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Production from wells in organic-rich shales often shows considerable lateral variation. Reliable predrill methods to characterize the lateral heterogeneity of such reservoirs are required to optimize the trajectory of lateral wells in these low-permeability reservoirs. Petrophysical interpretation of measured well logs provides information on mineral, porosity, and kerogen content. Combining the results of petrophysical analysis with P-wave, S-wave, and density logs allows generation of a probability density function (PDF) for each of the different significant lithofacies. The PDFs are applied to the P- and S-impedance from prestack seismic amplitude variation with offset inversion to predict the spatial variation in the distribution of lithofacies and associated probability for the Wolfcamp Formation in an area covered by a 3D seismic survey in the Delaware Basin, West Texas. An anisotropic rock-physics model for the Wolfcamp Formation allows the effect of complex mineralogy, organic carbon concentration, and porosity on the P- and S-impedance to be investigated. Kerogen inclusions and pores act to increase Thomsen’s anisotropy parameter [Formula: see text] relative to [Formula: see text], and there is a competition between clay matrix anisotropy and inclusion shape anisotropy in determining the anisotropy of the rock. Inclusions with isotropic elastic properties act to decrease the anisotropy due to the dilution effect, but this decrease is partially offset by the increase in anisotropy due to the anisotropic shape of the inclusions. Application of the model to the determination of minimum horizontal stress indicates that kerogen-rich siliceous shales have the lowest value of minimum horizontal stress, whereas silica-rich calcareous shales, mixed siliceous shales, and clay-rich siliceous shales have higher values and may therefore act as barriers for the vertical growth of hydraulic fractures.

Minimum horizontal stress (Sh) is the controlling parameter when hydraulic fracture stimulating tight oil formations but is next to impossible to measure quantitatively, especially in the far field and away from the wellbore. In-situ stress differences between bedding planes control fracture containment, which defines the complexity of fracture propagation and fracture geometry including orientation, height growth, width, and length. Geomechanical rock properties define elastic behavior, influencing how the subsurface will deform under induced stress. These properties include dynamic and static Young's modulus, Poisson's ratio, and Biot's coefficient. When combined with pore pressure and overburden stress, the elastic rock properties describe the mechanical earth model (MEM), which characterizes the geomechanical behavior of the subsurface. The MEM also defines key inputs for calculating Sh using the Ben Eaton stress equation, which has been commonly used by geoscientists for decades. However, calculated Sh from this simple model historically produces uncertain results when compared to field-measured stress due to an assumed homogeneous and isotropic subsurface. This is particularly contrary to tight oil formations that represent shale (or mudrock) reservoirs that are highly laminated and therefore anisotropic. Optimal parameterization of fracture geometry models for well spacing and engineered treatment design requires an anisotropic far-field in-situ stress measurement that accurately captures vertical and lateral variability of geomechanical properties in 3D space. A method is proposed herein that achieves this by using a modified version of the anisotropic Ben Eaton stress model. The method calculates minimum Sh by substitution of inverted 3D seismic volumes directly into the stress equation, replacing the bound Poisson's ratio term with an equivalent anisotropic corrected closure stress scalar (CSS) term. The CSS seismic volume is corrected for anisotropy using static triaxial core and is calibrated to multidomain data types including petrophysics, rock physics, geomechanics, and completion and reservoir engineering field measurements.

