231

Furthermore, the possibility of centralising services should beconsidered. The difficulties entailed in recruitment and retention ofstaff are recognised, and suggestions for coping with these includesharing resources between neighbouring sites, cross-disciplinarycover, a shift rather than an on-call system, and the re-design of theremuneration system.

1 Audit Commission The Pathology Services. a management review London:HMStationery Office 1991. Pp 60 £8.50. ISBN 0-118860356

Beware the barbecue

Although some may miss those seemingly far-off lazy summerevenings filled with the enticing aromas of gently sizzling food on abarbecue grill, a report from California shows how even life’s simplepleasures may carry a sting in the tail. 1

Four members of a family presented to hospital with headache,nausea, and abdominal pains and gave a history of drinkingunrefrigerated milk the previous evening. A diagnosis of infectivegastroenteritis was made, treatment with intravenous fluids wasgiven, and the patients were discharged home. A few hours laterfour more members of the same family came to the hospitalcomplaining of similar symptoms. The same diagnosis was made,the same treatment was given, and these patients were also

discharged. Several hours passed again and four more familymembers were admitted, one reporting that she had not had any ofthe milk that was thought to be the source of the infection. A clearhistory was difficult to obtain, because the family were non-Englishspeaking, but an interpreter was able to find that the family oftencooked over charcoal in the house. Measurement of

carboxyhaemoglobin (HbCO) in the most recently admitted familymembers showed increased serum concentrations in three of thefour. Treatment with 100% oxygen for 2 hours led to symptomaticimprovement, and a fall in the HbCO was found in one patient. Asubsequent visit to the family house revealed a barbecue grill in themiddle of the living room.

1. Gasman JD, Varon J, Gardner JP. Revenge of the barbecue grill. West J Med 1990,153: 656-57

Chronic meningococcaemia

Meningococcal infection is caused by the gram-negativediplococcus, Neisseria meningitidis. Spread is commonly byrespiratory droplets from symptom-free carriers. Pili enable theseorganisms to stick to nasopharyngeal epithelium from where theycan be endocytosed and reach the circulation. Bacteraemia results,and may lead to acute meningococcaemia and subsequentlymeningitis if organisms lodge in the meninges. Late complicationsmay take place as the bacterial antigen begins to clear from thecirculation and include vasculitis and arthropathy, which arethought to be due to immune-complex deposition.Chronic meningococcaemia is characterised by persistence of the

bacterium in the blood and may also lead to immune-complexmediated damage. Patients usually present with a fever and rash,and a recent report emphasises the pitfalls in diagnosis on this rarecondition.! 3 cases are described. All patients had fever, rash, andjoint involvement (arthralgia or arthritis). Blood cultures werenegative m all cases; in 2 patients these results led to a diagnosis ofphenytoin-induced lupus and disseminated gonococcal infection,respectively. In the former case, prednisolone was given for ninedays and it was only after 32 days of illness that blood cultures finallybecame positive for the meningococcus. Similarly, in the secondcase, positive blood cultures were first shown only after 11 days. Allpatients were eventually treated successfully with intravenouspenicillin.

Chronic meningococcaemia represents a balance-between theinfecting load of bacterium and attempted immune clearance-producing negative blood cultures but persisting infection. Anypatient with a fever, vasculitic rash, and joint symptoms merits atherapeutic trial with intravenous penicillin. Delay could be fatal.

1 Jennens ID O’Reilly M, Yung AP Chronic meningococcal disease. Med J Aust 1990;153: 556-59

Mr Michael Masser

A memorial service for Mr Michael Masser, FRCS, will be heldat Salisbury Cathedral on Saturday, Jan 26, at 2.30 pm.

In England Now

My Uncle Jimmy is the salt of the earth, with one majorobsession-fishing. His dedication to this art takes him to hisfavourite reaches to cast for salmon whenever the on-call rota

allows, irrespective of the weather or other commitments, andcomplete with essentials to his comfort, notably several cans oflager, a picnic lovingly prepared by my Aunt Jeannie (glad to havehim out from under her feet), and a bottle of claret "to wet the fish’shead". But the past two dry summers have been ruinous for thefishing- to the uninitiated that means that the river has been so lowthat the salmon are not running, and the catches have dropped from1 or 2 a session to nil. Never beaten by such adversity, Uncle Jimmyspotted an ad in a local paper, and being an enterprising sort of chapwhere fishing is concerned, wrote off for details of a hotel withfishing rights "going cheap". Imagine the dismay with which hereceived this reply from the proprietor of a firm of "auctioneers,exporters, grocers, victuallers, dairymen, and livestock salesmen":"I herewith enclose snap and particulars of ... Hotel, nowdemolished as requested (sic). The building itself is in perfectcondition, especially on the outside, little requires to be done with it.Also chimneys are good. The inside requires plastering becauseduring removal of roof, floor, windows and doors damage was done.There is an 18-hole golf course when the tide is out. Inspection isnecessary before you could really believe such a bargain, and Iconfidently advise immediate action as reserve has been over-reached"-and not a word about the fishing.

International Diary

1991

A symposium on New Neonatal Infections and Changes in Therapywill take place in London on Friday, May 17: Symposium Secretary, RoyalPostgraduate Medical School, Institute of Obstetrics and Gynaecology,Queen Charlotte’s and Chelsea Hospital, Goldhawk Road, London W6 OXG(081-7403904).

2nd international symposium on Neuroblastoma Screening will takeplace in Minnesota on May 22-24: Continuing Medical Education,University of Minnesota, Box 202 UMHC, 420 Delaware Street SE,Minneapolis, MN 55455, USA (612-626 7600).

A workshop on Contrast Enhanced Magnetic Resonance is to be heldin California on May 23-25: Society of Magnetic Resonance in Medicine,1918 University Avenue, Suite 3C, Berkeley, California 94704, USA(415-841 1899).

9th international meeting entitled Updates in Anesthesia andIntensive Care will take place in Pans on May 24-25: MAPAR, Hopital deBicetre, 78 rue de General Leclerc, 94275 Le Kremlin Bicetre Cedex, France(33-1 45 21 34 29).

A course on Critical Issues in Tumor Microcirculation,Angiogenesis, and Metastasis-Biological Significance and ClinicalRelevance is to take place in Pittsburgh on June 3-7: R. Hilda Diamond,Associate Director, Biomedical Engineering Program, Carnegie MellonUniversity, Pittsburgh, Pennsylvania 15213, USA (412-268 2521).

3rd international congress on Pancreatic and Islet Transplantationand symposium on Artificial Insulin Delivery Systems will take place inLyon on June 6-8: Administrative Secretary, Package Organization, 45 rueSte-Genevieve, 69006 Lyon, France (33-78 24 18 06).

7th international conference on AIDS is to be held in Florence, Italy, onJune 16-21: General Secretariat, Laboratory of Virology, Istituto Superioredi Sanita’, Viale Regina Elena 299, 00161 Rome, Italy (39-6 4457888).

8th international congress on Group Medicine will take place in Helsinkion June 24-26: Dr Antti Jaattela, President of the Congress and FinnishAssociation of Private Medical Centers, PO Box 63,00501 Helsinki, Finland.