SUMMARY In the study of 1984 routine hospital necropsies the mitral valve was examined from the left atrium in the intact heart with a pressure head of water in the left ventricle. The valve was graded from grade 0 (normal) to grade 4: grade 1, expansion of a small part of one cusp only; grade 2, over one-third of the posterior cusp or one-half of the anterior cusp expanded, with intact chordae; grade 3, ruptured chordae; grade 4, chordal fusion to ventricular wall. The frequency ofgrade 2 to 4 floppy valves rose with age with an overall incidence of 3 9 per cent in men and 5-2 per cent in women. Grade 1 floppy valves have no clinical significance. Grade 2 floppy valves were found to be associated with auscultatory signs but often only contributed to cardiac failure or were coincidental findings. Grade 3 and 4 floppy valves were direct causes of death from bacterial endocarditis and/or severe mitral regurgitation.The surgical series of floppy valves showed that chordal rupture was the event which most commonly made operation necessaryin middle age:in a minority this was caused bybacterial endocarditis. Dilatation of the annulus was an important contributory factor but can produce significant mitral regurgitation without chordal rupture, particularly in inherited connective tissue disorders such as the Marfan syndrome.Forensic necropsies confirm that sudden death occurs in patients with floppy valves. The majority have grade 3 or 4 floppy valves and presumably significant mitral regurgitation. A minority have minimal valve involvement and the mechanism of death is unexplained.The exact magnitude ofthe risk for any patient with a floppy valve of developing bacterial endocarditis, or chordal rupture leading to significant mitral regurgitation, or of dying suddenly, is not known but must be very low considering the frequency of the valve lesion.The essential pathology of the floppy mitral valve is weakening of the central fibrous core allowing cusp expansion and chordal elongation to occur. The weakness ofthe collagen is in part genetically determined, in part age related. Identical changes occur in the tricuspid valve, and in the aortic root, leading to aortic regurgitation. Similar pathological changes are well recognised in other mammals, particularly the aged dog.

As technology has leaped forward to provide valuable learning tools, parents and policy makers have begun raising concerns about the privacy of student data that schools and systems have. Federal laws are intended to protect students and their families but they have not and will never be able to keep up with rapidly evolving technology. School systems can help themselves and their students by following a list of guidelines, the authors say.

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PRACTITIONERS of mature years will recall the days when every practice had a ‘yardsman’. His duties were wide-ranging and might have included grooming the principal's horse ready for his rounds or assisting with manual tasks such as castrations. Perhaps he also would have cleaned the principal's spats and boots each morning. Nowadays, some practices employ a paraprofessional who will undertake tasks ranging from routine maintenance of property through to assisting with surgical procedures.

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