Chronic beryllium disease in identical twins

Identical male twins born in 1959 have developed chronic beryllium disease. Twin 1 was exposed to beryllium for more than 3 years. The diagnosis was first suspected at the time of his post-employment chest radiograph. Twin 2 was exposed for 21 months and ceased employment at the same time as his brother. His post-employment examination was normal. Thirty months later he developed an unusual skin rash which biopsy showed to be granulomatous. Further investigations proved the diagnosis. Both men have reduced tear secretion measured with Schirmer's test, a feature not previously reported in this condition. Bronchoalveolar lavage and laser microprobe mass spectrometry (LAMMS) were used as aids to the diagnosis. Sarcoidosis has been reported in identical twins, suggesting genetic susceptibility, which may also be of importance in chronic beryllium disease.

Disseminated bone and joint tuberculosis 25 years after development of lupus vulgaris

A case of extensive bone and joint tuberculosis is reported in a 62-year-old caucasian woman who had a 25 year history of inadequately treated facial lupus vulgaris. In spite of a good response to standard anti-tuberculosis chemotherapy there was extensive residual joint destruction.

Two-year experience with a computerized matching programme for allocation of pre-registration house posts in Wales

A review of the computerized house job matching programme for 1981-82 and 1982-83 in the principality of Wales is reported. A substantial number of students (up to 35%) obtained jobs before the start of the programme in 1981 and 58% of posts were allocated outside the computer system. In contrast, following active encouragement to adhere to the procedure, a dramatic improvement in operation was achieved in 1982-83; less than 5% of posts were allocated privately. The experience suggests that for large areas involving many jobs, the computer matching programme may be a most suitable means of allocating these posts. Further consideration should be given for the setting up of a United Kingdom national computerized matching programme.

Retrospective survey of the management of miliary tuberculosis in South and West Wales, 1976-8

In a survey of 1000 patients with tuberculosis 28 were found to have miliary disease. Half of these patients were over 60 years old. Anorexia and weight loss were present in 19 (70%) and pyrexia in 17 (63%). A factor predisposing to tuberculosis or a history of recent contact was found in 12 (43%), and 21 (75%) had positive cultures. Seventeen (61%) had classical miliary shadowing while four (14%) had cryptic miliary tuberculosis with no radiological evidence of tuberculosis. The remaining seven patients (25%) had radiological changes consistent with pulmonary tuberculosis, but no miliary shadows. Of those who completed chemotherapy, only five (42%) received 18 months' treatment. Nine patients (32%) died from their miliary tuberculosis. Failure to consider the diagnosis, leading to a delay in starting chemotherapy, appeared to be a major problem.

Management of extra-pulmonary tuberculosis (excluding miliary and meningeal) in south and west Wales (1976-8)

In a retrospective survey of the management of extrapulmonary tuberculosis lymph node and genitourinary tuberculosis were found more commonly than bone and joint or gynaecological disease. Only 29% of patients received 18 moths' chemotherapy while 31% received nine to 12 months' treatment with rifampicin and isoniazid regimens and 34% had short-course chemotherapy with other regimens. Five patients were not offered any chemotherapy after diagnosis, and in five patients the diagnosis was overlooked because of administrative errors. One patient died from tuberculosis (renal). Poor drug compliance appeared less of a problem than in pulmonary tuberculosis. Only 14% of patients had their disease managed solely by consultants who were not specialists in chest disease. Liaison with a chest consultant did not necessarily ensure chemotherapy for 18 moths.

Survey of pulmonary tuberculosis in south and west Wales (1976-8)

In routine clinical practice 20% of patients with pulmonary tuberculosis were treated with the regimen recommended by the British Thoracic Association after the British trial of short-course chemotherapy. Despite the use of several regimens that could be considered inadequate, no patients from the survey within south and west Wales appears to have relapsed yet. Deaths from pulmonary tuberculosis continue at the same rate as 10 years ago. Patient default remains a difficult problem even with modern, less toxic, short-course regimens.

Pulmonary tuberculosis due to B.C.G

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Ten-year haematological follow-up: mortality and haematological changes

In a 10-year follow-up study of 543 men and 180 women seen in a community survey in 1958 mortality was examined in relation to the 1958 haematological data, and 91% of the survivors were re-examined. Analyses based on the 1958 haemoglobin and packed cell volume estimations suggested that those with values near the mean may subsequently have lower death rates. Higher death rates occurred in those having low serum iron levels. Comparisons of haemoglobin concentrations and of packed cell volumes in 1958 and 1968 show correlation coefficients (r) between 0.30 and 0.60 in various subgroups.

Study of myocardial ischaemia in surgical patients

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