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Now is a historical time wrapped with grief. We face the loss of ecology: our relationships to one another and our natural environment are strained, disrupted, severed, and brutalized rather than r...

JET is the largest tokamak in operation and the main link between smaller machines, where intrinsic rotation has been mostly studied, and ITER the next step in fusion research. While the main ion in present tokamak plasmas is a single hydrogen isotope, mainly Deuterium (D) in JET, future nuclear fusion machines, such as ITER, will operate with a mixture of D and Tritium (T). Recent experimental campaigns at JET performed a series of experiments with different hydrogen isotopes, designed to clarify the impact that isotope mass has on physics questions, and in particular transport and confinement questions, relevant for reliable predictions for ITER. This talk will report on experiments that studied for the first time the isotope effect on intrinsic rotation in a tokamak plasma, by comparing rotation measurements in Hydrogen (H), D and T in Ohmic plasmas. One of the objects of the JET intrinsic rotation experiments was to study rotation reversals, a puzzling phenomenon commonly observed in small and medium size tokamaks, where a transition from monotonic to non-monotonic rotation profiles is observed at a critical density, in some cases leading to plasmas with central and outer regions flowing in opposite directions. At JET, as the density increased, two consecutive core rotation reversals were observed. The first, shows a change from peaked co- current rotation to hollow profiles with the core in some cases counter-current rotating, similarly to observations in smaller tokamaks. Further increasing the density leads to restoration of monotonic profiles. The magnitude of the core rotation was found to depend on isotope type, stronger co-current rotation observed in H. Core counter-rotation was observed with D and T but not with H. Gyrokinetic calculations, show that the low-density rotation reversal, for all three isotopes, occurs close to the density of transition from dominant TEM to ITG instabilities. The type of instability cannot be associated to different directions of core rotation since for all three isotopes, co-rotation is observed with dominant TEM for the low- densities and ITG for high-densities. Non-linear modeling of rotation profiles with the low- flow model show changes of sign in rotation gradient, qualitatively consistent with the observation of peaked to hollow to peaked profiles as the density increased .These results have strong implications for ITER, as rotation extrapolations from present day experiments, mostly based on D plasmas, might not recover in full the physics mechanisms playing a role in momentum transport.

Introduction: An oral glucose tolerance test (OGTT) six weeks after delivery is considered the gold standard test to identify persistently abnormal glucose metabolism in women with gestational diabetes mellitus (GDM) but the National Institute for Health and Clinical Excellence (NICE) recommends fasting plasma glucose (FPG) alone. This however, cannot be used to diagnose those with persisting impaired glucose tolerance and will also fail to identify some women with persisting diabetes mellitus (DM). This study aims to identify the percentage of women with DM and impaired glucose tolerance (IGT) that would be missed using this strategy. Methods: Data from 147 women from two sites were analysed. Fishers’ exact test was used to demonstrate differences between OGTT and FPG and a receiver operating characteristic curve was used to try and identify a FPG concentration that would predict a post-glucose load abnormality. Results: Fifty-two of the 147 women had a persistent abnormality in glucose metabolism. Twenty-three had impaired fasting glycaemia (IFG), 21 had IGT and eight women had DM. Only seven of the eight women with DM had a FPG ≥ 7.0 mmol/L and hence one out of eight women with DM (12.5%) and all 21 women with IGT would have been missed if FPG alone were used (pConclusion: Postnatal FPG alone is inadequate to identify all women with DM and would miss a significant number of women with IGT. An OGTT in all women with diagnosed GDM remains the gold standard test to identify persistent abnormal glucose metabolism in these women.

