Abstracts in this issue were prepared by residents in the University of Arizona Emergency Medicine Residency Program

ABSTRACTS Harvey W. Meislin, MD, FACEP Co-Editor Chief, Section of Emergency Medicine University of Arizona College of Medicine

Vincent J. Markovchick, MD, FACEP Co-Editor Emergency Medical Services Denver General Hospital

ACUTE OTITIS MEDIA

The use of an ant ihistamine-decongestant in conjunction with an anti- infective drug in the t reatment of acute otitis media Moran DM, Mutchie KD, Higbee MD, et al J Pediatr 101:132-136 Jul 1982

The authors introduce this article by stating that con- trolled clinical studies have demonstrated the efficacy of anti-infective drugs in the treatment of acute otitis media. They also note that adjunctive therapy has included the use of sympathomimetic and antihistaminic agents on the pre- sumption that these drugs will improve eustachian tube patency and promote resolution of the underlying patholo- gy. The value of these adjunctive agents, however, has not been clearly demonstrated. The authorS investigated the effectiveness of an antihistamine-decongestant treatment of acute otitis media with effusion when used in conjunction with the broad-spectrum antibiotic amoxicillin. Sixty-seven patients, ages seven months to 15 years, were involved in the study. Otitis media was diagnosed when the tympanic membrane was erythematous and immobile to pneumotos- copy. Tympanometry was performed to obtain objective data in support of the diagnosis of middle ear effusion. The patients were divided into two treatment groups. Group 1 received amoxicillin elixir orally at a dose of 50 mg/kg/day up to a maximum of 750 rag/day in three divided doses, and Naldecon elixir orally at a dose proportioned to deliver approximately 1 mg/kg/day phenylephrine, 3 mg/kg/day phenylpropanolamine, 0.35 mg/kg/day chlorpheniramine, and 1 mg/kg/day phenyltoloxamine in four divided doses. Group 2 received amoxicillin elixir orally at a dose of 50 mg/kg/day up to a maximum of 750 mg/kg in three divided doses and a placebo elixir. The duration of therapy with both drugs was 14 days. There was no significant difference between the study and placebo groups with respect to the mean duration of earache or cough. There was, however, a significant difference between the groups in the duration of nasal congestion, with a mean of six days in the treated group and nine days in the placebo group. Also, on day 14 of the investigation 28% of the Naldecon group met criteria for effusion, in contrast to 54% of the placebo group. The authors conclude that the use of Naldecon, in conjunction with an appropriate antibiotic, is an efficacious regimen for treating nasal congestion which frequently accompanies acute 0titis media with effusion. The incidence of persistent middle ear effusion is less in patients given an antihista- mine-decongestant when compared to placebo. [Editor's note: The literature is clear that antihistamines or decon-

gestants do not change the time course to resolve otitis media. However, whether resolution of effusion and associ- ated symptoms is hastened with these medications is not certain. Many studies refute the above findings, while others support it.]

William B. White, MD

FRACTURE, CARPAL SCAPHOID; FAT PADS; FAT STRIPES; FAT LINES

The navicular fat stripe (NFS) - - Signif icance in the diagnosis of navicular fractures Lorenz R, Fielder V Fortschr Geb Roentgenstr Nuklearmed Erganzungsband 137:286-290 Sep 1982

Presented are illustrations of normal and pathological appearances of the navicular fat stripe. Changes after trauma are not specific, but should strongly increase suspi- cion of occult navicular fracture. In 93 acute navicular frac- tures the stripe was partially or completely obliterated in 53, displaced in 27, and widened or blurred in 13. In com- parison, in a group of 300 normal patients, 22 had complete or partial obliteration and the remainder were unremark- able./Editor's note: Although in German, this article is in- telligible through cursory glance at the line drawings. The illustrations of the radiographs are, however, subtle, and will not reproduce well on xerography. Send for reprint to Dr. Ren~ Lorenz, Radiological Institute of the University, Joseph-Stelzmann-Strasse 9, D-5000 KOLN 41, West Ger- many.]

Douglas Lindsey, MD, DrPH

GLUTEAL INJURY, PENETRATING

Penetrating gluteal injuries Ivatury R, Rao P, Nallathambi M, et at J Trauma 22.'706-709 Aug 1982

Despite the sinister potential of penetrating gluteal wounds, these injuries rarely receive attention in the medi- cal literature. This article is a review of the authors' pro- tocol for, and experience with, penetrating gluteal injuries. Forty-five gunshot wounds and 15 stab wounds were in-

122/272 Annals of Emergency Medicine 12:4 April 1983