Melkersson's syndrome.

Abstract

1527first in a small scheme-to catch the patients, many of whom find travel to the surgery difficult or have young babies to contend with, at the moment they are most willing to follow the doctor's suggestions. The slide can be marked and put in a multi-holder in fixative then and there, and can safely stay there for several days.It seems to us that the position of the general practitioner in any future survey is obvious. Only he can explain the purpose, importance, scope, and limitations of the smear test to each individual patient in the way that that particular patient understands best; and only he can explain any positive result in a way that will not cause alarm to the patient or her family. We contend that slide-taking is no great trouble-and, with minimum organization, takes little time-and that our patients are far happier to have us doing it than to go to some strange centre, however efficient, where there is no understanding of their family background. We have come across several families, in which for socio-economic and other reasons the mother must be considered most at risk, where we have deliberately delayed taking or suggesting a slide at a time when one more worry would be literally more than that woman could bear. We remain convinced that this is general practitioners' work and that it would be positively dangerous to let it go elsewhere.In this survey the slides were stained and screened by one of the partners, since the local hospital laboratory has not yet got the facilities for screening the general population. It has recently been emphasized that, if screening of the population is to become general, full-time technicians in properly equipped laboratories must do the bulk of it, with referral of doubtful slides to a specialist pathologist. This must undoubtedly be the eventual scheme, but McLaren (1963) has wisely pointed out the pitfalls of full-time screening as a sole occupation. There will be days when the technician is feeling unwell or bored, and on these days he is the last person suitable to screen a whole collection of probably normal slides. Apart from this, there must come a time when screening as a whole-time occupation becomes frankly dull. Obviously there are dangers in employing too many people part time, but in our present small series the factors that play the greatest part in making routine screening of slides positively enjoyable are the ability to do it at one's own speed in one's own time, and knowledge of the patient whose name is attached to the slide. This last factor gives relevance to the whole scheme and adds much interest to each slide. For these reasons and others we feel that there will be a place for keen amateurs in any large screening project.Lastly, if a whole population is to be screened, advertising must be most carefully thought out and planned in order to emphasize the importance of the test and yet avoid frightening people too much. Among the majority of the population cancer is still thought of as totally incurable, and there is little difference in p...

Observations on Melkersson’s syndrome

“…(3) Facial oedema As a rule facial paresis precedes the first attack of oedema by a few months, but the latter may be delayed, rarely up to 25 years (Klaus & Brunsting, 1959), and an even longer period has been recorded (Evans, 1965) when 50 years elapsed between the first of several facial pareses and an attack of lymphoedema which affected the lower lip of a 63-year-old female. These swellings are remarkable for two things, a tendency to recur and the rapidity of their development.…”