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The role of abdominal x-rays in the diagnosis and management of intussusception
ABSTRACTS
intussusception; abdominal radiographs
The role of abdominal x-rays in the diagnosis and management of intussusception Smith DS, Bonadio WA, LosekJD, eta/ Pediatr Emerg Care 8.'325-327 Dec 1992 Intussusception is the most common cause of bowel obstruction in children between the ages of 2 months and 6 years. Only 10% to 20% of patients will present with the classic triad of colicky abdominal pain, vomiting, and bleeding per rectum. Therefore, other diagnostic adjuncts should be explored. This study was designed to determine the clinical sensitivity and specificity of abdominal radiographs in identifying patients with intussusception in the pediatric emergency department setting. Six full-time pediatric emergency physicians evaluated 126 radiographs from 42 patients with intussusception--42 in whom the disease was clinically suspected but ruled out and 42 controls in whom the final radiology report was normal. The radiographswere presented to pediatric emergency physicians in a blinded, randomized sequence without additional clinical information. These physicians then identified patients for whom they would proceed to barium enema. Mean sensitivity was 80.5% (range, 71% to 93%), and mean specificity was 58% (range, 48% to 69%). Although a sensitivity of 80% and a specificity of 58% are not adequate factors on which to base complete management decisions, they compare favorably with the reported incidence of signs and symptoms from previous studies. The authors conclude that plain and upright abdominal films are a useful adjunct for the clinician evaluating patients for suspected intussusception. TammyPerkins, MD
tympanic temperature
Core temperature measured in the auricular canal: Comparison between four different tympanic thermometers JakobssonJ, NilssonA, CarlssonC Acta Anaesthesiol Scand 36.'819-824 Dec 1992 Tympanic thermometers were studied for reliability fer repeated measurements and to compare tympanic temperature with esophageal, rectal, and pulmonary artery temperatures. Four different tympanic thermometers were used. Eight observers measured auricular temperatures in both ears on two occasions with three subjects. All four tympanic thermometer models measured core temperature accurately and measured changes in core temperature accurately. The authors concluded that the tympanic thermometer is accurate and a valuable alternative in many clinical settings. RonaldJ Widman, MD urinary tract infection; ciprofloxacin; trimethoprim~sulfamethoxazole
Ciprofloxacin versus trimethoprimsulfamethoxazole: Treatment of communityacquired urinary tract infections in a prospective, controlled, doubleblind comparison GrubbsNC, SchultzHJ, Henry NK, et al Mayo ClinProc67.1163-1168 Dec 1992 This prospective, randomized, controlled, double-blind trial compared
MAY 1993
22:5
ANNALS OF EMERGENCY MEDICINE
the safety and efficacy of ciprofloxacin (250 mg twice daily for ten days) with that of trimethoprimsulfamethoxazole (160 mg trimethoprim/80 mg sulfamethoxazole twice daily for ten days) in treating urinary tract infections in ambulatory adult patients. A urinary tract infection was defined as a positive urine culture with 104 or more colony-forming units per milliliter. A complicated urinary tract infection was defined by structural or functional abnormalities in the urinary tract, pyelonephritis, or prostatitis in addition to a positive culture. Two hundred three patients 18 to 75 years old were randomized to receive ciprofloxacin (98 women and five men) or trimethoprim-sulfamethoxazole(92 women and eight men). Patients were reassessed on day 3 or 4 during therapy and five to nine days and four weeks after completion. One hundred forty-eight of the 203 had culture-proven urinary tract infections. Relapsewas defined as recurrence of 104 organisms with the same susceptibility pattern within four weeks after completion. Reinfection was defined as 104 organisms per milliliter of a different micro-organism within four weeks after completion. Failure was defined as persistence or relapse, continued signs of infection that required a change in treatment, or inability te complete at least five days of treatment as a result of side effects. Treatment