ABSTRACTS

ventricular origin, however, there may be serious adverse re- sponses to verapamil and thus it should not be used when diagnosis is in doubt.

Dan Schlager, MD

occupation, coronary heart disease, death

Occupation and risk of death from coronary heart disease Buring JE, Evans DA, Fiore M, et al JAMA 258:791-792 Aug 1987

The association between the risk of death from coronary heart disease and occupation was evaluated with a retro- spective matched case-control study. Married white men be- tween 30 and 70 years old, residing in two Florida counties, whose deaths were attributed to coronary disease within 24 hours after onset of symptoms, were matched with an equal number of controls for age, sex, and neighborhood resi- dence. Information on medical history, life-style, and demo- graphic factors was obtained from the patients' wives. Oc- cupations were coded white collar or blue collar, according to Edward's US census grouping of occupations. Data were analyzed by paired, multiple logistic regression analysis. This resulted in 568 matched pairs of subjects, of which 330 pairs were concordant for occupation and 238 were discor- dant for occupation. These discordant pairs contributed to the crude relative risk of 0.80. However, when the known coronary risk factors were considered, three were signifi- cantly associated with occupational status: relative weight, Jewish religion, and level of leisure activity. The relative risk after adjustment for these factors was 0.70. Thus, there was a significant 30% decreased risk of fatal coronary heart disease among white-collar compared with blue-collar workers that could not be explained by known coronary risk factors.

Douglas Campbell, MD

urine culturing, infant

Urine culturing techniques in febrile infants Bonadio WA Pediatr Emerg Care 3:75-78 Jun 1987

This paper studied the incidence of urinary tract infec- tions in febrile infants less than 1 year old admitted with the diagnosis of "role out sepsis." The infants were evalu- ated using different culturing techniques to accurately diag- nose urinary tract infections (UTI). Urine was collected ac- cording to the following guidelines: infants and children not toilet trained underwent suprapubic aspiration or bladder catheterization; and toilet-trained children used a clean midstream catch. Two hundred sixty-five in/ants were eval-

uated, 146 boys, 119 girls. Sixty percent were less than two months old. The patients were placed into one of four groups based on the method of collection. There were 33 suprapubic aspirations, 66 bladder catheterizations, 92 bag collections, and 74 undocumented methods. Of these, there were 12 positive urine cultures diagnostic of a UTI. Su- prapubic aspirations with colony counts /> 103/mL, and bladder catheterization /> 104/mL were considered high probability for UTI. Ten of the 12 positive urine cultures were from female infants less than 2 months old. Of the 28 positive bag urine collections, 23 revealed mixture of more than two organisms. Overall, the incidence of UTIs was 5.53%. The majority of patients had urinalysis with less than 5 to 10 white blood cells/high power field, indicating that the absence of pyuria does not exclude UTI. Also, de- spite decreased oral intake, most infants with UTI had hy- posthenuria, suggesting that infants with a UTI may have a transient inability to concentrate their urine. Urine collec- tion by bag was found to be unreliable, often yielding multi- ple organisms and taking several hours to obtain. In this study, a clinical diagnosis of UTI was not obtained by bag collection because of contamination. The authors con- cluded that symptoms and physical findings for infants with UTI were nonspecific, and morbidity was quite signifi- cant. An accurate means for culturing urine is important.

Dan Schlager, MD

pulmonary edema, prehospital care

Comparison of nitroglycerin, morphine and furosemide in t rea tment of presumed prehospital pulmonary edema Hoffman JR, Reynolds S Chest 92:586-593 Oct 1987

This study compared the efficacy and consequences of various prehospital regimens for the treatment of pulmo- nary edema, particularly as at times these patients are treat- ed without knowledge of volume status or noncardiac pul- monary disease. Patients were entered into the study prospectively when telemetry communications indicated a chief complaint ,of shortness of breath presumed to be sec- ondary to pulmonary edema based on the presence of bilat- eral rales or peripheral edema. Patients with any chest pain, systolic blood pressure less than 120 m m Hg, or ventricular arrhythmias were excluded. Fifty-seven patients were en- tered into four treatment groups, receiving combinations of furosemide 40 mg, morphine 3 mg, and sublingual nitro- glycerin. Medications" were repeated every five minutes un- til relief of symptoms or a maximum of three doses. One group received all three drugs. Other groups received one of the three possible two-drug combinations. Groups were similar in presenting symptoms and vital signs; however, due to the small sample size they were not comparable re- garding history of prior cardiopulmonary disease and subse-

114/182 Annals of Emergency Medicine 17:2 February 1988