556 The Journal of Emergency Medicine

Jonsson S, Kjartansson G, Gislason D, et al. Chest. 1988; THROPLASLA REVISITED. Mashberg A, Feldman LJ. 94:123-6. Am J Surg. 1988;156:273-5.

In this prospective, randomized study, the effectiveness of intravenous and orally administered corticosteroids and theophylline were compared in treatment of acute episodes of lower airway obstruction. ?krenty-eight patients with acute exacerbations of obstructive airway disease were ran- domly assigned to receive either methylprednisolone 80 mg/ 24h and aminophylline based on body weight by continu- ous IV infusion or a comparable dose of a sustained-re- leased theophylline preparation and methylprednisolone md in two equally divided doses. All patients received in- haled P-agonists via conventional metered-dose inhaler or by nebulizer. Each patient received daily spirometry and had symptoms scored on a dyspnea index. Six patients were excluded after entry since they were felt to have COPD and not reactive airway disease. The overall response to therapy was good in both groups. There was no significant differ- ence between the IV and oral groups in the improvement of the dyspnea index or the improvement in their spirometric testing. The authors conclude that oral administration of steroids and theophylline is acceptable in hospitalized pa- tients with moderate exacerbations of airway obstruction.

[Jeffrey Schaider, MD]

In a high risk population for oral squamous carcinoma, 502 asymptomatic oral and oropharyngeal lesions were evaluated to determine which clinical characteristics were most commonly indicative of early mucosal cancer. Of the 502 lesions, 326 were malignant, (236 invasive and 90 car- cinoma in situ). The malignancies were evaluated for color, size, and texture. The invasive lesions were red or mostly red in 64% of cases, equal red and white in 23% and white or mostly white in only 12 %. Carcinoma in situ lesions were similar (54%) 30%) and 16%) respectively). Roughly 80% of the malignancies were 2 cm or less in size. The texture of the lesions was granular in 60% of invasive malignancies and smooth in 62% in situ malignancies. Invasive and in situ lesions were indurated in 12% and 6%) ulcerated in 12% and 3 % , and bleeding in 2% and 1% respectively. The au- thors conclude that traditional clinical characteristics of ulceration, induration, elevation, and bleeding were usually not present in these early lesions. They also suggest that physicians should be discouraged from a preoccupation with leukoplakia in screening for early malignancies in high-risk patients since erythroplastic lesions are more common. [Robert D. Schmidt, MD]

0 SAFETY AND EFFICACY OF MEZLOCILLIN: A SINGLE-DRUG THERAPY FOR PENETRATING AB- DOMINAL TRAUMA. Lou MA, Thadepalli H, Mandal AK. J Trauma. 1988;28:1541-7.

0 RANDOMIZED DOUBLE-BLIND TRIAL OF IN- TRAVENOUS PROCHLORPERAZINE FOR THE TREATMENT OF ACUTE HEADACHE. Jones J, Sklor D, Dougherty J, et al. JAMA. 1989;261:1174-6.

In this prospective, randomized study, 173 patients with penetrating abdominal injuries were given either mezlocillin or a combination of clindamycin and gentamicin to deter- mine if single antibiotic coverage is as effective as combined antibiotics to prevent infections in penetrating abdominal trauma. Of the 173 patients, 26 were excluded (18 due to absence of injuries at laparotomy, 8 due to clerical error). Seventy-four patients were given mezlocillin, and 73 re- ceived clindamycin/gentamicin. Antibiotic therapy was be- gun in the emergency department as soon as the diagnosis of penetrating abdominal injury was made. The overall clinical response was considered excellent or very good in 93% on mezlocillin and in 94% of those in the clindamycinl gentamicin group. The mean duration of hospital stay was 9 days in both antibiotic groups, and the mean duration of antibiotic therapy was 6 days in both groups. The perito- neal fluid was cultured from all patients. No bacteria were found in 72% of patients on mezlocillin and in 78% of the clindamycin/gentamicin group. The authors conclude that infection due to penetrating abdominal injuries can be pre- vented against E coli and B fragilis as well by a single antibiotic (mezlocillin) as by a combination of gentamicin and clindamycin. [Jeffrey Schaider, MD]

Many patients present to the emergency department seeking relief for severe headache pain. The traditional treatment for severe headache is parenteral narcotic analge- sics. An alternative medication that could effectively treat severe headache without addictive potential or side effects would be desirable in the emergency department setting. This prospective, randomized, double-blind clinical trial compared intravenous prochlorperazine edisylate with pla- cebo in the treatment of severe headaches. Of those receiv- ing prochlorperazine, 74% had complete relief of headache pain within 60 minutes of injection, and 14% had partial relief. Only 45% of the placebo group got either complete or partial relief. Within the prochlorperazine group there was no significant relationship between headache type and the degree of symptom relief. Adverse effects were minimal; one patient experienced orthostatic hypotension. The au- thors conclude that prochlorperazine is an effective treat- ment for patients with severe vascular or tension headaches who present to the emergency department.

[w. Fred Watkins, MD] Editor’s Note: We have noted similar efficacy with

chlorpromazine 1 mg/kg. For the 20% to 30% who receive no relief, we would use a conventional narcotic.

0 CLINICAL CRITERIA FOR IDENTIFYING EARLY ORAL AND OROPHARYNGEAL CARCINOMA: ERY-

0 SUPERIORITY OF ACTIVATED CHARCOAL ALONE COMPARED WITH IPECAC AND ACTIVAT-