provide the sole means of analgesia throughout the first stage of labour.Only 48% of the primigravidae required no other form of analgesia, as against 72% of the multiparae.Complications included a 17% incidence of maternal haemorrhage during insertion of the continuous needle, an overall fetal bradycardia rate of 11%, and two perinatal deaths foliowing single paracervical block. It is concluded that the use of continuous paracervical block should be discontinued, and that amide-type local anaesthetic agents should not be used for single paracervical block.

A 14 year old girl was referred to the paediatricians with symptoms of hyperthyroidism. She had a smooth diffuse goitre with dysthyroid eye disease (proptosis, lid lag, and lid retraction). Hyperthyroidism was confirmed biochemically (protein bound iodine 18.8, normal 5–8 μg). She was treated with carbimazole, 30 mg/day. Poor compliance resulted in inpatient care for treatment with carbimazole followed by subtotal thyroidectomy, two years later. Two years later she presented with a self limited episode of hyperthyroidism. Aged 22 years she was referred with eight weeks amenorrhoea when pregnancy was confirmed and terminated. She was floridly hyperthyroid (free thyroxine 36.6, normal 10–23 pmol/l, free triiodothyronine 14, normal 3–9 pmol/l; thyroid stimulating hormone (TSH) undetectable, normal 0.5–5 mU/l). She was treated with carbimazole for nine months with apparently good clinical response.

No abstract

No abstract

No abstract