Journal of the Royal Society of Medicine

This paper reviews a personal experience of 51 cases seen over a 30 year period. Patients were treated in either a combined Head and Neck clinic or a Combined Ophthalmology clinic and a balanced view is thus represented. A method of grading the severity of the disease is described as well as a method of assessing response. This approach has not been proposed hitherto. It is generally concluded that the preferred treatment for small lesions is excisional surgery and for larger lesions carefully planned and highly localized radiation.

To investigate the present status of pulmonary embolism as a cause of death in a general hospital patient population, a 5-year retrospective study of all autopsy reports and associated hospital records was undertaken. Pulmonary embolism was thought to be the cause of death in 239 of 2388 autopsies performed (10%): 15% of these patients were aged less than 60 years and 68% did not have cancer. Of these patients, 83% had deep-vein thrombosis (DVT) in the legs at autopsy, of whom only 19% had symptoms of DVT before death. Only 3% of patients who had DVT at autopsy had undergone an investigation for such before death. Twenty-four per cent of patients who died from pulmonary embolism had undergone surgery a mean of 6.9 days before. Screening tests for DVT should be applied widely in the hospital population.

Five splenectomized patients suffered six episodes of bacterial meningitis with positive cerebrospinal fluid cultures. They were admitted to the Nottingham hospitals between 1974 and 1985. The infecting organism in all cases was Streptococcus pneumoniae. Only one patient, who survived, had had pneumococcal vaccine; two patients died in spite of intensive therapy. There is now good evidence for giving prophylactic penicillin to asplenic patients but the efficacy of the pneumococcal vaccine remains uncertain.