The second of three studies being undertaken by the Confidential Enquiry into Maternal and Child Health (CEMACH) has recently reported its findings and recommendations. The standards of diabetes and maternal care and the outcomes of 3808 pregnancies in England, Wales and Northern Ireland are described. Pre-pregnancy planning and care before conception is poor. Stillbirth rate (26.8 per thousand) and perinatal mortality (41.8 per thousand) were 4-5 times higher than the background population, and congenital anomaly (41.8 per thousand) double the background rate. Type 2 diabetes now represents 27.3% of pre-gestational diabetes and more often of ethnic minority and deprived background than Type 1 diabetes. The ideals of the Diabetes National Service Framework and the target of the Saint Vincent declaration are far from being achieved. Much can be done to improve the outcomes of pregnancy within existing resources with better systems and organization of care. However, if significant progress is to be made, it is incumbent upon health-care professionals and health-care commissioners to direct resources specifically at improving pre-pregnancy and maternity services. Research is needed firstly to analyse in greater detail the wealth of data collected in the CEMACH survey and consider the implications of health-care costs. Further research to discover ways of reducing the adverse outcomes is urgently required. The need to educate, motivate and bring about improved pre-pregnancy care in women with diabetes is a priority.

Aims To monitor pregnancies in women with pregestational Type 1 diabetes for pregnancy loss, congenital malformations and fetal growth parameters, in a geographically defined area in the north west of England. Methods Population cohort study of 547 pregnancies in women with Type 1 diabetes from maternity clinics in 10 centres over a 5-year period (1995–1999 inclusive). Main outcome measures were numbers and rates of miscarriages, stillbirths, neonatal and post-neonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age. Results Among 547 pregnancies, there were six (1.1%) pairs of liveborn twins, 439 (80.3%) liveborn singletons; 72 (13.2%) spontaneous abortions, 14 (2.6%) stillbirths and 16 (2.9%) terminations. Four of the terminations were performed because of congenital malformations. Both the stillbirth rate (30.1/1000 total births (95% confidence interval (CI) 16.6–50.0)), and prevalence of congenital malformations (84.3/1000 live births (95% CI 60.3–113.8)) were significantly higher than the local population (P

Corresponding Author: F. Jenko, fsj@ipp.mpg.de The common view in fusion theory is that nonlinear gyrokinetics constitutes a reliable firstprinciples approach to describe turbulent transport in MCF devices. Surprisingly, however, two recent findings challenged this notion. First, the experimental ion heat fluxes in the outer core of certain DIII-D L-mode discharges were underpredicted by GK simulations by almost an order of magnitude. This finding has been dubbed the "shortfall problem" and has triggered extensive theoretical efforts on an international level. Second, a careful analysis of some L-mode discharges in the JET tokamak revealed a significant reduction of ion temperature profile stiffness in the presence of strong NBI r1s. This was first attributed to a combination of high toroidal flow shear and low magnetic shear. However, nonlinear GK simulations failed to confirm this suspicion, overpredicting the observed fluxes by up to an order of magnitude. This finding could be called the "excess problem" and is as severe as the shortfall problem described above. The main goal of the present contribution is to revisit both of these problems and substantiate or refute them. At stake is the plasma theory community's confidence to devise a predictive transport capability for devices like ITER or DEMO on the basis of nonlinear GK. Via careful studies with the GENE code (using about 30 million CPUh), both of these challenges could be met successfully. While the transport levels in outer-core L-mode discharges of DIII-D, C-Mod, and ASDEX Upgrade r2s can be reproduced within the experimental error bars, the observed ion temperature stiffness reduction in JET can be explained in terms of nonlinear electromagnetic effects in the presence of fast ions r3s. Thus, a number of ideas about possible elements missing in the present theoretical description or even a possible breakdown of GK are identified as premature. Meanwhile, these studies highlight the fact that the search for adequate minimal models of turbulent plasma transport under various experimental circumstances is highly non-trivial. This work was supported by EURATOM and carried out within the framework of the European Fusion Development Agreement. The views and opinions expressed herein do not necessarily reflect those of the European Commission. References r1s M. Mantica, PRL 107, 135004 (2011). r2s D. Told, PoP 20, 122312 (2013). r3s J. Citrin, PRL 111, 155001 (2013).

