Twenty geriatric subjects were treated with recombinant human growth hormone and results compared with a control group. The maximum dose of 3 units per day for 4 months was achieved in all patients. All patients had established atherosclerosis. Doppler Flow Studies were carried out at zero, 6 and 16 weeks. No alteration in plaque size or intima media thickness was observed. An increase in peak velocity in the treated group with a decrease in the control group in the left internal carotid artery only was observed. The study demonstrated a reduction in antero-posterior diameter of the left internal carotid in the treated group but the lesion grading remained unaltered. The expected reduction in total cholesterol LDL was however accompanied by a significant transient increase in triglyceride and P.A.I. 1. Fibrinogen levels were unaltered.

SummaryFollowing an episode of water contamination with sewage in a rural Irish town, a community-wide survey of gastrointestinal-associated illness and health service utilization was conducted. Random sampling of households yielded residents who were surveyed using a self-administered questionnaire. Of 560 respondents from 167 (84%) households, equal proportions lived in areas known to have been exposed and unexposed to the contaminated water, although 65% of subjects reported using contaminated water. Sixty-one percent of subjects met the case definition. The most common symptoms among cases were abdominal cramps (80%), diarhoea (75%), appetite loss (69%), nausea (68%) and tiredness (66%). Mean duration of illness was 7·4 days. Only 22 % of cases attended their general practitioner. Drinking unboiled water from the exposed area was strongly associated with being a case. A substantial degree of community illness associated with exposure to contaminated water was observed. The episode ranks as one of the largest reported water-borne outbreaks causing gastrointestinal illness in recent times.

Management of subcutaneous insulin resistance remains a difficult problem which can be treated by administering insulin intravenously by means of infusion pumps1,2. We wish to report the case of a 31 year old primigravida with subcutaneous insulin resistance who developed a hitherto undescribed clinical complication of clot formation at the catheter tip, successfully treated with anti-coagulant therapy. Previous publications on the use of pumps in pregnancy have reported on the intraperitoneal route for insulin administration.

It has been suggested that delirium in the elderly is caused by abnormally high levels of circulating glucocorticoids or by an increased vulnerability to their effects. We performed a dexamethasone suppression test (DST) in 16 consecutive patients without depression or dementia admitted to an acute-care geriatric unit with a clinical diagnosis of lower respiratory tract infection. Seven of 9 (78%) patients who developed delirium were non-suppressors on the DST compared with 1 of 7 (14%) patients without delirium (p = 0.04). Clinical and laboratory indicators of the severity of illness did not differ between the two groups. Of the 8 patients with an abnormal DST, 1 died and another was not available for repeat assessment. On re-examination 8 weeks later, after resolution of the delirium and of the chest infection, 5 of 6 non-suppressors still had an abnormal DST. It is known that some non-demented and non-depressed elderly patients fail to suppress cortisol in response to 1 mg of dexamethasone. Our results suggest that such patients may be at increased risk for developing delirium during acute illness.

C-erB-2 oneoprotein expression detected immunohistochemically in primary breast cancer is a potent poor prognostic variable for patients including Irish women t.2.Also primary C-erB-2 expression indicates hormone resistance in recurrent breast cancer and relative tumour resistance to low intensity chemotherapy with mitoxanthrone (data in press).Forty young women (median age 41 years) had staining for C-erB-2 in their primary tumonrs; 11 showed positive staining and 29 did not.All subsequently had recurrences of breast cancer and were then given intensiv e chemotherapy with doxombicin 40 mg/m 2 intravenously and ifosfamide/ mesna 5 g/m 2 by intravenous infusion over 24 hours, with mesna alone for 8 hours.Cycles repeated at 21 day intervals to a total of 4 cycles in patients with responsive tumours.Response rates in recurrences (82% C-erB-2+VE vs 72% C-erB-2-ve) median response durations, and post-treatment survival were no different between patients on the basis of primary turnout C-erB-2 expression.This strongly suggests that young women with operable breast cancer and expression of C-erB-2 should be selected for intensive doxombicin based nee-adjuvant/adjuvant chemother apy.

Atmospheric pollution in this country is mainly a Dublin city problem.Even there it is only a problem in the months of November, December and January when thermal inversions occur.The main sources of pollution are the burning of soft bituminous coal in dwelling houses and the fumes from vehicular traffic.The banning of use of bituminous coal under the Marketing, Sale and Distribution of Fuels Regulations 1990 has been followed by a marked drop in pollution levels over the past two winters, however there is evidence that these pollution levels were dropping for other reasons before the Regulations came into force.Since 1980 we are obliged under a European Community Directive to monitor air for smoke (particulate carbon matter), sulphur oxides, lead and nitrogen oxides.It is likely that as time goes on that other pollutants will be added to this list e.g.ozone and volatile organic compounds (V.O.C's) such as benzene, toluene, chloroethanas, aldehydes, styrenes e~.These pollutants arise from industrial processes and can have health implications.They are at present being monitored in many European countries on a voluntary basis.

Twenty-two patients with diabetes and hypertension were treated with Doxazosin. An acceptable fall in blood pressure was found with 1 mg. in 50% of patients and 2-8 mgs. in 50%. An increase in HDL cholesterol and a fall in LDL cholesterol levels which reached statistical significance was observed. A small but significant increase in HBA1 levels occurred in the 50% of patients on the higher Doxazosin dose.

In this article, the author describes the organization of the medical industry in the United Kingdom. As he provides some of the history of its development, he reveals the difficulties inherent in attempting to maintain both a centralized health service and an efficient system that is able to provide proper care for all communities throughout the nation.