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Since 1974 numerous clinical studies have made it clear that heavy alcohol consumption during pregnancy (in excess of 80 g or 8 units daily) can result in a child being born with specific combination of physical and mental disabilities known as the Fetal Alcohol Syndrome. More moderate levels of intake (as little as 10 g of 1 unit daily) are associated with other fetal problems known as Fetal Alcohol Effects. The most common of these is growth retardation. Reduction of alcohol consumption is beneficial to pregnancy outcome. However, despite this great clinical and research interest within the field there has been comparatively little attention paid to researching possible preventive strategies and appropriate policy development. This paper first describes the size of the problem posed by drinking in pregnancy in the U.S.A. and the U.K., detailing the contrasting policy response on either side of the Atlantic. It examines the difficulties of formulating appropriate advice and then assesses the available research reports on preventive measures. The strategies described include general publicity and counselling for pregnant women. In addition, attention has been paid to the problems of dissemination by emphasising professional education. One major shortcoming is that most of these studies appear to have been carried out with little reference to existing knowledge on health education and promotion, or educational work in the antenatal or alcohol fields. In addition, little attention appears to have been paid to the characteristics of the groups at whom intervention might be targeted or the underlying social or psychological factors which maintain drinking in these groups. The second part of this paper, therefore, attempts to suggest appropriate avenues for developing preventative strategies by presenting a wide-range review with special reference to British experience. Particular attention is given to the issues of form and content of appropriate messages, targeting of risk populations, the venue for intervention, and media and the actual mechanisms involved in implementing the programme. We conclude that women should be advised to limit their alcohol consumption to no more than one unit a day when they are either pregnant or planning a pregnancy. We recommend that pregnant women should be asked about their alcohol and given appropriate advice during routine antenatal clinic visits. We suggest that the form of advice should be designed with the characteristics of the risk population in mind. Information about appropriate levels of alcohol intake and further professional help for those in need should be widely available and form an integral part of the primary health service, as well as the antenatal and family planning clinics in addition to the more specialist alcohol treatment and prevention services already available.

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Alcohol consumption in pregnancy can produce a spectrum of abnormalities in the developing foetus, ranging from minor retardation of growth to the fully developed 'foetal alcohol syndrome'. This syndrome comprises a constellation of physical and mental defects associated with a characteristic facial appearance that is found in children born to chronic alcoholic women. Although it was thought to be extremely rare in the U.K., several case studies have recently appeared in the literature, and its incidence is probably increasing. In moderately drinking pregnant women increased rates of spontaneous abortion, stillbirth and congenital malformation as well as growth retardation have been reported, though some of these findings await confirmation. It is likely also that certain behavioural abnormalities are consequent on maternal alcohol intake. The major U.K. finding so far is that consumption of more than 100g alcohol per week in the early stages of pregnancy is associated with reduced birth weight. There is no doubt that alcohol is teratogenic in laboratory animals and that the effects are dose-related. In humans the threshold dose necessary to produce damage to the foetus and the time in pregnancy that alcohol is particularly likely to have deleterious effects have not yet been established. In the present state of knowledge there are difficulties in recommending safe limits. It is obvious that abstinence before and during pregnancy is the safest course, but one drink a day is unlikely to be harmful. Greater efforts are needed to educate women about the dangers of alcohol consumption in pregnancy. [ABSTRACT FROM AUTHOR]

Seventeen patients bleeding from oesophageal varices were treated by continuous infusion of vasopressin through a catheter inserted percutaneously and positioned in the superior mesenteric artery and in two other patients catheterization proved technically impossible. Bleeding was completely controlled on only four out of 18 occasions in the 17 patients treated. In seven patients, bleeding was controlled for two or more days but then recurred although the infusion was continued with an increased dose of vasopressin. There was a high incidence of complications, including bleeding from the site of catheter insertion in the groin and septicaemias. Sengstaken balloon tamponade and oesophageal transection had to be used to control bleeding in some patients but only six out of 17 survived to leave hospital. [ABSTRACT FROM PUBLISHER]

A patient with a multiple-hormone-producing islet cell carcinoma, who had previously been successfully treated with streptozotocin, was given three further infusions of this drug because of the redevelopment of gastric hypersecretion. Although some evidence of damage to the gastrinsecreting cells was obtained, the fasting plasma gastrin was not significantly altered and the patient died from a perforated duodenal ulcer. Serum insulin levels were considerably reduced and the patient became mildly diabetic but the main complication of treatment was a severe though reversible renal tubular defect. At necropsy considerable quantities of gastrin, but low levels of insulin and glucagon were extracted from a tumour metastasis. [ABSTRACT FROM PUBLISHER]