Displacement of the nearest relative under the Mental Health Act 1983.

A case of displacing the nearest relative under s.29 of the Mental Health Act 1983 is described. Difficulties in achieving displacement and some ethical dilemmas, particularly in an elderly couple married for nearly 50 years, are discussed.

Proptosis following nasal tamponade.

A fracture of the lamina papyracea as a result of nasal packing, though plausible is undocumented. A case is presented, with a cautionary note to avoid the use of excessive pressure in packs and balloons when attempting to control epistaxis in elderly patients.

The role of autonomic arousal in problem gambling.

The present study investigated the role of arousal in problem gambling. Three groups of subjects were recruited into the study corresponding to problem gamblers, high and low frequency social gamblers. For the two gambling groups, the preferred form of gambling was poker machine playing.

Obesity and insurance risk: the insurance industry's viewpoint.

Obesity is regarded by insurance companies as a substantial risk for both life and disability policies. This risk increases proportionally with the degree of obesity. Mortality statistics for life insurance were the earliest indicator that the cost of obesity to the individual was a decreased life span and increased illness, particularly that affecting the cardiovascular and musculoskeletal systems.

Audit of unexpected return visits to an accident and emergency department.

Unscheduled re-attendances of patients to the A&E Department were examined over 50 days. A re-attendance rate of 1.9 per 100 new patients was found.

Early diagnosis of acute myocardial infarction by CK-MB mass measurements.

We have studied the changes in creatine kinase (CK) and creatine kinase MB (CK-MB) activity and concentration for the diagnosis of acute myocardial infarction in 73 patients admitted to the coronary care unit with cardiac symptoms of 12 h duration or less. Serial blood samples were obtained for an 8 h period following admission and CK, CK-MB activity and concentration measured. We compared the performance of single values at optimized diagnostic cut-offs and incremental change (log slope) for all three measurements.

Perianal infection with group A streptococcus.

Anal fissure in childhood usually heals quickly after treatment with stool softeners and a local anaesthetic ointment; infection does not usually occur. Two cases are reported in which Lancefield group A beta haemolytic streptococci were isolated from cultures from the perianal skin, which was erythematous and excoriated.

Autoantibodies and immunogenetics in 30 patients with systemic sclerosis and their families.

Clinical and serological evidence of connective tissue disease was found in a high proportion of 132 family members of 30 patients with systemic sclerosis. In 20 probands with the milder CREST form of the disease, 10 had HLA-DR5 and 12 had null alleles at the C4 loci. None of 11 probands with more severe systemic sclerosis had HLA-DR5; all 11 had null alleles at the C4 loci.