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Objectives: To determine important risk factors associated with cases of gonorrhoea in England, and whether any particular risk groups were associated with the substantial rise in numbers of cases seen between 1994 and 1996.Design: Two retrospective cross sectional surveys.Setting: 70 randomly selected genitourinary medicine (GUM) clinics in England.Subjects: 10% of all gonorrhoea patients attending GUM clinics in England in 1994 (847 patients) and 1996 (1146 patients).Main Outcome Measures: For risk factors in 1996 (study 1), unadjusted rates per 100,000 population aged 14-70 and relative rates (RR) with 95% confidence intervals (CIs). For the change in risk factors between 1994 and 1996 (study 2), adjusted odds ratios (ORs) with 95% CIs, derived from logistic regression analyses of data on patients in 1996, with patients in 1994 as the comparison group.Results: The incidence of gonorrhoea in 1996 was higher in homosexual males (812 per 100,000; RR = 30.2, CI = 25.2 to 36.0) compared with heterosexual males (27 per 100,000); in black Caribbeans (467 per 100,000; 21.4, 17.9 to 25.5) and black Africans (235 per 100,000; 10.8, 7.5 to 15.5) compared with white people (22 per 100,000); and in previous GUM clinic attenders (433 per 100,000; 37.93, 35.46 to 40.56) compared with those who had not attended previously (11 per 100,000). However, most patients were either white or heterosexual. Heterosexual patients in 1996 were significantly more likely to have reduced sensitivity to penicillin (2.55, 1.20 to 5.41) than those in 1994. Male homo/bisexual patients in 1996 were significantly more likely to be from the north west (3.77, 1.45 to 9.80) and to have either reduced sensitivity (2.63, 1.03 to 6.73) or complete resistance (1.98, 1.03 to 3.78) to penicillin, compared with those in 1994.Conclusions: Homo/bisexual men and the black Caribbean population in England experience a disproportionate burden of gonococcal infections, however, the bulk of diagnoses are in white heterosexuals. No single risk group was associated with the rise in numbers of cases between 1994 and 1996. Resistance to penicillin is widespread and has increased in homo/bisexual men, and it is possible that a rise in treatment failures has, to some extent, enhanced transmission of gonorrhoea and contributed to the rise in numbers of diagnoses in this group. [ABSTRACT FROM AUTHOR]

Abdominal tuberculosis, although rare, occurs mainly in immigrants from the Indian subcontinent. Such people comprise 13.5% of our local population and contributed 90% of a series of 72 patients presenting in the last 16 years; a local disease incidence of 1:6000 for Asian immigrants. Men and women were equally affected, but on average women were much younger. Diagnosis was made from one month to 10 years after immigration. No clinical feature was diagnostic, but abdominal pain, night sweats and weight loss occurred in more than half the patients. The erythrocyte sedimentation rate (ESR) was elevated in 95% and no patient tested had a negative Mantoux test. In 20 patients diagnosis was by clinical suspicion and response to therapeutic trial. In 52, including 39 who had a laparotomy, histological and culture material was obtained but these patients fared no better. Only one organism was resistant (to streptomycin) and rapid response to chemotherapy was the rule. Successful outcome was not related to the type of presentation, operative findings or specific chemotherapeutic agents. We would suggest that in Asians presenting with difficult-to-diagnose abdominal symptoms accompanied by malaise, raised ESR and a positive Mantoux test, a therapeutic trial of anti-tuberculous therapy should precede diagnostic laparotomy. [ABSTRACT FROM PUBLISHER]

To establish our current practice and the potential value of the autopsy in general surgery, a retrospective review of general surgical autopsies was performed at one district general hospital from January 1989 to August 1991. There was considerable interconsultant variation in autopsy practice with a low 25% overall autopsy rate reflecting a low autopsy request rate. There were discrepancies between the clinical and pathological cause of death in 40 (63%) cases. There were important discrepancies which may have changed management in life in 18 (28%) autopsies, 7 (39%) of which were untreated visceral perforations. Autopsy is an important part of the surgical audit and will disclose considerable unsuspected pathology. Present autopsy rates are low and need to be improved. The unexpected finding of seven untreated visceral perforations requires further study.