Aspiration drainage of splenic abscesses

The successful use of guided percutaneous needle aspiration in the management of four patients with solitary splenic abscess is described. Two patients had needle aspiration alone and two patients, with large splenic abscesses, had drainage tubes inserted. The procedures were well tolerated and allowed rapid microbiological diagnosis with selection of appropriate antibiotic therapy. The techniques were useful in patients felt to be poor anaesthetic risks, and the complications of splenectomy were avoided.     

LIMITATIONS OF RADIOTHERAPY IN THE DEFINITIVE TREATMENT OF SQUAMOUS CARCINOMA OF THE TONSILLAR FOSSA

Between 1970 and 1990, 104 patients with squamous cell carcinoma (SCC) of the tonsil were treated. The median age was 58 years and 80% of patients were males. Distribution among clinical stages was: stage I, 19 patients; stage II, 12 patients; stage III, 23 patients; and stage IV, 48 patients. More than 70% of patients had initial radiotherapy as definitive treatment irrespective of stage, reflecting the treatment philosophy over much of this period. The overall survival rate was 26% at 5 years, with survival being significantly affected by T stage, clinical stage and age. Clinical node status did not significantly affect survival rates. Good local control of T₁N₀ cancers was achieved with radiotherapy alone, but patients with more advanced cancers did poorly. We have now moved away from a non-selective policy and use initial surgery combined with postoperative radiotherapy in most patients, reserving radiotherapy alone for mainly early tonsil cancers.     

Combination of ABO blood group incompatibility and glucose-6-phosphate dehydrogenase deficiency: effect on hemolysis and neonatal hyperbilirubinemia

The incidence (%) of hyperbilirubinemia (serum bilirubin ≥257 μmol/l) was similar in neonates with a combination of ABO incompatibility and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency (45%), with ABO incompatibility (54%) or G-6-PD deficiency (37%), alone (ns). Carboxyhemoglobin values, corrected for inspired CO, were similarly elevated in all three groups (0.87 ± 0.32%, 0.82 ± 0.29%, 0.76 ± 0.18%, respectively, ns), but correlated with bilirubin only in those with ABO incompatibility alone. ABO-incompatible/G-6-PD-deficient neonates, compared with those with either condition alone, are not at increased risk for hemolysis or hyperbilirubinemia.     

Providing welfare rights advice in primary care

OBJECTIVE: To evaluate the introduction of dedicated open access welfare rights advice sessions in a general practice setting. DESIGN: A retrospective study of 416 client visits over a 11 month period from August 1995. A prospective questionnaire survey of 34 attendees over a three month period from April 1996. Semi-structured interviews with 11 involved primary care staff. SETTING: An inner city health centre. OUTCOMES: Social characteristics of clients attending; problems presented; benefit uptake; views from the health centre staff and welfare rights advisers and comments on future development. RESULTS: A total of 270 new clients used the service during the study period with 146 repeat visits (35%). Of the new clients, 158 out of 270 (59%) reported that they were disabled and 50% of the 158 had specific disability based welfare rights enquiries. 15% of new clients (40 out of 270) were found to be owed money by the current benefit system. Of these, 24 clients obtained one-off payments totalling ?15,863 and 16 clients obtained regular payments totalling ?539 a week. 58% of interviewed clients had not previously accessed any welfare rights advisory services. The welfare rights service was considered by the primary health care team to be a very useful contribution in a highly deprived area. CONCLUSIONS: The advice service increased the uptake of social security benefits in 15% of all new attendees. An open access service may not have been the most efficient method of delivering such advice. However, the high proportion of new clients who reported having a disability suggested that a health centre setting may be particularly accessible for those reporting disability. Further work is required to explore these findings and the most effective and efficient method of delivering the service in a deprived inner city setting.