Paul J. Leo

Use of Chinese Therapies Among Chinese Patients Seeking Emergency Department Care

We observed that many Chinese-Americans presenting to our emergency department use traditional Chinese therapies. We therefore conducted a survey using a convenience sample of first- and second-generation adult Chinese immigrants to characterize their use of traditional therapies. Seventy-six patients completed the survey; 43% had used Chinese therapy within 1 week of the ED visit. Use of Chinese therapies was common among first- and second-generation immigrants (44% and 42%, respectively). Patients claiming affiliation with a practitioner of Chinese medicine used Chinese therapies most frequently (60%). However, those lacking a traditional therapist and those associated with a Western physician also used traditional therapies frequently (38% and 41%, respectively). Many Chinese patients visit both a Western and a Chinese practitioner (17%). Emergency physicians treating Chinese-Americans should consider the possibility of concomitant use of traditional therapies. Physicians should be aware of the medical and social implications of alternative medical therapies.

Complications from the use of thrombolytic agents in patients with cocaine associated chest pain

Previous investigators have noted that patients with cocaine associated chest pain frequently have abnormal electrocardiograms, including ST segment elevation, in the absence of ongoing myocardial ischemia. The effects of these nonischemic ST segment elevations have not been evaluated. We report two patients with cocaine associated chest pain and ST segment elevations who received thrombolytic agents in the absence of myocardial ischemia. Neither patient sustained a myocardial infarction, nor had clinical evidence of reperfusion. The ST segment elevations persisted after resolution of chest pain in both patients, and both of the patients experienced complications of thrombolytic therapy. One patient sustained a hemorrhagic stroke and one had minor oral-pharyngeal bleeding. Given the lack of documented efficacy, concerns about safety, and poor specificity of the electrocardiogram for myocardial ischemia in patients with cocaine associated chest pain, thrombolytic therapy should be used with caution in these patients.

Phenylpropanolamine and Associated Myocardial Injury

We report the cases of two patients without significant past medical history in whom developed myocardial injury attributed to the use of anorectic agents containing phenylpropanolamine. The pharmacologic properties of phenylpropanolamine and the current management of common adverse reactions to phenylpropanolamine are briefly reviewed.

The role of serum phosphate level and acute ischemic bowel disease

The objectives of this study were to determine whether an elevated serum phosphate level is predictive of acute ischemic bowel disease and whether it serves as a prognostic indicator in patients with intestinal ischemia. A retrospective chart review was performed at an urban teaching hospital emergency department. Twenty-three patients with documented acute ischemic bowel disease from 1990 through 1994 were compared with 27 patients with acute abdominal disease entities unrelated to intestinal ischemia. The sensitivity, specificity, and positive and negative predictive values of serum phosphate were 26%, 85%, 60%, and 58% respectively. Levels of phosphate in patients with intestinal ischemia versus controls were 4.20 versus 3.41 mg/dL (P = .1338). The length of bowel necrosis in the experimental group with elevated phosphate versus normal phosphate level was 57.53 cm versus 99.00 cm (P = .4132). Although not statistically significant, linear regression revealed slightly positive correlations in those with elevated phosphate versus normal phosphate level (in the experimental group) with the length of bowel necrosis and duration of hospital stay as r= .155 (P = .4813) and r= .134 (P= .5418), respectively. Serum phosphate level independently has no diagnostic or prognostic value in acute ischemic bowel disease.

Cocaine-associated intestinal gangrene in a pregnant woman.

A 31-year-old pregnant woman who was an active cocaine abuser presented to our emergency department five times in 1 week for abdominal pain and vomiting. She continued to use cocaine regularly despite having abdominal pain. Her fifth admission was for seizures. There were no objective signs of peritoneal inflammation and the rectal guiac examination was repeatedly negative. The patient progressed to severe septic shock. Intraabdominal sepsis and/or bowel perforation was suspected. Exploratory laporatomy revealed gangrene and perforation of the small intestine and fecal peritonitis. She rapidly developed multiorgan failure and died. Gastrointestinal complications resulting from cocaine use are uncommon. Our case is unique in that the patient was pregnant, used cocaine by the intranasal route, and lacked objective signs of acute abdomen. Emergency physicians should be aware of the morbidity associated with the use of cocaine.