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Jehoiada John Brown (“Joyda”) was a well known and highly respected physician and clinical scientist, who worked in the Medical Research Council Blood Pressure Unit in the Western Infirmary in Glasgow from 1967 until he retired in 1992. He had a high international reputation for his clinical practice, which was informed by research based observations, and, equally importantly, for the warmth and generousity of his nature. Joyda was born in Croescyceiliog, South Wales. He was intensely proud of his Welsh heritage and upbringing, and his adult persona reflected the values instilled during his formative years. His father was a cabinet maker and prominent in local government. It was this heritage of craftsmanship and public service, set against a background of Welsh non-conformism, that shaped his character, exemplified by hard work, precision of thought and deed, and a wish to serve others. He attended West Monmouthshire Grammar School, where he excelled in sport, representing Welsh schools at athletics and rugby. On leaving school he matriculated in medicine at Cardiff University, but his passion for rugby led him to transfer after one year to St Mary’s in London, which, at the time, had a high reputation for prowess in hospital rugby competitions. At St Mary’s he gained a first class degree in physiology and graduated in medicine in 1951. As a student he represented United London Hospitals at rugby, and continued to perform at a high level in athletics. He remained an enthusiastic, if somewhat caustic …

Next week 200 of Britain's oral and maxillofacial surgeons will visit secondary schools to warn pupils about the risks of facial injury from drinking and fighting and, with the help of patients, to show them the consequences of such injuries. What are those risks, and how may they be prevented? In few places is the effectiveness of legislation on seat belts and drinking and driving more obvious than in oral and maxillofacial trauma. From 1977 to 1987 the proportion of patients with maxillofacial fractures sustained in road accidents fell by 34%,1 and rates of facial bone fracture sustained in road accidents fell from 6.2 to 4.1 per 100 000 population. Violent crime, however, more than compensated for this decrease, and, although the incidence of serious injury such as complex pan-facial fractures decreased, the overall incidence of facial injury rose from 20 to 24 per 100 000 population.1 The proportion of injuries sustained in assaults increased from 40% in 1977 …

Editor—Hassey et al have highlighted the importance of ensuring that electronic records are accurate.1 In their study they explored a method of measuring the validity and utility of electronic records in general practice, including whether the coding of 15 marker diagnoses was a true reflection of the actual prevalence. They are, however, wrong in their assertion that no published accounts of measuring the validity of electronic record contents exist. Hogan and Wagner performed a literature review and compared 20 articles that met certain quality criteria.2 They recommended (as did Hassey et al) that measures of completeness (sensitivity or detection rate) and correctness (positive predictive value) were valuable. These measures have also been shown to be valuable in measuring the quality of data retrieval.3 Other measures derived from 2×2 contingency tables are less likely to be helpful because of the combination of a large total number of records and true negatives. To compensate for this, Hassey et al propose two new descriptive statistics. Previous reports have used Cohen's κ,4 a measure of the strength of agreement between the observed retrieval and the gold standard, against a result that might be expected by chance. Cohen's κ has the advantage of being a well validated single index and has been shown to be a useful index of measuring data retrieval from electronic records where performances of >0.9 can be achieved.3 When Cohen's κ is applied to the data by Hassey et al, it highlights similar priority areas of data concern where the value is

always assuming, of course, that no one else's welfare is at stake here. Even if the records, as physical objects, are government property it does not follow that this is true also of the information that they contain. Personal information disclosed in a consultation should perhaps be seen as effectively "on trust" to the doctor for the period of treatment, or for the period in which that doctor continues to have the person as a patient. (The whole issue of ownership of information is one that would merit more attention from moral philosophers.) Other arguments of a more pragmatic character will no doubt be advanced in favour of maintaining the status quo. One should be reluctant, it may be said, to advocate any new system that would add to the administrative burden under which hard pressed general practitioners and the NHS generally, currently labour. Some sacrifice of patient autonomy may be justified on the basis that it is a relatively small price to pay in return for the very great benefits of the present system, which allows the use of information collected over a long time to be used whenever required in a consultation. But even in therapeutic terms there could be much to be gained by a system that gave patients greater control over their own records; it might well serve to encourage greater openness, enhanced trust, and a greater spirit of cooperation between doctor and patient. We find it difficult to believe that a system more respectful of confidentiality and of the patient's wishes could not be made to work successfully if there was a sufficient will so to do.

