Abstracts in this issue were prepared by residents in the Denver General/St Anthony's/St Joseph Hospitals Emergency Medicine Residency Program.

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

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

rheumatic fever

Resurgence of acute rheumatic fever Hosier DM, Craenen JM, Teske DW, et al Am J Dis Child 141:730-733 Jul 1987

The incidence of acute rheumatic fever has declined over the past 20 years. However, these authors have documented a marked increase in the incidence of acute rheumatic fever seen at Columbus Children's Hospital during the past two years. Medical records were reviewed of 40 patients who met the modified Jones criteria for acute rheumatic fever from June 1984 through September 1986. Of the major crite- ria, migratory polyarthritis was seen in 26 of the 40 patients (65%), carditis in 20 (50%), chorea in seven (18%), erythema marginatum in five (13%), and subcutaneous nodules in one (5%). Of the minor criteria, positive antistreptolysin zero titers were found in 39 patients (97%), fever in 37 (93%), erythrocyte sedimentation rate was elevated (>20) in 35 (87%), and the pulse rate interval was prolonged in ten (25%). It was concluded that this outbreak in Ohio, in addi- tion to recent reports of outbreaks in Utah and Pennsylva- nia, suggests a resurgence of acute rheumatic fever nation- wide.

Greg Bennett, MD

methoxamine, CPR, regionat cerebral blood flow; epinephrine, CPR, regional cerebral blood flow

Methoxamine versus epinephrine on regional cerebral blood flow during cardiopulmonary resuscitation Brown CG, Davis EA, Werman HA, et al Crit Care Med 15:682-686 Jul 1987

However, epinephrine 0.2 mg/kg increased CBF to 12 to 13 mL/min • 100 g in the cerebral cortex, and to 29 mL/min • 100 g to the more caudal structures. The lower doses of either drag had no effect on CBE It was concluded that epi- nephrine in doses much larger than currently recommended signif icantly improved regional CBE Furthermore, epi- nephrine was significantly more effective than an equipo- tent dose of methoxamine.

Alan F Chou, MD

bacteriuria, asymptomatic

Prospective randomized comparison of t h e r a p y and no t h e r a p y for a s y m p t o m a t i c b a c t e r i u r i a in ins t i tu t iona l i zed e lder ly w o m e n Nicolle LE, Mayhew W J, Bryan L Am J Med 83:27 Jut 1987

This prospective, randomized study of elderly institu- tionalized women with asymptomatic bacteriuria compared cohorts treated or not treated with antibiotics for all epi- sodes of bacteriuria identified on monthly culture over one year. The treated group showed a lower monthly prevalence of bacteriuria and longer periods free of bacteriuria. How- ever, antimicrobial therapy was associated with increased incidence of reinfection, adverse drug effects, and isolation of increasingly resistant strains. There were no differences in morbidity or mortality between the two groups. These data support the current recommendations of no treatment for symptomatic bacteriuria in this population.

R Scott Israel, MD

nonsteroidal anti-inflammatory drugs, antihypertensive drugs, interaction

This randomized, controlled study on swine compares the effect of methoxamine and epinephrine in equipotent doses on cerebral blood flow (CBF) during CPR after pro- longed cardiac arrest. After ten minu tes of ventr icular fibrillation and three subsequent minutes of CPR with a pneumat ic compressor, 25 swine were randomized to re- ceive 0.02 or 0.2 mg/kg epinephrine, or 0.1, 1.0, or 10.0 mg/ kg methoxamine. The results showed that CBF during CPR was extremely low (7 mL/min • 100 g). Methoxamine 10 mg/ kg improved CBF to only the most caudal central nervous system structures (pons, medulla, and cervical spinal cord).

Ibuprofen interferes with the efficacy of antihypertensive drugs Radack KL, Deck CC, Bloomfield SS Ann Intern Med 107:628-635 Nov 1987

Forty-one patients with stable essential hypertension con- trolled by two or more drugs were evaluated in a double- blind, randomized, parallel, controlled trial comparing the effects of ibuprofen (400 mg three times a day), acetamino-

17:3 March 1988 Annals of Emergency Medicine 290/165