Abstracts 259

q RANDOMIZED TRIAL OF PNEUMATIC ANTI- SHOCK GARMENTS IN THE PRE-HOSPITAL MAN- AGEMENT OF PENETRATING ABDOMINAL INJU- RIES. Bickell WH, Pepe PE, Bailey ML, et al. Ann Emerg Med. 1987; 16:653-658. .

The pneumatic antishock garment (PASG) has become widely used in prehospital care. This randomized clinical trial evaluated the effect of the PASG on hypotensive pa- tients with penetrating abdominal injuries. Patients with penetrating abdominal injuries and a systolic blood pres- sure of 90 mm Hg or less were assigned to a PASG (n=97) or a no-PASG (n = 104) group on an alternate day basis over a 21/z-year period. The two groups were comparable in prehospital response and transport times, volume of intra- venous fluids infused, and survival probability indexes, but the average on-scene time was four minutes longer in the PASG group. There was no significant difference in survival rates between the two groups. [Alan F. Chou, MD]

Editor’s Note: Prehospital care has frequently suffered from the widespread adoption of a therapeutic modality as standard prior to thorough scientific evaluation. Thanks to this study, the use of military antishock trousers (MAST) is becoming confined to the stabilization of pelvic fractures.

Cl MAGNETIC RESONANCE IMAGING OF THE THORACIC AORTA. Lois JF, Gomes AS, Brown K, et al. Am J Cardiol. 1987; 60:358-362.

Forty-one patients with suspected thoracic aortic abnor- malities were studied with either magnetic resonance imag- ing (MRI) alone (n = 22), or MRI after aortography (n = 19) to determine the efficacy of MRI in diagnosis. In the pa- tients having both studies, MRI agreed with the aorto- graphic findings in 95 % . The authors conclude that since aortography carries certain risks, that MRI will replace aor- tography in a large proportion of patients with suspected thoracic aortic abnormalities. [Ben Maltz, MD]

Editor’s Note: Magnetic resonance imaging has many potential advantages in safety and in the amount of infor- mation produced by the study. However, the percentage of agreement measure used here is not a sound method for comparing diagnostic tests. Further investigation of the sensitivity and specificity of MRI is needed before it can be established as the diagnostic procedure of choice in diseases or injuries of the thoracic aorta.

0 DIAGNOSTIC AND PROGNOSTIC IMPLICATIONS OF RECURRENCES IN PATIENTS WITH SYNCOPE. Kapoor WN, Peterson J, Wieand HS, et al. Am J Med. 1987; 83:700-708.

This study evaluates the implications of recurrent syn- cope in a cohort of 433 patients enrolled in a prospective

syncope study. Over a 30-month period, 146 patients had recurrent syncope. The incidence was 3 1% in patients with an initial diagnosis of cardiovascular syncope, 36% in those with a noncardiovascular cause, and 43% in patients with an undetermined cause. These differences were not statisti- cally significant. Recurrence caused major morbidity in eight patients, but was not a significant predictor of overall mortality or sudden death. Evaluation of recurrent epi- sodes succeeded in establishing a diagnosis in only eight cases. The authors conclude that the diagnosis of recur- rence is usually the same as the initial diagnosis and that a new diagnosis is rarely established in patients in whom no cause is identified after the index episode.

[R. Scott Israel, MD]

Editor’s Note: When confronting frustrating clinical problems such as syncope, physicians would do well to re- member that absence of proof is not necessarily proof of absence.

0 IMMEDIATE MEDICAL CONSEQUENCE OF NU- CLEAR ACCIDENTS. Gale RP. JAMA. 1987; 258:625- 628.

This is a discussion of the medical response to the Chernobyl nuclear power station accident of April 26, 1986. Immediate medical response to nuclear accidents in- volves five phases: assessment, containment, reduction of exposure to individuals at risk, dosimetry of exposed indi- viduals, and medical interventions. Interventions will dif- fer, based upon the spectrum of injuries and the type of reactor involved. Graphite-moderated reactors such as the one at Chernobyl produce intense graphite fires, whereas light water reactors ‘will msalt in Iess significant thermal injuries. Further medical therapy involves treatment of skin burns and measures to correct or reverse bone marrow Fail- ure and gastrointestinal tract injury. The consideration of candidates for bone marrow transplantation involves iden- tification of those receiving whole-body radiation consis- tent with bone marrow failure while excluding those who are likely to die from nonhematopoietic toxic effects.

The Chernobyl accident resulted in two immediate deaths, 500 hospitalizations, and 29 additional deaths at 3- month follow-up. Nuclear accidents involve an extremely complex medical response, and the experience at Chernobyl shows humans can survive much greater radiation exposure than originally anticipated. The author concludes that the medical response to Chernobyl involving 20 nations and millions of dollars is trivial compared with the response necessary in the context of a nuclear war.

[Mark W. Elliot, MD] Editor’s Note: One hopes that this paper will remain the

world’s total experience with nuclear mass casualty incidents.