307proportionating system was dismantled and a gas leak found in the Cambridge Bourdon tube type dialysate temperature gauge which caused the needle pointer to register about 20'C too low. The fault had come on over a period of time and, unfortunately, it had been assumed that the Cambridge gauge was indicating the true dialysate temperature. Therefore the back-up temperature alarm system and the dialysate heater were adjusted to maintain the Cambridge gauge recording in the range 35-41°C. Probably, however, the dialysate was much hotter (possibly as much as 58°C). CommentThere are three reports of patients exposed to overheated dialysate.Fortner et all reported the death of a patient who developed gross haemolysis after accidentally dialysing with a bath at 55°C. Two patients had chronic haemolysis after being exposed to 47°C dialysate for 95 minutes2 and 50'C for 110 minutes; respectively.In-vitro experiments' have shown morphological changes in red cells heated to X51-C, regardless of the time of exposure. Temperature < 47°C produced no morphological changes, irrespective of the duration of exposure, and intermediate temperatures caused changes that were dependent on both temperature and exposure time. Heatdamaged canine erythrocytes reinjected into dogs suffered acute haemolysis if heated to -51°C and chronic haemolysis if heated to between 47°C and 51-C.4 We think that our patient's two episodes show both types of heat-induced haemolysis.

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SUMMARYThe pain that patients recollect having experienced at colonoscopy is likely to influence uptake of the procedure.We used visual analogue scales to assess recollected pain shortly before discharge, and compared these scores with assessments by the endoscopist and the attending nurse.Data were complete for 426 procedures (90%). The mean perceived pain score for patients was 3.2, for endoscopists 2.8 and for nurses 3.1. On multivariate analysis, the endoscopists' assessments of pain had little predictive value over and above those of nurses, whereas nurses' assessments remained significant when adjusted for endoscopists' assessments.Nurses were more accurate than endoscopists in gauging the pain of colonoscopy. This may be because endoscopists are focused on the video monitor while nurses are focused on the patient. More active use of nurses' assessments might help keep pain to a minimum.

Thirty patients with radiolucent stones in a radiologically functioning gall bladder were treated for up to two years with a combination of Rowachol (one capsule twice daily), a mixture of cyclic monoterpenes, and chenodeoxycholic acid (7-0-10-5 mg/kg/day). The patients were not selected for body weight or size of stones. All complete dissolutions diagnosed by oral cholecystography were confirmed or refuted by ultrasound examination. Control of symptoms was excellent, only one patient withdrawing from the study because of persistent biliary pain. No evidence of hepatotoxicity was detected biochemically, and diarrhoea due to chenodeoxycholic acid was minimal at this dose. Stones disappeared completely in 11 patients (37%) within one year and in 15 (50%) within two years.These results compared favourably with those obtained with similar doses of chenodeoxycholic acid alone, in particular those of the National Co-operative Gallstone

The pain that patients recollect having experienced at colonoscopy is likely to influence uptake of the procedure. We used visual analogue scales to assess recollected pain shortly before discharge, and compared these scores with assessments by the endoscopist and the attending nurse. Data were complete for 426 procedures (90%). The mean perceived pain score for patients was 3.2, for endoscopists 2.8 and for nurses 3.1. On multivariate analysis, the endoscopists' assessments of pain had little predictive value over and above those of nurses, whereas nurses' assessments remained significant when adjusted for endoscopists' assessments. Nurses were more accurate than endoscopists in gauging the pain of colonoscopy. This may be because endoscopists are focused on the video monitor while nurses are focused on the patient. More active use of nurses' assessments might help keep pain to a minimum.