Axonal transport is known to be impaired in peripheral nerve of experimentally diabetic rats. As axonal transport is dependent on the integrity of the neuronal cytoskeleton, we have studied the way in which rat brain and nerve cytoskeletal proteins are altered in experimental diabetes. Rats were made diabetic by injection of streptozotocin (STZ). Up to six weeks later, sciatic nerves, spinal cords, and brains were removed and used to prepare neurofilaments, microtubules, and a crude preparation of cytoskeletal proteins. The extent of nonenzymatic glycation of brain microtubule proteins and peripheral nerve tubulin was assessed by incubation with 3H-sodium borohydride followed by separation on two-dimensional polyacrylamide gels and affinity chromatography of the separated proteins. There was no difference in the nonenzymatic glycation of brain microtubule proteins from two-week diabetic and nondiabetic rats. Nor was the assembly of microtubule proteins into microtubules affected by the diabetic state. On the other hand, there was a significant increase in nonenzymatic glycation of sciatic nerve tubulin after 2 weeks of diabetes. We also identified an altered electrophoretic mobility of brain actin from a cytoskeletal protein preparation from brain of 2 week and 6 week diabetic rats. An additional novel polypeptide was demonstrated with a slightly more acidic isoelectric point than actin that could be immunostained with anti-actin antibodies. The same polypeptide could be produced by incubation of purified actin with glucose in vitro, thus identifying it as a product of nonenzymatic glycation. These results are discussed in relation to data from a clinical study of diabetic patients in which we identified increased glycation of platelet actin. STZ-diabetes also led to an increase in the phosphorylation of spinal cord neurofilament proteins in vivo during 6 weeks of diabetes. This hyperphosphorylation along with a reduced activity of a neurofilament-associated protein kinase led to a reduced incorporation of 32P into purified neurofilament proteins when they were incubated with 32P-ATP in vitro. Our combined data show a number of posttranslation modifications of neuronal cytoskeletal proteins that may contribute to the altered axonal transport and subsequent nerve dysfunction in experimental diabetes.

Pregnancy complicated by diabetes presents risks for the mother and her baby and a challenge to those responsible for their care. Type 2 diabetes now represents a significant and rapidly increasing proportion of pregestational diabetes. Outcomes of pregnancies complicated by Type 2 diabetes are certainly no better and sometimes worse than for Type 1 diabetes. Perinatal mortality, stillbirths and congenital anomalies are increased between two- and fourfold. Women with Type 2 diabetes and who are of child-bearing age merit special attention for contraception and prepregnancy care. This review considers the implications for women with Type 2 diabetes before, during and after pregnancy.

Sudden nocturnal death in type 1 diabetes (‘dead in bed’ syndrome) is thought to be due to ECG QT prolongation with subsequent ventricular tachyarrhythmia in response to nocturnal hypoglycaemia. We investigated this theoretical mechanism using continuous ECG and continuous glucose monitoring in a group of patients with type 1 diabetes. Twenty-five patients with type 1 diabetes (age 20–50 years) underwent two separate 24 h ECG and continuous glucose monitoring periods. Patients were fully ambulant and carried out normal daily activities. There were 13 episodes (26% of recordings) of nocturnal hypoglycaemia, eight of

Aims Improving care for women with pre-gestational diabetic pregnancy is a core objective of the St Vincent Declaration and the Diabetes National Service Framework. The aim was to develop a practicable collaborative audit methodology for pre-gestational diabetic pregnancy. Methods In 1999, care professionals in the north-west of England agreed standards and a simple monthly data collection system. Annual reports are compiled to summarize compliance with the standards. Each hospital receives an individualized report comprising tables and funnel plots that allow between-hospital comparisons. Results Data on pre-gestational diabetic pregnancies are collated from 30 maternity units. Funnel plots and tables presented in the annual reports highlight any large differences between hospitals in booking and outcome measures for diabetic pregnancies. Conclusions The annual audit reports allow the assessment of current management and outcomes for diabetic pregnancies at a regional and local level. These reports help to identify areas where diabetic pregnancy care requires further attention.

