Twenty patients with bronchial asthma who also had gastro-oesophageal reflux were investigated. The severity of their reflux was graded using symptom score of heartburn and regurgitation and by the following investigations: barium swallow and meal, fibreoptic endoscopy and biopsy, manometry and pH monitoring of the distal oesophagus, and an acid infusion test. Full lung function studies were performed and patients were entered into a double-blind crossover study using cimetidine to control their reflux in order to assess beneficial effects with respect to their respiratory problems. Eighteen patients completed the study. Significant improvements were seen in reflux and night time asthmatic symptoms, both these indices being measured on a scoring system. Home monitoring of peak flow values showed a statistical improvement for the last peak flow reading of the day. Fourteen patients felt that their chest symptoms had significantly improved during the cimetidine period.Gastro-oesophageal reflux commonly produces symptoms in subjects of all ages. The dominant complaints are usually related to the upper gastrointestinal tract and include heartburn, regurgitation, and occasionally dysphagia. Patients with re'lux are also liable to respiratory complications leading to severe, progressive, and disabling pulmonary damage.' More recently attention has been drawn to an association between reflux and exacerbations of bronchial asthma,23 and there have been several studies suggesting subjective improvement in such patients after surgical correction of hiatus hernia. [3][4][5] In this study we have attempted to demonstrate a measurable improvement in symptoms and respiratory function in a group of asthmatic patients, who also had well-documented reflux, by controlling their reflux with cimetidine in a double-blind, crossover trial. MethodsInformed consent for study was obtained from 20 patients, 13 men and seven women, whose ages ranged from 30-65 years (mean 54 years). All patients had bronchial asthma and were attending

Two cases of the rare condition of abdominal apoplexy are described. The two main clincial presentations of this condition are discussed as is the aetiology. It is suggested that selective visceral angiography might prove helpful in preoperative diagnosis.

Small clusters of microscopically normal thyroid follicles within cervical lymph nodes are very occasionally encountered during histological examination. We support the view that provided the thyroid gland is not palpable and a technetium thyroid scan is normal, these should be regarded as benign thyroid inclusions and do not represent small metastatic lesions from thyroid carcinoma. We report an example of these inclusions in a cervical lymph node which was removed incidentally during the excision of a branchial cyst in a 25-year-old woman. The inclusion was too small to be noticed macroscopically and consisted of a small aggregation of histologically normal thyroid follicles situated in the subcapsular region of the lymph node.