Topotecan has efficacy at least equivalent to paclitaxel manifested by the higher response rate and significantly longer time to progression.

Topotecan in a daily-times-five schedule is an effective regimen as second-line treatment in ovarian cancer. Further investigations of topotecan in ovarian cancer, including first-line use and combination with other active agents, are indicated.

Staphylococcal infections remain an important cause of morbidity and mortality. Methicillin-resistant Staphylococcus aureus (MRSA) present a particular problem because of the costs of treatment and containing outbreaks. The role of nasal carriage of staphylococci in the epidemiology of staphylococcal infection has been recognized for over 30 years. Until recently, eradication of nasal carriage of S. aureus has proved difficult, with a variety of topical and systemic agents yielding poor results with either little discernible effect on nasal carriage or rapid recolonization. Mupirocin is a novel topical antibiotic with excellent antibacterial activity against staphylococci, including MRSA. Intranasal administration of calcium mupirocin has achieved excellent results in the eradication of nasal carriage of S. aureus and producing an associated reduction in S. aureus infection in a variety of clinical settings, including MRSA outbreaks, neonatal nurseries, haemodialysis, cardiothoracic surgery and familial staphylococcal infections. This article reviews the efficacy and safety of intranasal mupirocin in the prevention of staphylococcal infections.

ABSTRACT. Determination of circulating red cell volume (RCV) in anemic preterm infants is, in theory, a better indicator of transfusion needs than Hb concentration. Our study reports the results of RCV measurement using biotin labeling of red cells on 40 occasions in preterm infants of 25-34 wk gestation. In 20 infants, who had estimations made within 24 h of birth, the RCV varied between 17.7 and 66 mL/kg. Twenty measurements were made at a later age at the time of a blood transfusion. RCV values were between 13.1 and 41.5 mL/kg before transfusion. In 13 infants, RCV was determined simultaneously using two methods, biotin and dilution of autologous HbF with donor HbA at transfusion. There was no significant difference between the results of RCV estimations using these two methods. Our study demonstrates that biotin labeling is an effective method for determining RCV in preterm infants. The RCV represents the total volume of red cells in the circulation. It has been suggested that the RCV is a better guide to red cell transfusion requirements than Hb concentration (l-3), which has been shown to be a poor predictor of benefit from blood transfusion (4-6). After acute blood loss and in anemia of prematurity, the Hb concentration is poorly correlated with RCV; some infants have a very low RCV, yet maintain an adequate Hb concentration (1, 2, 7). RCV may also be a more rational physiologic indicator than Hb concentration of the oxygen carrying capacity of the blood in the whole circulation (3). Low RCV at birth is associated with birth asphyxia (8, 9), increasing severity of hyaline membrane disease (9, lo), and increased mortality (8, 10). RCV estimation has become a vital investigation in adults with polycythemias, some anemias, and the assessment of erythropoiesis (1 1).Previously described methods for determining RCV include both techniques using the dilution principle after labeling of red cells with a tracer and indirect methods, which give a calculated RCV derived from plasma volume and Hct. Radioisotopes as tracers (1 1 iably to overestimate plasma volume. Accurate calculation of RCV from plasma volume requires not only accurate plasma volume estimation but also a knowledge of the total body Hct. Although correction factors allow for the difference between venous and total body Hct (14, 15, 16), they are of quite unknown reliability in sick infants. RCV can be estimated using dilution of autologous HbF at the time of a blood transfusion (2, 17). This is reliable provided that HbF estimation is accurate (e.g. alkali denaturation technique) (2) and at least 20% of the Hb in the circulation before transfusion is fetal. This technique cannot be used without a donor blood transfusion.A new method has recently been described for determination of RCV in adults. Biotin is used to label autologous red cells, and their dilution is quantitated in a fluorescence-activated cell sorter using the fluorescein-streptavidin reaction (17). Biotin is not toxic in infants, even in pharmacologic doses (1 8).We report here results...

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The concentrations of D-dimers (the D fragments of fibrinogen) were measured in blood from 15 preterm infants, and 45 born at fuli term, to establish normal ranges. The adult normal range is <0 25 mg/l; 31 of the 60 infants (52%) had values <0*25 mg/l, in 16 (27%) they were 0-25-0-5, in eight (13%) 0-5-1, in three (5%) 1-2, and in two (3%) 2-4. D-dimer concentrations measured during the neonatal period should be interpreted with caution.D-dimers (D fragments of fibrinogen) are produced during plasmin mediated lysis of fibrin.' They are more specific than fibrin/fibrinogen degradation products, which are formed during degradation of fibrinogen and fibrin.2 D-dimers can be measured using 10 1d of plasma in five minutes from specimens taken in EDTA, heparin, or citrate by a latex agglutination technique.3In adults the concentration of D-dimers is the most sensitive marker for monitoring the activity of disseminated intravascular coagulation,3 and the adult normal range is less than 0-25 mg/1.4 The aim of this study was to evaluate the test in newborn infants and to find out whether pregnant women had significantly increased values before delivery that might affect the concentrations in their infants. Patients and methods Full blood counts, coagulation screens, and D-dimers were measured in samples of venous blood taken from 15 preterm infants and 45 born at full term. The gestational ages of the preterm infants were: 27-28 weeks (n= 1), 29-30 weeks (n=l), 31-32 weeks (n=10), and 33-34 weeks (n= 3). The preterm infants had no serious complications of prematurity, although two received short periods of ventilation (less than 24 hours); this is our routine for infants of less than 30 weeks' gestational age. All infants received vitamin K 1 mg at birth by intramuscular injection.

The peri-operative course of 194 patients undergoing 244 procedures for primary repair of cleft lip and palate over an 8-year-period was studied. A marked increase in the extent of intra-operative monitoring was noted during this period. The Pierre Robin syndrome was the most common associated abnormality and was found in 17% of patients in this series. There were no deaths. A total of 101 procedures were undertaken in infants with cleft lip of whom 10% received an intra-opera tive blood transfusion. Post-operative opiate analgesics were administered following 97% of these procedures and profound respiratory depression was observed in three children. The use of lignocaine and noradrenaline did not signhcantly reduce the operative blood loss. A post-operative pyrexial illness was significantly associated with the presence of a positive pre-operative nasal and throat swab and this could be significantly reduced by pre-operative antibiotic treatment. A total of 143 children underwent repair of cleft palate and of these 16.8% received an operative blood transfusion. An elective tracheostomy was required in one patient because of unsuccessful attempts at endotracheal intubation. One patient developed a respiratory arrest after two doses of diamorphine perioperatively. The use of lignocaine and noradrenaline significantly reduced the operative blood loss. The presence of a positive bacteriological nose or throat swab did not influence the development of a post-operative pyrexia which could however be significantly reduced by the use of pre-operative antibiotics.

Interobserver reproducibility in deriving cardiac output by measuring aortic blood flow velocity and diameter with imaging and Doppler ultrasound was investigated in 20 healthy infants born at full term. Aortic diameter was measured in three ways. Mean blood flow velocity was measured at three sites with both continuous wave and pulsed Doppler. Two observers carried out each study independently. Intraobserver reproducibility was investigated in 12 infants using the suprasternal site for measuring blood flow velocity. The most reproducible determination of cardiac output was found when the suprasternal site with continuous wave Doppler was used for measurement of blood flow velocity and M mode trailing edge to leading edge echocardiography was used for diameter. Normal mean (2 SD) cardiac output is 231 (77) ml/kg/min.Technical difficulties in measuring aortic diameter accurately limit direct comparison between infants.