Chromosome abnormalities, identified using a banding technique and additional to the Ph, are reported in 10 consecutive cases of transformed chronic granulocytic leukaemia. In most of the cases the abnormalities were non random. In 2 cases serial studies were performed and additional abnormalities found, antedating transformation by one week and two months respectively. In 2 others the Ph status had been established during the chronic phase of the disease. In the remaining cases the first chromosome analysis was performed at the time of transformation.

This study examines the efficacy, safety, and long-term follow-up of low-energy internal cardioversion as a day-stay procedure in patients with long-standing persistent atrial fibrillation (AF) who have had unsuccessful conventional external cardioversion.

The 21-km-long Delivery Tunnel North for the Lesotho Highlands Water Project is split into true main tunnel drives of 8 km and 11 km lengths. The tunnel is located in the sedimentary rocks of the upper Karoo series with cover of up to 350 m. The rock units comprise claystones, siltstones and sandstones. In the poorer geology, early support of the tunnel periphery is essential. The method of tunnel construction involves excavation by a TBM and the simultaneous erection of a precast concrete segmental lining that provides both rock support and a final tunnel lining. The segmental lining is designed and constructed as part of an integrated excavation/support/lining system. There are three types of segments, differentiated by the amount of steel reinforcement. The distribution of the different segment types along the tunnel, relative to the geological conditions and depth of cover will be optimized by monitoring of the performance of the lining during the construction period.

Between 1980 and 1989, 2,212 outbreaks of food-borne infection were reported in Scotland. Of 2,073 episodes for which a causative agent was established, 1,732 (84%) were caused by salmonellae. An average of 980 people were affected each year, while the average number of individuals infected per general outbreak was 16.8. The infected foods were consumed outside Scotland in 25% of the outbreaks. In 75% of 1,107 episodes where the location was specified, the implicated foods were consumed in the home; hotels and restaurants accounted for 15%. Specific food items were identified in 603 (35%) of the 1,732 outbreaks; poultry meat was responsible for 332 (55%) and milk 49 (8%), while eggs accounted for 23 (4%) outbreaks.

Infections carried in milk, particularly salmonellosis and campylobacter enteritis, have continued to feature in Great Britain in recent years. Less commonly reported infections included an outbreak in 1984 in England due to Streptococcus zooepidemicus, in which 12 people, eight of whom died, were admitted to hospital. The implementation of legislation in 1983 requiring heat treatment of cows' milk for sale to the public reduced the incidence of milkborne infection in Scotland compared with previous years and compared with England and Wales, where, without legislative control, outbreaks continue to occur. Until compulsory pasteurisation is introduced throughout Britain and dairy farming communities can be persuaded to drink only heat treated milk outbreaks of milkborne infection will continue.

A 32-year-old West Indian woman with acute lympho? blastic leukaemia received induction chemotherapy with doxorubicin, vincristine, prednisolone, and asparaginase. Ten weeks after the diagnosis had been made, while in remission, she suddenly became short of breath. The haemoglobin concentra? tion had fallen to 7-8 g/dl from 12 g/dl over seven days. On examination by auscultation new murmurs of mitral and aortic r?gurgitation were heard. Over 24 hours her blood pressure fell from 120/80 mm Hg to 85/55 mm Hg, and there were signs of congestive cardiac failure with basal crepitations, a jugular venous pressure of 3 cm, and pulmonary oedema on the chest x-ray film. The sudden loss of her right radial pulse and recurrent transient ischaemic attacks suggested systemic embo lisation. A two-dimensional echocardiogram (figure) showed a large vegetation on the aortic valve and small vegetations on the mitral valve. Left ventricular function was not obviously impaired. Candida guilliermondi was isolated from blood cultures. Because of her clinical deterioration and the echocardiographic findings, the aortic and mitral valves were replaced without further investigation. The aortic valve had been destroyed by a large fungal vegetation, which had also eroded the anterior cusp of the mitral valve. The aortic and mitral valves were replaced with heterografts, though it was difficult to anchor the sutures through the friable and oedematous cardiac muscle. After 12 hours of inotropic support with dopamine she made Acute leukaemia is not a contraindication to major cardiac surgery

A newly developed form of high resolution microscope photometry has been employed in a study of the relationships between the chromosomes involved in the standard Philadelphia (Ph1) translocation of chronic myeloid leukemia (CML). The intention of the investigation was to provide quantitative data on the relative amount of material exchanged between the No. 9 and No. 22 chromosomes. A marked consistency in the amount of material lost from the Ph1 was observed, and the balanced nature of the standard Ph1 translocation was confirmed. The data are also in accordance with the concept of a reciprocal exchange between the No. 9 and No. 22 chromosomes.

The unit in question, at Liverpool Royal Hospital, recognises impending postmaturity as an indication for induction no earlier than 10 days past term and would not strive unduly to achieve an early induction in patients with mild or moderate hypertension, given satisfactory placental function. These two conditions constitute the majority of indications for ripening procedures. In these situations, the discovery of an unripe cervix would surely best be interpreted as an abnormal finding rather than one at the lower limit of physiological normal. If the unripe cervix is an early manifestation of poor uterine activity-and in the light of current theories on the initiation of physiological labour this would seem reasonable-then the ensuing induced labour might well be expected to have the characteristics of the cephalopelvic disproportion and incoordinate uterine activity syndrome. Perhaps, then, it is more realistic to find encouragement in a 750 vaginal delivery rate in such circumstances and to conclude that the underlying conditions, rather than the ripening procedures, are responsible for the high section rate.

Six cases of chronic granulocytic leukaemia (CGL) and two cases of acute myeloid leukaemia (AML) with dual populations of karyotypically normal and Philadelphia (Ph1) chromosome-positive cells are described. GTG and QF-banding characterized the Ph1 as resulting from a 9/22 translocation in all eight cases. Four of the patients suffering from CGL presented with 100% Ph1-positive bone marrows, and after receiving intensive chemotherapy, karyotypically normal cells were demonstrated. The other two patients with CGL showed Ph1 mosaicism at presentation. The two patients with AML exhibited Ph1 mosaicism at presentation and throughout the course of the disease. In both of these patients, a marker No. 10 chromosome was found in some of the Ph1-positive cells and in one hyperdiploidy was observed to have developed only in the clone with the additional chromosome anomaly.

The past decade has seen many changes in the relationships between the medical, veterinary and environmental health professions in Britain. Doctors and veterinarians had traditionally tended to remain in isolation to each other despite mutual interests, while working relationships between public health doctors and environmental health officers were disrupted following re-organization of the NHS in 1974 and of local government in 1975. The situation was, however, generally less acute in Scotland where active encouragement had been given since the early 1970s towards the creation of local liaison groups in different areas of the country, the first of which was formally established in Aberdeen in 1969. The subsequent development of other liaison groups and the role of the Communicable Diseases (Scotland) Unit in coordinating inter- and intra-professional liaison and communications throughout Scotland is described, along with examples of combined activities in surveillance, investigation and control measures.