Journal of the Royal Society of Medicine

Stools have been tested for occult gastrointestinal bleeding in 278 outpatients and 170 hospital inpatients using the Haemoccult and Haemastix methods. Seventeen outpatients (6.1%) and 42 inpatients (24.7%) were positive with the Haemoccult technique. Thirty-three outpatients (11.9%) and 93 inpatients (54.7%) were positive with the Haemastix test. Following investigation of the Haemoccult-positive patients, only 2 cases (3.4%) were considered false positives. However, the false positive rate with Haemastix was 22.9% which is unacceptable in a screening test. Haemoccult may be useful as a screening test for asymptomatic general practice patients, but a test of greater sensitivity is needed for hospital patients.

Satisfactory experience with single-layer colorectal anastomosis during 1969–74 led to an analysis of the results of single-layer large bowel anastomosis during the subsequent years 1975–79. This technique has continued to be associated with a low incidence of anastomotic failure, but anastomotic integrity also depends on rigorous attitudes to bowel preparation, to bacterial contamination and to the avoidance of anastomosis when the risk of anastomotic failure is high.

Four patients with hyperfunctioning intrathyroid parathyroid are reported. In each case the intrathyroid parathyroid was embedded within the thyroid parenchyma and appeared as a solitary ‘cold’ thyroid nodule by radioactive iodine scanning. It is believed that the intrathyroid parathyroid evolves as the lateral lobe of the thyroid fuses with the isthmus in the early development of the thyroid. Embryologically, an intrathyroid parathyroid is thus likely to be the superior gland. When the superior parathyroid gland is missing at the time of exploration, a nodule within the ipsilateral lobe of the thyroid may well be an intrathyroid parathyroid. Under these conditions, lobectomy for the exclusion of such a gland is mandatory.

Two cases of fatal systemic lupus erythematosus (SLE) with cerebral involvement are described. Both showed widespread microinfarction of the brain secondary to platelet and fibrin thrombi. There was no evidence of vasculitis. Anticoagulants and antiplatelet drugs may have an important role in the management of cerebral SLE.

A histopathological study is reported of the autopsy findings in two strains of rats treated with N-methyl-N-nitrosourea (MNU). The induced mammary tumours were histologically indistinguishable from those produced by dimethylbenz(a)anthracene (DMBA). A number of other primary tumours were found and there was no evidence of metastases.