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Unequal pupil size in patients with unilateral red eye
ABSTRACTS
rate and may not apply to other infusion rates); and the method also may be useful in determining when patients should be treated with deferoxamine as those patients with Fe:Cr ratios greater than 12.5 during initial infusions may warrant therapy. /Ed-
itor's vote: Although promising, the small number of patients, the methodology, and the end point selected in this study have not been correlated to clinical outcome. Hopefully, this technique will be validated and correlated to outcome. This approach cannot be recommended currently for clirTical use.] Stephen L Johnson, MD
eye disease
Unequal pupil size in patients with unilateral red eye Rose GE, Pearson RV Br Med J 302:571-572 Mar 1991
Difficulty in identifying patients with unilateral red eye who require ophthalmic supervision is a common clinical problem. Miosis is often noted in conditions causing a red eye. The authors measured the incidence of affected eye anisocoria (/> 0.5 ram) in 317 consecutive emergency department patients with a complaint of unilateral red eye to determine its clinical implications. Nearly 40% of patients with serious disease, ie, corneal abrasions, marginal keratitis, herpes simplex keratitis, and acute anterior uveitis, had relative miosis of the affected eye. Only 7% of patients with mild disease, ie, subconjunctival hemorrhage, conjunctivitis, episcleritis, and corneal foreign body, had relative miosis in the affected eye. Assuming that adults with physiological anisocoria would be evenly distributed between the groups (serious vs mild), the authors conclude that relative miosis in the red eye indicates a nine times greater likelihood of serious eye disease. They caution that, although less common, unilateral mydriasis also can indicate serious disease.
Paul J Sovei1, MD 162/1164
histamine; food poisoning
Evidence that histamine is the causative toxin of scombroid fish poisoning Morrow JD, Margolies GR, Rowland J, et al N Engl J Med 324:716-720 Mar 1991
Ingestion of spoiled scombroid fish such as tuna and mackerel is the most common cause of poisoning by fish. The authors investigated a local outbreak to test the hypothesis that h i s t a m i n e is the causative agent. Three persons developed symptoms of scrombotoxism (headache, nausea, facial flushing, and diarrhea) within 30 minutes of eating marlin. Two of the three were treated with diphenhydramine, with rapid improvement of s y m p t o m s . The third v i c t i m ' s symptoms resolved over three hours without treatment. Urine samples were collected to d e t e r m i n e the levels of histamine and the histamine m e t a b o l i t e N - m e t h y l h i s t a mine. As a control, three persons ate fresh marlin and provided urine samples. Urinary excretion of histamine and N-methylhistamine were markedly elevated in the affected persons as compared with the controls (nine to 20 times the normal mean). The implicated marlin contained histamine levels of 2,495, 1,456, 842, and 2,503 i~mol histamine/100 g fish; levels in the fresh marlin were undetectable. It was concluded that histamine is the causative agent of scrombotoxism, and patients should be treated with a combination of H] and H 2 receptor antagonists.
Cindy Madden, MD
sexually transmitted disease
Urinary l e u k o c y t e e s t e r a s e screening for a s y m p t o m a t i c sexually t r a n s m i t t e d disease in a d o l e s c e n t males Werner M J, Biro FM J Adolesc Health Care 12:326-328 1991, Number 4
U r i n e l e u k o c y t e e s t e r a s e (LE) screening on "first-catch" urine specAnnals
of EmergencyMedicine
linens has been demonstrated as useful in the diagnosis of urethritis by previous studies. Noting that approximately 12% of asymptomatic adolescent males are culture positive for Chlamydia trachomatis, the authors i n v e s t i g a t e d the effectiveness of urine LE screening on random specimens. Random specimens from 106 consecutive adolescent males entering a residential vocational training program were obtained. All subjects reported being sexually active, but all denied symptoms of urethritis. LE screening was performed within ten minutes of collection; subsequent chlamydial and gonococcal cultures were obtained during the following five days. Sixteen subjects (15%)had trace or positive LE activity; nine were culture positive for chlamydia, gonorrhea, or both. Comparison of results revealed a sensitivity of 78%, a specificity of 91%, and a positive predictive value of 44%. Cost of culturing all 106 subjects was $6,360, or $707 per case identified. Had only LE-positive subjects been cultured, 78% would have been identified at a cost of $140 per case. The authors maintain that these results compare favorably w i t h c u r r e n t screening methods when used on high-risk, high-prevalence, asymptomatic males.
