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AIM There is increasing interest in using collimated gamma cameras for [75Se]tauroselcholic acid (SeHCAT) studies to image the distribution and to make use of the collimator pressure sensitive devices (PSD) for patient safety. However, the use of a collimator will substantially decrease the sensitivity of the gamma camera. The aim of this article is to enable departments to calculate the uncertainty of SeHCAT retention measurements so that the acquisition time can be optimised to perform a reliable SeHCAT study. METHOD We derive a mathematical equation from the first principles that can be used to calculate the uncertainty in SeHCAT retention measurements on the basis of Poisson counting statistics. The equation takes account of background subtraction, use of the geometric mean for anterior/posterior attenuation compensation and the day 7 to day 0 quotient calculation. RESULTS Uncertainties in SeHCAT retention measurement using an intrinsic (uncollimated) gamma camera counting for 100 s are very low, typically of the order 15 ± 0.1%. Uncertainties from collimated gamma camera counting significantly increase for the same 100 s counting duration: 15 ± 0.8% for slim patients and 15 ± 4% for obese patients. CONCLUSION The acquisition time must be increased for collimated gamma camera SeHCAT counting to achieve acceptable counting statistics for an acceptable total uncertainty in the SeHCAT retention measurement. For slim patients, a minimum counting time of 2 min is required. For larger patients, the acquisition time needs to be increased to 30 min and further increased to 50 min for obese patients.

AIM A recent audit has highlighted that there is a large variation in the way gastric emptying scintigraphy is performed, analysed and reported in the UK. In this study, we have established a comprehensive protocol on how to perform gastric emptying including normal ranges for two of the most widely used meals. A standardized scrambled egg sandwich was used as the main meal. Normal ranges were also established for oat porridge as an alternative gluten-free meal. We have calculated normal ranges for several functional parameters which may be used to assess gastric emptying. We hope that establishing a reliable normal range for these two simple and commonly used meals will encourage adoption of a universally accepted protocol for measurement of solid gastric emptying in the UK. METHOD A total of 42 volunteers (20 male, 22 female, age range 22-68) with no history of gastrointestinal symptoms or diabetes were studied. Each volunteer fasted overnight and consumed two meals with similar nutritional composition on two separate days: scrambled eggs with two slices of bread were consumed on one day and gluten-free porridge (40 g in 200 mL whole milk) was consumed on a different day. Each meal was radiolabelled with 10 MBq of Tc-DTPA. Simultaneous anterior-posterior 2-min static images were acquired with the patient standing between the gamma camera detectors. Images were acquired every 5 min over a 2 hour period, followed by a single image at 3 hour. The data were modelled using a power-exponential function that allowed measurements of gastric emptying functional parameters including lag time, half-emptying time (HET), peak emptying rate, time-to-peak emptying (TPE) and exponential half-life (EHL). Three-hour retention was also calculated. Paired t-tests were used to compare the two meals and two-sample t-tests were used to assess gender-related differences. Regression analysis was used to assess correlation of the functional parameters with age and body habitus (body surface area, BSA). RESULTS All gastric emptying functional parameters were significantly different between the two meals (P

TauroH-23-((75)Se)selena-25-homocholic acid (SeHCAT) retention has been used for the diagnosis of bile acid malabsorption since the early 1980s. Bile acid malabsorption has been increasingly recognized as an important cause of severe chronic diarroea with subsequent increase in the number of referrals for the SeHCAT test. In this study, we review and discuss the standard techniques for the measurement of SeHCAT retention and describe a simple and modified technique using a noncollimated whole-body scanner, suitable for most modern dual-headed cameras.

Objective Aspects of ileal pouch surgery remain controversial. The authors' single practice experience of 107 operations illustrates many of them. It was hoped that its study would contribute usefully to the debate. Patients and methods Details of all 107 restorative proctocolectomies carried out since the operation was started in Gloucester in 1984 until the study period ended have been kept prospectively. All patients had proctectomy by mesorectal dissection, and 106 had W pouch restoration. Four suffered functional failure requiring reversion to ileostomy and three patients have died. The remaining 99 were sent a questionnaire concerning pelvic visceral function and evidence of pouchitis. Records of all but one of the patients have been reviewed. Results Surgical morbidity was low with neither chronic pelvic sepsis, pouch related fistula, pouch haemorrhage nor pouch ischaemia. Mucosectomised patients had similar bowel control to the stapled group. The policy change from routine to selective protective ileostomy proved satisfactory. W pouch function was found to be comparable to that reported from major J pouch series, although anti-diarrhoeal usage was reduced, and was not influenced by either gender, age or time since surgery. Conclusion None of the following reasonably intuitive assumptions seem supported by our findings: that mesorectal excision necessarily poses a greater danger to pelvic visceral function than close rectal dissection, that the greater capacity of W pouches will be reflected in markedly less frequency, that mucosectomy would impair anal control, or that a defunctioning ileostomy is a mandatory precaution. Pouch frequency is less if wind can be passed separately; otherwise functional outcome seems determined by other, non-technical, factors.

