Recent progress in understanding the molecular mechanisms of bile formation and cholestasis have led to new insights into the pathogenesis of drug induced cholestasis. This review summarizes their variable clinical presentations, examines the, role of transport proteins in hepatic drug clearance and toxicity and addresses the increasing importance of genetic determinants, as well as practical aspects of diagnosis and management.

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A study has been made of urinary infections in 466 old people living at home. Bacteriuria was present in 17 per cent of women and 6 per cent of men.Women with urinary infection had a significantly higher parity than those without infection, but there were no significant differences between the two in respect of urinary symptoms, previous operations on the urinary tract, blood pressure, renal function, haemoglobin, white cell count, or erythrocyte sedimentation rate.Comparison between subjects in the community with urinary infection and hospital patients showed that the latter had a higher frequency of infections with organisms other than EschericJria coli, particularly Proteus. Strains of E. colt isolated from hospital patients were conaiderably more often resistant to antibacterial agents than strains from infections in the community.

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A comprehensive medical, social, psychiatric and dietary survey of persons 65 years of age and over was carried out in Kilsyth, a town in Stirlingshire. A total of 286 persons were randomly selected for the survey; of which 200 completed all sections, 34 refused medical examination and 52 refused to participate in any part of it. All but 2 of the total refusals were visited by one doctor. Women refused significantly more often than men. Fear of the discovery of disease was the important reason given for not wishing to participate. Mental abnormality was rare and physical disability was conspicuously absent among those who would not participate. Most of the refusals thought favourably of the Health Service and doctors. It would seem that the refusals did not importantly bias the medical or psychiatric findings of the main survey.