Pseudomembranous colitis and co-trimoxazolePseudomembranous colitis is associated with antibiotic treatment. We report here its first published link with co-trimoxazole. Case reportAn 80-year-old woman was admitted to hospital with a fractured neck of the femur, which was managed by internal fixation. Antibiotic cover was not provided for the operation. On the sixth day after operation she developed a fever, which was clinically attributed to a urinary infection, although no organism was subsequently cultured. Treatment was started with cotrimoxazole (Septrin), two tablets twice daily. On the 15th day after operation the patient developed offensive diarrhoea, but the co-trimoxazole was not discontinued until the 20th day. Culture of the stool showed no pathogen,

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Africa south of the Sahara The Geographical Distribution of Duodenal Ulcer The geographical distribution of a disease may provide valuable clues with regard to its aetiology. Likewise any historical changes in prevalence, associated with changes in the mode of living, may give additional information. In this report the prevalence of duodenal ulcer in Africa, south of the Sahara, is reviewed and areas of high and low prevalence are identified. The information has been collected in several ways: by reviewing all the available literature; by extensive correspondence, personal interviews, and visits; and by replies to questionnaires sent out by Mr D. P. Burkitt of the Medical Research Council to a large number of mission hospitals, many of which have sent monthly returns over a period of three years. There are many difficult problems to overcome in trying to establish the prevalence of a disease with a low mortality such as duodenal ulcer. These problems are considerable in a developed country and much greater in developing countries. The authors have endeavoured only to establish whether duodenal ulcer is a common or a rare problem in a given area. It has not been possible for the most part to use any exact parameters. In making an assessment it was noted whether the diagnosis had been made on clinical findings, x-ray evidence, surgical experience, or necropsy examinations. Many hospitals are without x-ray facilities. Surgical statistics can be selective and misleading, depending often on the facilities available and the reputation of the hospital, but nonetheless can be a valuable guide. One of the most useful indicators has been the incidence of complications-pyloric stenosis, haemorrhage and perforation, none of which can be easily overlooked. Great value has been attached to reports from mission hospitals where there has been long-continued service by individual doctors and where records have been well kept. Wherever possible the number of proven duodenal ulcer cases has been related to the number of annual admissions (excluding maternity). Figure 1 presents the overall results of the survey. Areas in which duodenal ulcer is common, occurs occasionally, or is uncommon, are indicated. Both urban and rural areas are shown, but these will be commented on separately. Figure 2 is based on the available information relating the number of proven cases to hospital admissions. Three groups are portrayed as (1) less than one case per 1000 admissions; (2) one to 10 cases per 1000 admission; (3) over 10 cases per 1000 admissions.

SummaryIncreasing numbers of patients presenting for surgery are receiving concurrent medication with low-dose aspirin. We surveyed the opinions and working practices of consultant members of the Neuroanaesthesia Society regarding patients who present for elective intracranial surgery whilst taking this form of medication. Identical questionnaires were sent to 140 members of the society and proffered four main questions: (1) the adherence to any policy of stopping aspirin preoperatively, (2) the preferred method of treatment for excessive bleeding in this context, (3) personal knowledge of haemorrhagic complications in this group of patients, (4) the neurosurgical unit concerned. There were 121 responses (86.4%) of which 116 (82.9%) were valid. Of the respondents, 78 (67.2%) were unaware of a written departmental policy for the discontinuation of pre-operative aspirin treatment and had no personal policy. Thirty-two respondents (27.6%) had a personal policy but were unaware of a written departmental policy; only six respondents (5.2%) stated that a written departmental policy was in place. The mean time suggested for discontinuation of aspirin pre-operatively was 11.3 days (range: 1-42 days). Fifty-one respondents (44.0%) considered that patients taking low-dose aspirin were at increased risk of excessive perioperative haemorrhage and 15 (12.9%) anaesthetists reported having personal experience of such problems. Fifty-seven respondents (49.1%) would use a platelet infusion, alone or in association with other blood products or prohaemostatic agents, if haemorrhagic complications developed. The majority of neuroanaesthetists felt that aspirin was a risk factor for haemorrhagic complications associated with intracranial procedures, but most adopt no policy regarding its preoperative discontinuation.Keywords Surgery; neurosurgical. Analgesics; salicylates, aspirin. ...................................................................................... Correspondence to: D. N. James, Department of Anaesthesia, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK. Accepted: 18 October 1996 Aspirin is increasingly prescribed for its antithrombotic properties [1][2][3][4][5] and more patients are therefore presenting for surgery with dysfunctional circulating platelets. Aspirin is also a common constituent of many 'over the counter ' medications [6].The contribution of low-dose aspirin to increased perioperative blood loss is a contentious issue with conflicting published results from different surgical groups. Data from neurosurgical patients are sparse [7] but aspirin has been identified as an important risk factor in the development of postoperative haematomata following intracranial surgery [8].This survey examined the opinions and working practices of consultant neuroanaesthetists with regard to patients taking low-dose aspirin medication who present for elective intracranial surgery. MethodsIdentical questionnaires with stamped addressed return envelopes were sent to practising consultant members o...