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The ultrastructure of gamonts and sporulated oocysts of Goussia metchnikovi in the spleen of gudgeon, Gobio gobio from the river Lee, England is described. In developing microgamonts, small amylopectin granules were grouped centrally and nuclei were often arranged peripherally, close to the surface membrane. Nuclear chromatin condensed into peripheral dense portions that became the nuclei of flagellated microgametes, released to the parasitophorous vacuole. The cytoplasm of macrogametes had larger, scattered amylopectin granules, lipid globules and small electron-dense bodies, but no obvious wall forming bodies; peripheral vesicular structures with the appearance of mitochondria were also present and the parasitophorous vacuole contained flocculent material, but was otherwise free of structures. Sporulated oocysts contained four sporocysts and oocyst walls appeared to consist of a single membrane. Sporocyst walls showed a dehiscence suture, characteristic of the genus Goussia, which had filamentous extensions in places. The sporocyst wall comprised a dense inner layer and a thin outer layer with a fuzzy coat, separated by an electron lucent layer. Groups of oocysts were encapsulated by fibrous layers and inflammatory cells, and many sporocysts and their contained sporozoites showed evidence of elimination by the host.

Aims: To ascertain the proportion of adults with a pacemaker in situ attending the Accident and Emergency Department because of syncope or unexplained falls and the cause of index symptoms in these patients, including the prevalence of hypotensive syndromes., Methods and Results: Patients presenting to the Accident and Emergency Department with unexplained syncope or non-accidental falls, who had a pacemaker in situ, were studied. Eligible patients had cardiovascular assessment (morning orthostatic blood pressure measurement, heart rate and BP measurements during carotid sinus stimulation (supine and upright), head-up tilt at 70 degrees for 40 min), assessment of haemodynamics during fixed mode pacing and gait and balance assessment. Of 5863 patients screened, 13.5% had unexplained syncope or a non-accidental fall; of these only 3% (26 patients) had pacemakers in situ. Of 18 study patients (82 +/- 8 years), 10 were female. Sixteen had a hypotensive diagnosis. Seven had more than one attributable hypotensive diagnosis. Five of 13 with vasodepressor carotid sinus syndrome had no previous diagnosis of carotid sinus hypersensitivity. No patients had vasovagal syncope induced during passive head-up tilt testing., Conclusion: It is rare for patients who attend the Accident and Emergency Department because of syncope or unexplained falls to have a pacemaker in situ. In those who do, hypotensive disorders are a common finding.

In an attempt to detect markers of significance of coagulase-negative staphylococci (CNS) isolated from neonatal blood cultures, epidemiological data and the rate of appearance of positive blood cultures were examined. The main epidemiological factor studied was the relative abundance of the different biotypes of CNS in blood cultures, on neonatal skin and the hands of neonatal unit staff. Our results showed that the relative recovery rates of biotypes found from these sources showed no significant differences. The number of positive blood culture bottles in each set and the number of days taken for growth to appear showed wide variations. A higher proportion of aminoglycoside-resistant strains were found in the group showing both blood culture bottles positive and in the group where isolates were obtained by 24 h of incubation. We conclude that there is no advantage in biotyping CNS in assessing clinical significance, but the association of aminoglycoside resistance with the isolation pattern of CNS in neonatal blood cultures requires further examination.

Audits of antibiotic prescribing were done for periods of up to eight weeks in two successive years on medical, surgical, orthopaedic, gynaecology, obstetric, and urology wards and in an accident and emergency department. Clinical details were matched with antibiotic prescribing, and the appropriateness of the latter was judged independently by two medical microbiologists. Only when they agreed was an individual prescription included in the analysis. Overall, 28% of prescriptions in 1979 and 35% in 1980 were judged as unnecessary, with 17% and 16%, respectively, being for inappropriate choices of antibiotic. An educational programme about antibiotic prescribing carried out between the audits had no beneficial effect overall. Though the results compared favourably with those of audits published, prescribing could still be much improved. To judge by the failure of education, however, this might be difficult to achieve. Most prescriptions were written by junior staff, who in the absence of guidance from their seniors and because of their frequent moves would require a widespread and continual education programme. Published concern about the quality of antibiotic prescribing appears to be justified.

A questionnaire about the use of prophylactic antibiotics in bacterial meningitis was sent to medical officers of environmental health and microbiologists in England. There was broad agreement that prophylaxis should be offered to close contacts of acute meningitis due to Neisseria meningitidis but not to contacts of meningitis caused by Streptococcus pneumoniae. Overall 28% of those who replied said they could consider giving prophylaxis to contacts of meningitis due to Haemophilus influenzae. Rifampicin was the most common choice of drug. The indications for prophylaxis in bacterial meningitis are discussed.

A prospective survey was carried out in the winter of 1983-84 to determine the incidence of hospital-acquired pneumococcal chest infection in a district general hospital. Twenty-one patients (of a total of 103 infected with Streptococcus pneumoniae) were assessed as having hospital-acquired infection. The implication of this and the need for further studies are discussed.

A prospective survey of pneumococcal carriage and infection between October 1984 and April 1985 in a male medical ward of a district general hospital is reported. In the hospital as a whole, pneumococcal infection, acquired more than 5 days after admission, accounted for some 20% of all pneumococcal infection.