Painless split skin donor sites: a controlled double-blind trial of Opsite, scarlet red and bupivacaine.

A prospective randomized double-blind trial comparing Opsite alone, Opsite after application of bupivacaine, scarlet ointment dressing alone and scarlet ointment after bupivacaine was done to assess the effect of these four dressing regimens on split skin donor site pain and healing. Significantly less pain was reported by those dressed with Opsite and this was thought to be due to the immobility of an Opsite dressing. Many of the patients dressed with scarlet ointment felt no pain. It was concluded that movement of dressings is the main factor in pain production and that bupivacaine appeared to have no effect. There was no difference in healing rates between those treated with Opsite and those treated with scarlet ointment. It is concluded that using Opsite is a convenient way of preventing donor site pain, but that to gain maximum advantage from this it should not be applied under tension.

Clinical trials are usually beneficial to patients and hospitals.

We examined the cost of antibiotics used prophylactically in the first 25 patients in a controlled clinical trial comparing different antibiotic regimens in the prophylaxis of sepsis. We compared this with the costs of prophylaxis in 25 similar patients immediately before the trial started and found that the costs in the pretrial patients were significantly greater than in the trial patients. The trial is therefore beneficial to the hospital. We also examined the dispensing errors in the same patients. We found none in the trial patients but there were 77 out of 627 doses prescribed in the pretrial patients. We concluded that the abolition of dispensing errors brought about by the trial must be beneficial to the patients. They were also benefitted by the close monitoring which reveals complications at an early stage, and the improved case notes. The Hawthorne effect on medical and nursing staff is the most likely cause of these phenomena.

Ocular complications in haemodialysis and renal transplant patients.

115 patients on haemodialysis and 160 renal transplant patients were examined over an eight year period. A high percentage in both groups were found to have ocular complications. These included disorders of the cornea, lens, retina, choroid, and optic nerve. In contrast to other studies on renal transplant patients a relatively large number had symptoms and even required surgery for cataract removal. 65 (40.7%) had posterior sub-capsular cataracts. It is likely that nearly all were caused by the use of prednisone for immunosuppression. Of this number 25 (38.5%) had symptoms and 12 (18.5%) required cataract extraction. Pigmentary disturbances of the retinal pigment epithelium, together with vascular changes in the choroid were found in some. The implication of these relatively unknown complications, together with their possible aetiology, is discussed. The study emphasises the fact that all haemodialysis and renal transplant patients should be monitored for ocular complications.

The Auckland Hospital varicose veins and venous ulcer clinic: a report on six years work.

A report is given on the numbers of patients seen and treated by Auckland Hospital varicose veins clinic from May 1974 to May 1980. During this time 2145 patients have been seen in the clinic, 351 of these patients have had leg ulcers and 1191 have been treated by minimum operation with or without injection sclerotherapy. Of these 1191 patients, 84 percent have had their operations as outpatients. The problems of an increasing demand for a good service are mentioned and the necessity for increasing the facilities of the clinic is stressed. It is believed that most patients with varicose veins and venous ulcers can be treated as outpatients and that efforts should be made to increase the numbers so treated in the interests of economy both for the patient and for the hospitals concerned, but that provision should still be made for some patients to be treated as inpatients.

Gonorrhoea in the asymptomatic patient: presentation and the role of contact tracing for heterosexual men and women and for homosexual men.

Clinically silent gonorrhoea is the major problem in the control of the disease. Only 12 per cent of infected women reported in 1974 because of symptoms, compared with 97 per cent of infected heterosexual men and only 35 per cent of homosexual men with gonococcal proctitis alone. Homosexual men, compared with heterosexual men, had twice as many subsequent sexual contacts after infection and had a higher incidence of early syphilis. Eighty-four per cent had experienced passive anorectal intercourse. Ninety-seven per cent of men with gonococcal urethritis reported because of symptoms, but occasionally (particularly after unsuccessful treatment) urethral gonorrhoea in men may be clinically silent and even require tests of the overnight urethral secretion for diagnosis. For women, and for homosexual men who have had passive anorectal (or oral) intercourse, the indication for attendance for tests for gonorrhoea should be having run the risk, and not the presence of symptoms. Routine tests of the anorectum for gonorrhoea are essential in cases of 80 women at risk, and for most homosexual men since over 80 per cent of these men will have had passive anorectal intercourse. Because gonococcal infections following treatment-failure are often clinically silent in both women and men, symptoms cannot be relied upon to indicate such failure. Follow-up smears and cultures are always essential.

Value of routine serum-triiodothyronine estimation in diagnosis of thyrotoxicosis.

Thyroid-stimulating hormone (T.S.H.), triiodothyronine (T3), and thyroxine (T4) concentrations were estimated on 432 blood specimens from patients with a provisional diagnosis of thyrotoxicosis. 59 patients had a raised serum T3 concentration with T.S.H. and T4 levels in the normal range. Further information was obtained in 41 of these patients, and T3 toxicosis was diagnosed in 17 cases, thus providing a projected total of 24 patients with T3 toxicosis. In addition, there were 56 patients, with more common biochemical features of thyrotoxicosis, having both a raised serum T3 and T4 concentration. Therefore 30% of the patients considered thyrotoxic in this retrospective survey were only diagnosed with the aid of a serum-T3 estimation.