Pregnant women receiving daily supplements of 400 IU (10 microgram) of vitamin D2 from the 12th week of pregnancy had plasma calcium concentrations higher at 24 weeks but similar at delivery to those in control pregnant women who did not receive the supplements. Infants of the women receiving the supplements had higher calcium, lower phosphorus, and similar magnesium concentrations on the sixth day of life and a lower incidence of hypocalcaemia than infants of the control women. Plasma concentrations of 25-hydroxycholecalciferol, which showed a seasonal variation, were higher in mothers and infants in the treated group. Cord-blood calcium, magnesium, phosphorus, and 25-hydroxycholecalciferol concentrations correlated with maternal values at delivery. Breast-fed infants had higher calcium and magnesium and lower phosphorus and 25-hydroxycholecalciferol concentrations than artificially fed infants. A defect of dental enamel was found in a high proportion of infants (many of whom had suffered from hypocalcaemia) born to the control women. These results suggest that vitamin D supplementation during pregnancy would be beneficial for mothers, whose intake from diet and skin synthesis is appreciably less than 500 IU of vitamin D daily.

Fifty patients with hypertension, aldosterone excess, and low plasma renin concentration underwent adrenal surgery. There was a highly significant fall in mean systolic and diastolic pressures after the operation. The mean postoperative diastolic pressure fell to strictly normal levels, however, in only 19 out of 38 patients from whom an adrenocortical adenoma was removed and in only two out of 10 non-tumour patients. There was a significant correlation between the fall in blood pressure during spironolactone treatment and after adrenal surgery though levels were generally slightly lower during the former therapy. It is suggested that removal of an aldosterone-producing adenoma is the treatment of choice provided a good preoperative hypotensive response to spironolactone occurs, while the treatment of choice for non-tumour patients is often long-term spironolactone.

Plasma renin concentration was increased, usually appreciably, in 22 out of 25 patients with acute renal failure, the average value being 226 units/litre (mean for normal subjects 8.2 units/1.). The highest renin values were found in the first 10 days of the disease; lower and sometimes normal values were found subsequently. Unequivocal acute tubular necrosis was present in only two of the eight cases examined post mortem.These findings are compatible with Goormaghtigh's proposal that an excess of renin and angiotensin may act within the kidney to produce acute renal failure.

Twenty-six hypertensive patients with unilateral renal artery disease and normal overall renal function were treated surgically: eleven underwent arterial reconstruction and 15 unilateral nephrectomy. One year after operation there was similar reduction in blood pressure in each group (delta mean BP 45:3 mm Hg (p < 0.001) and 36.8 mm Hg (p < 0.001) respectively. contrary to previous reports, however, a small but significant improvement in overall renal function was observed in patients who underwent reconstructive surgery (delta mean serum creatinine--13.3 mumol/1 (p < 0.01); this was associated with a significant rise in para-aminohippurate (PAH) clearance in the operated kidney, while PAH clearance fell on the contralateral side. Overall renal function deteriorated in the patients who underwent unilateral nephrectomy (delta mean serum creatinine +22.7 mumol/1 (p < 0.01)). The latter was due partly to diminished clearance in the remaining kidney and partly to the loss of the excised kidney. The findings emphasise the superiority of renal artery reconstruction over nephrectomy in patients with renovascular hypertension.

Circulating levels of renin, angiotensin I, and angiotensin II were increased in six patients with chronic renal failure and hypertension uncontrolled by dialysis and hypotensive drugs. Lower and often normal levels were found in 10 patients whose blood pressure was controlled by dialysis treatment. For a variety of reasons all patients were subjected to bilateral nephrectomy. The logarithm of the decrease in plasma concentrations of renin and angiotensin II was significantly related to the fall of blood pressure after operation. Plasma renin concentration correlated significantly with blood angiotensin I concentration and with plasma angiotensin II in samples taken before and after nephrectomy. Renin, angiotensin I, and angiotensin II were measurable in samples of blood taken 48 hours or more after the operation.

Analyse des modifications de la frequence de la maladie de Crohn dans une population stable d'Irlande du Nord, pendant les periodes 1966-1973 et 1974-1981

The angiotensin converting-enzyme inhibitor captopril was used as long-term preoperative treatment in a series of hypertensive patients with unilateral renal arterial disease. There were immediate and sustained falls in plasma angiotensin II and aldosterone concentrations, with converse increases in circulating renin and angiotensin I. In patients with sodium and potassium deficiency and secondary aldosterone excess before treatment captopril corrected the sodium and potassium deficits; in these cases the initial hypotensive response was profound but the later effect was less pronounced. When sodium and potassium state was initially normal it remained unchanged during captopril treatment, while the full hypotensive effect took up to three weeks to be attained. The immediate, but not long-term, falls in arterial pressure with captopril were proportional to the immediate decrements of plasma angiotensin II. Nevertheless, while the immediate blood-pressure reduction with captopril variously overestimated and underestimated the eventual surgical response, the absolute blood-pressure values during long-term captopril related well with those after operation. Pretreatment plasma renin and angiotensin II concentrations, while closely predicting the immediate captopril response, are fallible guides to surgical prognosis. In contrast, long-term treatment with converting-enzyme inhibitors may provide an accurate indication of surgical outcome.