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BACKGROUND: With the prevalence of antibiotic use, the diagnosis and management of Clostridium difficile disease requires assessment. METHODS: In a retrospective review, patients with; a positive culture, toxin, or both during 1 year were identified. Recent literature was reviewed. Results of culture and toxin, prior antibiotic use, antibiotic treatment history and cost were analyzed. RESULTS: Of 592 patients tested, 101 were positive; 96 of 101 were available for review. Of those positive tested for both, 45% were positive for toxin and culture. Sixty-two of 96 were treated with antibiotics; metronidazole was used in 90%. Ten of 62 antibiotic treatments were changed (mean 3 days). Ten days of metronidazole is 1/200th the cost of vancomycin. CONCLUSIONS: In 55% of the positive cases in which culture and toxin were obtained, one test was negative. As metronidazole's efficacy and cost compares favorably with vancomycin, metronidazole is the drug of choice. Any changes made to antibiotic regimens occurred prior to the 6 days recommended in the literature. Am J Surg. 1998;175:403-407. [C] 1998 by Excerpta Medica, Inc.

A bolus method for noninvasive measurement of cardiac output (CO) and mixed venous oxygen content (Cv¯O2) has been tested against absolute CO andCv¯O2standards in dogs. No statistical differences in CO were found between bolus method and electromagnetic flowmeter measurement comparisons in an 18-dog study in which CO varied from 0.5 to 3.0 l/min. The SD for all paired differences was 0.14 l/min; however, data averaging over 10-min intervals were found to reduce the CO measurement uncertainty to <0.08 l/min. The ability of the bolus method to follow rapid CO changes, experimentally produced by control of a pump (surgically placed between the superior and inferior vena cava and the right atrium), was documented and found to satisfy CO monitoring requirements of unstable subjects.Cv¯O2bolus values were found to be statistically equivalent to reference measurements.