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Carcinoid tumors are formed from cells located in the intestinal tract, bile ducts, pancreas, bronchus, or ovary. Previous studies have reported that patients with carcinoid tumors have a protein called prealbumin present in their tumors. This protein is primarily made in the liver and can be detected in the blood. This article describes the results of a study designed to determine if prealbumin can be used as a marker for diagnosing carcinoid tumors in the lungs (bronchopulmonary carcinoid tumors). Samples from 60 lung carcinoid tumors were tested for prealbumin using a specific stain that allows the protein to be visualized when a thin slice of the tumor is examined with a microscope. For comparison, samples from three other types of lung tumors (squamous carcinoma, adenocarcinoma, and small cell carcinoma) were tested. Seventy-five percent of the carcinoid tumors tested positive for prealbumin. Prealbumin was not present in any of the adenocarcinomas, but was found in two of the small cell carcinomas and in five of the squamous carcinomas. It is concluded that testing for prealbumin is a useful method for diagnosing lung carcinoid tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

BACKGROUND Flucloxacillin is approved for intermittent dosing. The anti-bacterial activity of flucloxacillin is time dependent so con-tinuous infusion is probably more effective. Furthermore, for some patients continuous dosing can have practical benefits. Currently, the optimal flucloxacillin dosage for continuous infusion is unknown.OBJECTIVETo determine the optimal dosage for continuous flucloxa-cillin infusion in non-critically ill patients.METHODSUnbound flucloxacillin levels of 30 patients receiving intra venous flucloxacillin were analysed using non-linear mixed effects modelling. A Monte-Carlo simulation was used to assess the dosage needed to treat bacteria with a MIC of 0.25-2 mg/L in > 90% of the population.RESULTSA dosage of 4 g/24 hours was sufficient for 93.4% of the population to obtain a target of 100% fT > MIC of 0.5 mg/L. In 88.9% of the population a dosage of 12 g/24 hours was sufficient for a MIC of 2 mg/L, being the clinical breakpoint for S. aureus.CONCLUSIONThis simulation study showed that 4 g/24 hours is sufficient to reach unbound flucloxacillin levels exceeding 0.5 mg/L, the most common MICs found for S. aureus, in non-critically ill patients. In case of toxicity or if patients are not responding to a regular dosage, we advise to alter the dosage based on unbound flucloxacillin levels and the MIC. [ABSTRACT FROM AUTHOR]

Objectives Level one evidence on the value of adult tonsillectomy versus non-surgical management remains scarce. Before embarking on a costly national randomised controlled trial, it is essential to establish its feasibility. Design Feasibility study with in-depth qualitative and cognitive interviews. Setting ENT staff and patients were recruited from nine hospital centres across England and Scotland. Participants Patients who were referred for tonsillectomy ( n = 15), a convenience sample of general practitioners ( n = 11) and ear, nose and throat staff ( n = 22). Main outcome measures To ascertain whether ear, nose and throat staff would be willing to randomise patients to the treatment arms., To assess general practitioners' willingness to refer patients to the NAtional Trial of Tonsillectomy IN Adults (NATTINA) centres., To assess patients' willingness to be randomised and the acceptability of the deferred surgery treatment arm., To ascertain whether the study could progress to the pilot trial stage., Results Ear, nose and throat staff and general practitioners were willing to randomise patients to the proposed NATTINA. Not all ENT staff were in equipoise concerning the treatment pathways. Patients were reluctant to be randomised into the deferred surgery group if they had already waited a substantial time before being referred. Conclusions Findings suggest that the NATTINA may not be feasible. Proposed methods could not be realistically assessed without a pilot trial. Due to the importance of the question, as evidenced by NATTINA clinicians, and strong support from ENT staff, the pilot trial proceeded, with modifications. [ABSTRACT FROM AUTHOR]

Objectives To determine the impact of recurrent sore throats and tonsillitis in adults and stakeholder views of treatment pathways. Design Qualitative semistructured interview design reporting novel data from a feasibility study for a UK national trial of tonsillectomy in adults. Setting Nine study sites linked to ear, nose and throat departments in National Health Service hospitals located across the United Kingdom. Participants Fifteen patients, 11 general practitioners and 22 ear, nose and throat staff consented to in-depth interviews, which were analysed using a framework analysis approach. Main outcome measures Views of stakeholder groups. Results Recurrent sore throats were reported to severely impact patients' family, work and social life. Ear, nose and throat staff stated that patients faced increasing barriers to secondary care service access. General practitioners were under pressure to reduce 'limited clinical value' surgical procedures. Conclusions The findings from this study suggest that there is a disconnect between the attitudes of the stakeholders and the reality of recurrent sore throat, tonsillectomy procedures and service provision. More evidence for the role of tonsillectomy is needed from randomised controlled trials to determine whether it should continue to be ranked as a procedure of limited clinical effectiveness. [ABSTRACT FROM AUTHOR]