ABSTRACTS

positive in 56% (14 of 25) of all cases and in 87% (13 of 15) of cases in which the patient was in shock. The authors conclude that Gram staining of skin lesions in patients suspected of having an acute meningococcal infection is a quick method of diagnosing these infec- tions. This technique may be espe- cially useful in patients with sepsis and in those with inconclusive CSF results.

Gordon Hardenbergh, MD

angina; myocardial infarction

Effect of gender on long-term outcome of angina pectoris and myocardial infarction/sudden unexpected death Orencia A, Bailey K, Yawn BP, et al JAMA 269.2392-2397 May 1993

This report from the Rochester Coronary Heart Disease Project describes a 20-year experience of the gender differences in presenta- tion and outcome of coronary heart disease. Twenty thousand medical records from physicians' offices and hospitals were screened for diag- noses suggestive of coronary artery disease. A cardiologist reviewed the records and ECGs selected and assigned one of three diagnoses: angina pectoris, myocardial infarc- tion, or sudden unexpected death. Women were significantly older at the onset of angina (67 years versus 60 years), and a smaller proportion smoked as compared with men. Estrogen replacement was used by 38%. Women with angina pectoris as their initial manifestation of coro- nary heart disease had a risk of dying that was only 0.45 times that for men and a risk of subsequent myocardial infarction/cardiac death that was 0.47 times the risk for men with angina. Women with myocar- dial infarction or sudden unexpected death as their initial manifestation of coronary heart disease had a subsequent rate of myocardial

infarction and cardiac death that was no different than that of men with the same diagnosis and age. A higher proportion of women were prescribed diuretics and digoxin after an infarction, while men were more likely to receive anticoagu- lants. Women with an initial hard cardiac event (myocardial infarction or sudden unexpected death) had a poorer survival as compared with men, but this can be attributed entirely to the women's older age at the time of the event. [Editor's note: This report is purely descrip- tive. No inferences should be drawn regarding differences between genders in treating coronary artery disease.j

Michael Fallen, MD

thoracoscopy; diaphragmatic injury

Prospective evaluation of thoracoscopy for diagnosing diaphragmatic injury in thoraco- abdominal trauma: A preliminary report Ochsbner MG, Rozycki GS, Lucente F, et al

J Trauma 34.'704-709 May 1993

This prospective evaluation of 14 patients with penetrating trauma to the thoracoabdominal region sought to determine the value of thoracoscopy to rule out diaphrag- matic injury. Included patients had thoracoabdominal trauma within 24 hours of admission, hemedynamic stability, chest tube drainage of less than 1.5 L blood initially and less than 250 mL/hr for two consecutive hours, and indications for exploratory laparotomy. Rigid or video thora- coscopy was performed through the thoracic wall in the operating room to examine the mediastinum, peri- cardium, lung, chest wound, and diaphragm. The chest cavity was irrigated and a chest tube placed

under direct visualization. Thoraco- scopy correctly identified the pres- ence or absence of diaphragmatic injury (nine and five, respectively)in all 14 patients, as compared with laparotomy and laparoscopy. Two complications, a subphrenic abscess and empyema and a lung laceration, occurred. The authors conclude that thoracoscopy is a reliable alternative to laparotomy in patients at risk for diaphragmatic injuries when abdom- inal exploration is not deemed mandatory.

Merle Miller, MD

echocardiography; aorta

Use of transesophageal echocardiography in the evaluation of traumatic aortic injury Keamey PA, Smith DW, Johnson SB, eta/

J Trauma 34:696-701 May 1993

All patients with blunt chest trauma and suspected thoracic aortic injury admitted to the trauma surgery ser- vice at the University of Kentucky were considered for evaluation with transesophageal echocardiography (TEE) and aortography. TEE was performed by blinded staff cardiolo- gists and senior fellows using two- dimensional echocardiographs with color Doppler. Arch aortography was performed by staff radiologists or senior radiology residents. Sixty-nine patients with suggestive chest radio- graph findings (72%) or suggestive histories and chest radiographs (28%) were studied. There were no complications. Aortography took significantly longer than TEE (mean, 76 versus 27 minutes). TEE showed injury in seven patients; four were confirmed by aortography. One patient underwent thoracotomy based on TEE findings alone. Aortograms yielded false-negative results in two cases. Tears were confirmed on surgery and autopsy in one case each. Aortography had a

sensitivity of 67% and a specificity of 98% in this patient group; TEE had 100% sensitivity and specificity. The authors conclude that timely evaluation with TEE is an important new diagnostic tool in the evaluation of the patient with blunt chest trauma. [Editor's noie: The impres- sive sensitivity and specificity of TEE for aortic rupture in this study have not been equalled in studies of tho- racic dissection. Repeated documen- tation of superiority is warranted when considering a new technology as a replacement for a gold standard test. Rapid availability around the clock by an experienced echocardio- grapher may be a limiting factor in the use of this technology.]

Juliana Karp, MD

glove, perforations

Frequency of glove perforations and subsequent blood contact in association with selected obstetric surgical procedures Chapman S, Duff P Am J Obstet Gynecol 168.1354-1357 May 1993

A prospective study was performed to assess the frequency of glove perforations associated with select- ed obstetric procedures to determine whether time of day or urgency of the procedure affected the frequency of perforations. Obstetric personnel were asked to double glove for all procedures. After each procedure, all gloves were assessed for patency with two techniques. They were inflated with air and then immersed in water to detect air bubbles. After this, the gloves were filled with water and observed for leaks. Five hundred forty glove sets (2,160 indi- vidual gloves) were studied from cesarean deliveries (75%}, tubal ligations (12%), and vaginal deliver- ies (13%). Sixty-seven of the sets (12.4%) had at least one hole. Only

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