To compare different approaches to DCCT standardization of glycated haemoglobin (HbA(1c)) results.In the first part of the study seven laboratories in the Mersey area participated, using a variety of methods of measurement. The approaches used were the Standardization Initiative for Glycated Haemoglobin Scheme (SIGH) using fresh blood samples and the Wales External Quality Assurance Scheme (WEQAS) using both fresh and lyophilized blood samples. Additional studies performed in the Royal Liverpool University Hospital (RLUH) laboratory involved: (i) re-calibration of the HPLC analyser using lyophilized blood samples supplied by the manufacturer and (ii) the use of fresh blood samples from the UK National External Quality Assurance Scheme (UKNEQAS).Inter-laboratory analytical coefficients of variation following DCCT alignment showed little change. The effect on percentage bias was more marked and was independent of the level of HbA(1c). Comparing DCCT-aligned HbA(1c) results from 3902 diabetic patients attending the RLUH, indicated that there was a statistically significant difference (P0.0001) between the corrected results produced by the five schemes. The effect of DCCT alignment on reported HbA(1c) values using the different approaches was variable resulting in an apparent increase in the number of diabetic patients with poor glycaemic control (HbA(1c) values7.0%) in all cases.The method of HbA1c standardization used determines the degree of correction required and a consensus approach is recommended. Implementation will assist extrapolation from research-based evidence to local practice. Associated changes to patient management must come under the jurisdiction of the physicians responsible for the diabetic service.

Answers on p 280. A 60 year old woman presented with a six week history of symmetrical joint pains affecting her large joints, associated …

A 37-year-old man with type 1 diabetes presented with a few days history of persistent vomiting and lethargy associated with thirst and polyuria. He was not on any regular medication apart from insulin. He had omitted his insulin over the last 24 hours. Clinical examination revealed him to be dehydrated with a tachycardia of 120 beats/min and blood pressure 130/80 mmHg. He was dyspnoeic with a respiratory rate of 32 breaths/min; the pattern was characteristic of Kussmauls respiration. Laboratory investigations showed a metabolic acidosis …

Objective: To monitor pregnancies in women with pre-existent insulin dependent diabetes for pregnancy loss, congenital malformations, and fetal growth in a geographically defined area of north west England. Design: Population cohort study. Setting: 10 maternity units in Cheshire, Lancashire, and Merseyside which had no regional guidelines for the management of pregnancy in diabetic women. Subjects: 462 pregnancies in 355 women with insulin dependent diabetes from the 10 centres over five years (1990-4 inclusive). Main outcome measures: Numbers and rates of miscarriages, stillbirths, and neonatal and postneonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age. Results: Among 462 pregnancies, 351 (76%) resulted in a liveborn infant, 78 (17%) aborted spontaneously, nine (2%) resulted in stillbirth, and 24 (5%) were terminated. Of the terminations, nine were for congenital malformation. The stillbirth rate was 25.0/1000 total births (95% confidence interval 8.9 to 41.1) compared with a population rate of 5.0/1000, and infant mortality was 19.9/1000 live births (5.3 to 34.6) compared with 6.8/1000. The prevalence of congenital malformations was 94.0/1000 live births (63.5 to 124.5) compared with 9.7/1000 in the general population. When corrected for gestational age, mean birth weight in the sample was 1.3 standard deviations greater than that of infants of non-diabetic mothers. Infants with congenital malformations weighed less than those without. Conclusion: In an unselected population the infants of women with pre-existent insulin dependent diabetes mellitus have a 10-fold greater risk of a congenital malformation and a fivefold greater risk of being stillborn than infants in the general population. Further improvements in the management of pregnancy in diabetic women are needed if target of the St Vincent declaration of 1989 is to be met. Key messages Infants of women with established insulin dependent diabetes mellitus have 10 times the population risk of congenital malformations and five times the stillbirth rate Excess mortality among infants of women with pre-existent insulin dependent diabetes mellitus is predominantly due to congenital malformations The birth prevalence of congenital malformations can be reduced by good periconceptional glycaemic control, but the challenge remains to implement this on a population basis Macrosomia remains a problem among infants of women with established insulin dependent diabetes mellitus

Ranitidine is one of the widely prescribed H2 receptor antagonists in the treatment of peptic ulcer. It is well tolerated and has few side-effects. Vasculitic rash occurring in association with ranitidine has been described. We report a case of a 39-year-old man who developed a purpuric rash, polyarthritis, abdominal pain, melaena and impaired renal function characteristic of Henoch-Schonlein purpura, following treatment with ranitidine.

