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Five patients with dysembryoplastic neuroepithelial tumour (DNT) showing extensive secondary haemorrhage, a finding not previously associated with these neoplasms, are described. The clinical presentations, neuroimaging findings, and histopathological features of these patients are reviewed. One patient, a previously asymptomatic 12 year old girl, presented with an acute intracerebral haemorrhage into a DNT. A further four young adults with histories of intractable partial and generalised seizures dating from childhood showed significant chronic haemorrhages within DNT, the MRI appearances in one patient giving a false impression of a cavernoma. Histopathology disclosed vascular abnormalities within these tumours which, together with other factors discussed, may have predisposed these tumours to haemorrhage. [ABSTRACT FROM AUTHOR]

During screening of 16,800 primary schoolgirls, aged 4-12 years, in Cardiff and Oxford, significant bacteriuria was found in 294 (1-7%). Intravenous urography and micturating cystography were performed in 246 of these girls. The urinary tract was abnormal in 47%. Pyelonephritis with or without vesicoureteric reflux was present in 26% and reflux without renal abnormality in a further 16%. The prevalence of pyelonephritis and reflux was independent of age. With few exeptions kidneys without pyelonephritic scars appeared to be normal in size, even when ureteric reflux was present. [ABSTRACT FROM AUTHOR]

The aim was to examine the effects of smoking, physical activity, and body mass on total cholesterol and high density lipoprotein cholesterol (HDL-C) in adolescent schoolgirls in Sydney, Australia. Body mass index (BMI) and waist to hip ratio (WHR) were determined in 144 girls aged 15 to 18 years. Total cholesterol (TC) and HDL-C were estimated on fingerprick blood and behavioural variables assessed by questionnaire. Prevalence of overweight (> 90th centile for BMI) was less in Australian adolescents than reported from the USA. Smokers had lower total cholesterol than non-smokers; this was partly explained by a lower HDL-C in the smokers. Physical activity was associated with a less atherogenic TC/HDL-C ratio. Girls with BMI > 90th centile had higher mean TC/HDL-C and apoprotein B than the group as a whole but those > 90th centile for WHR did not. [ABSTRACT FROM AUTHOR]

Objective: Achieving joint regeneration in rheumatoid arthritis (RA) represents a future challenge. Autologous synovial mesenchymal stem cells (MSCs) could be therapeutically exploited. However, the inflammatory milieu in the RA synovium could adversely affect endogenous MSC function. To test this hypothesis, the frequency and multipotency of RA synovial MSCs was evaluated in relation to existing synovial inflammation. Methods: Synovial inflammation was measured using the arthroscopic visual analogue score (VAS) and further validated using immunohistochemistry and flow cytometry. Highly proliferative clonogenic in vivo MSCs were enumerated following fluorescence-activated cell sorting and expansion for 20 population doublings. MSC multipotency was quantified following standard in vitro culture expansion and trilineage differentiation assays. Real-time PCR, flow cytometry and ELISA were used to evaluate pro- and anti-chondrogenic molecules in standard polyclonal synovial MSCs. Results: The arthroscopic VAS significantly correlated with synovial macrophage infiltration. In RA, synovial MSC chondrogenesis was inhibited in direct relation to VAS (r = −0.777, p<0.05) and reduced compared with control osteoarthritis (OA)-MSCs (p<0.05). In vivo, MSCs resided in the synovial fibroblastic/stromal fraction (CD45CD31) and were reduced in frequency in relation to VAS (r = −0.695, p<0.05). In RA-MSCs, CD44 levels correlated negatively with inflammation and positively with chondrogenesis (r = −0.830 and r = 0.865, respectively). Cytokine production and Sox9 expression was similar in RA-MSCs and OA-MSCs. Conclusions: There is a negative relationship between synovial MSC chondrogenic and clonogenic capacities and the magnitude of synovitis in RA. Effective suppression of joint inflammation is therefore necessary for the development of autologous MSC treatments aimed at cartilage regeneration in RA. [ABSTRACT FROM PUBLISHER]