Detrimental effects on the thyroid of the developing fetus as a result of iodine-131 treatment for thyrotoxicosis of the mother in the first trimester of pregnancy are discussed. Dose estimations under typical clinical circumstances yield a fetal thyroid dose of 100- 450 Sv. This dose may increase considerably if the blood concentration of (131)I in the mother remains high. Under such circumstances there may be fetal thyroid dysfunction, which can lead to severe abnormalities.

Introduction Parastomal herniation is not uncommon and numerous surgical approaches to the problem have been employed including mesh reinforcement. Bowel wall erosion is a worrying potential complication of placing an edge of mesh around bowel. To reduce this possibility a simple modification is suggested. Method The polyproylene mesh repair is fashioned on the posterior rectus sheath. The required aperture for the bowel is marked appropriately on the mesh. Instead of simple removal of the marked circle, the aperture is fashioned by folding back and stitching in place the triangular flaps from the middle to form a rolled rather than sharp edge. Non-absorbable monofilament stitches reconstitute the mesh encirclement, and attach it laterally and medially to the aponeurotic tissue. A review of the case notes was conducted and each patient was contacted by a postal questionnaire. Results This technique has been used in 10 patients (7 end colostomies, 2 end ileostomies and 1 loop ileostomy) since 2000. Over a median follow-up period of 30 months (range 2 to 40 months) there have been no hernia recurrences, no infected meshes, no bowel damage attributable to the mesh and no troubles with stoma. The only complication encountered has been a segment of superficial wound breakdown in one patient. Conclusions This technique appears to offer a safe and reliable modification for mesh repair of parastomal herniation, in being designed to obviate the possibility of erosion of the stomal bowel wall by a sharp mesh edge but at the same time providing a sound herniorrhaphy by complete encirclement.

Background In this study, we have investigated the feasibility of a 180 degrees DaTSCAN brain SPECT acquisition. This technique has the advantage of being 'open view' for the patient and therefore more acceptable for claustrophobic patients. It also enables easier access for a technologist to hold the patient's head during acquisition to reduce movement in confused patients or in those with severe tremor. Methods In the first part of this study, we validated the practicality and image quality of a 180 degrees acquisition using a DaTSCAN Alderson head phantom with different camera configurations on GE Infinia and Philips AXIS gamma cameras. The effect on image quality of using half the acquisition time was also assessed. In the second part of the study, 50 sets of patient data were reprocessed by reconstructing half of the 360 degrees data to mimic a single-head 180 degrees acquisition. The 180 degrees images were then compared with 360 degrees images for the same patient using a visual score system. The effect of half-time 180 degrees data acquisition on quantification was also assessed using GE QuantiSPECT software. Results All phantom images from 180 degrees acquisitions contained some degree of distortion at the periphery, but clearly retain the presence of centrally positioned caudate and putamen; hence 180 degrees acquisitions were deemed to produce clinically useful diagnostic images. The shorter (half) acquisition time leads to noisier but acceptable images for all configurations. In the patient study, there was complete agreement between the two reporters with no clinical difference in the diagnostic accuracy between the 180 degrees and 360 degrees images. However, 6 of 50 180 degrees images were marked as poor quality but reportable, compared with 0 of 50 in 360 degrees images. Quantification gave consistently lower nuclei to background ratio values for 180 degrees compared with 360 degrees for normal and abnormal patients. Conclusion It is possible to obtain diagnostic DaTSCAN images using 180 degrees acquisition in difficult patients. The total length of the study may also be shortened by half using L-mode or V-mode camera head configuration.

