Controlled trial of bladder drill for detrusor instability.

Comment The toxic shock syndrome was first reported in seven children in 19782; in five of these Staphylococcus aureus was isolated from various sites. The occurrence of toxic shock syndrome in menstruating women was first reported in 19803; since then 299 cases have been reported in the United States with 25 deaths.4 About 95, of these cases have occurred in menstruating women, all of whom had been using tampons. Staphylococcus aureus has been isolated from vaginal swabs in more than 900o of cases; blood cultures are always sterile. Our patient had all the features of the toxic shock syndrome, and phage group 1 Staph aureus was isolated from her vagina and from the tampon she was using. The occurrence of scarlatiniform rashes in staphylococcal infections is well known and many of the features of toxic shock syndrome occur in staphylococcal septicaemia; in toxic shock syndrome, however, the organisms have not been found in the blood stream. It has been postulated that staphylococci in the genital tract produce a toxin which causes the syndrome4; the nature of this toxin has yet to be elucidated. Because we saw her before the toxic shock syndrome had been associated with tampons, we did not attempt to see if the staphylococcus produced a toxin. The risk of toxic shock syndrome may be reduced by using tampons intermittently rather than continuously during a menstrual period. The condition should be managed by intensive fluid replacement, and antistaphylococcal antibiotics should be administered after appropriate cultures have been obtained. It is recommended that women who have had an episode of toxic shock syndrome should not use tampons for several menstrual cycles. I thank Dr H Pullen for permission to report this case admitted under his care. The cerebral stimulant effects of the bronchodilator theophylline are well known. Nevertheless, we have recently seen two cases of severe depression with this drug, a paradoxical and unreported reaction. Case reports (1) A 19-year-old asthmatic girl (weight 48 kg) had theophylline 225 mg twice daily added to her standard regimen of inhaled salbutamol and beclomethasone because of increasing bronchospasm. Over a period of one month she unaccountably became depressed and-irritable having previously had a stable personality. Her symptoms disappeared promptly on withdrawal of theophylline alone, but its reintroduction two weeks later for an exacer-bation of bronchospasm precipitated afurther episode of profound depression. Stopping the drug again relieved the symptoms. (2) An 1 1-year-old …