282 detection of metastases from carcinoma of the liver, gallbladder, biliary tree, pancreas, stomach, and duodenum may be possible. However, at this time, hepatic damage cannot be completely excluded on the basis of this study. Department of Radiology, University of Rochester Medical Center, Rochester, New York 14642, U.S.A.
FRANCIS A. BURGENER STEPHEN I. SCHABEL.
Notes and News HOSPITAL COSTS FOR
1973/74
THE average N.H.S. hospital costs per inpatient week in England increased by about 20% compared with 1972/73; most of this increase was caused by pay increases and higher prices during the year.1 The costs per patient treated increased by about 16%, reflecting a continuing trend towards shorter stays in hospital. LANGUAGE COURSES FOR OVERSEAS DOCTORS
Anteroposterior view of canine abdomen liver lymphography. Dense hepatogram lymph-nodes.
one
and excellent view of
week after indirect
hepatic
and coeliac
modified Thomas cannula,l the common bileduct could be cannulated under direct vision with a Foley catheter. The balloon of the catheter was inflated to prevent leakage. After aspiration of the bile, the biliary system was filled to capacity with ethiodised oil (’ Lipiodol Ultra-Fluid’) and an additional 5-10 ml was infused slowly with a hydrostatic pressure slightly exceeding the biliary excretion pressure of 35 cm of water.2 A dense hepatogram and excellent and constant visualisation of the hepatic and coeliac lymph-nodes was obtained (see accompanying figure).
Splenic, pancreaticoduodenal, gastric, aortic, iliac, retrosternal, mediastinal, and supraclavicular lymph-nodes were displayed less frequently and they were usually incompletely filled. These results disagree with those of Mallet-Guy et a1.,3 who could only identify the hepatic lymph drainage radiographically by retrograde injection of barium sulphate but not ethiodised oil into the biliary system.4 The retrograde biliary injection of barium sulphate caused hepatic-cell necrosis.3 Judged by the estimation of iodine concentrations in the hepatic vein, no significant reflux of ethiodised oil occurred from the biliary system into the blood. No pulmonary complications have been observed by serial radiographs and lung scans. Bilirubin and S.G.O.T. levels increased from five to eight times above the average baseline value within two hours of the procedure, but returned to nearly normal the following day. A more delayed and less dramatic increase in S.G.P.T. and alkaline phosphatase occurred, reaching a peak at 24 hours after the procedure and returning to normal by one week. Periodic needle liver biopsies failed to show signs of hepatic inflammation or necrosis. Indirect liver lymphography offers a possible means of obtaining diagnostic information previously unavailable without laparotomy. By visualising lymph-nodes in the upper abdomen which are not accessible to direct lymphography, a more accurate staging of lymphoma, and earlier 1. Thomas, J. E. Proc. Soc. exp. Biol. Med. 1941, 46, 260. 2. Burgener, F. A., Fischer, H. W. Radiology, 1975, 116, 441. 3. Mallet-Guy, P., Michoulier, J., Kesner, L. F., Dolinski, J., Galindo, F., Leroy, J. Lyon Chir. 1964, 60, 816. 4. Mallet-Guy, P., Michoulier, J., Baev, S., Osleskiewicz, L., Woszczyk, M. ibid. 1962, 58, 847.
SPECIAL courses to help overseas doctors to communicate with their patients are being developed by English language specialists in the department of linguistics and modern English language at Lancaster University. The courses, which are based on a study of the language requirements of doctors in casualty departments, will be tried out by groups of 25 overseas doctors at 4 colleges of further education in the autumn. As a result of these pilot courses, the teaching materials and audiovisual aids (which have been designed with the help of a grant from the Nuffield Provincial Hospitals Trust) will be modified as necessary, and will then be made available for teaching on a national scale next year. The teaching materials are flexible enough to allow doctors to study at evening classes, while It is hoped that on day-release, or during short courses. the courses will be of benefit to those preparing for the General Medical Council tests in English language and clinical competence as well as to overseas doctors already employed in the National Health Service. Further details
on
the courses may be had from the Information
Officer, University of Lancaster, University House, Bailrigg, Lancaster.
University
of Liverpool
The status and title of professor of tropical have been conferred on Dr R. G. Hendrickse.
paediatrics
Dr Hendrickse, who is 48, graduated M.B. from the University of Cape Town in 1948 and M.D. in 1947; he became F.R.C.P. in 1973. After working at hospitals in Durban and Southern Rhodesia he was appointed lecturer in paediatrics at the University of Ibadan, Nigeria, becoming professor and head of the department in 1962 and director of the Institute of Child Health in Ibadan in 1964. In 1969 he moved to Liverpool, where he is at present senior lecturer in child health and tropical paediatrics, director of the course for the diploma in tropical child health, and consultant paediatrician to Alder Hey Children’s Hospital. His research has covered many aspects of tropical pasdiatrics, including sickle-cell ansemia, nutritional problems, the nephrotic syndrome, measles, tetanus, and malaria.
Royal College Prof. C.
of Obstetricians and
Gynaecologists
J. Dewhurst has been elected president.
Nuffield Foundation Mr John Maddox, formerly editor of Nature, has been appointed director in succession to Dr Clifford Butler. 1. Hospital
Costing Returns. H.M. Stationery Office. £1.70.
