Is screening for bacteriuria in pregnancy worth while?

A total of 4470 pregnant women were screened for bacteriuria by the dipslide method and significant growth found in 226 (5.1%). In 198 cases the urine was re-examined, in 119 by using suprapubic aspiration or catheterisation (62 (52%) samples contained bacteria) and in 79 by using midstream urine samples (26 (33%) samples contained greater than 10(8) colony forming units/1), showing the maximum prevalence of confirmed bacteriuria to be 2.6%. Overt urinary tract infection developed later in four of 80 patients with proved bacteriuria who had been given antibiotics, in one of eight untreated patients with bacteriuria, in one of 110 patients with unconfirmed bacteriuria, and in one of 226 non-bacteriuric controls. A history of urinary tract infection was given by 18% of controls and 42% of women with confirmed bacteriuria. Screening for bacteriuria and treatment with antibiotics to prevent later overt infection is expensive. Whether it is worth while and cost effective depends largely on the prevalence of bacteriuria in the local population and the proportion who develop overt infection. The screening and treatment programme reported here appeared to prevent only six cases of overt infection.     

Comparison between ankle and toe index in patients with peripheral arterial disease

In contrast to the systolic blood pressure at the posterior tibial artery, the evaluation of pressure at the digital artery of the foot before and after exercise in patients with peripheral arterial disease is not well known. Twenty three patients with peripheral vascular disease were examined. The systolic pressure was measured by means of an ultrasound velocity detector at the brachial and posterior tibial artery. Digital artery pressure was determined with photoplethysmography. Pressures were measured before and within 5 and 10 minutes after a treadmill test. Ankle and toe index was calculated. At rest the toe index is lower than the ankle index and after a treadmill test the decrease in toe index occurs in parallel to the ankle index.     

Marked hypodiploidy in blast phase chronic myelogenous leukemia: report of a case and review of the literature

The emergence of a near-haploid clone of cells in blast phase chronic myelogenous leukemia is an unusual event. We report such a case and review eight other cases described in the English literature. The significance of the substantial loss of genetic material is discussed as is the phenotypic and genotypic heterogeneity observed in this group of patients.     

Psychotropic prescribing patterns of nonpsychiatric residents in a general hospital in 1973 and 1982

The findings of a study of the frequency and type of psychotropic drugs that nonpsychiatric residents prescribed for nonpsychiatric patients in a teaching hospital in 1982 were compared with the findings of a similar study in the same hospital nine years earlier. The overall percentage of patients receiving psychotropic drugs remained almost the same, at less than 10 percent. However, in 1982 residents prescribed antidepressants almost four times as often as in 1973, and the use of antianxiety agents decreased. Deficiencies in chart documentation of psychotropic prescribing and the tendency to use conservative dosages remained unchanged from the earlier study.     

Carcinoma of the gallbladder

Gallbladder carcinoma is the fourth commonest gastrointestinal malignancy. Its growth is insidious and the majority of cases are advanced at the time of diagnosis. The recognized radiological features occur only in those with advanced disease. Cholecystectomy may be curative when carcinoma is confined to the gallbladder but the place of extensive surgery, chemotherapy or radiotherapy is unproven.