General practitioners' and practice nurses' knowledge of how much patients should and do drink.

Despite evidence linking high levels of alcohol consumption to ill health, the number of people drinking above the 'sensible' limits is increasing. Clinicians in primary care can influence this trend by appropriate screening and advice. To do this they need to know the recommended sensible limits and also be able to translate commonly reported drinking levels into units of alcohol. A postal survey of 499 general practitioners and 343 practice nurses in Cornwall and South West Devon asked responders to calculate the number of units of alcohol contained in six different drinks and also state what they thought were the current sensible levels of consumption. The response rate was 63%. Less than 40% of responders were able to assess the units of alcohol in five out of the six drinks to within 10%. Over 70% of responders were unable to determine the alcohol content of all six drinks to within 30%. Forty-four per cent of responders now recommend an increased safe level of consumption at 28 units per week for men and 21 units per week for women, against the advice of the Royal Colleges and the BMA but in line with the levels suggested by the Government.

Occlusion of umbilical artery in acardiac, acephalic twin.

In the acardiac, acephalic twin malformation the normal co-twin is put at risk because of the extra cardiac work-load. Surgical procedures may be hazardous to the mother. We describe a novel approach--the insertion of a helical metal coil to induce thrombosis in the umbilical artery of the acardiac twin--which immediately interrupted flow. The co-twin was delivered at 39 weeks and his neonatal course has been normal.

Treatment of scleroma with ceforanide.

Three patients with rhinoscleroma who presented with nasal and pharyngeal symptoms are described. Treatment with ceforanide, a new second-generation cephalosporin with high intrinsic activity against Klebsiella, and possessing a long half-life, was used as outpatient treatment. A total of 120 g of ceforanide was administered over a period of two months. All three patients showed signs of clinical improvement, but only two of three became bacteriologically sterile at the end of two months; one patient relapsed bacteriologically but not clinically, once the drug was discontinued. Second- and third-generation cephalosporins appear to have excellent activity against the causative pathogens of rhinoscleroma. Because of the impracticality of administering these agents parenterally over prolonged periods of time, there is a need for the development of an oral cephalosporin with similar intrinsic activity and beta-lactamase stability. Perhaps the novel beta-lactam antibiotics such as the penems and monobactams, some of which can be administered orally, will answer that need.