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Review of an annual series of cases of empyema seen at a regional cardiothoracic unit showed that six out of 25 were due to Streptococcus milleri. The details of the cases are summarised. This organism is now an important cause of empyema, occurring much more commonly in men than in women; but since it is highly sensitive to penicillins permanent resolution can be achieved with antibiotic treatment combined with open or closed drainage. [ABSTRACT FROM PUBLISHER]

The article presents two case reports concerning the treatment of symptomatic arterial disease in the amputated limbs. A certain 51-year-old man, who was fully mobile with a prosthesis in 2001, is noted to have been presented with claudication but denied the pain. On the other hand, a man of the eighties is believed to have presented with continual pain after the knee amputation he received after a road traffic accident in 1994.

Infection in hospitals is a serious problem. Attempting to address the spread of infection, many UK National Health Service trusts have adopted a 'bare-below-the-elbows' and tie-less dress-code policy. This followed publication of Department of Health guidelines on staff uniforms in September 2007. Although the potential for colonisation of clothing with pathogens has been investigated, patients' opinions on dress-code and policy change have not. This survey of 75 patients in Great Western Hospital, Swindon, UK, used questionnaires to address this. The survey showed that, although patients did feel that doctors' dress was important, neckties and white coats were not expected. Moreover, surgical scrubs were considered acceptable forms of attire. Problems of identifying doctors and determining their grade were repeatedly raised. Patients were generally unaware of the new dress-code, and few knew anything of its relationship to infection control. This work demonstrates that more 'traditional' dress is not expected. Given the problems of identification and perception of surgical scrubs as suitable, their introduction as a 'uniform for doctors' should be considered. Furthermore, work needs to be done to advertise policy change and increase patient awareness of infection control., (Copyright 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.)

It is often accepted by hospital staff that patients would prefer to be at home for the Christmas and Easter holiday periods. This is one of the reasons that elective surgery is reduced at these times. However there is very little evidence to prove whether this is true. To investigate this question 310 patients attending surgical or urological outpatients were given a self completion questionnaire asking them whether they would accept admission over these holidays if offered it. Overall 77 per cent of males and 76 per cent of females would accept admission over the Christmas period for elective surgery. This rises to 87 per cent and 88 per cent over the Easter period. Older patients, widows or widowers, retired patients and patients with subjectively severe symptoms and conditions were groups that independently accepted such admissions more readily than others. Contrary to the perceived opinion in hospital staff, in this sample of surgical and urological patients most patients appear willing to accept admission for elective surgery over the Christmas or Easter holiday periods.

Objective: To investigate factors influencing a general practitioner's decision to do a rectal examination in patients with anorectal or urinary symptoms., Design: Postal questionnaire survey., Setting: General practices in inner London and Devon., Subjects: 859 General practitioners, 609 (71%) of whom returned the questionnaire., Main Outcome Measures: Number of rectal examinations done each month; the indication score, derived from answers to a question asking whether the respondent would do a rectal examination for various symptoms; and the confidence score, which indicated the respondent's confidence in the diagnosis made on rectal examination., Results: 279 General practitioners did five or fewer rectal examinations each month and 96 did more than 10 each month. Factors significantly associated with doing fewer rectal examinations were a small partnership and being a female general practitioner, and the expectation that the examination would be repeated. Lack of time in the surgery, and a waiting time of less than two weeks for an urgent outpatient appointment were also important. General practitioners were deterred from doing rectal examinations by reluctance of the patient (278), the expectation that the examination would be repeated (141), and lack of time (123) or a chaperone (39). Confidence in diagnosis was significantly associated with doing more rectal examinations, the perception of having been well taught to do a rectal examination at medical school, and being a male general practitioner., Conclusions: Factors other than clinical judgment influence the frequency of rectal examination in general practice. Rectal examination may become commoner with the trend towards larger group practices and if diagnostic confidence is increased and greater emphasis put on rectal examination in undergraduate and postgraduate teaching.

The influence of a peroperative prostaglandin E1 (PGE1) infusion on systemic and pulmonary haemodynamics in a porcine model of aortic surgery was studied. Twenty-four pigs were randomised to PGE1 (100 ng/kg/min) or 0.9% Saline as placebo. Haemaccel was then infused to maintain a central venous pressure (CVP) of greater than 4 less than 6 mmHg and pulmonary artery wedge pressure (PAWP) of greater than 3 less than 5 mmHg. Standardised aortic surgery consisted of midline laparotomy, small bowel exteriorisation, 1.5 h aortic clamping and 1 h shock before resuscitation. Serial measurements of blood pressure (BP), cardiac output (CO), pulmonary vascular resistance (PVR), pulmonary shunt (A-V shunt), and arterial PO2 (PaO2) were recorded during and three days after surgery. Volume loading with Haemaccel prevented a significant fall in initial BP on PGE1 at 95.1 +/- 48 mmHg compared to 102 +/- 4.9 mmHg in control animals with similar CO in the two groups. Following release of the aortic clamp all animals became profoundly hypotensive with BP falling to 74.6 +/- 3.0 and 68.7 +/- 3.2 mmHg for PGE1 and placebo respectively, but CO was protected in those animals receiving PGE1 at 1.92 +/- 0.04 compared to 1.67 +/- 0.1 L/min/m2 on placebo and remained significantly higher following resuscitation and three days later (P less than 0.05). PGE1 also reduced the marked rise in pulmonary vascular resistance to 922 +/- 84 dynes-s/cm5/m2 during shock in control animals to only 555 +/- 30 (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

A 69-year-old man presented with a 20-year history of a slowly enlarging mass of the left index finger dating from a hammer injury. The mass was excised, and seen to have the characteristic histological appearance of an elastofibroma, a benign tumour-like growth usually found in the soft tissue of the back. Such a lesion has not previously been documented in the hand, which we consider surprising in view of the generally accepted traumatic aetiology of this entity and the susceptibility of the hand to injury.