The Permian Basin in North American has been the driving force behind global energy growth, resulting from the exploitation of unconventional resources. The combination of high quality stacked resources, horizontal drilling, completion tools, and hydraulic fracturing innovations has accelerated the learning curve in this basin over the past few years: which was the impetus of this study. This paper utilizes an integrated model approach to understand reservoir performance on a pad with four wells completed across multiple horizons in the Midland Basin. Rich multi-domain data sets were utilized that included seismic, wireline triple-combo, compressional and shear log suites, core (rock mechanics testing, geochemical analysis (XRF and XRD) and routine core analysis), completion data (fracture treatments with pre-and post-job shut-in pressures), and production data including 1,500 days of production history with bottom-hole pressure gauge data. 3-D surface seismic, high tier logs, and core data were used initially to create a facies model. Properties were distributed into a geo-model using the existing vertical well-control and seismic as constraints. A sector model was then built that enabled modeling of 4 development wells that consisted of parent well, followed by 3 child-wells. The history matching of fracture treatments and production data with bottom-hole pressure data resulted in significant understanding of key parameters driving subsurface performance. A workflow, representing the seamless integration of said models, is presented that enables an improved understanding of what impact sequence and timing of operations has on the subsurface contact area as well as the implied change in well performance if an optimal strategy is executed. Geomechanical facies that drive vertical connectivity and fracture geometry, as well as reservoir parameters that impact fracture contact with the reservoir, were identified.

To update and review novel insights into the mechanisms, measurements, and therapeutic approaches to arterial stiffness. Arterial (e.g., vascular) stiffness has been shown over time to prognosticate for cardiovascular and kidney outcomes. In this context, there has been increased interest behind the mechanisms that drive arterial stiffness beyond aging and interest in how to apply newer technologies in measurement of arterial stiffness. Pulse wave velocity has been the gold standard for measurement but industry has been innovating to improve measurement with use of single-point PWV as well as pharmacologic approaches with anti-hypertensives and oral hypoglycemic agents. Emerging data on the role of the mineralocorticoid receptor, the endothelial sodium channel (EnNaC), and uric acid in arterial stiffness are promising a number of potential therapies. Newer techniques of measuring PWV for arterial stiffness and novel therapies may soon lead to better outcomes from hypertension complications.

Aims: To correct renal anemia, subcutaneous (SC) route of recombinant human erythropoietin (rhuEPO) administration has been associated with increased efficacy and decreased dose requirements, when compared with intravenous (IV) route. The effect of obesity as a potential modifier during rhuEPO administration has not been well explored. Study Design: Single-center, Longitudinal Cohort Study. Place and Duration of Study: University of Mississippi Medical Center Outpatient Dialysis Unit, between February and November of 2009. Research Article British Journal of Medicine & Medical Research, 4(1): 184-193, 2014 185 Methodology: We performed IV to SC rhuEPO conversion for 86 in-center dialysis patients and, following a six-month equilibration period, we monitored outcomes over a period of three months. We obtained baseline demographic parameters, calculated Body Mass Index (BMI) and monitored iron saturation, ferritin, hemoglobin (Hgb) along with rhuEPO requirements. Patients were divided into 3 categories based on BMI [ 35 (n= 21) kg/m]. Results are reported either as percents, means with SD or median with 25-75% interquartile range, as appropriate. Results: The cohort was all African-American, 48.8% male, aged 54.7 (13.3) years and BMI calculated at 29.9 (7.4) kg/m. Baseline iron saturation was 24 (10.6)%, ferritin measured 641 (277) ng/mL. Hgb remained unchanged during the observation period: 11.1 (1.3) vs. 11.2 (1.3) gm/dL. Initial rhuEPO weekly dose for the entire cohort was 19,729 (17,448) Units/week (U/week); final dose 17,482 (14,860) U/week, with close correlation between initial and final doses (r: 0.653, P

