Adrenal abscess in the neonate

Adrenal abscess in the neonate is a rare complication of adrenal hemorrhage. The radiographic and clinical findings of 12 previously published cases and two new cases of adrenal abscess in the newborn are presented. Sonography was the most helpful examination in distinguishing a suprarenal lesion from an intrarenal lesion and in demonstrating the morphology of the abscess.     

Socio-economic status and patterns of care in lung cancer

OBJECTIVE: This retrospective study aims to explore the associations between socio-economic factors and lung cancer management and outcomes in the Australian setting. METHODS: The study population consisted of patients who were living in the Northern Sydney Area Health Service (NSAHS) or South Western Sydney Area Health Service (SWSAHS) at the time of their lung cancer diagnosis in 1996. Data on patient demographics, tumour characteristics, management details, recurrence and survival were collected and compared between the two areas. Socio-economic status indicators of the two Area Health Services were obtained from the Australian Bureau of Statistics. RESULTS: There were 270 and 256 new cases of lung cancer identified in NSAHS and SWSAHS respectively. Patients in NSAHS were slightly older and there were more women. Based on the 1996 Census data, the population of NSAHS is more affluent, better educated and more likely to be employed compared with SWSAHS. The stage distributions and performance status of the two areas were similar. The utilisation rates of different treatment modalities in the two areas were similar except for chemotherapy. The five-year overall survival rate was 10.5% in NSAHS and 7.2% in SWSAHS (p=0.08). Comparison based on the SEIFA Index of Relative Socio-economic Disadvantage did not reveal significant differences. CONCLUSION: Patients with lung cancer had similar patterns of care and survival despite differences in socio-economic profiles between the two Area Health Services. IMPLICATION: There seems to be equity of access to lung cancer services between the two Area Health Services.     

Non-multiresistant and multiresistant methicillin-resistant Staphylococcus aureus in community-acquired infections

OBJECTIVE: To survey Staphylococcus aureus strains isolated from patients presenting from the community, comparing clinical features and antibiotic sensitivity profiles between multiresistant and non-multiresistant methicillin-resistant and methicillin-sensitive isolates. DESIGN: Retrospective case series. PARTICIPANTS AND SETTING: Patients who presented to emergency or dermatology departments in hospitals served by the South Western Sydney Area Health Service between 1 May 1998 and 30 April 1999. All patients with methicillin-resistant S. aureus (MRSA) and the first 100 with methicillin-sensitive S. aureus were eligible. MAIN OUTCOME MEASURES: Patient demographic characteristics; risk factors; clinical presentation; treatment; outcome; and isolate antibiotic susceptibility. RESULTS: 139 patients were eligible, and 122 had clinical records available. Ten of these 122 (8%) had multiresistant MRSA, 26 (21%) non-multiresistant MRSA and 86 (70%) methicillin-sensitive S. aureus. Among patients with non-multiresistant MRSA, 29% (7/24) were born in New Zealand, Samoa or Tonga, a higher proportion than among those with multiresistant MRSA or methicillin-sensitive S. aureus (P= 0.03). Nearly half (44%) of non-multiresistant MRSA strains were community-acquired in patients with no risk factors. Two-thirds of patients with non-multiresistant MRSA (17/26) presented with cellulitis or abscess, and 58% (11/19 evaluable patients) required surgical treatment. CONCLUSIONS: Non-multiresistant MRSA strains are common, especially among people born in New Zealand, Samoa or Tonga, and are usually community acquired. Medical practitioners should routinely swab all staphylococcal lesions for culture and sensitivity.     

Enlarged gastric folds in association with Campylobacter pylori gastritis

Enlarged gastric folds in pediatric patients are uncommon. Fifteen patients with upper gastrointestinal (GI) tract symptoms of chronic epigastric abdominal pain, vomiting, or hematemesis underwent radiologic upper GI barium studies and were found to have Campylobacter pylori gastritis at endoscopic biopsy. Seven patients (47%) with C pylori gastric disease had radiologic evidence of enlarged folds. There was no clinical or pathologic evidence of Ménétrier disease. Therefore, C pylori gastritis should be considered in the differential diagnosis of children with upper GI tract symptoms and radiologic evidence of enlarged folds.     

An assessment of basic treatment equivalent at Cookridge Hospital

The Australian model of Basic Treatment Equivalent (BTE) for measuring radiotherapy treatment productivity was developed for and tested within a busy UK radiotherapy centre and the results assessed against three other BTE models. The department's productivity was compared for three different models of treatment machine. Treatment fraction durations were timed for 362 consecutive treatment episodes on three treatment machines at Cookridge Hospital. Leeds. The treatment factors found to have a statistically significant impact on fraction duration were: initial fraction; patient mobility; number of fields; treatment intent and the type of treatment machine. In comparison with the Australasian study, shorter mean fraction times were shown for a number of types of treatment, carried out on one particular linac type, which had multileaf collimation (MLC). The average non-operational time was 17% at Cookridge (31% in Australasia) with overall productivity gains. This efficiency may have been achieved partly by a higher number of staff per machine (five rather than four) and the presence of newer technology such as MLC. A BTE model was derived for Cookridge using the significant treatment factors and compared to other published models. The Cookridge model was most sensitive in predicting productivity. BTE models developed by other groups were also excellent in predicting treatment duration. The development of a BTE model is potentially applicable in the U.K. radiotherapy community at a time when optimizing activity per radiographer is key to minimizing waiting times.