Needle aspiration in the diagnosis of soft tissue infec- tions. Uman SJ, Kunin CM: Arch Intern Med, 135:959- 981, (July) 1975. A method for direct needle aspirat ion of soft t issue lesions to diag- nose infection is reported. The aspirate is cultured and gram stained. In seven pat ients therapy could be ins t i tu ted before the le- sions became f luctuant enough for incision and drainage. In at least one case, the early diagnosis was probably life-saving. It re- duced the morbidi ty in four other cases. Ini t ial clinical impression of the bacteriologic etiology of the lesion often turned out to differ with the cul ture results. Early aspirat ion of soft t issue infections js of special value in pat ients with underlying diseases where ear- ly diagnosis is vi tal to therapy. Richard Ostendorf. MD

infectious emergencies, differential diagnosis, soft tis- sue lesions

spinal epidural abscess. Baker AS, Ojemann R, Swartz MN, et al: N Eng J Med, 293:463-468, (Sept) 1975. Spinal epidural abscess is a serious infection in acute or chronic fdrms. Acute infection can occur at any spinal level and progres- sively causes spinal ache, nerve root pain, weakness and paralysis over a period of several days. Fever and leukocytosis are present and spinal fluid findings are consistent with a parameningea l in- fection (moderate white blood cells, h igh protein, normal glucose). With t r ea tmen t by surgical drainage of the abscess and antibiotics, results are impressive. Chronic infection causes the same symp- toms over weeks or months, and evidence of sepsis is absent. The treatment is antibiotics intravenously. Donald Blythe, MD

infectious emergencies; nervous system emergencies; abscess, spinal epidural

Periodic paralysis caused by abuse of thyroid hor- mone. Layzer RB, Goldfield E: Neurology 24:949-952, (Oct) 1974. Three pat ients tak ing thyroid medication for purposes of weight reduction experienced episodes of periodic paralysis. This was manifested by weakness of the proximal l imb muscles, main ly lower extremity, brought on usually after heavy meals or dur ing sleep. Two pat ients were tak ing large doses equivalent to 10 to 30 grains thyroid extract daily. The th i rd patient , of Japanese an- cestry, took only 2 to 4 grains thyroid extract equivalent daily and exhibited no signs or symptoms of thyrotoxicosis. The syndrome of thyrotoxic periodic paralysis is most common in Oriental males and, as in the three pat ients studied, disappears after t r ea tmen t of the thyrotoxic state or removal of exogenous thyroid hormone.

Richard Feldman, MD hormonal - metabolic emergencies; periodic paralysis; thyroid extract

A comparison of CIIndamycin and Penicillin V In the treatment of oral Infections. Schuen JN, Panzer JD, At- kinson WH: J Oral Surgery 32:503-505, (July) 1974. Sixty-eight pat ients with acute oral infections, 48 of whom had radiographic diagnosis of dentoalveolar abscess, were t rea ted with e i ther Clindamycin, 150 mg qid or Penicil l in V, 250 mg qid. No significant difference in recovery was noted, as judged by ab- sence of swelling, induration, drainage, f luctuation and pain four and eight days after t r e a tmen t was insti tuted. The authors con- clude t ha t Clindamycin can be considered as a suitable al terna- t ive to penicillin in the t r ea tmen t of acute oral infection. (Editor's note: While there is no argument on the effectiveness of Clinda- mycin, the risk of Clindamycin-induced colitus after oral ingestion is real. The drug should be reserved for anaerobic infections and penicillin allergy when no satisfactory alternative is available.)

Richard Feldman, MD

infectious emergencies; oral infections; Clindamycin; penicillin

Tolazamide hepatotoxicity-- a case report. Van Thiel DH, De Bene R, Mellow M, et ah Gastroenterology 67:506- 510, (Sept) 1974.

A case report of a pa t ient manifest ing symptoms of hepatotoxicity while taking tolazamide is presented. While there have been pre- vious reports of hepatotoxicity due to other sulfonylureal drugs, eg, chlorpropamide and tolhutamide, this may represent the first re- port of hepatotexicity secondary to telazamide. The mechanism probably is tha t of hypersensi t ivi ty reaction showing a histopath- ology of cholestasis with a nonspecific hepati t is .

James Greene, MD emergencies, chemical intoxications, poisons, tolaza- mide

Acute diarrhea in a residential institution for the retaru ed. Pierce JE, et al:Am Dis Child 128:772-775, (Dec) 1974. A study was under taken in 77 inst i tut ional ized children with d iar rhea to determine the usefulness of fecal leukocyte examina- tion. The stools of all children were examined for white blood cells using a methylene blue wet mount preparat ion prior to t rea tment . Only two of 22 children (9%) wi th parasit ic infection and three of 38 (8%) with non-specific d iar rhea had fecal leukocytes. All five pat ients with shigellosis had numerous leukocytes when the i r stools were examined before ant imicrobial therapy. After therapy was ins t i tu ted only 5 of 12 children (42%) with culture proven shi- gellosis had leukocytes. A methylene blue wet mount prepara- t ion is a quick, inexpensive, rapid screening test in a pat ient wi th acute d~arrhea not on ant imicrobial therapy_ Practically speak- ing, the presence of fecal leukocytes would indicate shigellosis, sal- monellosiS or enteric infection, in which case bacteriologic cultur- ing might be rewarding. Vincent Markovchick. MD

infectious emergencies, diarrhea

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