Objective: Previous research demonstrates inconsistent effects of hyaluronate (HA) viscosupplementation on patients with knee osteoarthritis (OA). The purpose of this study was to evaluate factors that predict clinical response to a single intra-articular injection of Hylan GF-20. Methods: This was an observational study of 55 patients with knee OA, scheduled to receive intra-articular injections of Hylan GF-20. These patients met the institution’s guidelines for use of viscosupplementation, which entails failure/intolerance of medical management of OA. At baseline, patients completed a series of questionnaires, including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Patient Health Questionnaire (PHQ-9) depression score. Questionnaires were repeated at three months post-injection. A clinical responder was someone with a change in KOOS score which exceeded the mean minimal detectable change (MDC) values calculated based on test-retest reliability coefficients reported in four prior studies. Hypothesized predictors of response included PHQ-9 score, baseline visual analog scale (VAS) pain score, age, body mass index (BMI), and Kellgren score. Results: There were 35 responders and 20 non-responders. There were no statistically significant differences between responders and non-responders for any of the primary predictors. There were no differences for secondary predictors, including history of knee injury or smoking, prior HA injection, prior intra-articular corticosteroid injection, or location of OA. There was a moderate negative correlation between age and change in total KOOS score (r = —0.32, p = 0.01). Conclusions: Our research did not confirm previous predictors of response to hyaluronate injections, and highlighted the need for prospective studies in order to answer this question.

To determine the attitudes, opinions, and current practice of adult outpatient tracheostomy care from the surgeon and primary care physician's perspective.Multidisciplinary physician survey.Found 53.4% (667 of 1250) and 28.9% (404 of 1400) of otolaryngologists and internists responded, respectively; 47% of otolaryngologists lack standardized tracheostomy discharge protocols. General ward nurses most commonly (33%) provide discharge education. A total of 64% of otolaryngologists felt primarily responsible for tracheostomy care and follow-up; 48% expect the primary physician to provide some or all tracheostomy care. Ninety-seven percent of internists received little or no residency training in tracheostomy care, which was significantly associated with decreased comfort (P0.0001) and willingness (P0.0001) to care for these patients.Tracheostomy care is a concerted effort between the patient, surgeon, primary physician, and interdisciplinary team. Otolaryngologists should strive to standardize tracheostomy discharge, education, and follow-up practices.Disparities are highlighted between disciplines in their comfort, willingness, and knowledge of outpatient tracheostomy care.

This study presents the results of an empirical modeling approach using integrated multidisciplinary measurements to optimize completion methodologies and future field development for stacked laterals. The objective is to ultimately high-grade basin-wide exploratory Wolfcamp landing zones from 3D seismic data. Shale mineralogy compositions and geomechanical properties are directly measured from 3D surface seismic data along lateral well trajectories at individual hydraulically stimulated stages which are monitored real-time using microseismic acquisition. Extrapolated lateral synthetic logs from 3D seismic of said shale properties, combined with microseismic and completions data, are numerically modeled to simulate hydraulic fractures for optimal completions design. Successful implementation is critical in landing areas with complex depositional environments characteristic of laterally varying mineralogy compositions and rock mechanics. The method is tested in the prolific oil-bearing Wolfcamp shale-oil play of the Midland Basin, West Texas, on three laterals drilled in a "chevron pattern", two of which in the deeper Wolfcamp B formation and the third in the Wolfcamp A. Real-time microseismic monitoring is used to measure the spatial and temporal evolution of the stimulation. Although identical pumping schedules are initially intended for all three laterals stimulated in a "zipper sequence", with geometric stage placement, it becomes apparent that mapped microseismic height varied significantly across the given laterals at individual stages with no apparent relationship with treatment injection rates. However, post-frac analyses of the microseismic and petrophysical data shows strong correlations between fracture height variability with: 1) lateral changes in shale facies and subsequent mineralogy composition, and 2) P-wave and S-wave log impedances which are ultimately tied to the 3D surface seismic data. Optimal fracture heights are observed in landing areas with significant volume of calcite, regions of high Young's modulus and closure stress. Production history match of those laterals and several others in the field confirms a strong correlation between seismic P- and S-wave impedance and initial 120-day-cumulative oil in landing zones where high volume of calcite exists. Further field development of stacked laterals requires optimal containment of fracture heights within pay zones, requiring an innovative integrated workflow. This involves the incorporation of 3D seismic with microseismic data which should be used to calibrate fracture modeling simulations for an optimized stimulation treatment schedule (i.e., volumes pumped with optimal slurry rates, etc.) Synthetic lateral logs from 3D seismic, representing estimated measurements of petrophysical and geomechanical rock properties can also be used to develop an engineered completion solution for cluster placement and stage spacing.