Objectives: To describe a series of lymphogranuloma venereum (LGV) cases presenting as inguinal syndrome and/or genital ulceration seen among men who have sex with men (MSM) in London, UK. Methods: Collaborative retrospective case note review. Clinicians from three London genitourinary medicine (GUM) clinics accessed by large populations of MSM within the current LGV outbreak collected clinical data from confirmed cases of LGV inguinal syndrome or genital ulcer. LGV was confirmed by the detection of LGV-specific DNA from specimens such as bubo aspirates, ulcer swabs, urethral swabs, first void urine and rectal biopsy material. Results: There were 13 cases detected overall: 5 cases of urethral LGV infection with inguinal adenopathy, 3 cases of genital ulcer with LGV inguinal adenopathy, 3 cases of isolated LGV-associated inguinal buboes, 1 case of a solitary LGV penile ulcer and 1 case with a penile ulcer and bubonulus. Only 6 of the 13 were HIV positive and all tested negative for hepatitis C. The majority of cases reported few sexual contacts in the 3 months preceding their diagnosis. Conclusions: Clinical manifestations of LGV in MSM have not been confined to proctitis in the current outbreak in the UK and a small but significant number of inguinogenital cases of LGV have been observed. Epidemiologically, many of the cases described seem to have occurred at the periphery of the current MSM LGV epidemic. Clinicians need to be vigilant for these less common presentations of LGV among MSM and specific diagnostic tests should be done from the relevant lesions. [ABSTRACT FROM AUTHOR]

Background: There is little research into medical students or doctors attitudes to abortion, yet knowing this is important, as policy makers should be aware of the views held by professionals directly involved in abortion provision and changing views may have practical implications for the provision of abortion in the future. Methods: We surveyed 300 medical students about their views on abortion, their beliefs about the status of the fetus and the rights of the mother, their attitude towards UK law and their willingness to be involved in abortion provision as qualified doctors. Results: 62% of medical students were pro-choice, 33% pro-life and 7% undecided. Students' views correlated with gender, year of study and holding a religious belief. Their beliefs about abortion, the status of the fetus and the rights of women significantly correlated with their attitudes towards the UK law and their willingness to be involved in abortion provision. Students' willingness to be involved in abortion provision was related to their views on abortion, the extent of participation required, the circumstances of the pregnancy and the stage of pregnancy. Conclusions: The percentage of pro-choice students was lower than that found in research on general practitioners' attitudes to abortion. It is unclear whether this is because students become more pro-choice as they progress through their medical career or because there is genuinely a change in attitudes to abortion. [ABSTRACT FROM AUTHOR]

Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians attitudes and practices regarding error discussions with colleagues. Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables. Results: Responses were received from 338 participants (response rate = 74%). In all, 73% of respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision (91%), wanting colleagues to learn from the mistake 180%) and wanting to receive support (79%). Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm 177%), minor harm (87%) or major harm (94%). Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion (OR 4.17, Cl 2.34 to 7.42). Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. [ABSTRACT FROM AUTHOR]

Objectives -- Primary: to compare sequential and simultaneous breast pumping on volume of milk expressed and its fat content. Secondary: to measure the effect of breast massage on milk volume and fat content. Design -- Sequential randomised controlled trial. Setting-Neonatal intensive care unit, North Staffordshire Hospital NHS Trust. Subjects -- Data on 36 women were analysed; 19 women used simultaneous pumping and 17 used sequential pumping. Interventions -- Women were randomly allocated to use either simultaneous (both breasts simultaneously) or sequential (one breast then the other) milk expression. Stratification was used to ensure that the groups were balanced for parity and gestation. A crossover design was used for massage, with patients acting as their own controls. Women were randomly allocated to receive either massage or non-massage first. Main outcome measures-Volume of milk expressed per expression and its fat content (estimated by the creamatocrit method). Results -- Milk yield per expression was: sequential pumping with no massage, 51.32 g (95% confidence interval (CI) 56.57 to 46.07); sequential pumping with massage, 78.71 g (95% CI 85.19 to 72.24); simultaneous pumping with no massage, 87.69 g (95% CI 96.80 to 78.57); simultaneous pumping with massage, 125.08 g (95% CI 140.43 to 109.74). The fat concentration in the milk was not affected by the increase in volume achieved by the interventions. Conclusions -- The results are unequivocal and show that simultaneous pumping is more effective at producing milk than sequential pumping and that breast massage has an additive effect, improving milk production in both groups. As frequent and efficient milk removal is essential for continued production of milk, mothers of preterm infants wishing to express milk for their sick babies should be taught these techniques. [ABSTRACT FROM AUTHOR]

