One hundred and sixteen patients with proven bronchiectasis diagnosed at least five years previously were studied to determine the clinical outcome, change in pulmonary function, and degree of social disability. Twenty-two patients had died and the mean duration of follow-up in the survivors was 14 years. The patients who died were characterised by a poorer initial ventilatory capacity than the survivors and cor pulmonale was present in 37 % at the time of death. The survivors showed a tendency for improvement in symptoms whether treated surgically or medically. Thirty per cent were better than at diagnosis while only 11 % were worse. Measurements of FEV1 and FVC were made at diagnosis and at review, mild airways obstruction being the predominant abnormality. The change in pulmonary function was expressed as the decline in FEV1 in ml/yr. The decline in FEV1 was no greater than expected in 80 % of patients and in a further 15 % was of the order seen in cigarette smokers with mild airways obstruction. Poor ventilatory capacity was therefore not an important limitation in these patients. Of the survivors 77 % had a good work record with less than two weeks loss of work annually from chest illness. The spouses of all married patients were interviewed at home by a trained social worker. Fifty per cent reported no social problem but 46 % of spouses found the patient's cough distasteful and 29 % of couples had experienced difficulties with normal sexual life. Seven per cent of the patients were severely disabled. While the overall prognosis of our patients was good a minority still have severe physical and social problems as a result of bronchiectasis.

We report a case of laryngeal tuberculosis in a 47-year-old Korean man. Laryngeal tuberculosis is rare and currently accounts for less than 1% of all cases of tuberculosis. Clinical features of laryngeal tuberculosis include hoarseness, odynophagia and dyspnoea. Macroscopically, laryngeal tuberculosis may mimic laryngeal carcinoma, chronic laryngitis or laryngeal candidiasis. The diagnosis is often delayed due to a low index of clinical suspicion and hence may pose a significant public health risk. Laryngeal tuberculosis should be considered in the differential diagnosis of patients who present with any form of laryngeal lesion.

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4Rapid mobilisation after acute myocardial infarction as the first step in a planned programme of rehabilitation and secondary prevention was studied in a group of 142 men under 65 years of age admitted to a coronary care unit.Patients without complications were mobilised after 2 days' bed rest, but the programme was flexible and those with complications were mobilised less rapidly. Fifteen patients died before mobilisation could be started.In 127 who survived long enough to be mobilised, 74 (58%1') spent 2 to 4 days in bed, 42 (33%) 5 to 10 days, and 11 (9%) more than 10 days. The mean period of bed rest was 5-4 days.Rapid mobilisation eliminated the need for physiotherapy and led to early discharge from hospital with more economic use of hospital beds. In 125 patients who were discharged, 99 (7900) had 16 days or less (5 to 16) in hospital. The mean period of hospital stay was 15-5 days.

Primary carcinoma of the trachea is a rare neoplasm. In a combined multicentre series only two primary carcinomas of trachea were found in 47 600 necropsies.1 In 30 years at the Mayo Clinic 47 primary carcinomas of trachea were diagnosed.2 These included 24 squamous carcinomas, which was the commonest histological type, but only two oat cell tumours.We report a case of primary carcinoma of trachea with an unusual mixed histological pattern of oat cell and squamous cell type. This mixed cellular pattern was also seen in varying proportions in metastases at different sites. Case reportThe patient, a 60-year-old man, had had increasing breathlessness on exertion for over six months, which eventually limited his walking to about 270 m on level * ; : < < -. . . . ; . in weight over the six months. At presentation there was faint stridor but no finger clubbing or cervical lymphadenopathy.The chest radiograph was normal but tomography showed the tracheal tumour 5 cm above the main carina and a right-sided paratracheal mass which later proved to be a lymph node containing metastatic tumour.At thoracotomy, the tracheal tumour was removed in continuity with the enlarged, paratracheal nodes and the defect repaired with a pericardial patch. Staphylococcal bronchopneumonia developed on the third postoperative day and, despite intensive treatment, the patient died 18 days after operation.