CPR and the RCP (2). Training of students and doctors in UK medical schools.

We asked British medical schools and teaching hospitals about the training they offer to medical students and hospital doctors in cardiopulmonary resuscitation. The response rate was 96%. Training that is practical and consistent with guidelines is offered to nearly all students and house officers, often by consultants. Training for other junior doctors and consultants is much less common. The organisation of training is haphazard, and many hospitals have no resuscitation training officers. As a result, few doctors receive the frequent retraining needed to maintain competence in managing cardiopulmonary arrest.

Allocation of junior hospital doctors to pre-registration posts: does Britain need a national matching scheme?

The attitudes of British postgraduate deans and senior medical students to the introduction of a national pre-registration house officer allocation scheme were investigated by postal questionnaire. Several postgraduate deans expressed interest, but most were not in favour of the proposal. Students held similar views. The advantages and disadvantages of a national scheme are discussed.

Isolated ACTH deficiency presenting with bilateral frozen shoulder.

We describe a 55-year-old female who presented with a 1-year history of tiredness, depression and painful stiff joints. The most striking clinical abnormality was bilateral frozen shoulders, local corticosteroid treatment of which provided the first diagnostic clue. She was found to have profound diminution of plasma cortisol secondary to an isolated deficiency of ACTH. There was no obvious cause for this. Steroid replacement eradicated her lethargy within 3 months and evidence of frozen shoulders resolved completely.

Recurrent phaeochromocytoma.

The recurrence of symptoms and hypertension in a patient who has previously undergone an operation for phaeochromocytoma should alert the physician to the need to investigate for recurrent tumour. Failure to perform complete excision of the adrenal gland containing the tumour may lead to disseminated recurrence.

Gallium-67 uptake in meningeal sarcoidosis.

A case of sarcoidosis limited to the central nervous system is described in which the diagnosis was suggested by high Ga-67 uptake in the cranial and spinal meninges. The diagnosis was confirmed by meningeal biopsy. Treatment with oral corticosteroids resulted in clinical improvement and marked reduction in Ga-67 uptake in the meninges. This is the first reported case of the central nervous system sarcoid diagnosed by Ga-67 imaging.

Lymph-vessel embolism in a case of Whipple's disease.

A case of Whipple's disease is described where the lymphatics in the regional lymph nodes appear to be obstructed by embolized macrophages, containing the characteristic PAS positive bacillary material. It is suggested that the regional lymphangiectasia in Whipple's disease may in part result from such cellular embolism.

Metergoline as an alternative to bromocriptine in amenorrhoea.

The results of this study offer further evidence that metergoline is a valuable alternative to bromocriptine in the suppression of excessive prolactin secretion. Forty-nine hyperprolactinaemic and 44 normoprolactinaemic women with amenorrhoea took part in a double-blind trial to compare the efficacy of metergoline 12 mg/day and bromocriptine 7.5 mg/day in restoring menstruation and ovulation. All the women had normal results on conventional tomography of the sella turcica, normal gonadotrophin levels and normal androgen levels. In the hyperprolactinaemic group, metergoline and bromocriptine were equally effective, with 84 and 75% respectively achieving menstruation, and 76 and 67% respectively achieving ovulation, within 4 months. In the normoprolactinaemic group, 47% menstruated and 40% ovulated on metergoline, against comparative figures of 36 and 21% for bromocriptine and 20 and 13% for placebo, but the differences were not statistically significant. Side effects were not a major problem.

Mammary gigantism and D-penicillamine.

Mammary gigantism is a rare complication of D-penicillamine treatment. We report a further case with pathological and endocrine details together with a review of the seven cases previously reported and possible mechanisms.

Teaching communication skills to pre-clinical medical students: a general practice based approach.

This paper describes a method of teaching communication skills to pre-clinical medical students in the setting of general practice. By focusing on the nature of the patient's problem this teaching tries to place interviewing and diagnostic procedures in their proper context in the doctor-patient relationship.