A series of 20 patients with definite or classical rheumatoid arthritis who subsequently developed a lymphoproliferative malignancy are described. The mean time between the onset of the 2 diseases was 13.2 years. A wide range of types of non-Hodgkin's lymphoma and Hodgkin's disease were found; there were no unusual histological features in the lymphomas. Although many of the patients had had gold, penicillamine, and other second-line drugs, none of them had received cytotoxic drugs, and there was no evidence that therapy was a cause of their malignancies. The likely cause of the association is a predisposition to both diseases. [ABSTRACT FROM AUTHOR]

Comments on issues related to health services in Great Britain. Program of BBC 'Panorama' on brain death and transplantation; Changes in the management of persons admitted to hospital with self-poisoning; Vaccination against smallpox.

AIMS--To evaluate antibodies directed against CD31 (JC70/A) and CD34 (QBEND/10 and anti-HPCA-1) more extensively in Kaposi sarcoma; to assess their value in routine diagnosis; and to compare them with the traditional endothelial cell markers Ulex europaeus agglutinin 1 (UEA-1) and factor VIII related antigen. METHODS--Twenty four cases of Kaposi sarcoma were studied retrospectively. All specimens had been fixed in formalin and embedded in paraffin wax. The antibodies were applied using the Streptavidin biotin technique in all cases except for UEA-1, for which an indirect two stage method was used involving peroxidase conjugated anti-ulex as the secondary antibody. RESULTS--Tumours were classified into those showing angiomatoid or lymphangiomatoid elements and spindle cell lesions. Universal labelling of all lesions and virtually all elements within lesions was seen with the anti-CD34 antibodies QBEND/10 and HPCA-1. Labelling of spindle cells was less consistent with JC70/A but both markers were superior to the traditional endothelial cell markers UEA-1 and factor VIII related antigen. CONCLUSIONS--These data confirm that Kaposi sarcoma is a tumour of endothelial cell origin. They shed further light on the histogenesis of this complex tumour and demonstrate that immunostaining for CD34 and CD31 can be used as an aid to diagnosis in routinely processed tissue. [ABSTRACT FROM PUBLISHER]

The Datatree costing project in Wales has provided the Welsh pathology laboratories with a standard costing package that allows pathologists to understand how their own laboratory's test costs are compiled. The software provides answers to the question "what if? ..." and shows instantly the effect of salary or consumable cost alterations. Resource management at a laboratory level is enhanced by a greater knowledge of costs, particularly in relation to volumes of work. Perhaps this is one of the stepping-stones across the river to the "open market." In the United Kingdom NHS any information of this kind must be regarded as invaluable. [ABSTRACT FROM PUBLISHER]

Sixteen lymph nodes from 14 patients with rheumatoid arthritis were examined immunohistochemically and morphometrically and compared with 10 control nodes showing follicular hyperplasia from patients without rheumatoid disease. Frozen material was available from nine patients and all controls. The nodes from patients with rheumatoid arthritis seemed to share characteristic features. The most striking of these was follicular hyperplasia in which the germinal centres, in spite of being quite large, showed relatively sparse proliferative activity. The nodes often showed infiltration of germinal centres by CD8 positive T lymphocytes and contained fewer IL2R positive cells in the paracortex than controls. These and other features may have some correlation with disease activity. Lymphadenopathy in rheumatoid arthritis may not just be a manifestation of joint inflammation but an active component of this multisystem disease and may reflect a widespread immunological abnormality. [ABSTRACT FROM PUBLISHER]

