Available data sources on disease due to Bordetella pertussis, including notifications, hospital admissions, deaths, and an enhanced laboratory-based surveillance system commenced in January 1994, were reviewed for the period 1995-7. Pertussis notifications continued their approximately 3-year cycle although at historically reduced levels. A slight seasonal increase in late summer/early autumn existed over and above a relatively constant background rate. Over time, the proportion of pertussis cases in younger, unvaccinated children, and to a lesser extent, adolescents and young adults, is increasing. There is a continuing significant and underreported mortality associated with pertussis in the very young age group. Disease due to serotype 1,2 is on the increase despite persistent high vaccination levels and this serotype causes more severe disease. The provision of preventative antibiotics prior to disease onset reduced the severity of the disease but its use remains uncommon in England and Wales. While overall levels of pertussis notifications have declined in recent times, vaccination efficacy wanes with increasing age, and pertussis remains a significant cause of mortality and severe morbidity in the very young. This could be reduced by timely booster vaccination and increased recognition of mild disease in older cases followed by early antibiotic therapy for the very young household contacts.

Although the transversus abdominis plane (TAP) block has an established role in providing postoperative analgesia following caesarean section, the technique is not widely used by obstetric anaesthetists. The conventional TAP block is associated with significant technical difficulties and risk of peritoneal, hollow viscus and organ perforation. We report a much simpler technique in which the obstetric surgeon, during open surgery, is able to introduce the TAP block via an intra-abdominal approach, which is technically easier and also obviates the risks associated with the conventional TAP procedure. We believe our technique may be easier, safer and equally effective.Keywords Caesarean section, local anaesthetic, postoperative analgesia, rescue analgesia, transversus abdominis plane block.

SUMMARYThe purpose of this study was to DNA fingerprint the majority (64 %) of isolates received at the Pertussis Reference Laboratory during the 1993 whooping cough epidemic by pulsed field gel electrophoresis of Xba I -generated restriction digests. Two DNA restriction patterns, types 1 and 3, predominated (40% and 23 %, respectively, of 180 isolates) but type 2, identified in a previous study was notably absent. Twenty-one new DNA types occurred (24% of isolates), some being atypical as bands 155-230 kb were no longer conserved, but there was no statistically significant difference in their incidence in the upswing (JuneSeptember) compared to the downswing (October-December) phase of the epidemic. There was a relatively high proportion of new types, compared to type 1, at the peak (September). About 50 % of isolates received were from the North Western Region, where 44 % of isolates were DNA type 1. Whereas only 1 out of 10 isolates from Scotland were of this type, suggesting some geographic variation. Statistically significant findings included a higher proportion of isolates from female patients (P < 0-01), most marked in the 12-24 months age group (P < 0 05); a higher proportion of infants under 12 months requiring hospital admission compared to older children (P < 005); and a greater number of isolates from unvaccinated children (P < 0-01). Analysis of serotype according to four age groups (under 3 months, 3-12 months, 12-24 months and above 2 years) showed statistically significant differences (P < 0 05) with a noticeably lower proportion (38%) of serotype 1,3 in 3-12 months age group and higher prevalence (74%) of serotype 1,3 in the 12-24 months age group. There was no correlation between DNA type and serotype.

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Cephaloridine is a wide-spectrum antibiotic derived from cephalosporin and, despite similarities to penicillin, it can be used in the treament of infections in penicillin-sensitive patients. Riley, Boyle, and Leopold (I968) and Records (I969) have reported the intraocular penetration of cephaloridine into the aqueous after intramuscular and intravenous administration, and Moll, Crawford, and McPherson (197i) have shown penetration into the subretinal fluid after subconjunctival injection, but penetration ofantibiotic into the subretinal fluid after systemic administration has not hitherto been reported.McMeel (I965), Criswick and Brockhurst (i969), and Lincoff, Nadel, and O'Connor (I970) have described infection after retinal detachment surgery. Langston, Lincoff, and McLean (I965) showed that a purulent endophthalmnitis may be produced experimentally with external plombage and diathermy without drainage of subretinal fluid and, although cryotherapy has largely replaced diathermy, the drainage site of subretinal fluid provides a potential route for the entry of organisms into the eye.In the management of endophthalmitis after retinal detachment surgery, it is not always simple to distinguish between the clinical signs of anterior segment ischaemia (Crock, I967), a sterile endophthalmitis, and endophthalmitis due to bacterial infection.Before diagnosis can be established, the systemic administration of an antibiotic may be indicated.In attempting to select antibiotics for the treatment of intraocular infection after detachment surgery, it would be valuable to know what levels of antibiotic are reached in subretinal fluid after systemic administration.The purpose of this paper is to report the penetration of cephaloridine into subretinal fluid in patients with retinal detachment after intramuscular injection.Material and methods 2I patients undergoing routine retinal detachment surgery were studied. In no case were local or systemic antibiotics administered during the week preceding operation. At varying times before surgery (if to 2* hrs), i g. cephaloridine, dissolved in 22-5 ml. sterile water, was injected intramuscularly into the gluteal region. In twelve patients IO ml. blood were taken before the injection of cephaloridine. IO ml. venous blood were taken at the time of subretinal fluid collection in all but three cases. Subretinal fluid was obtained by incising the sclera and then partly cauterizing the underlying choroid until the subretinal space was entered. Before puncture of the choroid, the site was carefully dried and haemostasis of the surrounding tissue was secured to avoid contamination of the specimen. A small receptacle (Figure) was held under the puncture wound and subretinal fluid was collected. The fluid was immediately transferred to the laboratory in vacuum flasks