Inappropriate use of antibiotics in croup at three types of hospital.

Despite recent suggestions that bacterial infection is an increasingly important cause of serious croup, most authorities still consider croup a viral disease in which antibiotic therapy is unnecessary. To assess the frequency of antibiotic use in croup among children in hospital, we reviewed the records at three types of hospital in Ontario. Children with evidence of a concurrent infection that might be bacterial were considered to have received antibiotics appropriately. Whereas only 6% of cases at a university-affiliated children''s hospital were inappropriately treated with antibiotics, the proportions at a small rural community hospital staffed by general practitioners and a general hospital staffed by both pediatricians and general practitioners in a medium-sized city were 63% and 38%. Possible reasons for these differences are discussed.     

Tuberous sclerosis: case report and investigation of family members

Familial tuberous sclerosis probably occurs more often than is indicated by the literature: many family members show signs of being carriers of the gene for the disease when carefully examined. This article reports on a family with documented tuberous sclerosis in three generations and discusses the examination and investigation of at-risk family members, including the newborn, for signs of the disease. The potential teratogenic effects of anticonvulsants, used to control seizures in tuberous sclerosis, are also discussed.     

The Pancreozymin-Secretin Test After Partial Gastrectomy

The administration of pancreozymin and secretin to eight control patients and 18 patients after partial gastrectomy caused no rise in serum amylase levels above normal. Four postgastrectomy patients had unexplained elevations of basal serum lipase levels but in only one did the lipase increase above the basal level after stimulation.Duodenal aspirates from the control group and from one patient with a Billroth I gastrectomy showed a wide range of values for volume, bicarbonate and amylase content. This would appear to limit the diagnostic value of the test. The two-tube method used for collecting duodenal contents proved difficult.