The aim of this study was to measure the internal dose received by family members from ingestion of radioactive contamination after outpatient therapy.Advice was given to minimise transfer of radioiodine. Home visits were made approximately 2, 7 and 21 days after treatment to measure radioactivity in the thyroids of family members. A decay correction was applied to radioactivity detected assuming ingestion had occurred at the earlier contact time, either the day of treatment or the previous home visit. An effective half-life of 6 or 7 days was used depending on age. Thyroid activity was summed if activity was found at more than one visit in excess of the amount attributable to radioactive decay. Effective dose (ED) was calculated using ICRP72.Fifty-three adults and 92 children, median age 12 (range 4-17) years participated. Median administered activity was 576 (range 329-690) MBq (131)I. Thyroid activity ranged from 0 to 5.4 kBq in the adults with activity detected in 17. Maximum adult ED was 0.4 mSv. Thyroid activity ranged from 0 to 11.8 kBq in the children with activity detected in 26. The two highest values of 5.0 and 11.8 kBq occurred in children aged 5 and 14 years from different families. Eighty-five children had no activity or1 kBq detected. ED was0.2 mSv in 86 out of 92 children (93%). Previous published data showed 93% of children received an EDor=0.8 mSv from external irradiation.With advice, families of outpatients receiving radioiodine should be able to comply with statutory dose limits and constraints.

Lower radiopharmaceutical activities are used for myocardial perfusion scintigraphy (MPS) in the UK than in other countries. There is no evidence to suggest that higher activities improve imaging or clinical outcome.We undertook a multicentre study of the relationship between radiopharmaceutical activity and imaging outcome. Fifty-one patients with clinical referrals for MPS followed a 2-day protocol with an injection of 1,000 MBq (99m)Tc-tetrofosmin for each of the stress and rest images. ECG-gated acquisition was performed in three rotations occupying 25, 35 and 40% of a standard acquisition, and rotations were summed to simulate administered activities of 250, 400, 750 and 1,000 MBq. Each set of images was reported by an experienced physician who was blinded to all clinical information and to the simulated activity. Scores were assigned for image quality, low count, attenuation and reconstruction artefact, segmental tracer uptake, segmental and global defect classification, and confidence in the global classification. The images were reported twice to assess intra-observer variability.Positive relationships were found between administered activity and overall image quality, observer confidence and intra-observer agreement of uptake score, and a negative relationship was found with low-count artefact. For the majority of comparisons, there was no additional improvement with increasing activity from 750 to 1,000 MBq. Intra-observer agreement was found to be better in female patients and in those below average body mass index.We conclude that higher administered radiopharmaceutical activities lead to better quality images and improved surrogate parameters for clinical outcome, but that activities above 750 MBq may be unnecessary in average patients.

Irradiation of pregnant women either in the workplace or as a consequence of clinical diagnosis is often unavoidable. This paper reviews the issues relating to this topic. For clinical exposures the "missed period" rule is applied prior to most clinical studies. However normal physiological variations in the menstrual cycle may need to be understood. The possible effects of irradiation, both deterministic and stochastic, on the fetus are also described. The decision process in relation to irradiation of a pregnant or potentially pregnant patient is discussed in terms of the regulatory guidance. A different approach is needed for studies which clearly involve a low dose to the uterus compared with studies involving a high dose, including therapy. The issue of a pregnant or potentially pregnant worker in nuclear medicine is also considered. Restrictions on certain work activities may be necessary once pregnancy is declared. Other areas considered are biomedical research and also the potential for exposure of pregnant woman in the home or in the workplace as a consequence of others having a nuclear medicine study.

BackgroundThere is widespread antipathy to digital dilatation of the anus (DDA) for medically resistant anal fissure. A retrospective study was therefore undertaken to test the validity of the criticism of this technique.MethodsSome 273 patients who underwent DDA for fissure between November 1982 and July 1997 were sent a questionnaire and/or telephoned. Those with impaired control were offered investigation. In addition, routine clinic follow-up data were scrutinized in the 302 available notes of the 307 patients who had undergone DDA for fissure to determine its efficacy.ResultsSome 241 patients (88·3 per cent) were contacted successfully a median of 7·8 years after operation. Follow-up records showed the fissure to have healed in 89·1 per cent of 302 patients. No patient was rendered incontinent. Fifteen patients indicated persistently impaired control in the questionnaire, nine (3·8 per cent) as a result of the DDA and six preceding it. All 23 patients who had experienced either temporary or permanent impairment, whether or not pre-existing, were invited to attend for ultrasonography and manometric measurements, of whom 18 accepted. No sphincteric fragmentation was seen, and resting and squeeze pressures did not differ from normal.ConclusionA single DDA appears to heal 89 per cent of chronic anal fissures. Consequent impairment of control is infrequent and minor if the procedure is performed carefully and with the patient paralysed.

