Management of epididymo-orchitis in primary care
Br J Gen Pract 2010; 60 (579): 763-9
This study used data from the General Practice Research Database. Men aged 15-60 years presenting over a five-year period were included. Their records from 28 days either side of the diagnosis date were analysed with respect to clinical management.
Results showed that 57 per cent were managed entirely within general practice. Of these, 92 per cent received antibiotics (usually ciprofloxacin) and 56 per cent received an antibiotic recommended for epididymo-orchitis.
Eighteen per cent received doxycycline, which is effective in chlamydial infections, and 29 per cent received an antibiotic indicated for a UTI but not for epididymo-orchitis.
Most men were not investigated and only 3 per cent had a chlamydia test. Twenty-two per cent had urinalysis, but most had no recorded result.
Since epididymo-orchitis in men under 35 years is commonly caused by STIs, management should include STI testing.
In older men, microscopy, culture and sensitivity of MSU should be performed.
Early versus delayed treatment of relapsed ovarian cancer
Lancet 2010; 376 (9747): 1155-63
This European trial enrolled women with ovarian cancer who were in complete remission following first-line chemotherapy with a platinum agent and who had a normal CA125 tumour marker level.
Women were examined and had their CA125 levels measured every three months. If the CA125 level exceeded twice the upper limit of normal, they were randomised to either early or delayed chemotherapy.
The early group started chemotherapy within 28 days. The delayed group continued having CA125 measurements and were only treated once there was clinical evidence or symptoms of disease relapse.
Of 1,442 patients registered, 529 were assigned to treatment groups. Early treatment was started in 265 patients and 264 had delayed treatment.
The median follow-up was 57 months and there were 370 deaths. Overall, there was no difference in survival between the groups. Therefore, the value in monitoring CA125 levels in the follow up of ovarian cancer is still unknown.
Urine cytology in a macroscopic (visible) haematuria clinic
Brit J Med Surg Urol 2010; 3 (5): 204-9
This study included 503 patients who presented in 2005 to the macroscopic haematuria clinic in York. Three-year follow-up was reviewed retrospectively. Results showed that 52 per cent had no significant abnormalities, 27 per cent had benign disease and 21 per cent had malignant disease (14 per cent urothelial cancer, 3 per cent renal cancer and 4 per cent prostate cancer). All bladder tumours were diagnosed with flexible cystoscopy and all upper tract tumours were diagnosed with ultrasound.
Cytology has a sensitivity of 66 per cent and specificity of 90 per cent but did not diagnose tumours that were not identified with other investigations. Those with abnormal cytology but no apparent cause had intravenous urogram, cystoscopy and biopsy, and no tumours were diagnosed. After three years, no occult diseases were apparent.
The authors concluded that although half of those presenting with visible haematuria had a significant urological diagnosis, urine cytology did not add any significant information in the initial assessment.
Pad usage, urinary incontinence and UTIs
Age Ageing 2010; 39: 549-54
This prospective study included 118 nursing home residents who use absorbent pads for urinary incontinence. Number of pads used per day, fluid intake and incontinence volumes were measured.
Their risk of developing a UTI was compared with residents who did not use pads. UTIs were diagnosed on the basis of two positive symptoms and a positive urine culture with >105 colony forming units/ml of a single bacteria.
Daily fluid intake and pads per day were not associated with UTIs, however the use of pads was. Hand hygiene among staff and in particular certain subsets of pad-using residents (for example, those with dementia) may be a factor. Constipation and stroke are also risk factors for urinary incontinence.
Serum CRP as a biomarker for detection of bacterial infection
Age Ageing 2010; 39: 559-65
In this Australian study, 232 elderly patients aged over 70 years had their CRP measured within 24 hours of admission to a geriatric ward. The significance of CRP in predicting bacterial infections was assessed and CRP was evaluated against other clinical features for diagnosing bacterial infections.
A CRP of 60 had the best combination of sensitivity (81 per cent) and specificity (96 per cent) in diagnosing bacterial infection, with a positive predictive value of 92 per cent and negative predictive value of 90 per cent. When combined with temperature level, CRP had a higher sensitivity and specificity than white cell or neutrophil count.
Patients had a definite infection if established clinical and microbiological criteria were met. Probable infections had clinical signs and radiological evidence, but without microbiological confirmation.
Patients were defined as not having any infection in the absence of clinical signs or microbiological/radiological evidence. The authors concluded that CRP is a useful biomarker in predicting early bacterial infection.
- Dr Ford is a locum GP in Worcestershire and a member of our team who regularly review the journals
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