Prognostic factors of the outcome of upper gastrointestinal bleeding in patients with cirrhosis are insufficiently defined. Pertinent clinical, biochemical, and endoscopic data of 332 upper gastrointestinal bleedings in 268 patients with cirrhosis observed in the participating centers during 31 months were recorded. Clinical data were analyzed until 40 days after bleeding. A further set of 82 bleedings was used as a validation group. Ninety-two of the 268 patients died within the time of the study, and 28 of the 82 patients of the validation group died. According to a stepwise logistic regression analysis, s-creatinine, ascites on admission, previous diagnosis of hepatocellular carcinoma, s-bilirubin, prothrombin index, varices as definite or probable source of bleeding, gender, and presentation with hemathemesis were the best set of covariates for predicting outcome. From them a prognostic index was developed and validated in the 82 further bleedings. Sensitivity and specificity in the cumulated training and test sets were 75 and 80%, respectively. In the present material, the prognostic index was significantly more efficient than Child-Pugh score or the prognostic index proposed by Garden et al. These data show that it is possible to predict the outcome of upper gastrointestinal bleeding in cirrhosis on the basis of few easily available data. The prognostic index we proposed and validated may become useful to predict the outcome of a bleeding and to select or stratify patients in clinical trials.

This double-blind study assesses the therapeutic efficacy and the safety of oral treatment with phosphatidylserine (BC-PS) vs placebo (300 mg/day for 6 months) in a group of geriatric patients with cognitive impairment. A total of 494 elderly patients (age between 65 and 93 years), with moderate to severe cognitive decline, according to the Mini Mental State Examination and Global Deterioration Scale, were recruited in 23 Geriatric or General Medicine Units in Northeastern Italy. Sixty-nine patients dropped out within the 6-month trial period. Patients were examined just before starting therapy, and 3 and 6 months thereafter. The efficacy of treatment compared to placebo was measured on the basis of changes occurring in behavior and cognitive performance using the Plutchik Geriatric Rating Scale and the Buschke Selective Reminding Test. Statistically significant improvements in the phosphatidylserine-treated group compared to placebo were observed both in terms of behavioral and cognitive parameters. In addition, clinical evaluation and laboratory tests demonstrated that BC-PS was well tolerated. These results are clinically important since the patients were representative of the geriatric population commonly met in clinical practice.

We report the results of a study of serum antibodies to proteins of the nerve cytoskeleton in patients with Type I and Type II diabetes mellitus, both with and without clinical signs of diabetic neuropathy. In contrast to previous reports, elevated levels of antibody to tubulin or glycated tubulin were not associated with either diabetes or diabetes with related neuropathy. Similarly, clinical evidence of neuropathy in patients with diabetes did not relate to increased levels of antibody to native or glycated microtubule-associated proteins (MAPs). The levels of antibody to MAPs and glycated MAPs were higher in control subjects over the age of 45 years compared with younger control subjects. Increased levels of antibody to tubulin and glycated tubulin were found in the sera of patients with systemic lupus erythematosus, but not rheumatoid arthritis.

We report the case of a patient who suffered recurrent episodes of hypoadrenal crisis, despite conventional replacement therapy for Addison's disease. She was found to have hyperthyroidism and after this was treated, she had no further relapse. Thyrotoxicosis should be considered when patients taking replacement therapy for Addison's disease present in hypoadrenal crisis.

