Paul Byrne

OCCULT CERVICAL CARCINOMA REVEALED BY LARGE LOOP DIATHERMY

SIR,-Dr Graner (July 15, p 150) reduces his colleague to tears and accuses him of not thinking enough when deciding not to treat pneumonia in a severely quadriplegic patient. One must know a case well before judging a colleague’s decision, but I suspect this doctor had no need to weep, having decided more rationally, more courageously, and more morally than Graner allows. He probably lacked the words or the will to defend his instinctively correct decision against Graner’s moralistic rhetoric. A doctor should give

Outcome of breech delivery at term.

at potentially higher risk are primigravid patients, a subgroup not considered in the report but presumably identifiable from the database. The critical question therefore remains: is a carefully planned and managed trial of vaginal delivery any less safe for the fetus than an elective caesarean section? The uncertainty is in itself an argument in favour of elective caesarean section for all breech presentations at term since this reduces the opportunity for errors of judgment.

Management of ectopic pregnancy.

Each year, around 11,000 women in the UK (around 1% of all pregnancies) present with an ectopic pregnancy, in which a fertilised ovum implants elsewhere than in the uterine cavity, usually a Fallopian tube. Left untreated, tubal ectopic pregnancy can lead to rupture of the Fallopian tube and life-threatening haemorrhage, and never results in a live birth. Improvements in management have led to a fall in the mortality rate from 2.9 per 1000 ectopic pregnancies in the early 1970s to 0.4 per 1000 in 1994-1996. Here we review the current management of tubal ectopic pregnancy.