The GP dilemma. Recommendations and synopsis of a student conference.

The proceedings of a conference organised by students are reported. The present standing of the general practitioner and his need in different societies are equated and the obvious deficiencies are considered. Such themes as maldistribution, service and education are discussed. Resolutions derived from the conference are reported in full.

Nephrogenic diabetes insipidus presenting with infantile hypotonia. A report of 2 cases.

Nephrogenic diabetes insipidus usually presents with polyuria, polydipsia, fever, vomiting, dehydration and failure to thrive. However, in infancy polyuria may be absent because of dehydration and reduced glomerular filtration rate. In 2 cases the main presenting feature was hypotonia, with marked head lag. Family studies confirmed the X-linked mode of inheritance of the disease; in case 1 the disease appeared to have arisen as a new mutation in the mother, and in case 2 the carrier status was traced back to the great-grandmother. Pitfalls in the diagnosis and detection of the carriers are discussed. Treatment with thiazide diuretics and prostaglandin synthesis inhibitors is effective in reducing urine volumes and polydipsia. The early detection of the disease and adequate management may prevent such complications as megacystis, mega-ureter and hydronephrosis, with resulting renal failure. Mental and physical retardation may also be avoided.

The problem of compliance in rheumatic fever.

During a 12-month period 115 patients defaulted from a rheumatic fever clinic, so a study was undertaken to identify factors related to non-compliance by comparing defaulters with a group of 50 regular attenders. Those defaulting were significantly more likely to be coloured, male, and over 12 years old. They lived 10-99 km from the hospital, were on several drugs and despite more frequent appointments, usually had a record of poor attendance. The severity of the underlying heart disease and use of parenteral penicillin did not affect compliance. Since the use of regular penicillin prophylaxis for the secondary prevention of rheumatic fever is an essential step in reducing the prevalence of rheumatic heart disease, rheumatic fever clinics should be structured to address the needs of adolescents. Furthermore, the use of neighbourhood clinics for routine therapy between visits to a rheumatic fever clinic is essential to improve compliance.

Neonatal septicaemia due to a nutritionally deficient streptococcus. A case report.

A case of neonatal septicaemia due to a nutritionally deficient streptococcus is described. Unusual features were abdominal distension and excessive nasogastric aspirate with infrequent stools. Recovery followed treatment with intravenous penicillin and gentamicin. Attention is drawn to the possibility of missing such infections unless culture media are supplemented with vitamin B in cases in which staining of the blood culture reveals Gram-positive cocci which fail to grow on standard plates.

Valve replacement in children.

The performance of the St. Jude prosthetic valve is reviewed in 81 patients aged 3 to 15 years. All 66 mitral (2 re-replacements), 8 aortic and 9 double valve replacements between February 1979 and August 1984 are included. The early mortality was 3.7% and actuarial analysis shows a 90% event free survival up to 5 years. Anticoagulant therapy was used in most patients, but comparison between groups receiving warfarin or aspirin or no therapy reveals no differences in the complication rate. The valve is well suited for use in children since the early degeneration seen with heterograft valves does not occur, and anticoagulation is not essential.