A 20 year old male patient presented with lack of sexual development. On examination he was eunuchoidal and hypogonadal, and olfactory function testing showed he was anosmic. Biochemical investigations proved he was hypogonadotrophic. Kallmann's syndrome was therefore diagnosed. His appearance was very different from his alleged identical twin who had undergone a normal puberty and had normal plasma testosterone and gonadotrophin levels. However, the twin was hyposmic. Genetic fingerprinting confirmed the twins were identical. Why Kallman's syndrome was incompletely expressed in one of them is unexplained. The parents and a normally menstruating sister had normal olfactory function.

Centralisation of care leads to better outcome Editor—The finding of a persistently poor outcome of pregnancy in women with insu› lin dependent diabetes in two (northern) English regions is an important statement of the problem. 12 Both studies provide figures and show outcomes that are no different from those widely reported in the past. Unfortunately, neither give evidence of any degree of centralisation of obstetric or diabetic care, with on›site neonatal intensive care, although this is a proved means of improving the outcome of pregnancy for diabetic mothers. 3 The St Vincent declara›

Proximal muscular weakness is a feature of many metabolic bone diseases but is not well recognized in spinal osteoporosis. Thirty-six post-menopausal women presenting with back pain, with or without osteoporosis, were therefore studied in order to define the relationship between abnormal electromyographic findings and disturbed vitamin D metabolism, as both low plasma 1,25 dihydroxy vitamin D concentrations and malabsorption of calcium have been reported in osteoporosis. Patients with abnormal electromyograms had lower concentrations of plasma 1,25 dihydroxy vitamin D (mean 78.3 pmol/1, SD 20.5, n=15) than normal subjects of similar age (mean 110.4 pmol/1, SD 39.4, n= 21; P

1. The effect of dietary sodium on the urine dopamine excretion of eight hypertensive patients and six matched controls was studied under metabolic balance conditions over a 2 week period during which dietary sodium intake was increased from 20 to 220 mmol/day. 2. The control group showed the expected increase in dopamine excretion in response to sodium but the hypertensive patients showed an initial fall followed by a return to baseline values. 3. Neither group showed a rise in blood pressure but the hypertensive patients showed a greater weight gain on salt loading, although this change was not significant. The cumulative sodium balance was greater and more prolonged in the hypertensive patients, although this difference also did not attain statistical significance. 4. This defect in dopamine mobilization may be important in relation to renal sodium handling by patients with essential hypertension.

The assembly of pig brain microtubule proteins was measured in vitro in the presence of serum from control rats and rats that had been rendered diabetic with 50 mg/kg streptozotocin 14 d previously. Control serum inhibited total microtubule assembly and increased the lag time before assembly commenced. Serum from diabetic animals was significantly more potent in both respects. The effect on lag time was reproduced in a predominantly albumin-containing fraction of serum that had been fractionated by affinity chromatography. Glycosylation of rat albumin in vitro led to an increase in its ability to increase polymerization lag time, but the concentration of albumin required was greater than that found in the serum fractions. The results indicate that diabetic serum contains factors that can adversely affect microtubule formation and that part of this effect may be caused by the presence of glycosylated albumin. This phenomenon may underlie some of the complications associated with diabetes.

Eight patients with chronic glomerulonephritis and five age-matched normal volunteers were given additional sodium chloride by mouth under conditions of metabolic balance. Whereas in the normal volunteers plasma renin activity was suppressed and urinary excretion of free dopamine increased, in the patients dopamine was not mobilised and plasma renin activity was not completely suppressed. Abnormal retention of sodium and water in glomerulonephritis may be due partly to a failure to mobilise dopamine in the kidney. Specific renal dopamine agonists may be natriuretic and hypotensive in chronic glomerulonephritis.

S. Grey 3 c 12 is a miscellany of Latin poems in the South African Library, Cape Town. It is one item in a collection of manuscripts, and a much larger number of printed books, given to the library in 1861 by Sir George Grey, governor of the Cape. At the time of the gift, he had relinquished his office for a similar post in New Zealand, where he had been governor also before coming to South Africa. While in New Zealand for the second time, he formed another but smaller collection of manuscripts, now in the Public Library at Auckland. Both collections are the work of an amateur bibliophile, a gentleman of private means, who assembled with intelligence and good taste.

