluded for first episode of wheezing, history of bronchitis or emphysema, oral temperature > 38.2”C, history of renal failure, CHF, or requiring tracheal intubation. All enrolled patients received 125 mg methylprednisolone IV, a third aerosol treatment, an aminophylline loading dose, and infusion to maintain the level approximately lSmg/L. Subjects were then randomized to three groups: an infusion group that received MgS04, 2 g IV over 20 min followed by continuous infusion of 2/g/h for 4 h; a bolus group that received 2 g MgS04 over 20 min, followed by a placebo infusion; and a placebo group that received a saline bolus and infusion. Pulmonary function measured by spirometry was assessed at 0, 20, 50, 80, 140, 200, and 260 min. Groups were analyzed for differences with respect to age, initial magnesium, theophylline levels, and initial PEFR and FEVl . Spirometric values were analyzed for differences in both absolute values and change from baseline. No significant differences were found between groups at study entry. No significant differences were observed over time in either PEFR, FEVl, or change in these values. It was concluded that IV magne-
C SERUM DOSAGE LEVELS IN NONPANCREATIC ABDOMINAL PAIN VS ACUTE PANCREATITIS. Gunasse VV, Roditis N, Mehta D, et al. Am J Gastroenterol. 1993;88(12):2051-4. Measurement of serum amylase is the most widely used screening test for acute pancreatitis. However, serum amylase levels may be elevated in many other conditions that cause abdominal pain, and levels may be low or normal in acute alcoholic pancreatitis. This study was done to compare serum lipase and serum amylase levels in patients with nonpancreatic abdominal pain and patients with acute pancreatitis. Ninety-five patients with nonpancreatic abdominal pain were placed in group A, and 75 patients with acute pancreatitis were placed in group P. Serum amylase levels in group A ranged from 11 to 416 U/L (mean 58 f 46), and in group P ranged from 124 to 13,000 U/L (mean 1620 f 1976). Twenty-seven percent of the patients in group P had levels that overlapped those found in group A. The serum lipase levels in group A ranged from 3 to 680 U/L (mean 111 f lOl), and in group P ranged from 711 to 3 I, 153 (mean 6705 f 7022). None of the patients in group P had levels that overlapped those in group A. The sensitivity of serum amylase in detecting acute pancreatitis was 75%; the specificity was 99%. The sensitivity of serum lipase was lOO%, and the specificity was 99%. The authors conclude that a serum lipase level of 3 times normal has a better diagnostic accuracy than serum amylase in detecting acute pancreatitis. [Bernard F. Kennerz, Jr .] Editor’s Comment: Serum lipase levels are also more valuable in the setting of chronic pancreatitis than are serum amylase levels.
[I STRIKING PREVALENCE OF OVER-THE-COUNTER NONSTEROIDAL ANTI-INFLAMMATORY DRUG USE IN PATIENTS WITH UPPER GASTROINTESTINAL HEMORRHAGE. Wilcox CM, Shalek KA, Cotsonis G. Arch Intern Med. 1994;154:42-6. Consecutive patients evaluated for upper gastrointestinal hemorrhage (UGIH) at a large inner city hospital were prospectively evaluated for over-the-counter (OTC) and
prescription use of nonsteroidal anti-inflammatory drugs (NSAID). Over a 2-year period, 421 patients were admitted and evaluated for UGIH. Most of these patients were black males with a mean age of 50 years. A standardized team questioned each patient for OTC or prescription NSAID use during the week prior to admission. It was found that 56% of the patients evaluated for UGIH had taken OTC or prescription NSAIDs the week prior to admission. Gastric lesions were much more common than other causes of UGIH in the patients taking any form of NSAID. The authors point out that the link of UGIH and prescription NSAID use has long been recognized, but in the light of this study they feel it is of great importance to inquire about OTC NSAID use in any patient with suspected UGIH. [Kelly Gray-Eurom, MD] Editor’s Comment: This study re-emphasizes the need for physicians to consider alternatives to NSAIDs for patients at risk for UGIH.
•I MAGNESIUM BOLUS OR INFUSION FAILS TO IMPROVE EXPIRATORY FLOW IN ACUTE ASTHMA EXACFBBATIONS. Tiffany B, Berk W, Todd I, et al. Chest. 1993;104(3):831-4. Standard therapy of acute asthma exacerbations has relied on B-agonist, parental steroids and methylxanthines. Controversial evidence exists to magnesium’s efficacy in acute asthma exacerbations. A prospective, randomized, double-blinded, placebo-controlled study was performed to ascertain whether magnesium provides objective evidence of improvement in expiratory flow when combined with standard therapy in acute asthma. Forty-eight patients who presented to the emergency department with acute asthma and initial peak expiratory flow rate (PEFR) < 200 l/m, and failed to improve by greater than 100% or remained c 2OOL/m after two nebulizer treatments were enrolled. Patients were excluded for first episode of wheezing, history of bronchitis or emphysema, oral temperature > 38.2”C, history of renal failure, CHF, or requiring tracheal intubation. All enrolled patients received 125 mg methylprednisolone IV, a third aerosol treatment, an aminophylline loading dose, and infusion to maintain the level approximately lSmg/L. Subjects were then randomized to three groups: an infusion group that received MgS04, 2 g IV over 20 min followed by continuous infusion of 2/g/h for 4 h; a bolus group that received 2 g MgS04 over 20 min, followed by a placebo infusion; and a placebo group that received a saline bolus and infusion. Pulmonary function measured by spirometry was assessed at 0, 20, 50, 80, 140, 200, and 260 min. Groups were analyzed for differences with respect to age, initial magnesium, theophylline levels, and initial PEFR and FEVl . Spirometric values were analyzed for differences in both absolute values and change from baseline. No significant differences were found between groups at study entry. No significant differences were observed over time in either PEFR, FEVl, or change in these values. It was concluded that IV magne-