The British journal of clinical practice最新文献

Twenty-three general practices in the UK randomised 229 paediatric patients (aged 1-12 years, body weight > 8 kg) with clinical evidence suggestive of streptococcal tonsillitis and/or pharyngitis in this physician-blind study. Patients received either clarithromycin suspension (7.5 mg/kg twice daily) or amoxycillin syrup (125 mg/kg three times daily body weight < 25 kg, or 250 mg/kg three times daily body weight 25 kg) for 7 days and were followed up 3-8 days post treatment and 21-28 days later. Clinical and microbiological assessments were made at each visit. A total of 189 patients (98 on clarithromycin and 91 on amoxycillin) were clinically evaluable. At the post-treatment visit, clinical success rates were high and comparable: 98% on clarithromycin and 97% on amoxycillin. Streptococcus pyogenes was eradicated in 88% of clarithromycin patients and 86% of amoxycillin patients. Both treatments were well tolerated. In conclusion, clarithromycin suspension was as safe and at least as effective as amoxycillin syrup for the treatment of pharyngitis and/or tonsillitis in children, and would be a suitable alternative therapy.

A patient prescribed oxymetazoline hydrochloride nasal drops presented with recurrent ventricular tachycardia of fascicular origin. Cardiac ultrasound showed a calcified lesion, presumably a fibroma arising from the interventricular septum. Fascicular tachycardia related to the lesion and provoked by the use of a sympathomimetic agent is postulated.

We have estimated that in 1995 more than 2 million pounds was spent by the National Health Service on throat swabs used to investigate chronic tonsillitis in the UK. This study was devised to assess the value of this investigation. The surface microflora, obtained using a throat swab, was compared with the microflora of the deep tonsil in 30 cases of chronic tonsillitis. None of the throat swabs grew pathogenic organisms, while in 16 cases, heavy growths of recognised pathogens were grown from the tonsillar tissue. This paper demonstrates that throat swabs have little value in the management of chronic tonsillitis, and if the investigation was omitted in this condition, a substantial saving could be made.

Recent research has shown that recreational water and bathing beach quality are associated with injury, infection and personal well-being. Continued surveillance is essential to audit the environmental and associated health trends. In the Coastwatch UK project and since 1989, annual surveys each autumn have been undertaken during a two-week study period, into the extent of littering of the UK coastline. The Public Health Laboratory Service also collects data on the use of hepatitis B immunoglobulin. In these studies it is now possible to examine time trends. The findings are not reassuring. They help to justify present concern about the health effects of discarded litter and medical waste and fears that environmental degradation could lead to loss of income from tourism. In response, some health and local authorities have started public education programmes, supplying litter bins on or near bathing beaches, emptying them regularly and undertaking beach cleansing during the summer months. The UK government is also introducing new legislation that will require 6 mm fine mesh wire screens on all shore-based sewage outlets around the UK coastline. Continued monitoring is needed to assess the effectiveness of these interventions. The need for greater personal responsibility is particularly identified.

Schistosomiasis is endemic in many parts of the world but is rare in the UK. It usually affects the bladder or intestine, resulting in bleeding and fibrosis. However, schistosomal eggs are frequently found in the appendix and these can be symptomatic. The present case describes appendiceal infestation accompanied by acute appendicitis.

Increasing age, certain medications such as diuretics, disease processes such as malignant neoplasm and schizophrenia, and a history of hyponatraemia or polydipsia may predispose patients to the development of hyponatraemia. In addition, certain psychotropic medications, including TCAs, MAOIs, carbamazepine, trazodone and neuroleptics, may predispose to hyponatraemia, yet a causative role for most has not been firmly established and the effect is most likely to be more idiosyncratic. The SSRIs have been associated with hyponatraemia in a small number of case reports. The mean age and sex of patients in reported cases is over 70 years and predominantly female, and patients were often receiving concomitant diuretic therapy. The frequency of hyponatraemia in elderly female patients receiving fluoxetine has been estimated to be as high as eight per 1000. The risk of developing hyponatraemia appears to be highest during the first few weeks of treatment. Because of the potential seriousness of hyponatraemia, if an elderly patient receiving an SSRI develops unexplained symptoms during the first few weeks of therapy, it is necessary to measure the serum sodium level.