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Attention has recently been drawn to the importance of assessing blood loss in paediatric surgery (Brit. med. 7., 1964), but little has been written about such loss in adenotonsillectomy (Shalom, 1964). In this investigation we have set out to measure the operative blood loss and the degree of pre-operative fluid depletion; the significance of these with regard to postoperative progress is discussed. The opportunity was also taken to compare the effects of two different anaesthetic sequences on the operative blood loss. MethodThe series consisted of 50 cases of dissection adenotonsillectomy taken in sequence and with no attempt at selection. Twenty-five were anaesthetized with ether and 25 with halothane by means of a Boyle-Davis gag in all cases.On arrival in hospital the patients were placed on fluid charts, and careful note was kept of all fluid intake in the 24-hour pre-operative period. Food and water were prohibited for the four hours prior to operation. For each child the predicted volumes of fluid necessary to maintain normal balance were calculated on a body-weight basis from a chart devised by Carre (1958). The deficit between the actual and the predicted intake was expressed as a percentage of the latter. Throughout the series the environmental conditions were constant, the children being nursed in the same ward under the same staff.Premedication was by oral pentobarbitone sodium (5 mg./kg.) and atropine (0.6 mg.) intramuscularly, given 60 Barr (1963). Blood loss was ascertained by measuring the volume of suctioned blood in graduated columns which contained an anticoagulant and silicone antifoam to prevent coagulation and clotting. Previously weighed dry gauze sponges were used and the quantity of blood soiling them was determined by immediate re-weighing. Gravimetric methods are convenient and simple, and they compare favourably with other methods (Baronofsky et al., 1946). Moreover, the method was checked against measured known volumes of blood, and the error was found to be + 2 %. Blood volume was taken to be 70 ml./kg. (Carre, 1963).The 50 cases included both sexes, and the average age was 7.3 years (range 2 to 12 years). The average weight was 26.1 kg. On admission the haemoglobin was measured in all patients, the average being 12.4 g./100 ml. (range 8.1-15.3 g.).Results Forty-nine patients had some deficit in their fluid requirement, the average being 57%, though 20 cases had a deficit of between 50% and 75% and in a further 11 it was more than

Germline loss-of-function mutations in BRCA1 are associated with a high lifetime risk of breast and ovarian cancer. Most mutations in the gene are 'truncating': in the main these induce premature termination codons, resulting in nonsense-mediated decay, loss of the transcript and/or the entire protein. The improved screening methods now in use across the UK will identify many carriers of unclassified BRCA1 variants. These are chiefly missense mutations, introducing an amino acid change in the context of an expressed protein. Indeed more than one-quarter of entries recorded in the Breast Cancer Information Core dataset of BRCA1 sequence variants collected from patients worldwide are unclassified missense alterations (http://research.nhgri.nih.gov/bic/). Currently, discovery of the majority of missense variants leaves both variant carriers and their families in an ambiguous position.

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