ABSTRACTS

urethritis (urethral smear with greater than 10 leukocytes per high-power field). The authors conclude that cefotaxime appears to be a useful drug in proven PPNG infections. [Editor's note: Claforan could thus serve as an alternative to spectinomycin for patients who probably acquired their infection in a PPNG-prevalent region or who have PPNG- proven infections.]

Kurt Zangerle, MD

BLUNT TRAUMA, MYOCARDIAL CONTUSION

M y o c a r d i a l c o n t u s i o n fo l low ing nonfa ta l b lunt c h e s t t r a u m a Kumar SA, Puri VK, Mittal VK, et al J Trauma 23:327-331 Apr 1983

The authors prospectively studied 30 victims of serious blunt chest trauma admitted for observation during a one- year period. Twenty-four of the patients were men and six were women. The ages ranged from 19 to 84 years. All had serial ECGs, total CPK and CPK-MB every eight hours for 24 hours, and myocardial scanning wi th t echne t ium pyrophosphate on day 2 or day 3 of their hospitalization.

Myocardial contusion was diagnosed ff any two of the three results were abnormal. Eight of the 30 patients met these criteria. Of these patients, two had rib fractures, one had a sternal fracture, and one had a hemopneumothorax. Seven of the eight patients had positive myocardial scans. CPK- MB fractions were increased in four patients, ranging from 4.9% to 22.6%. Two patients had normal ECGs, six had ab- normal ECGs ranging from persistent sinus tachycardia to specific injury patterns, but only two patients had EGG changes considered definitive for contusion (ie, evidence of acute injury). None of the patients diagnosed as having a myocardial contusion had complications during hospital stay, Of the 22 patients who failed to meet the contusion criteria, none had positive scans or elevated CPK-MB frac- tions, while nine had various EGG abnormalities. The au- thors acknowledge that while no single test is definitive, technetium pyrophosphate scanning may be the most spe- cific test for diagnosing myocardial contusion. [Editor's note: The basic problem with most studies of cardiac con- tusion is that short of autopsy, there is no "gold standard" for diagnosing its occurrence. This study suffers from the same shortcoming. The authors are not justified in using myocardial scans as a criterion for the diagnosis, and then using their results to conclude that scanning was the best test for diagnosing contusion. A reliable criterion correlated with autopsy findings remains to be found.]

Bill White, MD

126/299 Annals of Emergency Medicine 13:4 April 1984