FRANCIS A. BURGENER STEPHEN I. SCHABEL.
Notes and News HOSPITAL COSTS FOR
1973/74
THE average N.H.S. hospital costs per inpatient week in England increased by about 20% compared with 1972/73; most of this increase was caused by pay increases and higher prices during the year.1 The costs per patient treated increased by about 16%, reflecting a continuing trend towards shorter stays in hospital. LANGUAGE COURSES FOR OVERSEAS DOCTORS
Anteroposterior view of canine abdomen liver lymphography. Dense hepatogram lymph-nodes.
one
and excellent view of
week after indirect
hepatic
and coeliac
modified Thomas cannula,l the common bileduct could be cannulated under direct vision with a Foley catheter. The balloon of the catheter was inflated to prevent leakage. After aspiration of the bile, the biliary system was filled to capacity with ethiodised oil (’ Lipiodol Ultra-Fluid’) and an additional 5-10 ml was infused slowly with a hydrostatic pressure slightly exceeding the biliary excretion pressure of 35 cm of water.2 A dense hepatogram and excellent and constant visualisation of the hepatic and coeliac lymph-nodes was obtained (see accompanying figure).
Splenic, pancreaticoduodenal, gastric, aortic, iliac, retrosternal, mediastinal, and supraclavicular lymph-nodes were displayed less frequently and they were usually incompletely filled. These results disagree with those of Mallet-Guy et a1.,3 who could only identify the hepatic lymph drainage radiographically by retrograde injection of barium sulphate but not ethiodised oil into the biliary system.4 The retrograde biliary injection of barium sulphate caused hepatic-cell necrosis.3 Judged by the estimation of iodine concentrations in the hepatic vein, no significant reflux of ethiodised oil occurred from the biliary system into the blood. No pulmonary complications have been observed by serial radiographs and lung scans. Bilirubin and S.G.O.T. levels increased from five to eight times above the average baseline value within two hours of the procedure, but returned to nearly normal the following day. A more delayed and less dramatic increase in S.G.P.T. and alkaline phosphatase occurred, reaching a peak at 24 hours after the procedure and returning to normal by one week. Periodic needle liver biopsies failed to show signs of hepatic inflammation or necrosis. Indirect liver lymphography offers a possible means of obtaining diagnostic information previously unavailable without laparotomy. By visualising lymph-nodes in the upper abdomen which are not accessible to direct lymphography, a more accurate staging of lymphoma, and earlier 1. Thomas, J. E. Proc. Soc. exp. Biol. Med. 1941, 46, 260. 2. Burgener, F. A., Fischer, H. W. Radiology, 1975, 116, 441. 3. Mallet-Guy, P., Michoulier, J., Kesner, L. F., Dolinski, J., Galindo, F., Leroy, J. Lyon Chir. 1964, 60, 816. 4. Mallet-Guy, P., Michoulier, J., Baev, S., Osleskiewicz, L., Woszczyk, M. ibid. 1962, 58, 847.
SPECIAL courses to help overseas doctors to communicate with their patients are being developed by English language specialists in the department of linguistics and modern English language at Lancaster University. The courses, which are based on a study of the language requirements of doctors in casualty departments, will be tried out by groups of 25 overseas doctors at 4 colleges of further education in the autumn. As a result of these pilot courses, the teaching materials and audiovisual aids (which have been designed with the help of a grant from the Nuffield Provincial Hospitals Trust) will be modified as necessary, and will then be made available for teaching on a national scale next year. The teaching materials are flexible enough to allow doctors to study at evening classes, while It is hoped that on day-release, or during short courses. the courses will be of benefit to those preparing for the General Medical Council tests in English language and clinical competence as well as to overseas doctors already employed in the National Health Service. Further details
on
the courses may be had from the Information
Officer, University of Lancaster, University House, Bailrigg, Lancaster.
University
of Liverpool
The status and title of professor of tropical have been conferred on Dr R. G. Hendrickse.
paediatrics
Dr Hendrickse, who is 48, graduated M.B. from the University of Cape Town in 1948 and M.D. in 1947; he became F.R.C.P. in 1973. After working at hospitals in Durban and Southern Rhodesia he was appointed lecturer in paediatrics at the University of Ibadan, Nigeria, becoming professor and head of the department in 1962 and director of the Institute of Child Health in Ibadan in 1964. In 1969 he moved to Liverpool, where he is at present senior lecturer in child health and tropical paediatrics, director of the course for the diploma in tropical child health, and consultant paediatrician to Alder Hey Children’s Hospital. His research has covered many aspects of tropical pasdiatrics, including sickle-cell ansemia, nutritional problems, the nephrotic syndrome, measles, tetanus, and malaria.
Royal College Prof. C.
of Obstetricians and
Gynaecologists
J. Dewhurst has been elected president.
Nuffield Foundation Mr John Maddox, formerly editor of Nature, has been appointed director in succession to Dr Clifford Butler. 1. Hospital
Costing Returns. H.M. Stationery Office. £1.70.
