Painless stress fractures in diabetic neuropathic feet.

We describe two patients with diabetes mellitus and associated neuropathy, who presented with painless foot swelling and no history of trauma. X-Rays revealed recent underlying fractures-in one of a metatarsus, and the other of a proximal phalanx. These were assumed to be ''stress'' fractures unassociated with pain because of the severe sensory neuropathy. Though spontaneous fractures in neuropathic feet have been previously described, they almost always occur in association with Charcot joints, and are usually painful. The differential diagnosis of acute swelling in the foot of a diabetic patient with sensory neuropathy should include stress fracture.     

Sudden postoperative death caused by unheralded Mallory Weiss tears.

Mallory Weiss tears are a common cause of upper gastrointestinal bleeding, typically reported as following repeated vomiting after an alcoholic binge. This association may have been overemphasised, and these lesions could be caused by a wide range of spontaneous and iatrogenic events. A case of sudden postoperative death caused by massive haematemesis, unheralded by any evidence of vomiting or retching, as a result of Mallory Weiss tears is reported.     

Patients' Views on Electroconvulsive Therapy on Completion of a Course of Treatment

Patients' attitudes towards electroconvulsive therapy (ECT) on their completion of a course of treatment were studied using a semi-structured questionnaire. Twenty-six patients were seen before the junior doctors were trained in ECT administration and 28 patients afterwards. Most patients' attitudes were favourable, although very few fully understood the treatment. Training the junior doctors had no effect on patients' attitudes, but was associated with a shorter mean course length. ECT was acceptable to most patients who received it.     

Effect of Training on Administration of Electroconvulsive Therapy by Junior Doctors

An instrument was designed to rate the administration of electroconvulsive therapy. The performance of junior doctors was rated before and after videotape training in technique. The group showed a marked increase in ratings following training. The limitations and importance of the study are discussed.