This paper reviews the published data relating to the radiation hazards associated with nuclear medicine outpatients. It is discussed both in the context of the current UK advice as well as potential guidelines following the recommendations in ICRP 60. For diagnostic studies there is little need for restrictions. The main exceptions are for a prolonged journey home by public transport with high levels of 99Tcm and for the situation of an outpatient given 111In who has to look after a fretful infant. The main problem occurs following the administration of 131I therapy for thyrotoxicosis. The principal hazards are associated with external exposure; radiation doses from ingestion due to contamination are small. Restrictions should only be necessary for administered activities greater than 400 MBq (e.g. public transport, return to work, sleeping with partner). With such restrictions it is considered that 131I therapy for thyrotoxicosis can continue to be given on an outpatient basis.

A patient satisfaction survey was carried out in a nuclear medicine department of a large acute hospital. Surveys were initially carried out by interview and postal techniques, with approximately 100 responders in each category. The responses to each question were not significantly different for the two types of survey, although overall there was a significantly larger number of dissatisfied responses in the postal survey (22%) compared with the interview study (12%). The postal survey was repeated after 1 year, thus completing the audit loop. A significant reduction in dissatisfied responses has occurred in those areas which had been addressed following the criticisms revealed by the first survey.

We have examined the implications of ICRP60 for nuclear medicine. Radiation doses to staff are currently low and reduction of the dose limits will have little impact. However, the proposed figures for the fetus may have implications for pregnant women where the workloads are high. With nursing staff on the ward, laboratory staff or indeed departmental porters there seems little problem. Radiation dose to the fingers is, however, a key factor, and ensuring that no further restrictions are placed on the proposed dose limits is important. The concept of constraints is becoming clearer but will need further thought, particularly with regard to exposure of the general public. The previous basis for declaring controlled and supervised areas has been abandoned, and the situation is now less clear. A most important area of debate will be the patient who is a controlled area, and great care will have to be taken to ensure that the number of patients in this category is not increased so that many more patients need to be kept in hospital. Exposure of the general public is also an issue and expanding the concept of medical exposure to include carers is an important development. This should prevent a number of unnecessary restrictions and adds weight to the point that two waiting rooms are not justified in nuclear medicine departments. ICRP recommendations will soon be incorporated into the legislation of member states and it is import for everyone to ensure that drafts are read carefully and that national proposals are not too restrictive.

The ICRP has now recommended that the dose limit to the surface of the mother's abdomen during the declared term of pregnancy is reduced to 2 mSv. Direct measurements of the radiation dose to technologists carrying out a variety of imaging studies were made. The average dose ranged from 0.3 micro Sv for a liver scan to 5.3 micro Sv for a brain scan. Using national data for the frequency of nuclear medicine studies, a weighted average figure of 1.5 micro Sv per study was derived. A technologist could therefore perform approximately eight imaging studies per day during the declared term of her pregnancy and remain within the proposed limit. Generally, there should be no need to alter a technologist's duties during her pregnancy, and these findings should be helpful in allaying any anxiety.

Despite publication of the Approved Code of Practice and the Notes for Guidance, implementation of the UK Ionising Radiation Regulations has required local interpretation by nuclear medicine departments. One problem has been the lack of data upon which decisions can be based. In the last five years we and others have made a number of measurements of radiation doses to staff relating to nuclear medicine practice. This paper collates, summarizes and comments on this information. Where possible, results have been expressed in relation to the workload of an average nuclear medicine department.

The radiation dose to accompanying nurses, relatives and other patients in a nuclear medicine department waiting room was assessed at 5 min intervals by observing the seating arrangement. The total radiation dose to each person was calculated, using fixed values of dose rate per 100 MBq activity for radionuclides, and applying the inverse square law. Radioactive decay and attenuation effects due to intervening persons were also taken into account. The median radiation doses to accompanying nurses, relatives and other patients were 2.3, 2.0 and 0.2 microSv with maximum values of 17, 33 and 5 microSv respectively. In all cases, the radiation dose received by patients was less than 0.2% of the radiation dose resulting from their own investigation. Also, the maximum radiation dose received by an accompanying nurse or friend was less than 1% of their appropriate annual dose limit. Similar values were obtained with calculations based on a 15 min time interval. The radiation doses received by those in a nuclear medicine department waiting room are small, and separate waiting room facilities for radioactive patients are unnecessary.

