SUMMARY A case of congenital varicella infection is presented, in which despite profound cerebral damage, the cardinal features of cicatricial skin lesions and limb shortening were absent. The case is compared with previously described cases, and with published series, in which this combination is uncommon. The risks of maternal varicella infection to the developing fetus are discussed in the light of recent prospective studies which demonstrate a rather lower risk than had previously been thought to be the case. RÉSUMÉ La varicelle durant le deuxième trhnestre de la grossesse: lotijottrs sans effets? L'article rapporte un cas de varicelle congénitale, dans Iequel, en dépit de dommages cérébraux profonds, les signes caractéristiques de lésions cicatriciclles cutanécs et le raccourcissement des membres étaient absents. Le cas est comparéà des cas préalablement décrits, et avec des séries publiécs, dans lesquels cette combinaison est inhabituelle. Les risques d'une infection varicelleuse maternelle sur le foetus en développement sont discutés à la lumière d'études prospectives récentes qui démontrent un risque plutôt plus faible qu'il n'avait été cstimé auparavant. ZUSAMMENFASSUNG Windpocken im millleren Trimester der Schwangerschaft ‐ immer hannlos? Es wird ein Fall mit kongenitaler Varicellen‐Infektion vorgestellt, bei dem trotz eines schweren Cerebralschadens die Kardinalsymptome ‐ narbige Hautläsionen und Extremitätenverkürzungen fehlten. Der Fall wird mit früher beschriebenen Fällen und mit publizierten Untersuchungsreihen verglichen, bei denen diese Kombination ungewöhnilch ist. Die Risiken einer mütterlichen Varicelleninfektion für den Fetus werden anhand kürzlich erschienener prospektiver Studien diskutiert, die ein relativ niedrigeres Risiko zeigen als bisher angenommen. RESUMEN Varwela en el segundo trimestre de embarazo. Es siempre inocente? Se presenta un caso de infección varicelosa congénita, en la cual a pesar de una lesión cerebral grave, las características cardinales de lesiones cutáneas cicatriciales y acortamiento de miembros estaban ausentes. El caso se compara con otros descritos previamente y casos publicados, en los cuales esta combinación no es corriente. El riesgo de que una varicela materna pucda afectar al feto en desarrollo, se discute a la luz de estudios recientes prospectivos que demuestran un riego más bajo de lo que en principio se creia.

A retrospective review of the medical records of 161 geriatric nursing-home patients receiving diuretics alone or in combination with potassium supplements or potassium sparing-diuretics revealed a 13.7 per cent overall prevalence of hypokalemia. The prevalence of hypokalemia in patients receiving diuretics alone, diuretics with potassium supplements, and potassium-sparing diuretics with kaliuretic diuretics were similar. However, there was a significantly higher prevalence of hypokalemia in women (16.4 per cent) compared with men (3.0 per cent), P less than 0.05. In patients taking non-chloride salts of potassium, there was a significantly higher prevalence of hypokalemia than in those taking the chloride salt (3.6 per cent vs. 8 per cent, P less than 0.025). Seven per cent of patients taking diuretics with potassium supplements and 11.5 per cent of patients taking potassium-sparing diuretics had hyperkalemia. Thus, although many elderly women taking diuretics may have hypokalemia routine potassium supplementation for all non-digitalized geriatric patients receiving diuretics does not seem to be indicated.

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A controlled trial was conducted on four groups of seven rats to evaluate any beneficial effect of cooling to 15 degrees C on testicular ischaemia induced by clamping of the spermatic cord for 2, 4, 6 or 8 h. At operation the microscopic appearance of the testes on unclamping was a poor guide to ultimate viability, whereas by the third day macroscopic and microscopic appearances concurred. When killed on the third day, testicular histology demonstrated that increasing periods of clamping led to gross ischaemia and infarction when testes were maintained at 37 degrees C, and this was reduced greatly by testicular cooling. For each period of clamping, maintenance of spermatogenesis, expressed in terms of Johnsen's histological scores, was significant (P less than 0.01), being 2 (37 degrees C) vs 5.3 (15 degrees C) for 8-h clamping. It is proposed that testicular cooling should be used during autotransplantation of testes in humans.

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