Serial saliva cortisol measurements were used to assess pituitary-adrenal function in a group of asthmatic children treated with beclomethasone dipropionate (400 micrograms daily). Asthmatic children who were not being treated with steroids and normal children were also studied for comparison. A diurnal cortisol rhythm was observed in all three groups. Early morning cortisol concentrations were significantly higher in the group treated with beclomethasone dipropionate than in the normal children; this may indicate a stress induced response to decreased morning peak expiratory flow. In both groups, plasma and salivary cortisol responses after adrenocorticotrophic hormone stimulation test were normal but peak cortisol concentrations showed a 7 fold increase over basal values in saliva compared with a three fold increase in plasma. Beclomethasone dipropionate does not suppress pituitary-adrenal function in children when used in recommended doses. Serial measurement of the salivary cortisol concentration is a simple, safe, and sensitive method for the routine monitoring of adrenal function in children treated with this steroid. Monitoring may be supplemented with an assessment of the adrenal response to adrenocorticotrophic hormone stimulation, if necessary. [ABSTRACT FROM AUTHOR]

We describe a 3 year old girl with the typical clinical features of the X linked recessive condition, Hunter's disease. The diagnosis was confirmed by the pattern of urinary excretion of glycosaminoglycans and the absence of iduronate sulphatase activity in her fibroblasts. She also had an apparently balanced reciprocal chromosomal translocation 46XX,t(X:5) with the X breakpoint being between q26 and q27. Pedigree analysis, and the normal iduronate sulphatase activity in the mother's fibroblasts, serum, and hair roots indicate that the affected child represents a new mutation. Since the parents' karyotypes are normal, it seems that the translocation disrupted the iduronate sulphatase gene itself, thus mapping this to Xq26-27 for the first time. The severe clinical features, not expected in a girl, may be explained by non-random X inactivation. [ABSTRACT FROM AUTHOR]

Six very preterm (< 32 weeks' gestation) infants who developed late-onset respiratory distress were each matched for sex and gestation with 2 control preterm infants. Radiologically and biochemically the diagnosis of rickets and rachitic respiratory distress seemed clear and the pattern conformed with other reports of the syndrome. The control infants were of similar gastational ages but there was a significantly higher incidence of pre-eclampsia in the pregnancies of index cases. Also significant was a prolonged illness of several weeks' duration in the index cases; this illness was either heart failure due to patent ductus arteriosus or prolonged ventilation in the early weeks of life for apnoeic attacks. Awareness of these 2 aetiological factors shows the necessity of monitoring such infants for evidence of rickets. The use of water-soluble antirachitic prophylaxis such as 1 alpha-hydroxy-vitamin D or 1,25-dihydroxy-vitamin D is sometimes indicated. [ABSTRACT FROM AUTHOR]

Presents a correspondence on the journal 'British Medical Journal.' Importance on the management of gastrointestinal bleeding; Examination of factors related to colorectal surgery; Information on minor brain damage and alcoholism.

Immunohistochemical studies were performed in thirty skin biopsies from patients with Kaposi's sarcoma, who did and did not have the acquired immune deficiency syndrome (AIDS). Tumour histogenesis was rigorously tested using a battery of endothelial cell markers, which included two new monoclonal antibodies, EN4 and PAL E. These are both specific for endothelial cells and can be visualised in appropriately fixed paraffin embedded tissue. Whereas EN4 labels all endothelial cells, PAL E is negative in endothelium of lymphatic derivation. Lectin binding with Ulex europaeus agglutinin 1 (UEA-1) and the presence of factor VIII related antigen (FVIIIRA) and laminin were also examined. In nodular lesions of Kaposi's sarcoma the spindle cell areas were positive with EN4 and UEA-1, negative with PAL E, and showed focal staining for FVIIIRA and laminin. These results confirm that the tumour is of endothelial cell origin. Six patch stage lesions showed a network of angulated spaces, lined by cells that were positive with EN4 and UEA-1, negative with PAL E and anti-FVIIIRA, and showed only weak staining for laminin. This pattern was observed in both AIDS and non-AIDS related cases and strongly favours a lymphatic derivation for the tumour. This has important implications as it suggests that lymphatic endothelium may have special characteristics that lead to neoplastic transformation in patients with retrovirus infection. [ABSTRACT FROM PUBLISHER]

