One-stop chest pain clinic can identify high cardiac risk.

The aim of this study was to record prognosis for patients with stable chest pain referred for outpatient cardiac assessment. All 660 patients in the study had a normal resting ECG and no history of myocardial infarction, unstable angina or coronary revascularisation. Main outcome measures were all-cause mortality, non-fatal ischaemic events and coronary revascularisation.

Bilateral tubal ectopic pregnancy: diagnostic pitfalls.

A rare case of simultaneous bilateral tubal pregnancy after natural conception is presented, together with a review of the literature on this topic. Diagnostic aspects and treatment options are discussed.

Screening for Down's syndrome: experience in an inner city health district.

Objective: To review the experience of Down's syndrome screening in an inner city health district.

Design: In this retrospective study the names of the women were obtained from the Regional Cytogenetic Laboratory and District Down's Syndrome Register. Antenatal notes of the mothers were studied.

A major outbreak of asthma associated with a thunderstorm: experience of accident and emergency departments and patients' characteristics. Thames Regions Accident and Emergency Trainees Association.

Objective: To investigate the time course of an epidemic of asthma after a thunderstorm, characteristics of patients affected, and the demand on emergency medical resources.

Design: Study of registers and records in accident and emergency departments and questionnaire to staff.

Setting: London area.

When can elderly patients be excluded from discussing resuscitation?

Case notes of elderly medical patients were surveyed to determine when "do not resuscitate' (DNR) decisions could legitimately be made without consulting them. Patients were thought to be suitable for exclusion from decisions if morbidity scores indicated that they were unlikely to survive cardiopulmonary resuscitation (CPR) or if they were mentally incompetent. Thirty per cent of all patients were predicted not to survive CPR; another 28% were deemed incompetent.

Discussing cardiopulmonary resuscitation with patients and relatives.

This paper aims to give clear guidance for doctors working in the UK about their responsibilities when discussing cardiopulmonary resuscitation with patients and their relatives. The ethical and legal framework for making decisions is outlined and the commonly encountered dilemmas are discussed.

Homozygous protein C deficiency--management with protein C concentrate.

Unlabelled: Two unrelated female infants with homozygous protein C (Pr C) deficiency are reported. Both are of U.K.

A one-year survey of Neisseria gonorrhoeae isolated from patients attending an east London genitourinary medicine clinic: antibiotic susceptibility patterns and patients' characteristics.

Objectives: To collect epidemiological data on gonococcal infection in an east London genitourinary medicine (GUM) clinic; to perform antibiotic susceptibility testing on Neisseria gonorrhoeae isolates and relate results to patient data; to assess the efficacy of current first-line antibiotic therapy for treating gonorrhoea.

Methods: Gonococcal isolates were collected from 113 patients attending the GUM clinic at Newham General Hospital over a one year period. Isolates (104) were tested for susceptibility to various antibiotics.

DIAMOND: a computerized system for the management and evaluation of district-wide diabetes care.

A computerized diabetic clinic management system, DIAMOND, has been developed with the collaboration of local general practitioners (GPs) to assist communication about diabetic patients across the district. DIAMOND is written in a Windows format using Microsoft Access and its dataset is in line with BDA and Diabcare recommendations. DIAMOND is user-friendly and includes displays and help messages throughout and does not require advanced computer knowledge.

Does audit improve DNR decision making?

The use of 'do not resuscitate' (DNR) orders in hospitals has been the subject of considerable comment in both the medical and the lay press. Guidelines have been produced to help make DNR decisions but, as yet, there have been no published accounts of these in practice. We have used audit to accounts of these in practice.

Zinc protoporphyrin assays in patients with alpha and beta thalassaemia trait.

Aims: To determine the value of the red cell distribution width (RDW) and erythrocyte zinc protoporphyrin (ZPP) concentration in discriminating between iron deficiency, and beta and alpha thalassaemia in a mixed urban Asian population.

Methods: The RDW and ZPP concentrations were measured in 1412 subjects attending for outpatient phlebotomy, with classification into diagnostic groups on the basis of haemoglobin, mean cell haemoglobin, ferritin, HbA2 and haemoglobin electrophoresis.

Results: Non-parametric 95% reference ranges for RDW were 11.

Tibial tuberosity avulsion associated with patellar tendon avulsion.

We report an adolescent boy with avulsion of the tibial tuberosity associated with avulsion of the patellar tendon. He underwent open reduction and internal fixation of his bone injury and the patellar tendon was successfully reattached. The boy experienced a full recovery.

Tibial tuberosity avulsion associated with patellar tendon avulsion.

We report an adolescent boy with avulsion of the tibial tuberosity associated with avulsion of the patellar tendon. He underwent open reduction and internal fixation of his bone injury, and the patellar tendon was successfully reattached. The boy experienced a full recovery.

Acute haemarthrosis of the knee in athletes. A prospective study of 106 cases.

We made a prospective arthroscopic study of 106 skeletally mature male sportsmen with an average age of 28.35 years (16.8 to 44) who presented with an acute haemarthrosis of the knee due to sporting activities.

Post caesarean section delivery.

Recent clinical attention has focused upon the rising rate of caesarean sections being performed and whether patients with a previous caesarean section should be allowed a vaginal delivery. In this paper, the worldwide trend of caesarean section and the role of trial of scar following single and multiple caesarean surgery is reviewed. The role of oxytocin and regional epidural analgesia is evaluated as well as perinatal and maternal mortality.

Accidental injection of white spirit into the hand in golfers.

We report two cases in which white spirit has been injected accidentally into the hand by golfers, while attempting to remove the grip of the golf-club handle in order to replace it. One of our patients has anecdotal evidence of this happening in at least two other cases, one of which resulted in amputation of the index finger, and the other in severe damage to the thumb.

Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes.

In this study, 400 clinically anterior cruciate ligament (ACL) deficient knees were arthroscoped and studied prospectively in the period January 1986 to April 1992. An ACL tear was always confirmed, and 41 per cent of these patients did not have an associated meniscal tear. In 30.