Retropharyngeal calcific tendinitis: report of five cases and review of the literature.

Retropharyngeal calcific tendinitis is an inflammation of the longus colli muscle tendon, which is located on the anterior surface of the vertebral column extending from the atlas to the third thoracic vertebra. Five cases of acute retropharyngeal calcific tendinitis seen in the emergency department (ED) over a 15-month period are reported. In addition, a retrospective review of four cases diagnosed as retropharyngeal abscess and admitted to the hospital revealed that two of these cases actually represented retropharyngeal calcific tendinitis. A review of the literature and potential differential diagnoses are presented. For those primary care physicians who must evaluate patients with acute cervical pain, sore throat, or odynophagia, an x-ray study of the neck revealing retropharyngeal calcium deposition should raise the question of the diagnosis of acute retropharyngeal tendinitis. Clinical characteristics of this entity include a painful condition which is treatable and is often mistaken for retropharyngeal abscess, pharyngitis, or peritonsillar abscess. In our opinion, this condition may be more prevalent than the literature suggests.

The role of the physician's assistant in a university-based pediatric surgical service.

Physician's Assistants (P.A.), recent additions to the health profession, have proved valuable as "extenders" for primary physicians in relatively remote rural areas. More specialized surgical assistants have been trained for the community-practicing surgeon. The introduction of physician's assistants into university centers has been proceeding at a slower pace. A need has existed for an accurate assessment of the role of the P.A. in a residency-training program. In subspecialties, such as pediatric surgery and thoracic surgery, an increasing patient load has usually required a corresponding increase in junior resident staff. This resident coverage is usually dependent upon the availability of general surgical house staff since pediatric surgical trainees are currently fixed in number. Foreign medical graduates are no longer available in large numbers and general surgical programs themselves are being reevaluated and the number of trainees decreased. In this setting physician's assistants can be used to augment patient coverage by acting as junior surgical residents.

Species identification of coagulase-negative staphylococci from urinary tract isolates.

A new scheme for identification of coagulase-negative staphylococci was applied to 138 consecutive urinary isolates of coagulase-negative staphylococci. The most common species were Staphylococcus epidermidis (53%), S. hominis (12%), and S. haemolyticus (10%). S. saprophyticus comprised only 5%. The disk method for antibiotic susceptibility for all species grouped together disclosed resistance most commonly to penicillin (35%), tetracycline (33%), methicillin (27%), and sulfonamide (24%). This pattern was also seen specifically with S. epidermidis. Further studies are needed to determine the incidence of species-specific antibiotic resistance and species-specific infection by site. This may be of particular interest in those patients with nosocomial infections due to coagulase-negative staphylococci.

Antistaphylococcal activity and beta-lactamase resistance of newer cephalosporins.

Four newer cephalosporins (cefazolin, cefamandole, SK&F 59962, and cefoxitin) were investigated for determination of their antistaphylococcal activity and relative stability to staphylococcal beta-lactamase (penicillinase). Crude preparations of beta-lactamase from recent clinical isolates of Staphylococcus aureus were used. Cefamandole and SK&F 59962 were highly active against both large and small inocula of staphylococci and were resistant to staphylococcal beta-lactamase. Cefoxitin, although resistant to beta-lactamase, possessed less antibacterial potency but was still approximately as active as methicillin. Cefazolin was somewhat more susceptible to staphylococcal beta-lactamase than the other three agents and resembled cephaloridine in this respect. With minor exceptions, a correlation was found between the susceptibility of different agents to beta-lactamase and the magnitude of the effect of inoculum size when the drugs were tested against large and small inocula of staphylococci.

Susceptibility of Pseudomonas aeruginosa to tobramycin or gentamicin alone and combined with carbenicillin.

To explore more effective therapy for Pseudomonas aeruginosa, 264 recent clinical isolates were tested by agar dilution using gentamicin and tobramycin alone and combined with carbenicillin to seek synergistic effects. Synergism was defined as a fourfold or greater decrease in the minimal inhibitory concentration of each drug in a pair. At a concentration of 3.12 mug/ml, gentamicin inhibited 73% of the strains and tobramycin inhibited 98%. The gentamicin-carbenicillin combination was synergistically active against 57% of the strains, and tobramycin-carbenicillin was active against 46%. The effect did not correlate with either susceptibility or resistance to gentamicin or tobramycin alone. The data suggest that tobramycin or tobramycin plus carbenicillin may provide alternate therapy where susceptibility to gentamicin or synergism between gentamicin and carbenicillin cannot be demonstrated; however, the degree of susceptibility to either aminoglycoside antibiotic alone cannot be used to predict a synergistic effect.