Paul Sovell, MD
epinephrine
The effect of standard- and high.dose epinephrine on coronary perfusion pressure during prolonged cardiopulmonary resuscitation Paradis N, Martin G, Rosenberg J, et al JAMA 265:1139-1143 Mar 6, 1991
Coronary perfusion pressure correlates highly with myocardial blood flow and has been shown to be a predictor of outcome during cardiac arrest. A prospective study of the effect of epinephrine on coronary perfusion pressure was conducted in 32 patients with cardiac arrest refractory to standard epinephrine dose and ad20:10 October 1991
rate and may not apply to other infusion rates); and the method also may be useful in determining when patients should be treated with deferoxamine as those patients with Fe:Cr ratios greater than 12.5 during initial infusions may warrant therapy. /Ed-
itor's vote: Although promising, the small number of patients, the methodology, and the end point selected in this study have not been correlated to clinical outcome. Hopefully, this technique will be validated and correlated to outcome. This approach cannot be recommended currently for clirTical use.] Stephen L Johnson, MD
eye disease
Unequal pupil size in patients with unilateral red eye Rose GE, Pearson RV Br Med J 302:571-572 Mar 1991
Difficulty in identifying patients with unilateral red eye who require ophthalmic supervision is a common clinical problem. Miosis is often noted in conditions causing a red eye. The authors measured the incidence of affected eye anisocoria (/> 0.5 ram) in 317 consecutive emergency department patients with a complaint of unilateral red eye to determine its clinical implications. Nearly 40% of patients with serious disease, ie, corneal abrasions, marginal keratitis, herpes simplex keratitis, and acute anterior uveitis, had relative miosis of the affected eye. Only 7% of patients with mild disease, ie, subconjunctival hemorrhage, conjunctivitis, episcleritis, and corneal foreign body, had relative miosis in the affected eye. Assuming that adults with physiological anisocoria would be evenly distributed between the groups (serious vs mild), the authors conclude that relative miosis in the red eye indicates a nine times greater likelihood of serious eye disease. They caution that, although less common, unilateral mydriasis also can indicate serious disease.
Paul J Sovei1, MD 162/1164
histamine; food poisoning
Evidence that histamine is the causative toxin of scombroid fish poisoning Morrow JD, Margolies GR, Rowland J, et al N Engl J Med 324:716-720 Mar 1991
Ingestion of spoiled scombroid fish such as tuna and mackerel is the most common cause of poisoning by fish. The authors investigated a local outbreak to test the hypothesis that h i s t a m i n e is the causative agent. Three persons developed symptoms of scrombotoxism (headache, nausea, facial flushing, and diarrhea) within 30 minutes of eating marlin. Two of the three were treated with diphenhydramine, with rapid improvement of s y m p t o m s . The third v i c t i m ' s symptoms resolved over three hours without treatment. Urine samples were collected to d e t e r m i n e the levels of histamine and the histamine m e t a b o l i t e N - m e t h y l h i s t a mine. As a control, three persons ate fresh marlin and provided urine samples. Urinary excretion of histamine and N-methylhistamine were markedly elevated in the affected persons as compared with the controls (nine to 20 times the normal mean). The implicated marlin contained histamine levels of 2,495, 1,456, 842, and 2,503 i~mol histamine/100 g fish; levels in the fresh marlin were undetectable. It was concluded that histamine is the causative agent of scrombotoxism, and patients should be treated with a combination of H] and H 2 receptor antagonists.
Cindy Madden, MD
sexually transmitted disease
Urinary l e u k o c y t e e s t e r a s e screening for a s y m p t o m a t i c sexually t r a n s m i t t e d disease in a d o l e s c e n t males Werner M J, Biro FM J Adolesc Health Care 12:326-328 1991, Number 4
U r i n e l e u k o c y t e e s t e r a s e (LE) screening on "first-catch" urine specAnnals
of EmergencyMedicine
linens has been demonstrated as useful in the diagnosis of urethritis by previous studies. Noting that approximately 12% of asymptomatic adolescent males are culture positive for Chlamydia trachomatis, the authors i n v e s t i g a t e d the effectiveness of urine LE screening on random specimens. Random specimens from 106 consecutive adolescent males entering a residential vocational training program were obtained. All subjects reported being sexually active, but all denied symptoms of urethritis. LE screening was performed within ten minutes of collection; subsequent chlamydial and gonococcal cultures were obtained during the following five days. Sixteen subjects (15%)had trace or positive LE activity; nine were culture positive for chlamydia, gonorrhea, or both. Comparison of results revealed a sensitivity of 78%, a specificity of 91%, and a positive predictive value of 44%. Cost of culturing all 106 subjects was $6,360, or $707 per case identified. Had only LE-positive subjects been cultured, 78% would have been identified at a cost of $140 per case. The authors maintain that these results compare favorably w i t h c u r r e n t screening methods when used on high-risk, high-prevalence, asymptomatic males.
Paul Sovell, MD
epinephrine
The effect of standard- and high.dose epinephrine on coronary perfusion pressure during prolonged cardiopulmonary resuscitation Paradis N, Martin G, Rosenberg J, et al JAMA 265:1139-1143 Mar 6, 1991
Coronary perfusion pressure correlates highly with myocardial blood flow and has been shown to be a predictor of outcome during cardiac arrest. A prospective study of the effect of epinephrine on coronary perfusion pressure was conducted in 32 patients with cardiac arrest refractory to standard epinephrine dose and ad20:10 October 1991