The mean areas of lymphoid follicles have been determined in 20 specimens of malignant follicular (centrocytic-centroblastic) lymphoma, 15 specimens of reactive follicular hyperplasia and 10 palatine tonsils. In all of the benign specimens and whenever possible for those showing malignancy, the areas of both the whole follicles (including the "mantle" zones) and of the follicle centres were measured; this procedure was facilitated by means of the Reichert-Jung (Kontron) MOP-AMO3 image-analyser. Reactive lymph nodes were found to have larger mean follicle areas than centrocytic-centroblastic lymphomas; the areas of reactive follicles also show greater variation than do those of their malignant counterparts. In addition, the "mantle" zone is usually absent from malignant follicles but may account for up to 65.5% of the mean total follicle size in reactive lymph nodes and tonsils. [ABSTRACT FROM PUBLISHER]

The shape of alpha-naphthyl acetate esterase (ANAE)-positive cells (other than T lymphocytes) has been measured in 40 lymph nodes. The specimens comprised 15 high-grade lymphomas, 15 low-grade lymphomas and 10 reactive lymph nodes. The parameter used for the measurement of shape was form factor (FF), which is readily calculated by the Reichert-Jung (Kontron) MOP-AMO3 user-controlled image analyzer. Perfectly round cells have an FF value of 1.0, whereas the FF of irregularly-shaped cells diverges from unity. It has been demonstrated that the ANAE-positive cells in high-grade lymphomas have mean values for FF of 0.8-0.9, whereas in low-grade lymphomas and reactive nodes the mean value is 0.4-0.5. Thus, high-grade lymphomas contain many more rounded ANAE-positive macrophage type cells than do low-grade lymphomas and reactive nodes. In the latter two types of specimen there is an excess of branching and spindle-shaped ANAE-positive cells. [ABSTRACT FROM PUBLISHER]

The mean nuclear area, maximum nuclear diameter (Dmax) and form factor (FF) have been measured in 30 specimens of non-Hodgkin's lymphoma (NHL) and 10 reactive lymph nodes, using the Reichert-Jung (Kontron) MOP-AMO3 image analyzer. Nuclear area and Dmax were found to be greater in high-grade NHL than in low-grade lymphomas and reactive nodes. In addition, there was close correlation between nuclear area and Dmax, especially for low-grade NHL and reactive specimens. As a means of distinguishing between high- and low-grade lymphomas, however, the FF appears to be of little value. [ABSTRACT FROM PUBLISHER]

Three cases of acute renal toxicity in patients receiving long-term therapy with mitomycin C and 5-fluorouracil are reported. Two of the patients (1 and 3) are from a multicentre trial of adjuvant chemotherapy for gastric carcinoma. All three cases showed extensive fibrin deposition in the kidneys and lungs, the appearances of the renal lesions being similar to those seen in the haemolytic-uraemic syndrome. Two of the three cases had received blood transfusions, and attention is drawn to the possibility that mitomycin C may sensitise the kidneys to minor mismatches. With the increasing use of these antimitotic agents, great vigilance should be exercised with regard to renal function and haemolytic status. [ABSTRACT FROM PUBLISHER]

The numbers of alpha-naphthyl acetate esterase (ANAE)-positive cells (other than T cells) have been counted in 32 specimens of Hodgkin's disease and two specimens of histiocytic lymphoma. The different Rye subtypes of Hodgkin's disease contain varying numbers of enzyme-positive cells, ranging from 1.8-16% in the lymphocyte-predominant form to 39.8-47% in lymphocyte-depleted Hodgkin's disease. The percentage of enzyme-positive cells in the mixed cellularity variety was from only 6.5 to 14.6%. In the two specimens of apparently genuine histiocytic lymphoma, the enzyme-positive cells constituted 95.2 and 97.5% respectively of all cells. Thus, the numbers of macrophages and macrophage-like cells in true histiocytic lymphoma are much greater than in Hodgkin's disease. [ABSTRACT FROM PUBLISHER]

Using the post-hypoxic mouse method of assay, values for erythropoietin in the plasma of patients with chronic renal failure were equal to, or greater than, normal values. Results suggest that the source of erythropoietin may be primarily extrarenal. Normal renal tissue, provided in the assay by the intact mouse, is required for activation of the hormone. There still remains to be explained the enhanced erythropoietic response to haemorrhage or hypoxia that can occur in anephric man. [ABSTRACT FROM PUBLISHER]

