One of the syndromes commonly encountered in the outpatient clinic is flatulent dyspepsia. By this we mean epigastric discomfort after meals, a feeling of fullness so that tight clothing is loosened, eructation with temporary relief, and regurgitation of sour fluid to the mouth with heartburn. The At the interview the patient was asked how she had been since the operation and was led to speak of her indigestion. Then specific questions were put concerning the common symptoms of dyspepsia. Seventy-two patients with dyspepsia were asked to attend for review, but only 66 were seen. Four had left the district, one could not be traced, and one refused to attend-in the latter case we accepted her own doctor's opinion that the dyspepsia persisted unchanged. We do not feel that these absences invalidate our findings shown in the It will be seen that after cholecystectomy more than half the patients were completely free from dyspepsia and less than a quarter were unchanged. A history of attacks of biliary colic did not affect these proportions. The few males included in the survey did not have results that differed obviously from the females. The type of gall stone did not affect the result, nor did the impaction of a stone.Ten cases had a hiatus hernia as well as gall stones ; the results in these cases did not differ significantly from the rest. It was noted, however, that in the cases that were cured gastro-oesophageal reflux was not a prominent feature before operation; when it was a prominent feature in the preoperative symptoms it seldom improved. In contrast, several patients without a hiatus hernia had severe preoperative symptoms of gastro-oesophageal reflux and most of these were completely relieved of their symptoms after operation.The mere passage of time does not cure flatulent dyspepsia, as is shown by our review of the patients with radiologically negative dyspepsia ; only two of these patients were cured, and both ascribed their cure to the reassurance that there was nothing seriously wrong. After cholecystectomy the patients who were not improved usually complained in the early postoperative period; the others did not show a tendency to relapse after the psychotherapeutic effect of an operation might be expected to diminish. SummaryCholecystectomy for gall stones cures flatulent dyspepsia in more than half the cases, and less than a quarter are not improved. The presence of a hiatus hernia does not lessen the probability of cure unless the dominant symptoms indicate gastro-oesophageal reflux.
The chicken-pox lesions occurring in these cases may be missed if they are not looked for carefully early in the disease. However, 21 of the 33 patients with varicellar lesions showed a mild but widespread typical chicken-pox eruption. In the remaining cases only a few scattered lesions were observed.It is generally accepted that over 70 % of cases with herpes zoster have had chickenpox in the past-although in our series such a past history could seldom be recalled.The high incidence of simultaneous chicken-pox and herpes zoster is important from an epidemiological point of view, in view of the higher risk of spread of chicken-poxparticularly in hospital wards amongst nursing staff and young, debilitated, or steroid-treated patients.-We are, etc.,
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