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Two cases of benign duodeno-colic fistula are described. In the first, no cause was evident, but complete cure of an illness characterized by fatty diarrhoea, loss of weight, anaemia, and osteomalacia followed surgical repair. In the second patient cure was spontaneous after a peri-duodenal abscess from a perforated post-bulbar duodenal ulcer discharged into the hepatic flexure of the colon. [ABSTRACT FROM PUBLISHER]

Most series of haematemesis or melaena present data about the clinical problems in relation to the final diagnosis. When a patient is admitted there is the problem of management which depends to a considerable extent on the diagnosis. This paper demonstrates that it is possible to achieve an accurate diagnosis in 80% during the first 24 hours. [ABSTRACT FROM PUBLISHER]

A case of massive lower gastrointestinal bleeding from Crohn's disease is reported. This is an uncommon complication of the disease and the literature is reviewed. Successful control of gastrointestinal bleeding by intra-arterial vasopressin infusion has not previously been reported in Crohn's disease. We suggest that this technique may be used in an attempt to avoid surgery. [ABSTRACT FROM PUBLISHER]

A 76-year-old woman with giant cell arteritis who presented with peripheral neuropathy is described. [ABSTRACT FROM PUBLISHER]

Two factors characterize innovative organizational climates as perceived by nonmanagerial hospital employees. The first, innovation, comprises perceptions about the consequences or contingencies (e.g., punished, ignored, rewarded) of such proactive activities as implementing new ideas, questioning established methods, and communicating with other departments and the supervisor. The second, restrictive conformity, comprises perceptions about the consequences of risk-aversive, conflict-avoidant activities that suggest dysfunctional conformity (e.g., "sticking to the rules no matter what"). Positive personal outcomes--greater role clarity, organizational involvement, and satisfaction, and lower role conflict and willingness to leave the organization--are associated with innovation; negative personal outcomes are associated with restrictive conformity. The dialectical tension between conformity and innovation is discussed in terms of loose coupling and a reward systems perspective.

Fifty-seven mothers in Indonesia were involved in a face-to-face health education programme which encouraged hand-washing with soap. The intervention spanned 4 months and comprised fortnightly visits by 2 community organizers, who supplied free soap. Two years after the intervention, 79% of mothers were still using hand soap, despite the fact that they now had to buy it themselves. The community seemed to be benefiting from a sustained reduction in diarrhoea episodes due to improved hygiene practices.

Sixty-five mothers from Balai Lua, Central Lombok, Indonesia were given soap and an explanation of the faecal-oral route of diarrhoea transmission. This very simple health message was repeated and reinforced fortnightly when mothers were also asked whether any members of their family had suffered from diarrhoea over the previous 2 weeks. Children of these mothers experienced an 89% reduction in diarrhoea episodes compared to a control period before the intervention.

Plasma levels of zinc and albumin have been measured for eight consecutive days in patients suffering chest pain due to myocardial infarction or myocardial ischaemia. A substantial diurnal variation has been found in both controls and patients. Plasma zinc falls after myocardial infarction reaching the lowest level on day 2, thereafter returning to normal by day 8. The lowest plasma zinc levels occur within 48 h of a myocardial infarction and in some patients herald the development of a serious cardiac arrhythmia. Plasma albumin falls progressively after myocardial infarction, being lowest on day 8. The fall in plasma zinc is not totally explained by the fall in plasma albumin.