The biochemical disturbance produced by thiazide diuretics and by amiloride during treatment of moderate hypertension were compared. Two parallel studies were initiated. In one 40 patients with newly diagnosed hypertension were treated with metoprolol and a diuretic, either hydrochlorothiazide or amiloride. In a second study 38 patients receiving longstanding treatment with hypotensives and thiazides either continued the treatment or replaced the thiazide with amiloride. Initial biochemical assessments were compared with those after two years in the study. In previously untreated patients, thiazide produced a significant fall in plasma potassium and hyperuricaemia that did not occur with amiloride (p less than 0.001). Those patients receiving long term treatment for their hypertension who continued to take thiazides had persistent hypokalaemia and hyperuricaemia. Substitution with amiloride corrected the hypokalaemia and serum uric acid returned toward normal ranges, but this change was not statistically significant. Patients receiving long term treatment also had impaired glucose tolerance, this remained unchanged in those receiving thiazide but was corrected in those receiving amiloride. Compared with amiloride thiazides produced undesirable but reversible biochemical changes. As control of hypertension was equally effective with both preparations, we suggest that a combination of amiloride with a beta blocker in treatment of moderate hypertension in preferred.

Summary The application of the 1985 Ionizing Radiations Regulations and Approved Code of Practice to a typical Nuclear Medicine Department has been considered. References to the Regulations are given so that their implications in a given department may be examined. The radiopharmacy, radioisotope dispensary and injection room will need to be Controlled Areas. It will also be necessary to designate Controlled Areas if radiopharmaceuticals are injected in imaging rooms or on wards. Waiting rooms will need to be Controlled Areas. The area around individual patients will, however, not need to be Controlled except for some patients receiving therapeutic doses of 131I for thyrotoxicosis. It should not generally be necessary to designate employees as Classified persons. Major problems in implementing the Regulations are not envisaged in situations where the previous Code of Practice has been followed.

The present study compared the physiological responses to exercise, the anaerobic fitness, and the body composition of high-ability prepubescent wrestlers and normally active boys. The wrestlers (N = 15, mean age +/- S.D. = 11.3 +/- 0.30 yr) were recruited to participate in a summer wrestling camp. Their wrestling experience averaged 3.0 +/- 1.63 yr, during which time they won 78 +/- 10.5% of the matches. The comparison boys (N = 13, 10.7 +/- 0.36 yr) were volunteers from a local Boy's Club. Each subject performed a graded treadmill exercise test (Bruce protocol) and an anaerobic cycle ergometer test. Additionally, body composition was assessed using densitometry and skinfolds. There were no differences (P greater than 0.05) between the wrestlers and the comparison subjects for age or height. The wrestlers exercised for 1.5 min longer on the treadmill and obtained a higher VO2max (54.0 +/- 1.15 ml X min-1 X kg-1, P less than 0.05) than the comparison subjects (45.6 +/- 2.10 ml X min-1 X kg-1). Also, the wrestlers had higher anaerobic test scores, greater body densities, and lower subcutaneous fat totals at all sites than the normally active boys. These data indicate that the favorable fitness and body composition scores found previously for more mature wrestlers are already present in prepubescent wrestlers.

The effects of 10 wk of exercise training at low (40% VO2max) or high (75% VO2max) intensity on serum lipids and lipoproteins were compared in prepubescent boys and adult men. The final sample size consisted of: 8 boys (mean +/- SE age = 8.5 +/- 1.96 yr) and 8 men (36.6 +/- 3.18 yr) in low; 12 boys (8.0 +/- 1.40 yr) and 12 men (36.6 +/- 4.09 yr) in high; and 10 boys (9.0 +/- 2.08 yr) and 10 men (36.7 +/- 4.82 yr) in control. Training involved walking/jogging/running 3 d X wk-1 at a distance which progressed from 2.4 km X d-1 in the first week to 4.8 km X d-1 from the fifth week. Fasting blood samples, collected on 2 d during both pre- and post-training, were assayed for triglycerides, total cholesterol (CHOL), and high density lipoprotein cholesterol (HDL-C). Maximum aerobic power (VO2max) was determined from a treadmill test. Additionally, dietary intake was assessed from a 3-d dietary record and body composition from the sum of 6 skinfolds. The only statistically significant (P less than 0.05) changes occurred in HDL-C and CHOL for the high groups. HDL-C decreased following training. CHOL was lower for high than the other groups for the first day post-training only. There were no differences in the changes in HDL-C/CHOL ratio among the groups. VO2max only increased in the high groups. Dietary intake and body weight did not change. Further statistical adjustment in lipids for changes in sum of 6 skinfolds did not alter the results.(ABSTRACT TRUNCATED AT 250 WORDS)

