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A 36-year-old man was treated with dapsone, rifampicin and clofazimine for borderline lepromatous leprosy. After 9 months, his leprosy plaques became progressively more red and after 23 months, the clofazimine was stopped and he was given minocycline instead. Six weeks later, he developed blue-black pigmentation in his leprosy lesions. The histology was consistent with minocycline-induced hyperpigmentation. This is the first report of minocycline-induced pigmentation in leprosy. We suggest it is important to consider this side-effect before the administration of minocycline in leprosy, particularly if it is prescribed in place of clofazimine.

Venous thrombo-embolism is a major and often unrecognized cause of morbidity and mortality in patients after acute strokes. Three hundred and five elderly patients were randomly allocated to either control (161) or treatment (144) with 5000 units calcium heparin subcutaneously 8-hourly for two weeks. A reduction in deep-vein thrombosis rate from 72.7% in the control group to 22.2% in treatment patients was achieved. In patients who died (84), post-mortem examination to look for pulmonary emboli was performed in 71. Comparison between treated and untreated patients showed significantly fewer deaths and pulmonary emboli in the treated group. Most of the beneficial effect on mortality was seen in patients with lighter strokes. When patients with pulmonary emboli at post-mortem were excluded, there was no significant difference in the death rate in treatment (17) and control (14) groups. At post-mortem, 9.9% of the strokes were haemorrhagic (4 in the treatment and 3 in the control group). Low-dose calcium heparin given subcutaneously following acute stroke reduced the number of deep-vein thromboses, pulmonary emboli and deaths without increasing the number of haemorrhagic strokes in this study.

A consultant-led day hospital in a district general hospital (DGH) was compared with general practitioner-controlled day hospitals in community hospitals (CHs). CHs were more generously provided for their populations, 3.87 compared with 1.38 places per 1000, but less well staffed at 70% of the DGH levels. Patients were similar demographically and in dependence, but differed in some diagnoses; 33% of CH patients were referred for social reasons alone, compared with 2% in the DGH. CH patients received fewer treatment sessions each day, 2.11 compared with 2.55 in the DGH and the difference was mainly in medical input. Median duration of attendance was 332 days in the CH and 92 days in the DGH; the 6-month discharge rate was 67% in the CH and 35% in the DGH, with 48% of patients attending for more than a year in the CH compared with 24% in the DGH. This study suggests that while the DGH unit provides an active service the CH units offer supportive care which largely duplicates that which could be provided more cheaply in day centres.

A radioimmunoassay is described for parathyroid hormone in human serum, in which commercially available reagents are used almost exclusively. This assay can be done by any laboratory with experience in radloimmunoassay. Thirty-two of thirty-three patients with surgically proven primary hyperparathyroidism had detectable concentrations of parathyroid hormone in their serum, and concentrations of the hormone exceeded the normal range in 24 of them. Significant positive correlations were found between pre-operative serum calcium, pre-operative serum parathyroid hormone, and the weight of parathyroid tissue removed at operation. These three parameters were also significantly correlated with severity of the skeletal changes as assessed by semiquantitative histological methods.