Simple peroperative antimicrobial chemoprophylaxis in elective neurosurgical operations.

From August 1981 to February 1982 postoperative infections due to different strains of penicillin-resistant Staphylococcus aureus occurred in 20 of 467 patients (4.3%) undergoing elective cranial and spinal operations. These infections were not attributable to defects in procedures or the theatre environment, therefore chemoprophylaxis was instituted. In the following 8 months, when patients were given penicillin G and sulphadiazine for 5 days commencing immediately postoperatively, S. aureus infections occurred in five of 579 patients (0.9%). In a subsequent randomized uncontrolled study, infections occurred in six of 265 patients receiving penicillin (2.3%), three of 270 receiving penicillin and sulphadiazine (1.1%) and one of 45 receiving erythromycin (2.2%) immediately postoperatively for 5 days. In a further study in which 587 patients received penicillin for 5 days commencing immediately preoperatively, infections due to S. aureus occurred in six (1.1%). Infections due to gram-negative organisms were seen in five (0.4%) of 1167 patients in the two uncontrolled studies.

Five days versus one day of penicillin as prophylaxis in elective neurosurgical operations.

Of 423 patients undergoing elective cranial and spinal operations, infections due to Staphylococcus aureus occurred in 3 of 217 (1.4%) receiving penicillin for 1 day, in none of 206 receiving penicillin for 5 days. There was no significant difference in rates of infection between the two groups receiving penicillin. It is concluded that penicillin for 1 day is as effective as penicillin for 5 days, in the prevention of wound infections due to S. aureus.

Focal infections of the central nervous system due to Propionibacterium acnes.

Propionibacterium acnes as the single cause of intracranial infections has rarely been described. We present four patients in whom the infection arose as a result of a breach of skin tegument, and postulate that P. acnes is an under-recognised pathogen.

Amelogenesis imperfecta phenotype-genotype correlations with two amelogenin gene mutations.

Amelogenin, the predominant matrix protein in developing dental enamel, is considered essential for normal enamel formation, but its exact functions are undefined. Mutations in the AMELX gene that encodes for amelogenin protein cause X-linked amelogenesis imperfecta (AI), with phenotypes characterized by hypoplastic and/or poorly mineralized enamel. Eight different AMELX deletion and substitution mutations have been reported to date. The purpose here was to evaluate the genotype and phenotype of two large kindreds segregating for X-linked AI. Phenotypically affected males in family 1 had yellowish-brown, poorly mineralized enamel; those in family 2 had thin, smooth, hypoplastic enamel. Heterozygous females in both kindreds had vertical hypoplastic grooves in their enamel. DNA was obtained from family members; exons 1-7 of AMELX were amplified and sequenced. Mutational analysis of family 1 revealed a single-base-pair change of A-->T at nucleotide 256, resulting in a His-->Leu change. Analysis of family 2 revealed deletion of a C-nucleotide in codon 119 causing a frameshift alteration of the next six codons, and a premature stop codon resulting in truncation of the protein 18 amino acids shorter than the wild-type. To date, all mutations that alter the C-terminus of amelogenin after the 157th amino acid have resulted in a hypoplastic phenotype. In contrast, other AMELX mutations appear to cause predominantly mineralization defects (e.g. the mutation seen in family 1). This difference suggests that the C-terminus of the normal amelogenin protein is important for controlling enamel thickness.

Microvascular reconstruction of complex craniofacial defects.

Many large vault or skull base tumours are best treated by wide surgical excision and primary reconstruction using a microvascular free tissue transfer (free flap). We report 23 patients who were reconstructed using free flaps, eight having been previously treated surgically elsewhere and seven of whom had recurrent disease after radiotherapy. There was one flap failure and a local recurrence rate of 16% (3/19). The outcome at a mean follow-up period of 29 months, was 19 patients alive and four deaths.

The use of adhesively retained gold onlays in the management of dental erosion in a child: a 4-year case report.

Tooth erosion, particularly in young people, presents a considerable challenge to restorative dentistry. A case of a 12-year-old is described where the use of minimal tooth preparation, precious metal onlays and a 4-META bonding system, together with dietary counselling, have provided a satisfactory result over 4 years.

Massive giant cell epulis in a child with familial cyclic neutropenia.

A case of a boy with familial cyclic neutropenia and a large giant cell epulis is reported. The clinical management is described and the significance of the neutropenia in relation to subsequent infection of the epulis is discussed.

Dental care for the patient with a cleft lip and palate. Part 2: The mixed dentition stage through to adolescence and young adulthood.

This is the second of two articles looking at dental care for the patient with a cleft lip and palate. Part 1 looked at the needs of the child from birth through to the mixed dentition stage. Part 2 looks at dental care from the mixed dentition stage through to adolescence and young adulthood.

Dental care for the patient with a cleft lip and palate. Part 1: From birth to the mixed dentition stage.

This is the first of two articles looking at dental care for the patient with a cleft lip and palate. Part 1 looks at the needs of the child with a cleft lip and palate from birth through to the mixed dentition stage.

A randomised trial of calcium alginate swabs to control blood loss in 3-5-year-old children.

OBJECTIVE: To compare the effectiveness of calcium alginate swabs and traditional cotton swabs in the control of blood loss after extraction of deciduous teeth from healthy children, aged 3-5 years, under general anaesthetic. DESIGN: Prospective, randomised clinical trial. SETTING: General anaesthetic suite in a dental teaching hospital. SUBJECTS: 101 patients were recruited to the study, comprising 50 randomised to be treated with cotton swabs and 51 with alginate swabs. INTERVENTIONS: Teeth were extracted under general anaesthesia and blood collected for measurement in order to compare blood loss using the two systems. MAIN OUTCOME MEASURES: The number of teeth extracted ranged from 1-14. The total blood loss ranged from 0.53-78.13 ml with a median of 12.9 ml. CONCLUSION: Calcium alginate swabs were not found to produce any clinical or statistical advantage over traditional cotton swabs in this surgical setting.

From here to accountability: securing healthy rivers.

While specifying "responsibilities" for river planning and management implies that outcomes are desired, defining "accountabilities" demands that results are achieved. This paper examines innovative ways of converting aspirations to results, with particular reference to the changes initiated in New South Wales in response to the establishment of the Healthy Rivers Commission of New South Wales and its first round of inquiries.

Recreational overdosage of carbamazepine in Paisley drug abusers.

Oral drug abuse is a major social and medical issue. Paisley, in the West of Scotland, has become infamous for its problem with oral temazepam abuse. With the crack down on the prescription of temazepam in our area and the resultant lack of its supply on the streets, drug abusers appear to be experimenting with new drugs for their psychotropic effects. We report five cases of recreational carbamazepine overdosage in young temazepam abusers.

Guidelines for taking radiographs of children.

Dental radiographs are required for monitoring many aspects of the dental care of children. This article reviews the current guidelines for taking dental radiographs of children, with particular reference to diagnosing caries, monitoring growth and development and managing trauma. There are a number of practical difficulties in taking radiographs of this age group, which are also discussed. The use of selection criteria to assist the clinician in choosing the optimal radiograph examination is recommended.