Two common sources of error in blood pH and blood gas analysis were studied. The effect of delay in estimation was studied in 10 volunteers and 40 patients. Syringes were stored at 0°C, (crushed ice), 4°C (refrigerator) and 22°C (room temperature). The pressure of oxygen (Po2) fell significantly by 20 minutes at 4°C and 22°C but did not change significantly at 0°C for up to 30 minutes.

The right of consultants to study leave and expenses is not binding on trusts and has been eroded in directly managed units. Complaints led to a survey of consultants in North West Thames region. This showed that most consultants use their own time and money to maintain their knowledge by buying and consulting journals and textbooks, attending local meetings, and using their annual leave for study, but they feel the need for study leave to attend meetings of specialist societies and courses. Leave is usually granted readily but without cover provided by a locum and with a very limited contribution to expenses. To maintain quality of medical care both the right and obligation to take study leave should be contractual. MethodsThe sample was drawn from the regional file of consultant staff. Each consultant has a number; from these a 1 in 5 sample was chosen by using random numbers. No stratification was used.The questionnaire was designed in house and tested on members of staff in the directorate and, in its penultimate form, on regional advisers, who were asked to criticise it. The final version sought factual information about the consultant's use of study leave over the past two years (one year in the case of three consultants between one and two years in post); the local arrangements for obtaining study leave and expenses and any ceiling on reimbursement; and their future intended use of study leave. Consultants were asked to give their view of the main purposes of study leave before being cued by direct questions; to list the other methods they used to keep up to date; to rank the value of these methods to them personally; and to rank the importance of arguments in favour of retaining and protecting study leave. Copies of the questionnaire are available on request from the authors. Results THE RESPONSETo the 268 questionnaires distributed a reply was received from 135 after the initial inquiry and from 204 after two reminders. The 64 non-responders included 29 for whom reasons were provided (one had died, three had retired, six had moved, one was on sabbatical, three were on long sick leave, three were recently appointed, six were about to retire, five were holders of contracts inapplicable to questionnaire, and one was "too busy to take study leave for past 12 years"). The response rate from those who were eligible to respond was therefore 85%.The combined effect of sampling error and differential rates of return between specialties resulted in an overrepresentation of psychiatric disciplines (23% against an expected 13% in the region) balanced by a modest underrepresentation of medical (24% against an expected 29%) and other disciplines, but the replies were drawn from 47 medical and dental specialties and from all the district general and teaching hospitals in the region. Fourteen (7%) of the respondents were university staff, among whom those who took a large amount of study leave were overrepresented (see below). No conclusion of the survey, however, is altered by omitting the academic group so we report...

Aspergillosis of the central nervous system (CNS) is a rare condition with exceedingly high mortality. This study describes the case of an immunocompetent 42-year-old man with a history of intravenous drug use and hepatitis C who developed multiple Aspergillus lesions in the cerebellum. Despite neurosurgery and antifungal therapy with amphotericin B, he had a protracted hospital course with multiple complications, eventually developing cognitive and motor impairment due to progressive cerebellar lesions. After transfer to hospice and palliative care service, oral itraconazole was escalated to 1600 mg/day with the hope of palliating headache, nausea, and cognitive impairment. Remarkably, the patient stabilized and improved over time. After 14 months, this unprecedented high-dose regimen was discontinued, and the patient was discharged home with only mild cerebellar motor impairment.

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