Hospital discharge using salbutamol as required after acute attacks of wheeze in children: a service evaluation.

OBJECTIVE: Most UK hospitals discharge children after acute wheeze with advice to give regular salbutamol using a fixed dose weaning regime. We have introduced and evaluated the safety and efficacy of changing practice to using bronchodilators only as needed after 4 hourly assessments. DESIGN: A multidisciplinary team of healthcare professionals worked with eight families of children who had needed hospital treatment with acute wheeze to develop guidance for the use of salbutamol on an as required basis after 4 hourly assessments. Data on salbutamol used with this approach were compared with a similar period in the previous year. RESULTS: Data from 103 families showed a 73% reduction in salbutamol on day 1, 69% on day 2 and 50% on day 3 compared with what would have been used according to previous advice. Families found the advice easy to follow. There was a trend towards lower reattendance rates within 1 week compared with those recorded in the previous year. Those who had previously attended preferred this change in practice. CONCLUSIONS: These data suggest that with information to support the use of salbutamol on an as required basis after hospital attendance, children can be safely managed by their parents/guardians with much lower doses of salbutamol than those recommended in commonly used fixed dose weaning regimes.

A comparative immunohistochemical analysis of cortactin in orthokeratinized odontogenic cyst (OOC), sporadic odontogenic keratocyst (OKC), and syndromic OKC.

OBJECTIVES: To evaluate and compare the immunohistochemical expression of cortactin in the epithelial lining of orthokeratinized odontogenic cyst (OOC), sporadic odontogenic keratocyst (OKC), and syndromic OKC. METHODS: Formalin-fixed paraffin-embedded tissue blocks of histopathologically diagnosed cases of OOC, OKC, syndromic OKC, normal buccal mucosa (NBM), and oral squamous cell carcinoma (OSCC) were examined for immunohistochemical expression of cortactin. Clear brown cytoplasmic and membranous staining was considered positive. RESULTS: A statistically significant difference was observed between OOC and syndromic OKC (p < 0.001), as well as between sporadic OKC and syndromic OKC (p < 0.001). Although not statistically significant, the expression of cortactin was slightly higher in the basal layer of NBM (mean = 0.47), OOC (mean = 0.27), sporadic OKC (mean = 0.47) syndromic OKC (mean = 1.53), and OSCC (mean = 0.67) than in the parabasal layers of NBM (mean = 0.27), OOC (mean = 0.20), sporadic OKC (mean = 0.47), syndromic OKC (mean = 1.27), and OSCC (mean = 0.60). CONCLUSION: The expression of cortactin in the basal layer may suggest the formation of invadopodia in the basal layer where the invasion mechanism occurs. This finding is further supported by the higher localization of cortactin in areas of epithelial budding and daughter cysts in syndromic OKC, thereby reaffirming its possible association with recurrence.

Assessment of a software guided system to reduce pre-existing astigmatism in cataract surgery.

The aim of this pilot study was to assess the astigmatism after small incision cataract surgery by use of a novel software guided surgical technique. The software system guides the surgeon toward a hypothetical shape of the cornea. When this shape is achieved, the vertical meridian is relaxed and the incision does not produce any astigmatism. How that hypothetical shape is to be achieved by the surgeon is described. If preoperative astigmatism exists, the hypothetical shape calculated by the system takes that into account. This enables the surgeon to reduce preexisting astigmatism, without having to change the site or size of the standard 6 mm 12 o clock incision of SICS. Results: Results indicated that preoperative astigmatism reduced in 11 out of 14 cases at the end of 8 weeks, remained unchanged in one, and increased by less than 0.5D in two cases. This proves the hypothesis that the vertical corneal meridian is under higher tension and relaxing it by flattening the perpendicular meridian has a reducing effect on postoperative astigmatism.