A patient with Type 1 (insulin-dependent) diabetes mellitus developed localised amyloidosis at the sites of his injections of porcine insulin. A major amyloid fibril protein was extracted and, by means of its amino acid composition and amino acid sequence, it was shown to contain intact insulin molecules. Porcine insulin is the tenth protein and the first foreign protein to be chemically identified in human amyloid fibrils.

About 40% of patients who undergo Hartmann's procedure will not have a reversal. Reversal is a feasible operation for selected patients, but there is a high complication rate.

No abstract

DNA hypomethylation may increase the risk of colorectal cancer. The main aim of this study was to assess the influence of folate status (serum and erythrocyte folate and plasma homocysteine concentrations) on DNA methylation. Methylenetetrahydrofolate reductase (MTHFR 677C-T and 1298A-C), methionine synthase (MS 2756A-G) and cystathionine synthase (CBS 844ins68) polymorphisms were measured to account for potential confounding effects on folate status and DNA methylation. A total of 68 subjects (33 men and 35 women, 36 -78 years) free from colorectal polyps or cancer were recruited in a cross-sectional study. Tissue biopsies were obtained at colonoscopy for the determination of DNA methylation in colonic mucosa using an in vitro radiolabelled methyl acceptance assay. Serum and erythrocyte folate were inversely correlated with plasma homocysteine (r ¼ À0.573, Po0.001 and r ¼ À0.307, P ¼ 0.01 respectively) and DNA hypomethylation in colonic mucosa (r ¼ À0.311, P ¼ 0.01 and r ¼ À0.356, P ¼ 0.03). After adjusting for gender, age, body mass index, smoking and genotype, there were weak negative associations between serum and erythrocyte folate and colonic DNA hypomethylation (P ¼ 0.07 and P ¼ 0.08, respectively).

In patients with diverticular disease, smoking is associated with an increased risk of complications.

A short course of mild steroid ointment is an effective treatment for PA.

Patients should be warned about compensatory sweating before thoracic sympathectomy.

Students in so called 'parallel' clerkships did not receive comparable teaching. The traditional opportunistic nature of clinical teaching led, in effect, to individual curricula within each clerkship. The General Medical Council has called for a core curriculum to be delivered across different clinical sites within each medical school. To achieve this, medical schools may need to introduce guidelines to direct teaching in the same way that clinical protocols have been developed to achieve greater standardization in clinical practice.