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[⇓][1] ![Figure][2] The use of psychotherapy to treat alcohol dependence has a provenance almost as long as the recognition of alcoholism as a medical concern. Despite some famous successes – the playwright Eugene O’Neill, for one – psychoanalysis was not deemed an effective

[⇓][1] ![Figure][2] One of the seminal experiences in my early career was an exchange visit to South Carolina in 1991 during which I spent most of my time observing addiction treatment in both public and private settings. Compared with my training in Scotland in a unit for treating

[⇓][1] ![Figure][2] The name Gordon Alles may not be as famous as that of Albert Hoffman but the chemist who synthesised beta-phenylisopropylamine deserves as much recognition as the progenitor of lysergic acid diethylamide (LSD) if the impact of his drug in the world were your guide.

We read with interest the Editorial by Gupta & Warner,[1][1] in which they postulated a possible `silent epidemic of alcohol-related dementia'. We welcome the call for increased awareness, but would make the following points. First, nosology. The term \`alcohol-related dementia' (alcohol-induced

Cytochrome P450IIE1 metabolises, and is induced by ethanol. The 5′ regulatory sequence of the gene is polymorphic; that identified by the c2 allele has been shown by transfection studies to confer an increased rate of transcription. A recent report indicating an association between this allele and alcohol induced cirrhosis suggests that it may contribute to the genetic vulnerability to this disease. We have examined this polymorphism in patients of western European origin with alcohol induced cirrhosis, alcohol Korsakoff's syndrome and alcohol dependence syndrome. We were unable to detect any association between this allele and any of these diseases.

The opportunities presented to commissioning health authorities to decide what health care to purchase for local people has also provided an opportunity to rethink old prejudices. The old prejudices against complementary medicine are being rethought for several reasons. Firstly, many commissioning authorities and fundholding general practitioners are either commissioning or providing complementary medicine as part of routine contracting.1 Financially, this is marginal activity, costing typically less than pounds sterling20000 a year out of an average authority budget of pounds sterling200m. Also some complementary medicines, such as acupuncture and homoeopathy, have been part of normal NHS activity for many years and this has blurred the margins between conventional and complementary medicine. Secondly, the medical profession has relaxed its attitude toward complementary medicine over the past decade.2 Thirdly, both main political parties support the development of …

Addiction and Art Edited by Patricia B. Santora, Margaret L. Dowell, Jack E. Henningfield. Johns Hopkins University Press. 2010. US$29.95 (hb). 184pp. ISBN: 9780801894817 As the ‘High Society’ exhibition at the Wellcome Collection in London has shown, there is widespread interest in the

EDITOR,—The reports from the College of Health1 2 continue to confirm a considerable variation between health authorities in their purchasing intentions for in vitro fertilisation. Some have also included sociomedical criteria for allocating these scarce resources. It is unclear as to whether these policies are subject to review and whether such criteria are explicit. We have …

With the advent of comprehensive secondary schools it would appear that the curricular differentiation of English secondary school pupils is decreasingly based on early selection or the use of the relatively simple set of criteria represented by 11 + test procedures. Instead it seems that the allocation of pupils to routes of distinctive curricular content and of different academic levels occurs later and is the outcome of a complex interaction between the elective choices of pupils and parents and the advice or guidance of teachers. Ostensibly the transition between the third year and the fourth years of secondary school is the most important point at which these processes occur. American researchers have produced a body of knowledge on curriculum placement in US high schools. Cicourel & Kitsuse (1963) claimed that curriculum placement in 'Lakeshore High School' was a function not only of ability and attainment but also of ascribed characteristics related to social class, and they explained these features as a consequence of the organisational procedures of counselling personnel. More recently, an extensive literature has developed which examines the effect of variables such as social class, ability, attainment, sex and student and parental expectations on placement in 'college' and 'non-college' high school tracks (e.g. Alexander & Eckland, 1975; Alexander & McDill, 1976; Rehberg & Hotchkiss, 1972; Sewell & Shah, 1967, 1968; Sewell, Hauser & Featherman, 1976). While these American studies cannot be translated exactly into a British context and while one must have some additional reservations about some of them, they suggest in general terms a strategy which may be illuminating in studying curriculum placement in British schools. They also suggest some of the hypotheses which may be tested, in particular the limitations on explaining placement in terms of ability and achievement (Alexander, Cook & McDill, 1978) and the possible effects of sex (Alexander & Eckland, 1975) and of social class (Alexander & McDill, 1976) on levels of placement. British research in this field has tended to be ethnographic and descriptive. In general terms, some studies have focused on curricular arrangements and

(1981). Educational Differentiation and Curricular Guidance: a review. Educational Studies: Vol. 7, No. 2, pp. 87-94.

Background Hepatic hydrothorax is a major pulmonary complication of liver disease occurring in up to 5-10% of patients with cirrhosis. Case presentation We report four observations of the development of pneumothorax ex-vacuo or trapped lung in the setting of hepatic hydrothorax. The diagnosis of trapped lung was made based on the presence of a hydropneumothorax after evacuation of a longstanding hepatic hydrothorax with failure of the lung to re-expand after chest tube placement in three of the four cases. Two patients underwent surgical decortication with one subsequent death from post-operative bleeding. The other two patients remarkably had spontaneous improvement of their “trapped lung” without surgical intervention. Conclusions While pneumothorax ex-vacuo is a known phenomenon in malignant effusions, to our knowledge, it has never been described in association with hepatic hydrothoraces. The pathophysiology of this phenomenon remains unclear but could be related to chronic inflammation with development of a fibrous layer along the visceral pleura.