A case is described of a patient with a ganglioneuroblastoma, initially located in the right adrenal, which produced an excess of dopamine (7646 and 7959 nmol/24 h), approximately two and a half times the upper limit of the normal daily urine output. The urinary excretion of noradrenaline, adrenaline and methylated derivatives was always within the normal reference ranges. The patient was generally well, with normal blood pressure and only mild flushes. Two years after surgical resection, recurrence was indicated by an increase in urinary dopamine (8507 nmol/24 h); it was located in the tumour bed and left side of the neck by CT and (123)I MIBG scans. The patient was treated with a high dose of (131)I MIBG, with subsequent reduction in dopamine production. This was repeated on four other occasions, the latest being in January 2005. The output of dopamine was thus used as a marker of tumour diagnosis and progression and it is recommended that the assay of dopamine be included in the screening of catecholamine-secreting tumours to avoid possible misdiagnosis.

In conjunction with local general practices a scheme for shared care of diabetes was set up with an initial pilot study in 1985. Subsequently this was expanded to include virtually all patients with insulin‐dependent diabetes and non‐insulin‐dependent diabetes attending the hospital clinic and incorporated over 1200 patients by the end of 1989. In the pilot study the improved ability to screen for complications was not offset by any deterioration in biochemical control resulting from the reduced frequency of hospital visits. Patients and general practitioners appeared enthusiastic in support of the ‘clinic‐wide’ Chester shared care scheme.

^strn postvt faor a nerve shath origi preparation and for S-100 protein (Figure 2). Some of the small nerve bundles within the tumour were involved.A second lesion excised one month later had similar histopathological features.

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SUMMARYTight control of glycaemia during gestation is the mainstay of antenatal care in women with diabetes. This relies heavily on blood glucose monitoring. A simple technique for assessing the accuracy of the patients' own blood glucose monitoring is described. The method involves patients collecting a few drops of blood in fluoride oxalate-coated plastic capillary tubes, which they store in their own refrigerator before delivery for laboratory analysis on the day of the antenatal clinic assessment. The readings can be compared with blood glucose monitor readings recorded by the patient and subsequently used by clinicians and nurses to guide therapy.