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Physician login mol mol newsletter home news medical drugs health topics bid 4 surgery bid 4 medicine health shop mol press room home medical drugs drugs beginning with d dextroamphetamine sulfate tablets, usp 5 mg and 10 mg medical references health topics bid for medicine bid for surgery vitamins & health shop medical dictionary diseases & treatments medical news doctors search diseases & conditions allergy arthritis alzheimer's cancer cardiovascular disorders cholesterol constipation diabetes eczema aids hiv more topics. J. S. Gopal Kothandapani, L. Heaf, K. Southern, A. Riordan, J. Couriel & D. Heaf Respiratory Unit, Alder Hey Children's Hospital, Liverpool Introduction Empyema as a complication of bacterial pneumonia is a significant cause of morbidity in children and an increased number of children have presented to this regional unit in the last year. Aim To evaluate the clinical presentation, pathogenesis, management and complications of children admitted with empyema between December 2005 and May 2006. Methods Retrospective case note analysis using a structured proforma. Results 44 patients presented with empyema. Mean age 5.9yrs range 4mths16yrs ; , 26 boys and 18 girls. 25 56% ; were referred from DGHs.38 86% ; patients were entered onto the empyema pathway. Ultrasound was performed on 42 44 95% ; patients, 1 patient had bilateral effusion. Pleural loculation was found in 31 73% ; patients. Effusion depth measured between 11mm and 8 cms. CT chest was performed in 4 patients, 1 patient had an intrapulmonary abscess. 10 34 patients with an effusion depth less than 6cm were treated with antibiotics alone. 34 patients 77% ; had a chest drain inserted, 32 34 94% ; had intra pleural Urokinase. 32 44 patients required oxygen and 7 needed ventilator support. 9 patients were admitted to PICU and 7 to HDU. 3 34 had primary thoracotomy and 5 34 had a later thoracotomy, including 3 who had decortication. 24 44 55% ; had an organism identified. 15 34% ; S. pneumoniae 11 pleural fluid PCR, 1 pleural fluid culture, 3 blood culture ; , 8 18% ; S.Pyogenes pleural fluid culture ; , 1 2% ; Streptococcus intermedius pleural fluid culture ; . 1 patient with S.pyogenes grew S. aureus and alpha haemolytic streptococcus from blood culture and had high Infuenza B titres. 1 patient had chicken pox in the previous month. Average length of IV antibiotics 12 range 422 ; days, average chest drain 7 range 316 ; days with no difference between S. pneumoniae and S. pyogenes groups. No patients had long term sequale at 3 months follow up. Conclusion The combined use of chest drain and intrapleural urokinase forms an effective therapy in children presenting with empyema. source of intracranial infection and accounted for 58% of all cases. When isolated SDE is considered meningitis was implicated in 71% of cases but overall it occurred in less than half 42% ; of all infections. Conclusion Intracranial empyema remains a serious complication of meningitis and particularly sinusitis. A high index of suspicion and prompt treatment is required. Emergency neurosurgery with systemic antibiotics resulted in a good outcome in this series.

Hyperparathyroidism can truly be attributed to the disease. Silverberg et al. say "maybe no", while Bone would appear to argue "maybe yes". The pace of investigation and access to research funding have increased markedly. During the past decade, funding by the National Institutes of Health for skeletal research has increased by a factor of approximately ten. Congress, women's groups, densitometry companies, pharmaceutical companies, the lay press, and our patients are forcing scientists and clinical investigators to ask the difficult, large-scale outcome questions, and vitamin suppliers and health food product makers have jumped on the "bone health" bandwagon. Perhaps to the surprise of younger investigators and physicians, it was not always like this-- widespread interest in bone health is a relatively new phenomenon. So, at the conclusion of the decade that has passed since the last NIH Consensus Conference, where do we now stand with respect to optimal evaluation and management of primary hyperparathyroidism? We think it is time for two major events to occur, perhaps separately, perhaps together. First, we now have guidelines, endorsed by the National Osteoporosis Foundation NOF ; and by the American Society for Bone and Mineral Research Society ASBMR ; , for the evaluation and management of postmenopausal osteoporosis. It is time to do the same for primary hyperparathyroidism. Second, it is time for a new millennial NIH Consensus Conference with four goals in mind: 1. Develop Diagnosis and Treatment Guidelines. The Consensus Conferees should make another attempt at developing useful evaluation and management guidelines, as suggested above. 2. Provide Definition and Focus. The Conference should focus on the compelling questions that need to be answered in the current era. In our minds, some of these questions should be definitional, some operational, and some investigational: What exactly will the criteria be for asymptomatic vs. symptomatic primary hyperparathyroidism in the new millennium? Can we finally put to rest the arguments relating to peptic ulcer disease, hypertension, pancreatitis, marrow suppression, diabetes, and subtle mental changes as indications for surgery? If not, which of these should be studied and how? Which assays for PTH are best? Who should have bone mineral density measurements, and how often should they be performed if surgery is or is not performed? Is the under50-yr-old cutoff still applicable? And what really are the risks of surgery--minimal as Bone would have us believe ; , or more substantial as our patients who would gladly trade their vocal cord paralysis for a 0.5% decrement in bone mineral density might advocate ; ? Are we ready for genetic testing in any forms of primary hyperparathyroidism such as the MEN syndromes or familial hypocalciuric hypercalcemic syndromes? And how does PTH increase or decrease bone mass and strength at the cellular level? Are there pharmacologic or gene therapeutic strategies.

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