Community outbreak of legionellosis and an environmental investigation into a community water system.

During two legionellosis outbreak investigations, one at a geriatric centre and the other in high-rise housing for seniors, it was observed that additional cases of legionellosis occurred in nearby smaller residential settings. This apparent geographical cluster of legionellosis occurred in the same general area of a community water storage tank. No potential airborne sources in or near the area could be identified, but a community water system storage tank that was centrally located among case residences spurred an investigation of water-quality factors in the identified investigation area. Conditions conducive for Legionella growth, particularly low chlorine residuals, were found. The rate of legionellosis among residents aged ⩾50 years in the investigation areas (61·0 and 64·1/100 000) was eight times higher than in the rest of the service area (9·0/100 000) and almost 20 times higher than the statewide annual average incidence rate (3·2/100 000). A water mains flushing programme in the area was launched by the water utility, and water samples taken before and during flushing found L. pneumophila.

Aggressive gastric peripheral T-cell lymphoma of CD8+ type associated with lymphomatous meningitis.

Most gastric lymphomas are of B-cell origin, and many are either low-grade or high-grade B-cell lymphomas of mucosa-associated lymphoid tissue type. Gastric T-cell lymphomas are very rare, usually of CD4+ type, and few have had genotypic studies. We report the case of a gastric peripheral T-cell lymphoma of CD8+ type. Genotypic studies demonstrated partial deletion with rearrangement of the T-cell receptor beta-chain gene. Lymphomatous meningitis developed, and the patient died after only 2 months despite chemotherapy. The case is compared with the other gastric T-cell lymphomas that have been reported.

Comparison of meclofenamate sodium with codeine and placebo for the treatment of episiotomy pain.

Meclofenamate sodium, a nonsteroidal anti-inflammatory drug with proven analgesic effects, was compared at two dose levels (200 mg and 100 mg) with codeine (60 mg) and placebo in a double-blind, randomized study of 327 women experiencing episiotomy pain after normal delivery. Meclofenamate sodium at either dose was significantly better than codeine or placebo in reducing pain intensity and increasing pain relief, and it had a longer duration of action. Adverse effects were minimal, and their frequency did not differ significantly among treatment groups. Meclofenamate sodium appears to be as safe as and more effective than codeine for the management of episiotomy pain.