A 35-year old African-American male with end-stage renal disease on hemodialysis through a tunneled dialysis catheter (TDC) presented with fever, diffuse aches and generalized distress. Blood cultures (BC) were obtained and empirical broad-spectrum antibiotic therapy started. After urgent renal dialysis, TDC was pulled at the bedside. Chest computed tomography (CT) diagnosed pulmonary embolism and systemic i.v. heparin was initiated. BC grew Gram positive cocci (methicillin-sensitive S. aureus) and cardiac echocardiogram confirmed acute bacterial endocarditis. Due to declined mental status, CT imaging was obtained revealing massive intracranial hemorrhage leading to the patient's death. Further chest CT review revealed only hemodynamically non-significant pulmonary emboli in some segmental and subsegmental arteries. Pulmonary embolization may be an expected occurrence with removal of infected TDC; systemic anticoagulation may not be warranted in such cases and may lead to catastrophic intracranial hemorrhage. This case draws our attention to the perils of rigid adherence to protocol and the failure of considering the needs of special patient cohorts and individualized care.

Background In general, there is a good correlation between the specific gravity and osmolality of a urine sample. In certain clinical conditions, such as uncontrolled diabetes mellitus, nephrotic syndrome, after the administration of intravenous radiocontrast material or saline diuresis, dependence upon specific gravity for determining the concentrating ability will result in over- or underestimation. Methods We studied the relationship between specific gravity and osmolality in vitro with simulated urines of varying composition. Urine samples from patients with different clinical conditions were also analyzed. Results The in vitro curves for sodium chloride, urea, creatinine, glucose, contrast dye, and albumin were plotted (specific gravity versus osmolality). We found a linear correlation between the specific gravity and osmolality of the 6 substances that were studied and for their combinations. The urine samples obtained from patients with different clinical conditions documented that reliance on specific gravity could over- or underestimate the urine osmolality. Conclusions We concluded that in those clinical conditions, urine osmolality should always be determined and it should not be estimated based on specific gravity.

Background: The use of complementary/alternative medicine has garnered rising interest in recent years. Natural products including herbs, vitamins, and minerals are the most popularly consumed. The Internet is a ubiquitous source of information/market for these supplements. Aim: To systematically evaluate the dietary and herbal supplement recommended for patients with CKD and ESRD on the Internet, and try to distinguish between the claim of the manufacturer and proven scientific data. Methods: A questionnaire assessing each website was formulated. Each product ingredient was recorded in the questionnaire by two independent reviewers and statistically analyzed. Results: Of the 184 websites, 28% claimed to decrease CKD progression, 60% did not advise to consult a doctor before taking the supplement, and >90% did not mention any potential drug interaction, disease interaction, or caution in use during pregnancy or in children. The ten common plant ingredients claiming to be beneficial in kidney diseases were uva ursi, dandelion, parsley, corn silk, juniper, celery, buchu, horsetail, marshmallow, and stinging nettle. In contrast to their claims, these substances were not adequately studied in humans. The available animal studies showed detrimental effects and potential drug interactions with commonly used medications in the CKD/ESRD population. Conclusions: Nephrologists need to be cognizant of the lack of substantiated proven benefits of these substances and of the potential adverse effects in the animal models that can translate to the patients. Most importantly, the policy needs to change regarding the regulation of these products to prevent patient harm and misinformation. i 2014 S. Karger AG, Basel

