ABSTRACTS

the elevation of creatinine phosphokinase associated with intramuscular injections.

Joanne M Edney, MD

intravenous pyelography, blunt trauma

Use of i n t r a v e n o u s pye lography in b lunt t r a u m a m A reappra isa l Hoffman JR, Simon RR, Smith M, et al West J Med 146:576-579 May 1987

In a retrospective cohort study charts of 150 consecutive patients receiving intravenous pyelogram (IVP) following blunt trauma were reviewed. Attention was directed to any clinical or laboratory findings correlating with an abnormal IVP and whether the results of the IVP affected manage- ment of the patient. Of clinical findings commonly used as indications for IVP in the setting of blunt trauma, ie, back pain, groin pain, abdominal tenderness, CVA tenderness, transverse process fracture, lower rib fracture, and gross hematuria, only gross hematuria was statistically signifi- cant in its association with an abnormal IVP. The sen- sitivity, specificity, and positive and negative predictive values were 44%, 87%, 17%, and 96%, respectively. Con- versely, 42 of 43 patients (98%) with < 10 RBC/hpf had a normal IVP, suggest ing tha t absence of mic roscop ic hematuria has an excellent negative predictive value for genitourinary injury, Of the nine patients with abnormal IVPs, none had their management influenced by the test. The authors cite four other studies, all supporting the fact that the IVP rarely influences management. Indications for an IVP in blunt trauma are > 10 RBC/hpf in association with back pain, groin pain, transverse process fractures, or a highly suggestive mechanism of injury. Furthermore, it is again emphasized that an IVP is important for a patient un- dergoing exploratory laparotomy following trauma to dem- onstrate two functioning kidneys./Editor's note: It must be emphasized that all the patients Jn this study had experi- enced blunt trauma. An IVP may be indicated even in the absence of hematuria when a penetrating injury has oc- curred in juxtaposition to the kidney]

Paul Howes, MD

human immunodeficiency virus

U n s u s p e c t e d h u m a n i m m u n o d e f i c i e n c y virus in c r i t ica l ly ill e m e r g e n c y p a t i e n t s Baker JL, Kelen GD, Sivertson KT, et al JAMA 257:2609-2611 May 1987

A prospective anonymous analysis of serum samples of

203 critically ill or severely injured patients was performed in an urban emergency department investigating the fre- quency of HIV antibody seropositivity to determine the po- tential of unsuspected exposure to ED personnel and to de- termine if a "high risk" patient group could be identified. Six (3%) of the total were HIV antibody positive. All were between 25 and 34 years old and were victims of trauma. Five of these six were v ic t ims of penetra t ing t rauma (gunshot or stab wounds), and they represented 19% of the 27 such patients in that age group; none were previously suspected as HIV infected. The 3% prevalence rate in this study is contrasted to the 0.8% prevalence rate in the gener- al US population. A history of IV drug abuse did not prove to be a discriminator in this study. The authors suggest cau- tion in extrapolating conclusions from these data because of the limited sample and because of the specific nature of their urban population.

Mark W Elliott, MD

stroke, behavioral disturbance

I n o b v i o u s s t roke: A c a u s e of de l i r ium and d e m e n t i a Dunne JW, Ledman P J, Edis RH Aust NZ J Med 16:771-778 Jul 1986

A retrospective analysis of 661 patients with stroke proven by CT scan or autopsy was conducted to evaluate the frequency of disease presentation without specific lo- calizing neurologic signs. Nineteen patients (four with cere- bral hemorrhage and 15 with cerebral infarction) had behav- ioral abnormalities as their primary presenting feature with minimal, transient, or even absent neurologic findings. Nine patients demonstrated reversible acute delirium or organic personality disorders. Eight of the nine had a non- dominant hemispheric lesion, and all demonstrated marked mood alterations, including paranoia, mania, emotional la- bility, and apathetic affect. Acute, irreversible dementia oc- curred in seven patients with predominantly right temporal and parietal lesions. This group had global impairment of cognitive ability involving memory, judgment, and abstract thought. Emotional lability, aggressiveness, and paranoia were typical of these patients. A final group of three pa- tients developed delayed, intermittent behavioral abnor- malit ies with hallucinations, delusions, and mania. All three developed EEG disturbances, two exhibiting epilepsy. The authors found the lesions involved in these 19 stroke patients usually located in the peri-Sylvian cortex of the nondominant hemisphere, accounting for the predominant emotional disorientation and paucity of limb neurologic ab- normalities.

Michael Hunt, MD

236/1094 Annals of Emergency Medicine 16:9 September 1987