ABSTRACTS

tempted once. Conventional tube thoracostomy was used when the second aspiration was unsuccessful. The etiology of pneumothorax was blunt t rauma in 3 patients, stab wound in 4, and IV drug abuse through the subclavian vein in 10 patients. Simple aspiration was successful in 14 (82%) of patients on the first attempt and in 2 patients on the second attempt, an overall success rate of 94%. Only one patient required chest tube due to failure of the second at- tempt. There was no other morbidity in the study group. A control group of 17 patients, matched for extent of pneumo- thorax and lack of complicating factors, who were treated with tube thoracostomy was identified retrospectively. Two control patients (11%)had comphcations (chest wall cel- lulitis, persistent air leak). The control group required an average of 5 days hospitalization with a cost 10 times great- er than that of the study group. The authors concluded that simple aspiration is a reasonable alternative to tube thora- costomy when strict criteria for selection of patients are ap- plied. [Editor's note: IV drug abusers may represent a spe- cial group in whom the small puncture that caused the pneumothorax would readi'ly seal. In most cases of trau- matic pneumothorax, however, an immediate tube thora- costomy is indicated.)

A Adam Cwinn, MD

optic nerve, function

Optic nerve dysfunction during gravity inversion Friberg TR, Sanborn G Arch Ophthalmol 103:1687-1689 Nov 1985

Sixteen healthy people serving as their own controls had intraocular pressures (IOPs) and pattern reversal visual evoked potentials (PRVEPs) recorded in both sitting and in- verted positions. Ten of the 16 subjects also had PRVEPs measured after artificial elevation of IOP by suction cup. For all values measured, there was a significant reduction of PRVEP amplitude in gravity inversion versus suction cup IOP elevation as well as significant reduction in amplitude for all measurements with elevated IOPs as compared to controls. Because the PRVEP is a sensitive indicator of optic

nerve disease, the authors used additional unpublished data to conclude that gravity inversion, as popularized by many physical fitness proponents, may lead to visual field loss and optic nerve damage.

Michael Hunt, MD

neuroleptic malignant syndrome

Neurolept ic mal ignant syndrome Guze BH, Baxter LR N Engl J Med Jul 1985

Neuroleptic drugs, antipsychotic agents, and "major" tranquilizers are among the mos t frequently prescribed medications today. Although they have many well-known side effects, the neuroleptic malignant syndrome is not widely recognized. The incidence of neuroleptic malignant syndrome is estimated to be 0.5% to 1% of all patients ex- posed to neuroleptics. Predisposing factors include physical exhaustion, dehydration, concurrent organic brain syn- drome, and use of the long-acting depot neuroleptics. This syndrome typically develops over 24 to 72 hours, and has been reported to last 5 to 10 days, even after oral neurolep- tics are discontinued. The syndrome is characterized by hy o pertherrnia, hypertonicity of skeletal muscles, fluctuating consciousness, and instability of the autonomic nervous system as evidenced by pallor, diaphoresis, blood-pressure instability, tachycardia, and cardiac dysrhythmias. The dif- ferential diagnosis includes phenothiazine-related heat stroke, malignant hyperthermia associated with anesthesia, idiopathic acute lethal catatonia, drug interactions with monamine -ox idase inhibi tors , and the centra l anti- cholinergic syndrome. The mortality from neuroleptic ma- lignant syndrome is estimated to be 20% to 30%, with death commonly resuking from respiratory failure, cardio- vascular collapse, renal failure, arrhythmias, or thromboem- bolism. Treatment includes discontinuing neuroleptics and using general supportive measures. Dantrolene, amantidine, and bromocriptine have been reported to be successful in treating the syndrome, but there have been no controlled studies.

James E Gruber, MD

212/380 Annals of Emergency Medicine 15:3 March 1986