The red cell mass was measured in 44 normal subjects and showed a closer correlation with total body water or surface area than with body weight. The results obtained in a group of patients with polycythaemia, however, still overlap with the normal range. When the total number of circulating red cells is measured these patients form a group quite separate from the normals. The diagnostic value of this measurement is therefore considerably greater than results obtained with the red cell mass.

Body composition and physical dimensions were compared between 23 young, experienced wrestlers (mean age +/- SE = 11.0 +/- 0.21 yr) and 23 school children (11.2 +/- 0.24 yr). The wrestlers were among the best wrestlers from local wrestling clubs and averaged 2.7 (+/- 0.27) yr of experience. They had won 72% (+/- 1.8%) of the total 75 (+/- 9.1) matches. The comparison group consisted of volunteers from local elementary schools. Standard densitometric and anthropometric techniques were used to measure the body composition and physical dimensions of each group. The wrestlers were 4 kg lighter (P less than 0.05) and had a smaller percent fat than the comparison group (13.3 +/- 0.66% and 20.0 +/- 1.13%, respectively). The weight difference between groups was due to the larger fat weight of the comparison group since lean weight differed by only 0.8 kg. Fat differences were also reflected in the larger skinfolds and "fat" circumferences of the comparison group. No group differences were noted in diameters. It is concluded that compared to other children young experienced wrestlers have similar skeletal structures and lean body weights. The comparison group possessed more body fat.

The radiation dose to the pulp of both index fingers has been measured in a radiopharmacy supplying 11 000 patient doses a year, in a hospital dispensary (4500 doses a year) and in its injection area. Tungsten syringe shields were used for one week and not used during the other week. In the radiopharmacy and the dispensary the highest finger dose recorded was 6.8 mSv, which corresponds to an annual figure of 330 mSv. Syringe shields gave a protection factor of less than two, and the dose to the left hand was approximately half that to the right. When giving injections the corresponding weekly and annual doses were 4.6 and 220 mSv respectively. If all injections had been given by a single person the corresponding annual dose would have been 430 mSv. Using syringe shields this could be reduced by factors of at least eight for the right hand but only 1.3 for the left hand. Dose rates for unshielded syringes expressed per 10 GBq handled are similar to other data in the literature. However, syringe shields reduce the dose rates less than anticipated. Tungsten 1.94 to 3.05 mm thick would be expected to give an attenuation factor of 27 to 178.

WHEN the splenic capsule is found to be lacerated or the spleen avulsed from its pedicle, it is almost always due to recent injury. Occasionally, a patient will present as an acute abdominal emergency with or without the signs of haemorrhage but no history of recent injury, and at laparotomy, rupture of the spleen will be found. If, in such circumstances, careful questioning has failed to reveal a history of trauma or unusual effort, and on examination of the spleen, both macroscopically and microscopically, no abnormality apart from the haemorrhage and laceration can be found, then such an example can be truly labelled spontaneous rupture of the normal spleen. Such an event is but rarely reported. Orloff & Peskin in 1958, after reviewing seventy-one reported cases in the literature, considered only twenty to be fully acceptable. Seven years later, Naiberg and his colleagues (Naiberg, Sidlofsky & Chris, 1965) reported a case conforming to the above criteria but were able to add only two further examples. Much commoner is sudden rupture of the diseased spleen and this event has been recorded in a wide range of splenic diseases. In this context, a controversial point which recurs in the literature concerns the interpretation of the meaning of the term 'spontaneous'. Whereas in 1964, Hynes, Silverstein & Fawcett found seventeen examples of spontaneous rupture of the spleen in leukaemia, Stiles & Ultman in 1966 in reviewing thirty-two cases of rupture of the leukaemic spleen accepted only eight as being truly spontaneous in origin. The following is a case report of rupture of the diseased spleen in the absence of any trauma.