was successful in 69 of 76 ciprofloxacin patients (91%) and 62 of 68 trimethoprimsulfamethoxazole patients (92%). Rates of reinfection were similar in the two groups. Of 15 patients with complicated urinary tract infections, two failures occurred in the ciprofloxacin group because of persistent symptoms despite negative cultures. Adverse reactions, including gastrointestinal upset, headache, rash, and vaginitis, occurred in 32% of the trimetheprim-sulfamethexazole group compared with 17% of the ciprofloxacin group. The authors concluded that the two treatments are equally effective but that treatment with ciprofioxacin is associated with fewer adverse reactions
although it is more expensive than trimethoprim-sulfamethoxazole. Charles Peterson,MD sedation, pediatric; midazolam; ketamine; atropine
Effectiveness of preoperative sedation with rectal midazolam, ketamine, or their combination in young children Beebe DS, BelaniKG, ChangPN, et al Anesth Analg 75.880-884 Dec 1992 This randomized, single-blinded study was conducted to determine which of three types of rectal sedation was most effective before surgery in facilitating parental separation and IV cannulation in young children. One hundred children 3.0 + 1.7 years old were randomly assigned to four equal groups. Group 1 received rectal midazolam (0.5 mg/kg), ketamine (3 mg/kg), and atropine (0.02 mg/kg). Group 2 received midazolam and atropine at the same doses, group 3 received ketamine and atropine, and group 4 received atropine alone. The medications were administered rectally via a 2.0-ram pediatric feeding tube passed 8 to 10 cm beyond the anus. The children were separated from their parents after 15 minutes, and IV cannulation was attempted by an anesthesiologist. 0nly two IV attempts were allowed. Induction was accomplished with nitrous/halothane induction when access was unavailable. A child psychologist used a four-tier scale to grade the level of sedation before, during, and after the medication was administered as well as during separation from the parents. The psychologist also graded the child's response to IV placement, and the overall cannulation procedure was judged as satisfactory or unsatisfactory by the anesthesiologist. Most
8 71/ 14 7
intussusception; abdominal radiographs
The role of abdominal x-rays in the diagnosis and management of intussusception Smith DS, Bonadio WA, LosekJD, eta/ Pediatr Emerg Care 8.'325-327 Dec 1992 Intussusception is the most common cause of bowel obstruction in children between the ages of 2 months and 6 years. Only 10% to 20% of patients will present with the classic triad of colicky abdominal pain, vomiting, and bleeding per rectum. Therefore, other diagnostic adjuncts should be explored. This study was designed to determine the clinical sensitivity and specificity of abdominal radiographs in identifying patients with intussusception in the pediatric emergency department setting. Six full-time pediatric emergency physicians evaluated 126 radiographs from 42 patients with intussusception--42 in whom the disease was clinically suspected but ruled out and 42 controls in whom the final radiology report was normal. The radiographswere presented to pediatric emergency physicians in a blinded, randomized sequence without additional clinical information. These physicians then identified patients for whom they would proceed to barium enema. Mean sensitivity was 80.5% (range, 71% to 93%), and mean specificity was 58% (range, 48% to 69%). Although a sensitivity of 80% and a specificity of 58% are not adequate factors on which to base complete management decisions, they compare favorably with the reported incidence of signs and symptoms from previous studies. The authors conclude that plain and upright abdominal films are a useful adjunct for the clinician evaluating patients for suspected intussusception. TammyPerkins, MD
tympanic temperature
Core temperature measured in the auricular canal: Comparison between four different tympanic thermometers JakobssonJ, NilssonA, CarlssonC Acta Anaesthesiol Scand 36.'819-824 Dec 1992 Tympanic thermometers were studied for reliability fer repeated measurements and to compare tympanic temperature with esophageal, rectal, and pulmonary artery temperatures. Four different tympanic thermometers were used. Eight observers measured auricular temperatures in both ears on two occasions with three subjects. All four tympanic thermometer models measured core temperature accurately and measured changes in core temperature accurately. The authors concluded that the tympanic thermometer is accurate and a valuable alternative in many clinical settings. RonaldJ Widman, MD urinary tract infection; ciprofloxacin; trimethoprim~sulfamethoxazole
