Case reports 53 overall mortality, of the order of 10-25% in several collected series (Bigler, 1960; Marshall and Hartzog, 1964; Sarmiento, 1966). More frequent early surgical intervention with antibiotic cover might conceivably lead to a reduction in this figure. AcknowledgmentWe wish to thank Professor F. McKeown, Pathology Department, Queen's University of Belfast for her detailed pathological examination of the gall bladder.

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Siegler, D. (1977). Thorax, 32,[328][329][330][331][332] Reversible electrocardiographic changes in severe acute asthma. Previous reports have documented the occurrence of reversible electrocardiographic changes including right axis deviation, P pulmonale, right bundle-branch block, and ST-segment and T-wave abnormalities in patients with acute attacks of asthma. In a further systematic study, the electrocardiographs of 63 patients admitted with severe acute asthma have been evaluated. The most consistent change was an abnormally vertical P-wave axis in 78% of the patients. P pulmonale was present in 22% and right ventricular enlargement in only one patient. Right axis deviation, right bundle-branch block, and rhythm abnormality were not present in any patient. In 11%, ST-segment or T-wave abnormalities suggesting myocardial ischaemia were noted. These abnormalities persisted for up to nine days and were unexplained. Other ECG abnormalities in acute asthma may reflect positional changes of the heart due to overdistension of the lungs. All ECG changes resolved after clinical improvement.Reversible abnormalities in the electrocardiogram are well recognised in patients with acute attacks of bronchial asthma. Previously reported changes have included right axis deviation, prominent P waves suggesting right atrial enlargement, inversioIn of T waves, right bundle-branch block, and abnormalities of the ST segment (Gunstone, 1971;Rebuck and Read, 1971;Da Costa and Chia, 1974