Postal survey of paediatric practice and training among consultant anaesthetists in the UK

A postal survey of previous paediatric anaesthetic training,current paediatric experience and man agement of an infant pyloromyotomywas under taken among consultant anaesthetists in the UK. Atotal of 851 questionnaires were returned, giving a responserate of 31%; 352 (41%) consultants had at least one paediatriclist each week, 180 (21%) anaesthetized more than one infantless than 6 months old each month and 373 (44%) had obtainedmore than 6 months' specialist training. Consultants trainedmost recently had received significantly longer (P<0.001)specialist training than their senior colleagues: 558 (66%)consultants dealt with infants requiring a pyloromyotomy, 348with one or two cases annually. Two-thirds preferred to usean i.v. induction technique and less than half used cricoidpressure. Choice of technique was related to the duration ofspecialist paediatric training and when it was received, butnot to current paediatric anaesthetic experience. The resultsare discussed in relation to recently published recommendationson paediatric anaesthetic services.     

Acute tubulointerstitial nephritis,treatment with steroid and impact on renal outcomes

Background: The use and timing of steroids in the management of acute tubulointerstitial nephritis (ATIN) remains debatable. Aims: To determine the incidence and aetiology of ATIN in our unit, and to examine trends in the use of steroids and their impact on renal outcomes. Methods: Patients with a histological diagnosis of ATIN over a 9‐year period were identified and divided into steroid‐treated (StG) and steroid‐naïve groups (SnG). Mean change in estimated glomerular filtration rate (eGFR) was determined. Results: Forty‐nine patients had ATIN as their main diagnosis, 67% of cases were drug‐induced, and proton pump inhibitors (PPI) were the second commonest implicated drug category. Majority (75%) of patients received steroids, and eGFR improved to a significantly greater degree in these steroid‐treated patients (3.4‐fold improvement vs 2.0‐fold in SnG; P < 0.05, unpaired t‐test). Despite comparable eGFR at presentation (StG: 11.7; SnG: 15.4), steroid‐treated patients were less likely to receive dialysis, although not significantly so (OR 0.27; 95% CI 0.06–1.15, P = 0.066, chi‐squared test). However, there was no significant relation between the degree of eGFR improvement and delay in starting steroids (Pearson r = ?0.25, P > 0.45), and no difference in eGFR at the time of last follow‐up (StG: 33 ± 3; SnG: 32 ± 7; P > 0.9, unpaired t‐test). Conclusion: StG patients had a greater degree of improvement in renal function, but with no correlation between degree of improvement in eGFR and delay in starting steroids, and similar eGFR values at final follow‐up. PPI were the second commonest drug category among drug‐induced cases.     

Aspects of dietary survey methodology

The measurement of the dietary intake of individuals is one of the prime requisites of the nutritional sciences. However, considerable care is needed in the use of various methods for assessing dietary intake in order to avoid the substantial errors that can be introduced. The sources and magnitude of errors associated with each stage of dietary assessment are reviewed and their implications for the testing of hypotheses concerning diet and disease in free living individuals is discussed.     

Pre-admission assessment clinics: an answer to non-attendance for ENT operations

Non-attendance by patients for elective surgery with insufficient time to find replacement leads to wasted theatre time and wasted resources. The introduction of pre-admission clinics at the North Riding Infirmary, Middlesbrough has alleviated this problem and has led to considerable financial savings. A 12 month prospective study has shown an increase in operations performed from 3738 to 3944. Financial savings have not been taken into consideration in this publication.     

Anogenital warts in children

Fourteen children presenting with anogenital (AG) warts and their close family members were studied; 28.6 and 8.3% of presenting children and other child household members, respectively, had non-genital cutaneous warts; 42.8% of children with AG warts had one or more adult household member with common hand warts. Fifty per cent of all mothers had subclinical cervical papilloma virus (PV) infection; only one male adult had subclinical PV infection of the penis without concurrent AG warts. Of the children with AG warts 42.8% had one or more adult household member with AG warts. Human papilloma virus (HPV) deoxyribonucleic acid (DNA), type 6/11 most frequently, was detected in 38.5% AG wart biopsies from children, and 67% AG wart biopsies from adults. HPV 31/33/35 was detected in 28.5% of cervical preneoplasias and type 6/11 in the one case of subclinical PV infection of the penile shaft. Detection of HPV types 6/11, 16/18, or 31/33/35 in AG warts in children was significantly associated with vertical (from an HPV-infected maternal birth canal during vaginal delivery) or sexual transmission of these warts (Fisher exact probability P= 0.031).     

CLINICAL EFFICACY OF TESTOSTERONE UNDECANOATE IN MALE HYPOGONADISM

Testosterone undecanoate (Restandol, Organon Laboratories Ltd * * Andriol, Organan International.
) dissolved in oleic acid, was administered orally to seventy-six hypogonadal males for three consecutive 3-week periods and the subjective clinical response assessed by a standard interview. Plasma testosterone and testosterone undecanoate levels were determined by radioimmunoassay before the study and after 3, 6 and 9 weeks treatment. The treatment was effective in sixty of the sixty-six patients who completed the trial. Ten patients did not complete the trial; two for reasons unrelated to the drug and eight because of side effects, mainly gastro-intestinal. There was a significant rise in plasma testosterone levels during treatment and a positive correlation between plasma testosterone and testosterone undecanoate levels. Testosterone undecanoate is a potentially valuable drug for the oral treatment of male hypogonadism.