Ciprofloxacin versus trimethoprimsulfamethoxazole: Treatment of communityacquired urinary tract infections in a prospective, controlled, doubleblind comparison GrubbsNC, SchultzHJ, Henry NK, et al Mayo ClinProc67.1163-1168 Dec 1992 This prospective, randomized, controlled, double-blind trial compared
MAY 1993
22:5
ANNALS OF EMERGENCY MEDICINE
the safety and efficacy of ciprofloxacin (250 mg twice daily for ten days) with that of trimethoprimsulfamethoxazole (160 mg trimethoprim/80 mg sulfamethoxazole twice daily for ten days) in treating urinary tract infections in ambulatory adult patients. A urinary tract infection was defined as a positive urine culture with 104 or more colony-forming units per milliliter. A complicated urinary tract infection was defined by structural or functional abnormalities in the urinary tract, pyelonephritis, or prostatitis in addition to a positive culture. Two hundred three patients 18 to 75 years old were randomized to receive ciprofloxacin (98 women and five men) or trimethoprim-sulfamethoxazole(92 women and eight men). Patients were reassessed on day 3 or 4 during therapy and five to nine days and four weeks after completion. One hundred forty-eight of the 203 had culture-proven urinary tract infections. Relapsewas defined as recurrence of 104 organisms with the same susceptibility pattern within four weeks after completion. Reinfection was defined as 104 organisms per milliliter of a different micro-organism within four weeks after completion. Failure was defined as persistence or relapse, continued signs of infection that required a change in treatment, or inability te complete at least five days of treatment as a result of side effects. Treatment was successful in 69 of 76 ciprofloxacin patients (91%) and 62 of 68 trimethoprimsulfamethoxazole patients (92%). Rates of reinfection were similar in the two groups. Of 15 patients with complicated urinary tract infections, two failures occurred in the ciprofloxacin group because of persistent symptoms despite negative cultures. Adverse reactions, including gastrointestinal upset, headache, rash, and vaginitis, occurred in 32% of the trimetheprim-sulfamethexazole group compared with 17% of the ciprofloxacin group. The authors concluded that the two treatments are equally effective but that treatment with ciprofioxacin is associated with fewer adverse reactions
although it is more expensive than trimethoprim-sulfamethoxazole. Charles Peterson,MD sedation, pediatric; midazolam; ketamine; atropine
Effectiveness of preoperative sedation with rectal midazolam, ketamine, or their combination in young children Beebe DS, BelaniKG, ChangPN, et al Anesth Analg 75.880-884 Dec 1992 This randomized, single-blinded study was conducted to determine which of three types of rectal sedation was most effective before surgery in facilitating parental separation and IV cannulation in young children. One hundred children 3.0 + 1.7 years old were randomly assigned to four equal groups. Group 1 received rectal midazolam (0.5 mg/kg), ketamine (3 mg/kg), and atropine (0.02 mg/kg). Group 2 received midazolam and atropine at the same doses, group 3 received ketamine and atropine, and group 4 received atropine alone. The medications were administered rectally via a 2.0-ram pediatric feeding tube passed 8 to 10 cm beyond the anus. The children were separated from their parents after 15 minutes, and IV cannulation was attempted by an anesthesiologist. 0nly two IV attempts were allowed. Induction was accomplished with nitrous/halothane induction when access was unavailable. A child psychologist used a four-tier scale to grade the level of sedation before, during, and after the medication was administered as well as during separation from the parents. The psychologist also graded the child's response to IV placement, and the overall cannulation procedure was judged as satisfactory or unsatisfactory by the anesthesiologist. Most
8 71/ 14 7