Twelve cases of malignant melanoma of childhood were collected from the pathology files of Memorial and James Ewing Hospitals covering a 40‐year period from 1928 to 1968. All of these cases had documented evidence of metastatic disease; 4 have survived longer than 5 years, and 2 of these are alive and well more than 15 years after therapeutic regional lymph node dissection. Clinical and pathologic findings in these cases are summarized, and a brief historical review is included.
Antibiotics in surgical treatment of acute abscesses SIR,-I am pleased to see that primary closure, under antibiotic cover, of acute superficial abscesses continues to be advocated (12 July, p 111). However, it is surprising that the investigators of the trial prescribed a five-day course of clindamycin for one-quarter of their patients, since the Committee on Safety of Medicines, in June 1979, recom-mended that this drug "should in general be reserved for serious or life-threatening conditions where other antibiotic therapy is ineffective or undesirable."' This recommendation was made because of the wellknown association between clindamycin and antibiotic-associated colitis.Dr P W H Blick and others have, however, shown that a single preoperative dose of clindamycin provides adequate antibiotic cover when closing an abscess cavity by primary suture. This is an important finding as a single-dose method might reduce the (admittedly small) risk of inducing pseudomembranous colitis to infinitesimal proportions and allow the method of primary closure, with this antibiotic, to be advocated widely once again.While I too have found that the time needed for skin healing after incision, curettage, and primary suture under antibiotic cover is rather less than that after incision and open drainage, I believe that the main advantage of the former technique is that it allows the patient to return to work sooner; there is no need for him to remain at home for nursing visits or to make daily trips to hospital for dressings.2
441 not cloud the clinical fact that the intelligent use of CAT technology could make it sufficiently simple for those responsible for the care of these patients to treat them effectively and reduce the mortality to nearer 5°,,.The case for a wider deployment and more open access to CAT scanning for the care of the injured merits serious attention.
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