Mismatch between suspected pyelonephritis and microbiological diagnosis: a cohort study from a UK teaching hospital.

Urinary tract infections are a common reason for prescribing empirical antibiotics in the emergency department. This study investigated the role of microbiological culture and urinalysis in the diagnosis of pyelonephritis by extracting data on 105 patients with a clinical diagnosis of pyelonephritis at a London teaching hospital. In total, 99 of 102 patients were treated empirically with intravenous antibiotics, but only 55 of 100 patients who were sampled had microbiological evidence of infection in urine and/or blood. Almost half (10/21) of the patients with a negative urine dipstick test had a positive urine culture. Diagnostic uncertainty in this context undoubtedly drives inappropriate antibiotic use.

Advanced colorectal cancer is associated with impaired interleukin 12 and enhanced interleukin 10 production.

Interleukin 12 (IL-12) is a heterodimeric cytokine that has been demonstrated to have a major role in stimulating a cell-mediated antitumor response. IL-10, a product of T helper 2 lymphocytes, is its most potent inhibitor. The aim of this study was to investigate whether patients with colorectal cancer had an imbalance in production of IL-12 and IL-10 preoperatively, and whether this was associated with advanced disease at surgery. Blood was obtained before surgery from 60 patients with colorectal cancer and from 30 controls. Peripheral blood mononuclear cells were incubated with Staphylococcus aureus Cowan's strain 1 in vitro for 24 h to assess IL-12 expression after stimulation, and serum was used for IL-10 measurement. IL-12 and IL-10 levels were assessed by ELISA. A single pathologist staged the tumors according to the tumor-node-metastasis (TNM) and Dukes' classifications. Patients with colorectal cancer had significantly lower levels of IL-12 (P <0.001) and higher levels of IL-10(P = 0.004) compared to controls. In addition, lower levels of IL-12 were detected in those patients who were node positive (P<0.05), had Dukes' C lesions (P < or = 0.001), and T3 or T4 lesions (P<0.033) when compared to controls. Patients with Dukes' B and C lesions (P<0.01) and T3 and T4 lesions (P<0.05) also had higher levels of IL-10 compared to controls. This study is the first to demonstrate that patients with colorectal cancer have decreased IL-12 production and increased serum IL-10. This suggests an impaired T helper 1 cell-mediated antitumor response and provides some justification for exogenous IL-12 therapy or anti-IL-10 therapy in these patients.

Factors affecting rehospitalisation rates of chronic schizophrenic patients living in the community.

Eighty-eight [corrected] patients selected from a depot neuroleptic clinic in the hospital outpatients department were assessed clinically on various demographic and clinical variables with a view to determining the factors that may contribute to high rates of rehospitalisation amongst schizophrenics in remission. It was found that rehospitalisation rates during the preceding 5 years correlated with an early age of onset of illness, severity of positive and affective symptoms, current neuroleptic dose and total AIMS score, all reflecting the severity of underlying psychotic disorder and the neuroleptic treatment required to treat the psychosis. Poor compliance with neuroleptic prophylaxis was not found to be of importance in contributing to high relapse rates in this sample. It was concluded that patients who repeatedly relapse may do so because of the clinical characteristics of their illness.

Differences between chronic schizophrenic patients in the hospital and in the community.

Clinical differences between stable, chronic schizophrenic patients with long stays in the hospital and schizophrenic patients living in the community were investigated. Patients were matched for age, gender, and diagnosis. Hospitalized patients had more severe thought disorder and negative symptoms, and those in the community had a significantly higher incidence of depression and anxiety. The community-based patients were also receiving higher doses of neuroleptic drugs and had a higher incidence and severity of extra-pyramidal side effects. Results suggest that living in the community, despite its obvious benefits, may have its price in terms of the distressing effects of affective symptoms and neuroleptic side effects.

Prevalence and characteristics of at-risk drinkers among a health visitor's caseload.

There has been a steady rise in alcohol consumption in the UK over the past 40 years. There is now plenty of evidence that this increase has been greatest in women and young people. Among young women excessive drinking leads to a variety of physical, mental and social problems of direct relevance to a health visitor who is concerned with the health and well being of her clients and their children. However the assessment of alcohol consumption is often not recognised as a part of the health visitors' role and no study was found which looked at the levels of alcohol consumption among a health visitors caseload. The aims of this study were to determine the amount of alcohol consumption in this group of people and to look at factors associated with heavy alcohol use.