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The association of high-amplitude echoes returned from the liver in diffuse fatty infiltration has now become well recognized. We report our experience on the accuracy with which ultrasound will detect a fatty liver. A review was made of the liver ultrasound images in patients known to have either histologically normal livers or livers with fatty infiltration. Only two of 40 patients with normal liver biopsies had a brightly reflective echo pattern, but 12 of 20 patients with fatty infiltration showed this pattern. Of the patients with histologically moderate or severe fatty infiltration, nine out of ten had a brightly reflective echo pattern.

To determine the prevalence of alpha 1-antitrypsin deficiency in patients with cirrhosis or chronic active hepatitis, we performed a five-year prospective study of liver-biopsy specimens from 1055 adults. Thirty-four patients whose specimens contained hepatocyte inclusions characteristic of the deficiency were phenotyped, and 25 had phenotype MZ (2.4 per cent). The distribution of patients with this phenotype among the 185 patients with cirrhosis diagnosed histologically was three of 84 patients with alcoholic cirrhosis (3.5 per cent), seven of 34 with non-B chronic active hepatitis (20.5 per cent), six of 28 with cryptogenic cirrhosis (21 per cent), and one of 39 with other kinds of cirrhosis (2.6 per cent). The increased prevalence of MZ in patients with cryptogenic cirrhosis and with chronic active hepatitis is highly significant (P < 0.001). Because serum levels of alpha 1-antitrypsin may be unreliable for identification of the subgroup of patients with chronic active hepatitis or cryptogenic cirrhosis, analysis of serum for the MZ phenotype and meticulous examination of biopsy specimens may be necessary.

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EDICRxmJsOUNAL one attempt within a year. Please include all relevant cases, irrespective of whether or not they were admitted to hospital. Do not include " successful " attempts with fatal outcome.It is sometimes difficult to distinguish between a suicidal threat or gesture and a suicidal attempt. The latter should be defined as any act of self-damage undertaken with the apparent intention of self-destruction, however half-hearted and ineffective. The patient may have been only vaguely aware of this intention, which sometimes has to be inferred from his actions. The degree of actual danger to life, as seen from our point of view, is not relevant for inclusion in this group; many attempts which to us seem harmless are undertaken with serious intent, and vice versa. The questionary has a category for doubtful cases.We should be glad to answer any questions you might wish to ask us. (Sarles et al., 1959;Rider et al., 1960). However, the difficulty in assessing the value of eliminating a particular food from the diet in a disease in which remissions and relapses are variable and unpredictable has made this contention difficult to prove.Our own interest in this possibility arose when a small group of patients with ulcerative colitis who had become symptom-free on a milk-free diet all relapsed when milk was reintroduced into the diet (Truelove, 1961). By taking into account the average relapse rate in ulcerative colitis it was estimated that the odds were more than 1,000 to 1 against this run of relapses after challenge being due to chance. Although this finding strongly suggests that milk may be a factor in the aetiology of ulcerative colitis so far as some patients are concerned, it does not provide proof.It seemed essential to test the therapeutic value of a milk-free diet in ulcerative colitis under more stringent conditions than in previous studies. We have therefore made a controlled clinical trial of various diets in this disease. In view of the findings of Taylor and Truelove (1961) that patients with ulcerative colitis are more likely than normal subjects to have high titres of circulating antibodies to two of the purified proteins of cow's milk, the immunological reactions to several dietary proteins have been studied in parallel.The results of the clinical study are now presented. The immunological findings are only mentioned briefly, as they are being reported in detail separately (Wright and Truelove, 1965). Experimental DesignPatients presenting with an attack of ulcerative colitis were allocated at random to one of three dietary groups: (a) a milk-* Nuffield Department of Clinical Medicine, the Radcliffe Infirmary, Ox!ord. free diet; (b) a gluten-free plus milk-free diet ; and (c) a control group on a " dummy " diet.A stratified design was used to ensure a close balance between the three dietary groups. The patients were divided into those seen during the first attack and those seen during a relapse of established disease. The patients in relapse were further divided into those patients with a short h...

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