OBJECTIVES: Hepatitis C virus is a common chronic infection that is widely associated with symptoms of fatigue and pain in the right upper quadrant. Nausea may be an underrecognized symptom. This study was designed to study the frequency of nausea in patients with hepatitis C virus infection compared to controls. METHODS: A cross-sectional study design with consecutive outpatients was used. Three groups were administered a dyspepsia and a previously validated Nausea Profile questionnaire. Univariate and multivariate analysis was performed. RESULTS: A total of 64 hepatitis C virus (HCV) patients, 53 liver disease controls (LC), and 64 normal controls (NC) were studied. An increased period prevalence of nausea was found in HCV patients 43% versus 29.7% in NC and 18.9% in LC (p = 0.009). There was an increased frequency of fatigue and abdominal pain in HCV patients over 1 month compared to LC and NC combined (p = 0.0001 and 0.0065 respectively). The Nausea Profile score revealed statistically higher total scores and higher subscale scores in the HCV group compared to controls. The total NP score expressed as a percentage of the maximum was 27% in HCV versus 12.7% for LC and 9.2% for NC (p = 0.0005). The odds of nausea using logistic regression were 2.1 CI (1.0–4.5) in HCV patients compared to controls (p = 0.05). Using linear regression, higher Nausea Profile scores were found to be independently associated with the diagnosis of HCV (.0005), fatigue (p = 0.0003), and abdominal pain (p = 0.0001). CONCLUSIONS: HCV infection is associated with an increased risk for nausea. The strong association between abdominal pain and nausea may be a clue to the etiology of nausea in these patients. Further etiological studies are needed.

Dudley Ridge is an arcuate, north-trending terrace remnant of Wisconsinan (late Quaternary) outwash in the Western Lowlands of southeast Missouri. The ridge, an elongate topographic bulge, is approximately 12 km long and 2 km wide with up to 5 m of relief. Previous workers have attributed the ridge to fluvial erosion, or to a combination of fluvial erosion and tectonic deformation during the late Quaternary. The Commerce geophysical lineament, which is a major northeast-trending basement feature, is located a few kilometers to the southeast, and swarms of paleoliquefaction and possible neotectonic deformations have been reported in nearby areas of the Western Lowlands. To test the tectonic hypothesis, in 1994 and 1995 we acquired two west–east high-resolution seismic reflection profiles along the crest and western flank of Dudley Ridge to determine whether Paleozoic, Cretaceous and shallow Quaternary strata are faulted or folded. Profile SPB-1 shows several near-vertical faults indicative of at least three periods of movement: Paleozoic to middle Mesozoic; late Cretaceous to Tertiary; and early to late Wisconsinan (late Quaternary). Profile SPB-2 shows three ambiguous fault-like features which cut Cretaceous and Quaternary reflectors, but cannot be interpreted unequivocally to extend down into the Paleozoic section. These new seismic reflection data are interpreted to show that at least three major periods of faulting have disrupted Paleozoic, Cretaceous and Quaternary strata beneath Dudley Ridge, with the most recent faulting being early to late Wisconsinan in age and producing about 6–8 m (8–10 ms) of near-vertical displacement. Because Quaternary reflectors cannot be resolved above about 30–40 ms, the seismic data alone do not reveal whether or not the Wisconsinan deformation affected the surface of Dudley Ridge or whether the faults may have died out as they propagated up through the soft, saturated Wisconsinan outwash. However, the presence of the Farmdale Geosol beneath lower terraces adjacent to Dudley Ridge and the geosol’s apparent absence, or near-total truncation, beneath modern soils on Dudley Ridge suggest that one or more periods of tectonic bulging and accelerated erosion may have occurred between the Farmdale Interstadial and the Holocene about 25,000–10,000 years before present.

