Clinical evaluation of flucloxacillin in the treatment of serious staphylococcal infections in children

A total of twenty-nine children were admitted to the paediatric unit with confirmed or presumed staphylococcal infection and subsequently treated with the narrow spectrum antibiotic--flucloxacillin. Despite the gravity of their condition all but two patients made a satisfactory recovery. There were no side-effects associated with this treatment.     

Prognostic factors for extracorporeal shock-wave lithotripsy of ureteric stones--a multivariate analysis study

OBJECTIVE: To define factors that have a significant impact on the stone-free rate after extracorporeal shock-wave lithotripsy (ESWL) of ureteric stones using multivariate analysis. MATERIAL AND METHODS: Between February 1992 and February 2002, a total of 938 patients with ureteric stones were treated with in situ ESWL using the Dornier MFL 5000 lithotripter. The outcome of treatment was evaluated after 3 months and failure was defined as the presence of any residual stones. The stone-free rate was correlated with patient characteristics (age, sex and radiological renal picture) and stone features (site, side, length, width, nature, opacity and the presence of ureteral stents). Factors with a significant impact on the stone-free rate using the chi (2) test were further analyzed using multivariate analysis. RESULTS: Overall, the stone-free rate was 88.7%. Repeat treatment was required in 50.4% of cases. Post-ESWL complications were observed in 32 cases (3.4%), including static steinstrasse in 19 (2%). Auxiliary procedures were needed in 28 cases (3%). Using the chi (2) test, only three factors had a significant impact on the stone-free rate, namely stone site, the transverse diameter of the stone and the presence of a ureteral stent. The stone-free rate was highest for stones located in the lumbar ureter (436/470; 92.8%) and lowest for those located in the pelvic ureter (268/324; 82.7%) (p = 0.0017). Stones with a transverse diameter of < or =1 cm were associated with a stone-free rate of 89.7% (715/797), compared to 83% (114/141) for those with a transverse diameter of >1 cm (p = 0.017). Non-stented patients had a stone-free rate of 89.8% (732/815), compared to 81.3% (100/123) for stented patients (p = 0.006). On multivariate analysis, these three factors maintained their statistical significance. A logistic regression model was designed to estimate the probability of stone-free status after ESWL. CONCLUSION: The site and transverse diameter of the stone and the presence of a ureteral stent are the only significant predictors of success of ESWL therapy for ureteric stones.     

Diagnostic and therapeutic strategy of bilateral nephroblastoma (apropos of 4 cases)

Four cases of bilateral nephroblastoma out of a total number of 99 cases have been observed during a period of 18 years at the INSE of Tunis (4%). The frequency of associated anomalies, the familial incidence, the young age of the patients are underlined. The main therapeutic modalities are discussed. Based on the most recent studies published in the literature, the prognosis of bilateral nephroblastoma has been improved in recent years with a possibility of survival at 2 years exceeding two thirds of the cases.     

Investigation of some materials as dry binders for direct compression in tablet manufacture. Part 6: Effect of drug.

The effect of addition of ascorbic acid, which is a drug known to be difficult to compress directly, on the self-binding efficiency of tragacanth, Carbowax 4000, Plasdone, and mannitol were investigated. The flow properties of ascorbic acid of different particle sizes were determined since they would affect the flowability of the binders investigated and would help to determine the optimum particle size of the drug required for maximum binding efficiency.     

Teaching Practices of Thoracic Epidural Anesthesia in the United States: Should Lumbar Epidurals Be Taught Before Thoracic Epidurals?

OBJECTIVE: The purpose of this study was to determine the current teaching practice of thoracic epidural procedures in the United States and to determine the effect of the teaching sequence of thoracic and lumbar epidurals on technical difficulties and complications. DESIGN AND SETTING: The first part was a survey, which was distributed to all American Board of Anesthesiology-accredited programs. The second part was a noninterventional retrospective review of 2,007 epidural procedures in a university teaching program. INTERVENTIONS: The survey questions were designed to determine the number of epidural procedures performed monthly on various services, teaching sequence, insertion technique, indications, and service provider. RESULTS:The survey received 81 responses (60%) from 134 programs; 34% of the programs placed more thoracic than lumbar epidurals, 92% of the programs placed epidurals mainly for postoperative pain control, and 88% of programs mainly teach lumbar before thoracic epidurals, whereas only 10 programs (12%) mainly teach residents thoracic before lumbar epidurals. The authors' residents were divided into 2 groups: group 1 (42 residents, 70%) who learned thoracic before lumbar epidurals and group 2 (18 residents, 30%) who learned lumbar before thoracic epidurals during their earlier obstetric anesthesia training. There were no significant differences between the 2 groups in the degree of technical difficulties or the incidence of procedure-related complications. CONCLUSIONS: Thoracic epidurals are widely taught in the United States. Most programs teach lumbar before thoracic epidurals. Thoracic epidurals are safe to teach without prior experience with lumbar epidurals.