To describe differences in childhood hospital admissions at ages 1 to 5 years in two generations, and to compare the intergenerational differences in risks of admission. Information was taken from a longitudinal birth cohort study of a national sample and their firstborn offspring. England, Wales, and Scotland. the 5022 birth cohort members for whom information is available from ages 1 to 5 years and their 2205 firstborn offspring. Data comprised reports of hospital admissions, which were checked with hospitals. Mean numbers of days spent in hospital were fewer in the offspring generation than in their parents, but the proportion ever admitted fell by only 1%. Low birth weight babies (< 2500 g), who comprised 6% of cohort births and 7% of the following generation, used a high proportion of all inpatient time in the offspring population, rising from 3% to 14% of all days of admission. Compared with the early years of the NHS, published statistics show that the effectiveness of paediatric care has improved greatly, and that childhood mortality and the risk of serious illness have decreased significantly. This study reports intergenerational changes in the reasons for hospital admission and shows, with the benefit of good denominator data, that although there was only a small intergenerational decrease in the proportion of children treated in hospital, there was a large reduction in the time spent in hospital and an increase in admissions of children of low birth weight. [ABSTRACT FROM AUTHOR]

In order to assess the quality of care in a community-wide sample of diabetic patients, a study was performed on 217 such patients identified in three group practices in an east London health district. Only 46% of the patients were currently attending a hospital. In the two years before review, 64% of patients had had their blood pressure recorded and 59% had had retinal examinations. Levels of glycosylated haemoglobin were significantly higher in patients on insulin than in those on oral regimes (P = 0.0004). The mean level of glycosylated haemoglobin was higher in patients from Social Classes III, IV, and V than in patients from Social Classes I and II (P = 0.005), but there was no difference in level between those patients attending hospital and those attending their general practitioners after accounting for differences in these two populations (P = 0.19). Over 50% of all diabetic patients in this study had levels of glycosylated haemoglobin which may indicate vulnerability to microvascular disease. [ABSTRACT FROM AUTHOR]

The neuroleptic malignant syndrome is a rare but dangerous complication of treatment with neuroleptics. The aetiology and pathophysiology of the syndrome are reviewed, and a fatal case is presented where both brain and muscle pathology are described. Striking myopathic changes in this case, accompanied by only minimal and non-specific brain abnormalities, support a peripheral rather than central mechanism for the hyperthermia. [ABSTRACT FROM AUTHOR]

The effects of controlling childhood asthma of the same daily dose (400 micrograms) of beclomethasone dipropionate, given in two or four equal divided doses from a metered aerosol, were compared in a double blind crossover study. Thirty one children aged 6-14 years completed the study. They had previously been shown to need beclomethasone by showing either symptoms or reduced peak flow when the treatment was withdrawn. They recorded their daytime and night time symptoms on a visual analogue scale and their morning and evening peak expiratory flow (PEF), and recorded their symptomatic use of bronchodilator aerosols. Spirometry was performed at the end of each treatment period. Control of asthma was good on both regimens. There were small differences in both objective and subjective measurements in favour of the four times daily regimen, but none reached statistical significance, apart from patients' assessment of daytime wheeze (p less than 0.05). In particular, the differences in the results of lung function tests were very small. Compliance was better for morning and evening doses. These results suggest that beclomethasone given as 200 micrograms twice daily is effective in controlling mild childhood asthma. It may be preferable to 100 micrograms four times daily because of better compliance and because it is unnecessary to take medication to school. [ABSTRACT FROM PUBLISHER]

We report results of HLA-A, B, C, and DR typing in groups of white Caucasians of English descent and black West Indians of African descent with sarcoidosis. In the English patients we found a significantly increased frequency of Cw7, which was not found in the West Indian patients. Our results also suggest that DR3 and, in particular, inheritance of the B8/Cw7/DR3 haplotype is associated with good prognosis in English patients with sarcoidosis. There was no association between any HLA antigen and prognosis in the West Indian patients in this study. [ABSTRACT FROM AUTHOR]

