Journal of the Royal Society ofMedicine Volume 71 May 1978
the muscle hypertrophy, and presumably any difference that a fibre diet makes to the symptoms of 'diverticular' disease is due to its effect on the hypertrophied muscle (by prevention as well as by relieving symptoms due to the hypertrophy). Clearly 'diverticular disease' is still tenable by convention if not pathology, but the same cannot be said for 'pre-diverticular disease' where diverticula may never appear. Would the term 'hypertrophic colonic muscle syndrome' be an alternative? Yours faithfully
Polyarteritis nodosa presenting with bilateral nerve deafness From Professor I Friedmann Department of Histopathology, Northwick Park Hospital and Clinical Research Centre, Harrow, Middlesex HA1 3UJ Dear Sir, I have read with interest the case reported by G Lake-Bakaar (February Journal, p 144) and I should like briefly to refer to a report by Ruth Gussen (1977, Archives ofOto-Rhino-Laryngology 217, 263271) on the temporal bone changes in a 66-year-old MILO KEYNES woman with polyarteritis nodosa, who became deaf 1 March 1978 seven months before death. Her illness started about two and a half years earlier when the microscopical muscle and nerve changes were interpreted as compatible with polyarteritis nodosa. She received Problems of communication of a extensive steroid and immunosuppressive treatment drug-regulatory authority and, during the month before her death, a course of From Dr S E Smith cyclophosphamide and increased amounts of cortiDepartment of Pharmacology, costeroids, but she died of cerebral oedema and St Thomas's Hospital Medical School, renal failure. London SE1 7EH Autopsy tissue from various organs, including the Dear Sir, Professor Charles Fletcher (February kidneys, showed no evidence ofpolyarteritis nodosa Journal, p 152) expresses surprise that doctors (probably as a result of her treatment), but the appear to pay scant attention to messages they temporal bone sections revealed polyarteritis noreceive from the Department of Health about the dosa of the left internal auditory artery. There was side effects of drugs. Nobody can deny that effective endolymphatic hydrops of the basal turn of the transmission ofsuch information is urgently needed, cochlea, an unusual lesion, and there was fibrosis but I believe that the failure ofthe present method of and ossification in the cochlea and vestibular communication is quite understandable and far system that may occur following obstruction of the from surprising. auditory vessels. During recent years I have, on several occasions, The labyrinthine structures and the middle ear acted as locum tenens for a general practitioner cleft can be grossly affected in Wegener's granulofriend who runs a busy single-handed rural practice matosis, and sudden deafness can be a presenting in the West Country. Each day he receives through symptom (Friedmann I & Bauer F, 1973, Journal of the mail a pile of papers several inches thick, the Laryngology and Otology 87, 449-464). sorting of which alone takes up much ofhis valuable I am, Yours sincerely time. He occasionally receives Prescribers Journal, I FRIEDMANN Drug and Therapeutics Bulletin and information 6 March 1978 leaflets from the Department of Health, all of which provide important and impartial information about both desirable and undesirable effects of particular drugs. Such documents are, however, lost in a welter Obturating balloon colostomy of unsolicited mail. From Mr J W S Rickett Doctors rightly put the day-to-day care of their Torquay TQ2 SNZ patients first. If such care leaves insufficent time to Dear Sir, I am pleased to reply to the points raised by deal with the daily mountain of paper, and they Professor J C Goligher and Mr Ian Todd (March necessarily confine it all to the waste bin, who could Journal, pp 233-234)concerningmypaper (January blame them? I agree with Professor Fletcher that Journal, p 31). The balloon colostomy has been used on 28 something urgently needs to be done to correct an intolerable situation, but I would not waste money occasions over the past two years. Necrosis of the on 'research into the reasons why so few doctors colon is not a problem, nor is leakage around the appear to pay attention to the messages they receive'. tube. The latter is minimized by catgut ligatures If one looks, one principal reason is self-evident. placed outside the colon around it to snug the colon Yours faithfully onto the soft rubber balloon. In addition, a purseS E SMITH string suture is tied around the point of exit of the 8 March 1978 tube from the colonic wall.