The protective effect of a high dietary sodium intake in models of acute renal failure is well known. This effect may be mediated via an increased endogenous dopamine production. The effects of different salt intakes and υ-glutamyl dopa (a renal pro-drug for dopamine) on the histological changes following s.c. glycerol were studied in the rat. The protective effect on a high sodium diet was confirmed and υ-glutamyl dopa was also shown to reduce significantly the damage caused by glycerol.

The effect of serum from non-diabetic patients, diabetics without neuropathy and diabetics with significant neuropathy on the ability of pig brain microtubule proteins to polymerize in vitro to microtubules was observed. The extent of polymerisation on the second and third cycles of polymerisation was significantly reduced in the presence of diabetics' serum compared with non-diabetics' serum. No significant difference between the serum samples from diabetics with and without neuropathy could be found. The finding suggests the presence of a factor in the serum of diabetics, whether or not they have neuropathy, which will impair microtubule formation in vitro.

We report the history, laboratory and histological findings in a man who presented with Cushing's disease. Despite removal of the primary pituitary tumour, his disease progressed and after bilateral adrenalectomy, he became pigmented and plasma ACTH levels remained elevated. He had further pituitary surgery and radiotherapy, to relieve compression of the optic chiasma. Plasma ACTH levels remained elevated. He developed liver, bone and lymph gland metastases and after an acute paraparesis due to spinal metastases he died. Immunoperoxidase staining techniques demonstrated ACTH in the pituitary recurrence and metastases. The combination of bone, liver and lymph node metastases has not previously been reported, nor has ACTH been reported before in metastases from a primary intrasellar tumour.

SUMMARY This paper identifies obstacles to the inclusion of families by residential establishments. A review of the literature indicates that the notion of including families is a worthwhile consideration, but that few programmes have committed themselves with sufficient energies over time to test the worth of this assumption. To bring families centre stage a set of obligations is proposed to managers and certain principles from the family dynamics literature are identified for inclusion in the training curriculum of residential workers. Typical feedback from residential and community workers confirms that in many programmes family members are not included in care and treatment activities and sometimes they are specifically excluded. Work ers are not permitted time for contact with family members. Care and treatment are focused on changing the resident's perceptions, or on changing his or her ways of coping with the family, while nothing is done with the other family members. The rationale for involving parents in some way with their behaviourally-disordered or delinquent child while that child lives in residential group accommodation has been advanced with careful preci sion particularly by Hobbs (1982), Whittaker (1981), Whittaker et al.

Pregnancy in patients with Cushing's syndrome is rare. It is associated with a high fetal loss, increased frequency of preterm labour and excessive maternal morbidity. We describe a patient who became pregnant while investigations for hypertension were being done. Cushing's disease was diagnosed and the patient had transsphenoidal pituitary surgery at 22 weeks gestation. To our knowledge this is the first time this operation has been done during pregnancy for this condition. Cushing's disease was controlled, but because of worsening hypertension, she had a caesarean section at 30 weeks gestation. Subsequently her blood pressure fell and her hydrocortisone replacement therapy is being withdrawn. Her daughter is now thriving after initial problems with pneumothoraces.

1. γ-Glutamyl l-dopa, a renal pro-drug for dopamine, was administered to rats before and after injection of glycerol, and to a control group which received water in place of glycerol. A third group of rats was given glycerol but no γ-glutamyl l-dopa. 2. The plasma creatinine in rats given γ-glutamyl l-dopa and glycerol was significantly lower than in rats receiving glycerol alone. 3. The fall in urine creatinine excretion, and polyuria, after glycerol was reduced by γ-glutamyl l-dopa and the natriuresis abolished. 4. γ-Glutamyl l-dopa given alone caused a 4000-fold increase in urine dopamine excretion, associated with a natriuresis. 5. The administration of γ-glutamyl l-dopa reduces the severity of renal failure produced by glycerol.