SummarySome controversial aspects of rheumatic heart disease are discussed in the light of personal experience in Edinburgh. Symptoms are not always a reliable guide to severity, and the correct time for surgical treatment should be based on an objective assessment. Dangers of delay include progressive damage to the pulmonary circulation, lungs, right ventricle, and liver, and the risks of systemic embolism, pulmonary oedema, and pulmonary infarction.The New York Heart Association classification of disability is unreliable and a potentially dangerous guide.The concepts of the pliant valve, critical stenosis, areas of auscultation, and the ejection murmur are criticized.No relation has been found between the size of the left auricle or atrium and the incidence of embolism. There is reason to doubt the value of anticoagulants.In relation to mitral valvotomy factors influencing operative mortality, complications, traumatic mitral incompetence, systemic embolism, and restenosis are discussed, and also the influence of calcification and of associated aortic valvular disease.Reference is also made to the place of open heart surgery. Two hundred and six women attending the antenatal clinic at St. Mary's Hospital took part in the study. All were less than 16 weeks pregnant at the first attendance, and in order to eliminate iron deficiency all received 1 g. of intravenous iron dextran as four 250-mg. doses at weekly intervals. At the 20th week they were allotted to one of two groups, receiving tablets dispensed in a bottle with a grey or a red label. These were to be taken once daily, and contained either ferrous fumarate 260 mg. or ferrous fumarate 260 mg. and 100 jug. of folic acid, the survey being conducted as a blind trial.On the first attendance (average 15 weeks) blood was taken for a blood count, serum iron estimation, and folate determination of both serum and red cells. This was repeated at the 30th and 38th weeks of pregnancy and a sternal marrow aspiration was performed in the 37th-38th week. All the marrows were assessed at the end of the survey without any knowledge of the colour of tablet taken or of any of the assay results obtained.Haematological methods were those set out by Dacie and Lewis (1963). Neutrophil polymorphs having five or more distinct nuclear segments were termed hypersegmented, the normal frequency of such cells being 0 to 3 %. Marrows were regarded as showing megaloblastic haemopoiesis when megaloblastic change was present in erythroblasts. Giant metamyelocytes were usually present as well. Iron status was assessed by both serum iron estimation and staining of marrow spreads for iron by Perls's Prussian-blue method.Red cell and serum folates were determined by microbiological assay with the method of Toepfer et al. (1951) and Lactobacillus casei as the test organism. One gramme of ascorbate was added to each 500 ml. of medium. For red cell folate assay the blood was diluted tenfold in a 0.1 M phosphate-ascorbate buffer pH 6 (Hansen, 1964). In our hands this method gave red cell folate r...

BRITISHIsotope~~~b MEDICAL JOURNAL impression that multiple metastases are more readily shown by scanning than by pneumography or angiography. Single metastases are often revealed by these latter methods, but second or third ones are not often shown.While it is possible to predict the pathology of a certain number of lesions by studying the topography, this is by no means always so. Planiol (1963) uses an entirely different technique by means of which she is able to make a specific diagnosis in a much higher percentage of cases. Her method depends upon the change in count rate at fixed points on the skull at intervals of 2, 24, and 48 hours after an intravenous injection of radioiodinated human serum albumin. She has shown that meningiomas take up the isotope early and metastases late, while the astrocytomas take it up at an intermediate SummaryThe results of 100 brain scans are described. All the scans were made with 203Hg chlormerodrin using a standard technique. There was no selection of cases referred by neurologists and neurosurgeons, except that patients under the age of 18 were excluded.There were 53 positive scans, and all these patients appeared to have lesions, though not all these were confirmed histologically. There were 42 negative scans. Of these, 22 were probably truly negative. The remaining 20 were proved to be false-that is, these patients harboured tumours not demonstrated by the method. The causes of the false negatives are discussed and their reduced number in the future is foreshadowed.There were five equivocal scans. These showed some departure from the normal, but the appearances were not sufficiently clear-cut for definite diagnosis.Since a positive scan always denotes a lesion and the scanning process is painless and free from risk, it seems that, ideally, this investigation should be made before angiography and/or pneumography. But a negative scan in the face of positive clinical evidence of a mass always requires further investigation.The method is particularly valuable in the investigation of out-patients and of patients whose clinical picture hardly justifies submission to the more traumatic procedures which also carry some morbidity.Scanning has been a great help in the diagnosis of metastases, because the older-established neuroradiological procedures tend to show only the larger ones. The results in these cases suggest that secondary deposits in the brain are more often multiple than was previously suggested by classical neuroradiological investigation, although well known by pathologists.Location of brain turnours by modern scanning techniques is accurate. In some cases the contour and topography allow a precise pathological diagnosis to be made. Unfortunately this is by no means always so, but it is hoped that still greater accuracy will be achieved by refining the technique.Isotope encephalography has clearly earned its place alongside other neuroradiological contrast methods of investigation. , 1965, 1, 480-485 The application of newer methods to the detection of vitamin...

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