Two reflection seismic profiles at English Hill, across the southern edge of the Benton Hills escarpment, southeast Missouri, establish that geologic structures at English Hill are of tectonic origin. The lowland area to the south of the escarpment is relatively undisturbed. The geology at English Hill is structurally complex, and reflection seismic and geologic data indicate extensive and episodic faulting of Paleozoic, Cretaceous, Tertiary, and Quaternary strata. The individual faults have near-vertical fault surfaces with maximum vertical separations on the order of 15 m. They appear to be clustered in north-northeast trending zones that essentially parallel one of the dominant Benton Hills structural trends. These observations suggest that previously mapped Quaternary faults at English Hill are deep-seated and tectonic in origin. This paper documents recent faulting at English Hill and is the first time late Quaternary, surface-rupture faulting has been recognized in the middle Mississippi River Valley region outside of the New Madrid seismic zone. This has important implications for earthquake assessment in the midcontinent.

A portable ammonium analyser was developed and used to measure in situ ammonium in the marine environment. The analyser incorporates an improved LED photodiode-based fluorescence detector (LPFD). This system is more sensitive and considerably smaller than previous systems and incorporates a pre-filtering subsystem enabling measurements in turbid, sediment-laden waters. Over the typical range for ammonium in marine waters (0–10 mM), the response is linear (r(2) = 0.9930) with a limit of detection (S/N ratio > 3) of 10 nM. The working range for marine waters is 0.05–10 mM. Repeatability is 0.3% (n =10) at an ammonium level of 2 mM. Results from automated operation in 15 min cycles over 16 days had good overall precision (RSD = 3%, n = 660). The system was field tested at three shallow South Florida sites. Diurnal cycles and possibly a tidal influence were expressed in the concentration variability observed.

Although conventional 3D reflection seismic data has been invaluable in the exploration and development of oil and gas fields worldwide, the stand-alone technology fundamentally lacks the resolution required to adequately characterize complex, thin-bedded hydrocarbon reservoirs. Limited vertical seismic resolution, implicitly defined at ¼ wavelength tuning thickness, can become particularly problematic when predicting reservoir dimensions, and ultimately for risk and reserve evaluation. Widess (1973) observed that thickness estimation of a “thin-bed”, below ¼ wavelength tuning, can be detected (or is encoded) within the amplitude of the composite amplitude, which results from the increasing constructive interference of the top and base reflections as the bed thins. Herein, a methodology is introduced whereby aggregate reservoir sandstone thickness is successfully predicted away from well control via full bandwidth (0 to 25 Hz) inverted seismic impedance.

A YAC/STS map has been assembled spanning 22 Mb across Xq12–q21.31, between markers DXS1125 and DXS95. In addition to the landmark loci for the X-inactivation center XIST and the ATRX, ATP7A, phosphoglycerate kinase, POU3F4, and choroideremia genes, the candidate disease gene regions for torsion dystonia 3 and two X-linked mental retardation syndromes are included. Also, the human voltage-dependent anion channel gene (HVDAC1) has been placed near DXS986. The current map incorporates 211 YACs from five different libraries, formatted with 185 STSs that comprise 26 genetic linkage markers, 60 newly-developed YAC-end STSs, and eight ESTs. The multiple clone coverage and average resolution of one STS per 120 kb provide resources for disease gene searches and are facilitating complete sequencing of the region.

In May of 1997, the Department of Geology and Geophysics at the University of Missouri-Rolla conducted a reflection seismic survey and a ground penetrating radar (GPR) survey for the Missouri Department of Transportation (MoDOT) along and adjacent to a 300 meter section of Interstate 44 in Springfield, Missouri. In October of 1997, a second GPR survey was conducted along the same section of interstate. The site was located approximately 1.5 kilometers west of Missouri Highway 266. The section of interstate studied overlies an active sinkhole and has experienced continued, localized subsidence. Seven 12-fold reflection seismic profiles were acquired along or near Interstate 44, using a Bison 24- channel seismograph and an EWG weight drop source. Forty-live GPR profiles were acquired along paved sections of Interstate 44 during the first survey. During the second GPR survey, the survey area was expanded to include a total of seventy ground penetrating radar profiles. A GSSI SIR-S GPR unit equipped with a 500 MHZ (megahertz) monostatic antenna/receiver was used to acquire the data. The geophysical surveys were successful. The reflection seismic data established that sinkholes, both active and nonactive are prevalent in the area. The seismic data also supports the interpretation that a sinkhole lies immediately beneath the interstate. The ground-penetrating radar data also proved to be of significant utility. Anomalous areas interpreted as voids on the GPR data were drilled and significant volumes of grout were injected. The second GPR survey established the success of the grouting program.

