No abstract

Executive, MerseysideŜ UMMARY A random sample of 170 patients (88 men) with chronic inflammatory bowel disease (75 ulcerative colitis) were first interviewed in 1978 about their employment status, problems at work, and influence of surgery. Surgery had been carried out on 120 and 53 had an ileostomy. After six years 144 (92%) ofthe 156 survivors replied to a follow up postal questionnaire. Of the initial sample, 122 (72%) were working and there were only three (1%) registered unemployed. After six years a similar proportion were working and only seven (5%) were unemployed. Continuity of employment was good with 57% in the same job. Changes in work because of health had been made by 72 patients mainly caused by bowel disease. After surgery 10% completely changed and 22% modified their work while a few had to retrain or retire. Panproctocolectomy and ileostomy resulted in more changes and longer time off work after surgery than colectomy and ileorectal anastomosis, with 35°% and 17% respectively off work after one year. Problems at work, in particular general malaise and arthritis were experienced by 34 (28%) patients. Fewer problems were experienced by patients with a stoma who also had less sickness absence than those without a stoma. Colleagues and employers were usually supportive although some patients encountered discrimination especially those with a stoma or working in the food industry. Few patients had been counselled on their work. In general employment prospects and time off work were good and employers should be encouraged to take an optimistic and supportive role. Doctors should consider that convalescence after surgery may be longer than they perceive and must provide better counselling for patients.The objective of surgical and medical management of patients with inflammatory bowel disease are to minimise morbidity and restore the individual to good health so that they can return to work. There have been few detailed studies, however, on the impact of chronic inflammatory bowel disease and treatment on employment. Two surveys of patients with Crohn's disease and another of patients with ulcerative colitis have shown that between 65 and 90% respectively were 'working' or 'fully employed'. ' 1 Similarly the formation of an ileostomy, as part of panproctocolectomy, has been shown to be followed by resumption of work in 85 to 95% of patients but in some series housewives were included as 'employed'.A More detailed information

SUMMARY Serum from 23 of 26 patients with fulminant hepatic failure and grade IV encephalopathy had defective opsonisation of E. coli and yeast (S. cerevisiae)

Two distinct types of ultrastructural changes were found in the hepatocytes of chimpanzees infected with two forms of non-A, non-B hepatitis. In the type of infection that was of long incubation, there was a marked cytoplasmic derangement of the endoplasmic reticulum, with the formation of tubules, but no pathological changes in the nuclei. In the short-incubation type of non-A, non-B hepatitis, induced experimentally in a chimpanzee that had recovered from the long-incubation type of infection, nuclear alterations were found together with the presence of aggregates of particles measuring 15--27 nm in diameter. Cytoplasmic tubules were not seen in this type of non-A, non-B infection.