Late onset group B streptococcal disease manifests as submandibular cellulitis.

A 3033g male infant was born to a healthy mother at 39 weeks gestation by normal vaginal delivery with Grade 1 meconium stained liquor. There was no prolonged rupture of membranes or any antenatal risk factors for sepsis. The immediate neonatal period was uneventful and the baby was discharged after two days. At 6 weeks of age the baby was admitted with an 8-hour history of inconsolable crying. He was pyrexial. Initially the possibility of intussuception was considered, however, the submandibular swelling became more obvious and tender. His airway was clear. Chest x-ray and abdominal x-ray were normal. Ultrasound of the submandibular region showed soft tissue swelling with no fluid collection. CRP was initially 0.7 but increased to 87 the next day. Blood cultures grew group B streptococcus. (GBS) He was treated for five days with appropriate intravenous antibiotics. He was discharged home and recovered fully.

Diagnoses made in a secondary care "fits, faints, and funny turns" clinic.

AIMS: To investigate the diagnoses made for children referred to a "fits, faints, and funny turns" clinic. METHODS: Prospective study of 380 children referred to a dedicated secondary care clinic over an eight year period. RESULTS: Twenty three per cent of children were given a final diagnosis of one of the childhood epilepsies, with 48% of these having a specific epilepsy syndrome. Syncope was the commonest cause of a non-epileptic event (syncope and reflex anoxic seizures comprised 100/238, 42%) but there were a wide variety of other causes. Fifty three events (14%) were unclassified and managed without a diagnostic label or treatment. CONCLUSIONS: In children with funny turns referred to secondary care, the diagnostic possibilities are numerous; among non-epileptic events, syncopes predominate. The majority do not have epilepsy. Unclassifiable events with no clear epileptic or non-epileptic cause are common and can be safely managed expectantly.

A randomised study of "wet wraps" versus conventional treatment for atopic eczema.

AIMS: To compare two treatments in common usage for children with atopic eczema: "wet wrap" bandages versus conventional topically applied ointments. METHODS: A total of 50 children (age 4-27 months) with moderate to severe eczema were randomised to one or other treatment. Two research nurses supervised the study. The first gave advice and support, and the second, blinded to the treatment modality being used, scored the change in eczema severity over a period of four weeks using the SCORAD eczema severity scale. RESULTS: Both treatments gave a benefit in overall SCORAD scores (mean change for wet wrap group was 53 to 24; for the conventional group, 41 to 17). There was no significant difference between the two groups in terms of overall improvement at four weeks or in the timescale of improvements. The amount of topical of topical steroid used was similar in both groups. The wet wrap group suffered significantly more skin infections requiring antibiotics. Carers reported that wet wraps were less easy to apply than conventional treatment.

Diagnosis of Down's syndrome in neonates.

The results of karyotyping for Down's syndrome in neonates were surveyed. From local data 36%, and from a national questionnaire, 32% of such samples were negative for Down's syndrome. To examine this, a subset of notes was reviewed for documentation of clinical signs of Down's syndrome. Some characteristics were often recorded, but other common discriminatory characteristics were noted less often or not at all.

Genital herpes: an increasing problem?

Over the past 10 years there has been a pronounced increase in the number of cases of genital herpes seen in sexually transmitted disease (STD) clinics in the United Kingdom. The reporting system, however, does not differentiate between primary and recurrent infections, and consequently any increase in the number of patients reattending clinics with recurrent genital herpes would falsely inflate the statistics. A study of cases of herpes seen in the department of genitourinary medicine of this hospital in the two years 1972 and 1982 is presented. It showed that the proportion of patients attending with recurrent herpes had increased from 18% in 1972 to 31% in 1982. As a result of this, the 68% increase between 1972 and 1982 in the total number of cases of herpes seen in the clinic overestimates the real increase in the size of the problem, which is closer to 40%, based upon cases of primary herpes only. Modifications to the national recording system are necessary to overcome the problems highlighted by this study. These modifications could include classifying each case of genital herpes as primary, recurrent, or recurrent but not previously recorded, which would provide a more accurate picture of the size of the problem of genital herpes in the population.

Prophylactic oral acyclovir in recurrent genital herpes.

56 patients with frequently recurring genital herpes were treated in a randomised double-blind trial with either oral acyclovir 200 mg four times a day or placebo for 12 weeks. 29 patients received the drug and 27 the placebo. The mean recurrence rate per month of treatment was 1.4 in the placebo-treated patients and 0.05 in the acyclovir group. Median time to the first recurrence after the start of therapy was 14 days in the placebo group compared with 100 days in the acyclovir group. After the end of treatment the recurrence rate was similar in the two groups. Prophylactic oral acyclovir seems to be an effective treatment for patients with frequently recurring genital herpes.