Enteropancreatic polypeptide responses during a 50 g oral glucose tolerance test were studied in 10 young men, 10 young women, 10 elderly men and 10 elderly women. Elderly females had higher gastric inhibitory polypeptide (GIP) responses to oral glucose than elderly males. Elderly males and females had higher fasting and post-glucose human pancreatic polypeptide (HPP) levels than young males and females. N-Glucagon-like immunoreactivity (N-GLI) responses differed between the young and elderly. In the young, N-GLI levels fell after oral glucose but in the elderly they rose. Post-glucose C-glucagon-like immunoreactivity (C-GLI) responses were higher in elderly females than in young females. The significance of the higher plasma levels of GIP, N-GLI and C-GLI following oral glucose in elderly females compared to elderly males is unclear.

Oral glucose tolerance tests were performed in young and elderly subjects with minimal risk factors for diabetes mellitus. Compared to the normal glucose tolerance in the young there was a 45% rate of impaired tolerance in the elderly. Fasting insulin levels were significantly lower in the elderly but post-glucose insulin responses in the first hour were similar in young and elderly subjects. Peripheral insulin action was assessed in terms of the 125 monoiodoinsulin binding to specific insulin receptor sites on circulating lymphocytes in the young, the elderly and a group of age and sex matched obese maturity-onset diabetics. Specific insulin binding was not significantly different in the elderly than in the young but was significantly lower in the diabetics than the young and the elderly. The results suggest that neither defective insulin binding are major causative factors in the reduced glucose tolerance of the elderly.

Depression in the elderly is a common problem, cited as occurring in up to 10% of elderly people living at home, half of whom may need specialist referral.1 The introduction of selective serotonin reuptake inhibitors has been reported as a major advance in the treatment of depression in that they are less sedating, have fewer anticholinergic effects and are less toxic in overdose.2 We report three cases of severe hyponatraemia, seen in the past 12 months, associated with the selective serotonin reuptake inhibitors fluoxetine and sertraline. Hyponatraemia has been reported as a rare adverse effect of selective serotonin reuptake inhibitors.3,4

parents given smoking advice were as a result of the child suffering with acute otitis media. In addition, we could only identify parents who were registered with our practice. There was no way of including adults in the home who were not parents or guardians. This audit was presented to the partners, and a plan was made to put up reminders to discuss smoking with the parents of any children presenting with acute otitis media. The audit is to be repeated in 1 year to allow sufficient numbers of cases to present. We realise that this is just one of many motivational factors that can be used to encourage patients to stop smoking, but smoking cessation is such a high priority that this window of opportunity should not be overlooked. Prevention rather than prescriptions must remain our ideal in the management of otitis media.

corneoscleral perforating injury of the left eye was noted, with iris, ciliary body and vitreous prolapse, total hyphaema and loss of the crystalline lens. The eyelids were intact. Abscision of damaged uvea, anterior vitrectomy and wound repair was performed. The scalp and facial lacerations were explored, cleaned and repaired in layers. Postoperatively an anterior vitreous membrane prevented visual improvement beyond 6/36 and anterior vitrectomy was performed at 7 weeks postinjury. The eye now sees 6/5 with a contact lens. Case 2: A 56-year-old man was attacked by his own dog, a Pit Bull Terrier. The patient was reticent as to the exact circumstances of the injury. On presentation 24 h later, there was a puncture wound over the right temple, and a complex perforation of the right globe, comprising a circumferential medial scleral rupture, and a corneal laceration crossing the visual axis. The crystalline lens was disrupted but present. The anterior segment was cleared of vitreous and visible lens matter and the wounds repaired. Persistent hyphaema, and fibrinous uveitis with retained lens matter made further surgery necessary within 7 days. Anterior segment clearance revealed cyclodialysis and retinal detachment, necessitating globe encirclement and gas tamponade. Postoperatively a total retinal detachment supervened and the patient refused further surgery. The eye is blind. Discussion Even in the presence of severe periocular lacerations caused by dog bites, the eye is usually undamaged''". Occasionally, however, the orbit is entered, and lacrimal gland injury", transsection of the medial rsctus" and trochlear damage" have been reported. Perforating injury itself is rare. It seems likely from the location of these injuries that the upper canines provided a fulcrum on the cranium while a lower canine entered the orbit inferomedially with sufficient force to perforate the globe. These two patients demonstrate contrasting visual outcomes. The reasons for this are numerous, but in case 2, the