Supine vs semirecumbent and upright 12-lead electrocardiogram: does change in body position alter the electrocardiographic interpretation for ischemia?

OBJECTIVE: The goal of this study was to determine if a change in body position alters the 12-lead electrocardiographic (ECG) interpretation for ischemia and ST-segment elevation, the latter having direct implications for initial patient management in the emergency department. METHODS: Twelve-lead ECGs were sequentially obtained from a convenience sample of healthy adult volunteers in 3 positions (supine, 0 degrees; inclined, 45 degrees; and upright, 90 degrees). The tracings were randomized, blinded, and then independently read by 2 trained emergency medicine physicians who also assessed for the presence of ischemia and ST-segment elevation myocardial infarction. RESULTS: Seventy-five subjects were enrolled, with 7 (9%; 95% confidence interval [CI], 4-18) having ischemia on the supine ECG, 9 (12%; 95% CI, 6-22) on the incline, and 9 on the upright tracings. ST-segment elevation myocardial infarction pattern was present on 2 (3%; 95% CI, 0-9) supine, 2 inclined, and 2 upright ECGs. CONCLUSIONS: Changes in body position result in some ischemic variations of the 12-lead ECG.

Group A beta-hemolytic streptococcal glossal necrotizing myositis--case report and review.

We report the first case of glossal necrotizing myositis by group A beta-hemolytic Streptococcus in an 8-year-old girl on chronic nonsteroidal anti-inflammatory drugs, immunomodulators, and steroids for juvenile rheumatoid arthritis. Treatment included partial glossectomy and parenteral antibiotics. After a critical course, full recovery ensued. The subject of necrotizing myositis is reviewed.

Beckman Access versus the Bayer ACS:180 and the Abbott AxSYM cardiac Troponin-I real-time immunoassays: an observational prospective study.

BACKGROUND: Reliability of cardiac troponin-I assays under real-time conditions has not been previously well studied. Most large published cTnI trials have utilized protocols which required the freezing of serum (or plasma) for delayed batch cTnI analysis. We sought to correlate the presence of the acute ischemic coronary syndrome (AICS) to troponin-I values obtained in real-time by three random-mode analyzer immunoassay systems: the Beckman ACCESS (BA), the Bayer ACS:180 (CC) and the Abbott AxSYM (AX). METHODS: This was an observational prospective study at a university tertiary referral center. Serum from a convenience sampling of telemetry patients was analyzed in real-time for troponin-I by either the BA-CC (Arm-1) or BA-AX (Arm-2) assay pairs. Presence of the AICS was determined retrospectively and then correlated with troponin-I results. RESULTS: 100 patients were enrolled in Arm-1 (38 with AICS) and 94 in Arm-2 (48 with AICS). The BA system produced 51% false positives in Arm-1, 44% in Arm-2, with negative predictive values of 92% and 100% respectively. In Arm-1, the BA and the CC assays had sensitivities of 97% and 63% and specificities of 18% and 87%. In Arm-2, the BA and the AX assays had sensitivities of 100% and 83% and specificities of 11% and 78%. CONCLUSIONS: In real-time analysis, the performance of the AxSYM and ACS:180 assay systems produced more accurate troponin-I results than the ACCESS system.

Antipyretic effectiveness of intravenous ketorolac tromethamine.

We assessed the antipyretic effectiveness of intravenously administered ketorolac tromethamine in the febrile adult. A double-blind placebo controlled trial enrolling a convenience sample of febrile (T > 38.0 degrees C, oral) patients (18-65 years old) randomized to receive either 0.5 mg/kg (max 30 mg) intravenous ketorolac or placebo. Oral temperatures were recorded every 15 min during the 1-h study period. There were 20 patients in each group. At 60 min, the temperature decrease was 0.4 degrees C (95% CI: 0.0 degrees, 0.7 degrees ) for the control group and 0.8 degrees C (95% CI: 0.5 degrees, 1.1 degrees ) for the ketorolac group. Logistic regression modeling of afebrile at 60 min, controlling for baseline temperature, yielded an odds ratio for ketorolac of 7.1 (95% CI: 1.3, 39.5). In conclusion, our data support that intravenously administered ketorolac has antipyretic properties.