In October and November of 1996, the department of Geology and Geophysics at the University of Missouri-Rolla conducted a reflection seismic survey for the Missouri Department of Transportation (MoDOT) along a proposed interstate route near Joplin, Missouri. In total, six, 24-fold reflection seismic profiles (6,000 m) were acquired across previously mined (lead/zinc) ground. Checkshot data was acquired to correlate the reflection seismic data with the subsurface geology. The principle objective was to provide MoDOT with interpreted seismic profiles (re: abandoned open-pit mine workings) with a view in assisting MoDOT engineers with route planning and site remediation.

INVESTIGATION OF THE EFFICACY OF SUBCUTANEOUS VERSUS INTRAVENOUS ERYTHROPOIETIN IN OBESE AFRICAN AMERICAN PATIENTS Michael Shoemaker-Moyle, Manjunath Ramiah, Catherine Wells, Tibor Fulop, Lajos Zsom. University of Mississippi Medical Center, Jackson, MS, USA Forrest General Hospital, Hattiesburg, MS, USA To correct renal anemia, the subcutaneous (SC) route of erythropoietin (EP) administration has been associated with increased efficacy and decreased dose requirements, when compared with intravenous (IV) route. The effect of obesity as potential modifier to date is little explored. This study aims to answer the question of whether BMI influences the decrease in dose of EP when switching from IV to SC route. We performed IV to SC conversion of EP for 83 in-center dialysis patients and monitored outcomes over a 9 month period. Patients were divided into three categories based on BMI [ 35 (n=20)]. We obtained baseline demographic parameters, calculated BMI, and monitored iron saturation, ferritin, hemoglobin (Hg) along with EP requirements. Statistical analysis has been performed with SPSS v.18 with results reported either percents or means with standard deviations (SD). The cohort was all African American, 48% male with a mean age of 54 (13.3), and BMI 29.9 (7.5). Baseline iron saturation was 24.1 (10.7)%, ferritin 642.5 (280.4)ng/mL. Hg remained unchanged: 11.19 (1.32) vs. 11.33 (1.35)g/dL. Initial EP weekly dose for the entire cohort was 20, 658 (17,398) units (U): final dose 18,400 (16,426)U, with close correlation between initial and final doses (r 0.627; p

Peritonsillitis encompasses both cellulitis and abscess. To determine the distinguishing factors for cellulitis and abscess, we reviewed 29 patients, 15 with cellulitis and 14 with abscess. Common presenting complaints included dysphagia, trismus, drooling, voice change and fever. Unilateral tonsillar enlargement was usually present, and uvular deviation was noted in 10 of 29 patients. The mean ages of patients with abscess was 15.0 years, and that of patients with cellulitis was 10.8 years. The two groups differed significantly by age (P = 0.02), and discriminant analysis showed age, dysphagia and drooling to be discriminators for abscess patients, while bilaterality or fever were not. Trismus was a discriminator for cellulitis patients. Etiology for abscess included Group A and non-Group A beta-hemolytic streptococci, Group D streptococcus, alpha-streptococcus, anaerobic diphtheroids and coagulase-negative staphylococci. The etiology of the cellulitis was Group A and non-Group A beta-hemolytic streptococci and Streptococcus pneumoniae. Peritonsillitis appeared to increase in frequency. On presentation patients with cellulitis are similar to patients with abscess. Abscess is more likely in adolescents. Recommended therapy is intravenous penicillin and prompt drainage for patients failing to respond.