suMMARY Some details of 544 episodes of infective endocarditis occurring in 541 patients during 1981 and 1982 are reported. The mean age of patients was 51*6 years and there was a greater proportion of males (2:1). Of the 544 episodes 347 (63%) were due to streptococci, 19%o to staphylococci, and 14%o to bowel organisms. A wide variety of other organisms were responsible for a few cases, and 10% were culture negative. In 60(% the portal of entry of the infection could not be ascertained: 19% were probably of dental origin: 16% arose from the alimentary, genitourinary, or respiratory tracts or from the skin or in association with drug addiction, fractures, or pregnancy; the remaining 5% were related to cardiac or other vascular surgery, cardiac catheterisation, haemodialysis, or other procedures involving the blood stream. Seventy-four (14%) of the 541 patients (mean age 59*0 years) died; the mortality was 30% in staphylococcal cases, 14%o in infections due to bowel organisms, and 6% in other streptococcal infections. One hundred and seventy-one (32%) of the patients appeared to have had normal hearts before the onset of illness and another 59 (1Y1%) had cardiac lesions not previously recognised. The aortic valve was the most common site of infection. Ninety (17%) of the patients had prosthetic valves or had undergone other cardiac surgery while 34 (6%) had had a previous episode of infective endocarditis. Nine (1-6%) episodes were not diagnosed until necropsy or operation and 34 (6.3%) required urgent valve replacement.Since Horder's classic description of infective endocarditis nearly three quarters of a century ago' antibiotics and valve replacement have transformed the then hopeless prognosis. Studies have shown a changing pattern of the disease,2-9 but despite the enormous advances in microbiology, particularly the speciation of the streptococci, the source of the infection is often not known and the proportion of cases related to dental procedures or sepsis is probably smaller than previously believed. A recent study of 541 patients with infective endocarditis with particular reference to dental prophylaxis has confirmed this.10 The number of patients studied was so large compared with previous reports that we considered it appropriate to present some of the other findings in respect of microbiology and pathogenesis.

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A specific radioimmunoassay for carcinoembryonic antigen was used to investigate aspects of its measurement in lung disease. The results confirm that serum carcinoembryonic antigen concentrations are higher in healthy smokers and patients with chronic obstructive bronchitis than in healthy non smokers (p < 0.01). Corticosteroid treatment reduced the concentration in nine patients with bronchitis (p < 0.05). Other inflammatory lung diseases (bronchiectasis, pneumonia, fibrosing alveolitis) are not associated with a raised serum carcinoembryonic antigen concentration. The sputum concentrations were about 100 times those found in serum and there was a positive correlation (r = 0.611 2p < 0.01) between the concentrations in sputum and serum in patients with bronchitis. No preferential rise in sputum concentration was found in current smokers or patients with lung carcinoma (n = 16). A higher ratio of carcinoembryonic antigen to albumin concentration (p < 0.05) was, however, found in lavage fluid obtained from the tumour site than in fluid from "normal" lung in the same patients, suggesting an increase in carcinoembryonic antigen secretion in the vicinity of the tumour. Despite this "local" effect the sputum concentration does not, however, appear to be a useful marker of lung carcinoma and the measurement could not be used as a screening test.

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