Updated treatment for influenza A and B.

Influenza causes significant morbidity and mortality and is responsible for considerable medical expenditures. Vaccination is the most effective public health measure to combat this illness. Amantadine and rimantadine are older antiviral agents that have been important adjuncts in the prevention and treatment of influenza A outbreaks. Zanamivir and oseltamivir are newer agents indicated for the treatment of both influenza A and B. For antiviral agents to be effective, they must be used within 48 hours of the onset of influenza symptoms. Antiviral agents reduce the duration of fever and illness by one to two and one-half days and also reduce the severity of some symptoms. Use of amantadine or rimantadine is appropriate if influenza virus A is known to be the predominant agent in a particular year or location. Data need to be evaluated on the development of resistance and use of the newer antiviral agents in geriatric patients, high-risk patients and children. For optimal use of antiviral agents, patients with influenza symptoms must present early, and family physicians must accurately and rapidly diagnose the illness.

Routine thyroid function tests as a case-finding tool.

A comprehensive, multiphasic blood panel was used as a case-finding tool for 738 patients. The thyroid function tests T4 (total thyroxine), rT3U (resin T3 uptake), and FTI (free thyroxine index) were included in this panel. Among the 711 patients found to be clinically euthyroid without known thyroid disorder, 54 had at least one abnormal parameter. Of these patients, four new diagnoses of thyroid dysfunction were made. All four cases had an abnormal T4 and FTI. Two patients had a slightly elevated FTI and normal T4, and have remained clinically euthyroid. All other patients had a normal FTI, and no thyroid dysfunction was noted. This gives FTI in this study a sensitivity of 1.0 and specificity of 0.993, which is camparable to what others have found (1). The prevalence of unsuspected thyroid dysfunction was 0.56 per cent, again comparable to other studies (1-3). It would seem the high sensitivity/specificity of FTI offsets the relatively low prevalence of unsuspected thyroid dysfunction. Since FTI is a sensitive predictor of thyroid dysfunction, consideration should be given to the inclusion of thyroid function studies in existing multiphasic case-finding panels.

A new look at the multifactoral etiology of gallbladder disease in children.

The etiology of gallbladder disease in children is multifactoral. Seven of these factors are fairly well known: obstruction of biliary ductal system, hemolytic disease, estrogen effect, obesity, familial, metabolic, and stress related. Our biggest group of patients, 19 out of the total 61 or 31 per cent, were found to have had prior abdominal/renal surgery or partial bowel obstruction. It has been shown that ileal resections result in gallstones due to loss of bile salt absorption; however, volvulus and partial obstruction from adhesive bands have never been incriminated before. A number of teenagers appear to develop acalculous cholecystitis and have symptoms a good many months before stones develop. These patients who have delayed (greater than 36 hours) excretion of oral cholecystogram dye also have positive duodenal drainage studies after cholecystokinin. Gallbladder disease in children is not a rarity as surgical textbooks would lead one to believe.