ABSTRACTS

(C2-C4). Thirty-three patients had lower cervical cord le- sions (C5-C8), six had T1-T6 injuries, and six had T7-T12 injuries. The type of lesions included complete cord tran- section (12), central cord syndrome (21), partial cord syn- drome (16), and Brown-Sequard syndrome (six). Fifteen pa- tients had delayed neurologic deterioration with a latent period of 30 minutes to four days. Nine of these had tran- sient warning signs (paresthesias, weakness, or a lighten- ing sensation down the spine associated with neck move- ment) immediately after trauma. No other predictive fac- tors were found. Recurrent SCIWORA was observed in eight patients who reinjured the spinal cord after dis- charge from hospital (one to ten weeks later). While mech- anism of injury in these eight patients was significantly less than original trauma, neurologic deficits were univer- sally more severe than initial injury. Long-term neurologic outcome was best predicted by initial neurologic status. It is recommended that all children who have experienced transient neurologic symptoms undergo computed tomog- raphy and dynamic radiographs followed by admission for observation and admission for six weeks because the ben- efit of preventing a potentially serious neurologic injury outweighs the inconvenience of treatment. [Editor's note: Because this is a retrospective review over a six-to-seven- year period of children from a tertiary spinal cord center, the incidence of this devastating syndrome is unknown but, fortunately, is probably very low. It seems the only clinical clues to the possibility of the development of SCIWORA are transient neurologic symptoms obtained from a careful history and possibly the presence of severe paravertebra] muscle spasm which, from our experience, seems to be unusual in children.]

James Bodenhamer, MD

myocardial infarction, ventricular fibrillation

One-year prognosis of pr imary ventr icular fibrillation complicat ing acute myocardial infarction Volpi A, Cavatli A, Franzosi MG, et al Am J Cardio/ 63:1174-1178 May 1989

In an effort to determine the long-term prognosis of pri- mary ventricular fibrillation (VF) complicating acute myo- cardial infarction (AMI), the one-year prognosis of 293 pa- t ients discharged after AMI complicated in the acute phase by primary VF was compared with a reference group of 6,337 patients identified from the same population in- cluded in the Gruppo Italiano per lo Studio della Strep- tochinasi nell'Infarto miocardico (GISSI) trial. Primary VF was defined as VF complicating a first AMI unassociated with heart failure or shock, and occurring within two days of admission. No differences in six- or 12-month mortality between the patients with primary VF and the reference

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group were found. When patients were stratified according to infarct site and whether they received streptokinase, survival between the two groups was also similar. It was concluded that the one-year mortal i ty of patients dis- charged after an AMI complicated by primary VF is low and is not influenced by fibrinolytic therapy or infarct size.

Cynthia Elliott, MD

trauma, penetrating, angiography

Stab wounds to the neck: Role of angiography Hartling RE McGahan JP, Lindfors KK, et al Radiology 172:79-82 Jut 1989

Angiographic evaluations of 61 stab wounds were corre- lated with clinical findings and long-term outcome to de- termine if some type of algorithm for the ordering of an- giograms could be constructed. The wounds were classi- fied according to location on the neck, zone I, zone II, or zone III, and the presence or absence of major physical findings defined as palpably diminished or absent pulses, active bleeding or expanding hematoma, bruit or murmur, neurologic deficit, or hypotension directly related to the injury. Two angiograms in the 13 patients with major physical findings (18 injuries total), demonstrated signifi- cant vascular trauma. Both stab wounds were in zone I. All zone II and all zone III wounds were free of arterial trauma. Selective carotid/vertebral angiography is associ-, ated with a 0.16% to 0.33% frequency of permanent com- plications in the general patient population. The resultant ! algorithm calls for angiography in all patients with major physical findings. It is also recommended that all zone I stab wounds have angiographic evaluation based on the high frequency of occult vascular trauma in this area. Pa- tients who are hemodynamically unstable should bypass angiography and go for immediate surgical exploration.

David Rosenberg, MD

myocardial infarction, analgesia

Treatment of pain in acute myocardial infarction Herlitz J, Hjalmarson A, Waagstein F Br Heart J 6t:9-13 Jan 1989

This review article on the t rea tment of myocardial chest pain notes the importance of and wide variation in modalities. Though narcotics remain appropriate analge- sics for chest pain, studies indicate that pain relief is often

i Annals of Emergency Medicine 18:9 September 1989