Mite counts and tests for mite antigen were performed on samples of dust taken from the bedding of 53 children with mite-sensitive asthma. The samples from damp houses and the beds or enuretic children had markedly more mites and mite-antigen than those from dry houses. although the predominant species was usually Dermatophagoides pteronyssinus, some of the beds in the damp houses were heavily infested with another pyroglyphid mite Euroglyphus maynei, so that this was the species found in the greatest numbers. D pteronyssinus antigen was found to be correlated broadly with the total mite count, but more antigen was present for a given number of mites in the mattresses than in the blankets. The children were randomly allocated into two groups, one of which carried out rigorous anti-mite measures. The amounts of dust and mite antigen were reduced, though not the numbers of mites. Peak flow readings were monitored in the two groups for eight weeks and a final assessment made by a paediatrician who was unaware of the allocation of each patient in the trial. No significant differences emerged in the progress of the two groups, both tending to improve. Measures designed to remove mites from bedding do not greatly benefit the majority of children with mite-sensitive asthma. [ABSTRACT FROM AUTHOR]

596-600. Twenty-four patients suffering from thoracic and other injuries were admitted to an intensive care unit over a three-year period. The first four patients died from infection by Gram-negative bacilli with associated features of bacterial toxaemia although it was anticipated that most, if not all, of the patients would have recovered with intensive care. Antibiotics had been started when a patient showed signs of bacterial toxaemia but were ineffective. Retrospective analysis showed that, in each patient, a rapid rise in rectal temperature, white cell count, and blood sugar preceded the clinical features of bacterial toxaemia by one or two days. These observations were incorporated into an antibiotic policy for patients with similar injuries. The criteria for starting two or three wide spectrum antibiotics were as follows: (1) Gram-negative bacilli in the tracheal aspirate together with radiological evidence of consolidation or absorption collapse; (ii) two of the following three signs—a rectal temperature of 38·5°C or more, a white blood cell count of 11·0 × 10/l or above, a blood glucose of 11·2 mmol/l or above; (iii) laparotomy. This policy was tested out over two years on 20 patients with thoracic and other injuries. Sixteen of the patients fulfilled the criteria for antibiotic therapy. Two of the six deaths were due to bacterial infection with toxaemia, a result which suggests that the policy was beneficial. [ABSTRACT FROM PUBLISHER]

Patients with primary biliary cirrhosis have a defect in the receptor mediated clearance of complement coated erythrocytes by fixed macrophages of the reticuloendothelial system. To investigate the probable mechanism of this defect peripheral blood monocytes were isolated from nine patients with primary biliary cirrhosis and seven control subjects and the ability of these cells to form rosettes with complement coated, IgM-sensitised sheep erythrocytes was assessed. Primary biliary cirrhosis peripheral blood monocytes formed rosettes to the same extent as control peripheral blood monocytes (71.0 +/- 7.1% [SEM] versus 73.3 +/- 4.3%) suggesting normal complement receptor function of primary biliary cirrhosis peripheral blood monocytes. When primary biliary cirrhosis or control peripheral blood monocytes were preincubated with primary biliary cirrhosis serum, however, the per cent of peripheral blood monocytes that formed rosettes was decreased: 2.4 +/- 0.8 and 3.1 +/- 1.3 fold respectively. To study this phenomenon further, fractions containing IgG or IgM synthesised by cultures of control or primary biliary cirrhosis lymphocytes were prepared. Rosette formation was not affected by exposure to fractions containing control or primary biliary cirrhosis IgG or control IgM, but was markedly inhibited (6.0 +/- 4.8 fold) by exposure to fractions containing primary biliary cirrhosis IgM. Similar results were obtained when freshly isolated peripheral blood monocytes or peripheral blood monocytes that had been cultured for 7-10 days--that is, macrophages, were used. Assuming that one can draw inferences concerning the status of fixed macrophages from data obtained using peripheral blood monocytes, the results of this study suggest that the complement specific defect in reticuloendothelial system clearance function in primary biliary cirrhosis is not caused by abnormality in the functional status of complement receptors on fixed macrophages but rather by a factor present in the serum of patients with primary biliary cirrhosis that has the capacity to inhibit the adherence of complement coated erythrocytes to complement receptors present on the surface of fixed macrophages. This serum factor does not appear to be a complement component but rather a product of peripheral blood mononuclear cells, other than IgG. [ABSTRACT FROM PUBLISHER]

