Abstracts Peter Rosen, MD - - editor Professor of Emergency Medicine and Director of the Division of Emergency Medicine, University of Chicago Hospitals and Clinics

Beverly Fauman, MD - - a s s i s t a n t e d i t o r

Assistant Professor of Emergency Medicine and Psychiatry, University of Chicago Hospitals and Clinics

Recognition of streptococcal pharyngitis in adults, Walsh BT, Bookheim WW, Johnson RC, etal, Arch Intern Med 135:1493-1497, (Nov) 1975. Based on their study of 418 patients with sore throats, the authors developed a clinical algorithm and computed discriminant func- tion scores to identify people and level of risk. Patients with posi- tive throat cultures for group AJ-hemolyt ic streptococci had a higher frequency of recent exposure to streptococci infection, pharyngeal exudate, enlarged or tender cervical nodes, and temp- erature greater than 101 F (38.3 C) than people with negative cultures. The patient with negative cultures tended to complain more often of cough or rhinorrhea. The high and moderate risk groups defined by the algorithm included 91% of patients with positive throat cultures but only 67% of the total pat ient popula- tion. The authors, while cautioning that the study is based on suburban, working class, white patients, felt that extension of their algorithm to other pat ient groups may reduce the cost in- volved in diagnosing and treat ing sore throats. (Editor's note: In our and other high volume emergency departments it becomes logis- tically impossible to culture all patients. Instead, we recommend treating any strop throat was 2.4 million units of bicillin C-R.)

Richard Ostendorf, MD

infection, streptococcal pharyngitis

A practical approach to the diagnosis of abdominal aor- tic aneurysms, Lee KR, etal, Surgery 78:195-201, (Aug) 1975. The use of ultrasonography in the evaluation of patients with suspected abdominal aortic aneurysms was assessed. Review- ing a series of 217 patients with proven aneurysms, the authors found that the aneurysms were suspected by plain abdominal roentgenography in 70% of cases and physical examination in 81%. Aortography had a diagnostic accuracy of 86% with false negatives occurring. In a second smaller series evaluated pro- spectively, ultrasonography had a diagnostic accuracy of over 97% with one false positive. The authors oppose the routine use of aortography preoperatively to evaluate the renal and iliac artery since a) aortography as an invasive procedure has a definite mor- bidity; b ) t h e renal ar tery is infrequent ly involved by the aneurysmal process (3.7% in their larger series); c) surgical results are consistently good in patients with renal and/or iliac artery involvement where no preoperative aortogram is done, and d) an isotope renogram combined with photo scan of the kidney is an acceptable way to assess renal status preoperatively. In conclu- sion, the authors strongly favor the use of ultrasonography as a rapid and safe means of detecting, evaluating and following (where needed) abdominal aortic aneurysms_ (Editor's note: Ul- trasound may someday be a readily available tool for the emergency department.) Gerald Schwartz, MD

cardiovasology; ultrasound, aneurysms, abdominal aor- tic; aortography

High altitude pulmonary edema: A rare disease. Kleiner JP, Nelson WP, JAMA 234:491-495, (Nov) 1975. High altitude pulmonary edema in the United States may not be

as rare as the lack of previous reports may indicate because the diagnosis is neither made nor suspected in many cases. It is seen most frequently in young males under age 21 who work at al. t i tudes above 9,000 feet. Its early symptoms may mimic acute mountain sickness or an upper respiratory infection, and late symptoms may be confused with bmnchopneumonia. High flow oxygen and bedrest are the mainstays of therapy. Morphine and Lasix may be helpful. Aminophylline, digitalis and steroids are of no value. (Editor's note: High altitude pulmonary edema is another form of adult respiratory insufficiency syndrome. It re. spends best to oxygen therapy, and patient withdrawal from al- titude.) Vincent Markovchick, MD pulmonary edema, high altitude; respiratory emergen. cies

The organisation of an accident service. Sarkin TL, S Afr Med J 48:1954, 1974. After outlining three possible methods for handling trauma pa- tients, the author concludes that the method employed at the Groote Schuur Hospital in Cape Town offers the best solution. The establishment of an Accident Service that handles trauma patients solely, and is entirely separate from other patients who visit the emergency department, has been the ideal solution for the hospital. Any t rea tment needed is given i n this unit, which has its own x-ray department, intensive care unit, and operating suite, and is capable of handl ing cases in all disciplines of medicine. A major benefit of this type of service has been the ability to assess closely the results of management of certain cases. The possibility of pooling sophisticated equipment in this service uni t has benefi ted the pa t i en t wi th major trauma. (Editor's note: This would seem to be the k ind of fragmented, expensive, duplication of equipment and personnel that could best be obviated by a good emergency department, supported by an inpatient trauma service.) John van de Leuv, MD, CM

emergency department, organization

Monistat: A new fungicide for treatment of vulvovagi- nal candidiasis. Culbertson C, Am J Obstet Gynecot 120:973-976, (Dec) 1974, The author reports a controlled study comparing Monistat Cream with nystat in in the t r ea tmen t of vulvovaginal can- didiasis. Both groups had pregnant and nonpregnant members. A primary cure rate of 82.2% with one course of Monistat con- trasts with a 64.7% primary cure rate with nystatin. The preg- nant patients in the Menistat group had a higher Cure rate than the pregnant patients in the nystat in group. The retreat': ment success rate was also higher in the Monistat group. The author concludes that Monistat is more effective than nys ta t in for vulvovaginal candidiasis in both pregnant and nonpregna~t patients. Richard Ostendorf, MD

obstetrics~gynecology; candidiasis, vulvovaginal, Moni" s ta t . . , nystatin

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