ABSTRACTS

0.1% of the IJ vein cannulations were extrathoracic in posi- tion. The only complication was carotid artery puncture, occurring in 8% of the IJ attempts. No sequelae other than a small clinically insignificant hematoma were observed. The authors conclude that the higher success rate, reliabili- ty of placement, and lack of significant complications asso- ciated with IJ catheter insertion favor the use of this approach over that using the EJ vein,

Kurt Duffens, MD

dysmenorrhea and premenstrual tension were no different in the two groups, as was the case for appendectomy and cholecystectomy rates. Furthermore heartburn, a symptom commonly reported in IBS, also was not significantly differ- ent from the control. The authors conclude that IBS may be a more diffuse disorder of smooth muscle than currently recognized and may involve other organs such as the blad- der.

Alan Chou, MD

emergency thoracotomy, trauma ultrasound, scrotum

Emergency thoracotomy in an urban community hosPital: Initial cardiac rhythm as a new predictor of survival Brautigan MW, Tietz G Am J Emerg Med 3:311-315 Jul 1985

High resolution scrotal ultrasonograph: A highly sensitive but nonspecific diagnostic technique Fournier GR Jr, Laing FC, Jeffrey RB, et al J Urol 134:490-493 Sep 1985

This was a retrospective review of 47 emergency thora- cotomies performed during a two-year period in a commu- nity hospital. Thirty-one were for gunshot wounds, eight for stab wounds, and eight for blunt trauma. There were 13 sttr- vivors (28%), eight (17%) of whom were neurologically in- tact. There were no survivors in the patients with blunt t rauma and in those who presented with bradysystolic rhythms or asystole. All 13 survivors came from the group of 25 patients with a sinus rhythm on arrival in the emer- gency department. It was concluded that presenting cardiac rhythm is an important prognostic factor in patients under- going emergency thoracotomy.

Michael Catapano, MD

irritable bowel syndrome, nongastrointestinal symptoms

Non-colonic features of irritable bowel syndrome Whorwell P J, McCallum M, Creed FH, et al Gut 27:37-40 Jan 1986

One hundred patients with irritable bowel syndrome (IBS) were compared to a control group of 100 patients matched for age, sex, and social class. The frequency of nongastroin- testinal symptoms was compared in both groups by inter- viewed questionnaire. The study group consisted of 90 women and ten men (ages 18 to 64). All had abdominal pain, abdominal distention, and abnormal bowel habit asso- ciated with normal hematologN, serum biochemistrg, rectal histology, and colonoscopy or barium enema. Symptoms of dysphagia, nausea, early satiety, back pain, unpleasant taste in the mouth, a constant feeling of tiredness, frequency and urgency of micturation, and dyspareunia were significantly more common in the study group. However, symptoms of

Fifty patients undergoing surgical exploration for testic- ular trauma, tumors, or benign atraumatic conditions were examined prospectively prior to surgery by scrotal ultra- sound. Surgical and ultrasound findings were compared to test the predictive value of ultrasound for pathologic condi- tions of the testis. With testicular trauma, ultrasound cor- rectly predicted a normal or abnormal testis in 17 of 18 pa- tients (94%). One false positive occurred when a scrotal hematoma was mistaken for a ruptured testis. Of 11 pa- tients wi th tumors, ultrasound correctly demonstrated 100% to be parenchymal. Malignant and benign lesions were not distinguishable by ultrasound. In 21 patients with benign atraumatic conditions a normal echo pattern of tes- ticular parenchyma correlated with a normal testis at sur- gery. Ultrasonic imaging could not predict the presence or absence of torsion with uniform reliability.

Sarah K Scott, MD

Digoxin specific antibody (Fab) fragments in 34 cases of severe digitalis intoxication Smocarz A, Roesch E, Lenz E, et al Clin Toxicol 23:327-340 1985

Thirty-four patients with severe digitalis poisoning treat- ed with highly specific digoxin antibody (Fab) fragments were analyzed retrospectively. Patient ages ranged from 2 to 80 (mean, 44 years). Ingested doses of digoxin or its deriva- tives ranged from 3 to 40 mg and serum digoxin levels var- ied between 3.4 and 29 ng/mL (mean, 12.2 ng/mL). Indica- tions for administration included high-grade A-V block, multifocal ectopic beats, ventricular tachycardia, and recur- rent ventricular fibrillation. Treatment was initiated an average of 11.5 hours (range, 2.5 to 24 hours) after ingestion.

194/1129 Annals of Emergency Medicine 15:9 September 1986

Eighty milligrams of Fab binds l mg of glycoside in the body. Only about 80% of ingested glycoside will be ab- sorbed. The total Fab dose was calculated based on 80% of the estimated amount ingested and this was infused in saline during a 30-minute period. Free serum digoxin fell soon after starting treatment with nearly complete Fab binding and digoxin neutralization occurring within 12 hours. Severe rhythm disturbances were stabilized an aver- age 3.2 hours after the first Fab dose, and 32 of 34 patients recovered completely. There were two deaths. One was at- tributed to septic shock and the other to heart failure sec- ondary to Valvular defects. There were no complications of therapy. It was concluded that this life-saving therapy can be administered simply and safely.

Michael Hunt, MD

elbow trauma, radial head-capitellum view

Assessment of the radial head-capi te l lum view and the dorsal fat-pad sign in acute e lbow t rauma Hall-Craggs MA, Shorvon PJ, Chapman M A JR 145:607-609 Sep 1985

A prospective study that assessed the efficacy of the radi- al head-capitellum (RHC) view in acute elbow trauma was performed. The RHC view demonstrated only 16 of 32 frac- tures, including one fracture that was not seen on routine projections. However, fat pads were displaced in all patients with fractures. It was concluded that routine use of the RHC view is not justified. If the fat pads are abnormal as seen on routine anteroposterior and lateral views and the

fracture is not demonstrated, it is reasonable to order the RHC view in an effort to visualize the fracture.

Eric Simrod, MD

ligament injury, metacarpophalangeal joint injury

Pat ient - induced stress test of the first metacarpopha langea l joint: A radiographic assessment of col lateral l igament injuries Downey EF Jr, Curtis DJ Radiology 158:679-683 Mar 1986

This is a prospective study of 52 patients who sustained injury to the first (thumb) metacarpophalangeal joint. After routine radiographs, each patient stressed the collateral liga- ments of both thumbs by using the index finger to apply both radial then ulnar deviation to the distal phalanx while a radiograph was obtained. In this manner, the amount of subluxation of the metacarpophalangeal joint can be mea- sured while the normal thumb serves as a control. Twenty of 52 patients showed no subluxation and were asympto- matic one year later. The remaining 32 patients had docu- mented subluxuation and were referred for orthopedic eval- uation. This procedure is simple, requires no extra equipment and minimal technician skill, and offers the ad- vantage of a normal control on the same film. [Editor's Note: This radiological technique should only be used as an adjunct to the clinical examination in which the nonin- jured thumb also can be used as a normal control. In some instances, the clinical examination will obviate the need for these stress films.]

Nicholas J Jouriles, MD

15:9 September 1986 Annals of Emergency Medicine 1130/195