The histopathological features and results of treatment of malignant polyps removed by endoscopic polypectomy from 60 patients are presented. The patients were followed for a minimum of five years. Forty six patients were treated by polypectomy alone as local excision was judged complete and the invasive carcinoma was well or moderately well differentiated. Thirty seven of these patients are alive and well after five years and the remaining nine have died of other causes up to four years later: there was no evidence of recurrence in any of these cases. Fourteen patients underwent a subsequent major surgical resection and residual tumour was found at the site of polypectomy in two cases but regional lymph nodes were not involved. Only one patient from this group with a high grade tumour developed metastases although the operative specimen was free of tumour. Malignant polyps can be successfully treated by polypectomy alone provided both the laboratory techniques of examination and the histopathological criteria are strictly applied. [ABSTRACT FROM PUBLISHER]

Eighty-four patients who had undergone different types of operation for duodenal ulcer have been studied by endoscopy and gastric biopsy. Half suffered from dyspepsia and vomiting but the other half had no symptoms and acted as controls. Endoscopic and histological abnormalities were found in both groups of patients. However, certain findings occurred more commonly in those with symptoms; severe and extensive hyperaemia, bile staining of the gastric mucus, and bile reflux seen on endoscopy were all significantly more common in those with symptoms than in those without. Active gastritis in the proximal stomach was also more common in those with symptoms. Gastritis of the stoma and antrum was found in 89% of all patients; as it was unconnected with symptoms it can be regarded as a "normal" finding. The incidences of contact bleeding, erosions, and oedema were not significantly different in the two groups. [ABSTRACT FROM PUBLISHER]

The effect of metoclopramide has been studied on the emptying of solid meals labelled with Cr and monitored with a gamma camera. Metoclopramide, 10 mg iv or a dummy injection, was given randomly and double blind to 10 normal subjects and to 10 patients within three months of a truncal vagotomy and pyloroplasty. All were tested in the recumbent position. Metoclopramide had no effect on emptying rates in the normal subjects nor in four postvagotomy patients who had emptying within the normal range (T½ 30-150 min). In six patients with abnormally delayed emptying (mean T½ 369 min) metoclopramide produced a significant improvement (mean T½ 194 min, p < 0·01). [ABSTRACT FROM PUBLISHER]

A cohort of 53 patients (age range 1.9-16.5 years) with sickle cell disease (49 homozygous SS and four S beta zero-thalassaemia) was studied for evidence of sleep related upper airway obstruction (UAO). This involved (i) a clinical assessment based on a history of snoring, a score of tonsillar size, and (for 50 patients) overnight multichannel respiratory recordings, and (ii) a blinded analysis of arterial oxygen saturation (SaO2) from the above recordings, and comparison with results from 50 healthy age matched controls of both white (n = 25) and Afro-Caribbean race. There was no difference in the baseline SaO2 values of the white and Afro-Caribbean controls. Eighteen patients with sickle cell disease (36%) were found to have sleep related UAO. The blinded analysis showed that eight patients (16%) had episodic hypoxaemia (SaO2 less than or equal to 80%, a value not observed in controls) and/or low baseline SaO2 values (less than 95.8%, the lowest value seen in the controls). Postoperative assessment was undertaken in 15 patients who underwent adenotonsillectomy. All demonstrated an improvement in symptoms and a reduction or abolition of episodic hypoxaemia. Of the 47 patients assessed when free of UAO (not demonstrated on screening, n = 32, or resolved following surgery, n = 15), seven continued to show baseline hypoxaemia. Sleep related UAO and baseline hypoxaemia are common complications of sickle cell disease in children. [ABSTRACT FROM AUTHOR]

A case of hypertrophic mononeuropathy is described in a 19-year-old female. The entity is very rare as only three previous cases have been reported. The light and electron-microscope appearances resemble those of progressive hypertrophic polyneuritis. [ABSTRACT FROM AUTHOR]