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Emergency detention of elderly psychiatric inpatients appears to have attracted very little or no attention in published studies. In this retrospective review, all applications of sections 5(2) and 5(4) of the Mental Health Act 1983, detaining elderly inpatients in North Cheshire between 1985 and 1997 were reviewed. Forty-three percent of elderly inpatients under s.5(2) regained their voluntary status, while 57% were detained under another section by the end of the 72 hours (p < 0.05). Duration in hospital prior to applying s.5(2), clinical diagnosis of functional mental illness and use of s.5(4) appear to increase the likelihood of converting s.5(2) into other sections. The high rate of non-conversion of s.5(2) in the elderly to s.2 or 3 may imply that in almost half of the cases, emergency detention may have been used to control isolated incidents of disturbed behaviour in otherwise co-operative patients. Educating doctors and nurses in guidance put forward by the Code of Practice (1993) remains, probably, the main key to a better use of emergency holding powers.

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Increased menstrual loss and irregular uterine bleeding are major drawbacks to acceptibility of intrauterine contraceptive devices (IUCDs). Fibrinolytic activity around IUCDs removed from 80 women was measured by embedding the device immediately after removal in a plasminogen-rich fibrin plate. In fifteen of the women an endometrial biopsy was also taken at the time of removal of the IUCD. In women who had the IUCDs removed because of bleeding a much higher fibrinolytic activity was found than in women not complaining of excessive bleeding. The fibrinolytic activity was shown to be due to plasminogen activator and not plasmin. The findings suggest that the excessive menstrual bleeding which occurs with the IUCD may be due to enhancement of fibrinolytic activity in the endometrium which can be modified by fibrinolytic inhibitors such as epsilon aminocaproic acid.