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Notes: Summary. Urinary albumin excretion during pregnancy has been studied using a sensitive radioimmunoassay. One hundred pregnant women attending a high-risk antenatal clinic and 14 normal pregnant women were investigated serially, during pregnancy and post-partum. The normal subjects showed a small but significant rise in albumin excretion in the third trimester, which was sustained pre-delivery and in the first postnatal week. Twenty-six women were classified as having mild pre-eclampsia and 44 as having chronic hypertension without evidence of superimposed pre-eclampsia. In neither group was there evidence of proteinuria by conventional testing, nor was the median albumin excretion different from normal antenatally; in the first week after delivery a significant increase was observed, but this regressed to normal 6 weeks later. Eight patients developed severe pre-eclampsia, of whom one had evidence of underlying renal disease. Three presented with proteinuria already established. In the remaining five patients, the shift from normal to high albumin excretion occurred rapidly, usually preceded by a rise in uric acid and a decrease in the platelet count. These data suggest that proteinuric pre-eclampsia, as defined by relatively insensitive routine laboratory measurement, is not preceded by a phase of increasing albumin loss which can be detected by more sensitive assays.

Notes: We report a case of acetaminophen-induced liver necrosis in a 14-year-old girl. At autopsy, a 9 cm subcapsular nodule was present in the right lobe of the liver which showed distinct zonation: a central greyish white area of fibrolamellar carcinoma with a peripheral fleshy, tan-coloured rim ranging from 1 to 2 cm in thickness. This peripheral zone consisted of nodular, hyperplastic parenchyma resembling the changes seen in focal nodular hyperplasia, and stood out from the adjacent necrotic parenchyma. The sparing of this zone from the deleterious effects of acetaminophen provides indirect evidence of a predominantly arterial rather than portal blood supply to this region. The arterial supply was most probably derived from the tumour vasculature and may explain the parenchymal hyperplasia sometimes reported adjacent to a fibrolamellar carcinoma. Awareness of this phenomenon is essential when evaluating a needle biopsy, as sampling of this region may lead to a false negative diagnosis.

Notes: Sections from 95 skin lesions excised at pigmented lesion clinics in England and Scotland were studied by eight histopathologists in order to evaluate consistency in the use of histopathological terms for features of diagnostic and prognostic importance for cutaneous malignant melanoma. The level of agreement (kappa) amongst the panel improved after discussion and re-definement of criteria for several features. These included, architectural and nuclear atypia, pagetoid infiltration and radial and vertical growth phases. A high level of agreement was achieved for an overall benign or malignant diagnosis (κ = 0.77) but use of more specific terms such as benign naevi with atypia and melanoma ≤0.76 mm thickness, was associated with only an intermediate level of agreement. Of the original diagnosis of melanoma, 17% were re-classified by the panel as benign with atypia and 2% reported to be benign were judged to be melanoma. This reflected the high proportion of borderline lesions in the study. The use of standardized diagnostic criteria with precise definitions has been shown to improve consistency in diagnosis and it is recommended for general application. From this should emanate more reliable incidence figures for thin melanoma, and improved understanding of the nature of these early lesions, to the benefit of patient and clinician alike. The poor concordance in distinguishing severe dysplasia in the junctional component of melanocyte proliferations from melanoma in situ and superficial dermal invasion improved only modestly despite intensive efforts. Since melanoma in situ and severe dysplasia cannot be distinguished by objective measurements and since their clinical management is the same, the panel suggests that attempts to separate them in diagnostic reports should be discontinued and they could both be referred to as melanocytic intraepidermal neoplasia (MIN). If it becomes accepted that dermal invasion without a vertical growth component can also be managed identically to MIN, then this invasive radial phase may be appropriately referred to as microinvasion and linked to MIN for the purposes of clinical management.

Notes: Air travel has increased steadily over the last decade, and its effect on the health of passengers has been the subject of much debate. There is a paucity of evidence on the effects of air travel on oxygen saturation in general populations. The peripheral oxygen saturation and pulse rate of 84 passengers, aged 1–78 years, were measured by pulse oximetry at round level and altitude during air travel. There was a statistically significant reduction in oxygen saturation in all passengers travelling long haul and short haul flights (p 〈 0.05). The mean [range] (SD) SpO2 for all flights at ground level was 97% [93–100] (1.33) and at cruising altitude 93% [85–98] (2.33). Fifty-four per cent of passengers had SpO2 values of 94% or less at cruising altitude. This is a value which may prompt physicians to administer supplemental oxygen in hospital patients.