D. BarltropD.G. BeeversI. ChanarinK.M. CitronD.J. ColtartA.H. Crisp

I.J.T. Davies

Postgraduate Medical Journal

EDITORIAL BOARD

B.I. HoffbrandEditor

C.D.M. DrewH. Ellis

R. GouldingJ.P. HopewellD. IngramH,S. JacobsD.G. JamesR.S. Kocen

L. KreelJ.G. LewisJ.S. MalpasA. PatonP. Turner

R.G. TwycrossD. Innes Williams

Editorial Representativefor AustraliaJ.R. Lawrence

Editorial Representativefor CanadaP. Tugwell

Editorial AssistantMrs J.M. Coops

Volume 62, Number 730

August 1986

The Postgraduate Medical Journal is publishedmonthly on behalf of the Fellowship ofPostgraduate Medicine by the Scientific & MedicalDivision, The Macmillan Press Ltd, Houndmills,Basingstoke, Hampshire, RC21 2XS, UK.Telephone: Basingstoke (0256) 29242

Postgraduate Medical Journal publishes originalpapers on subjects ofcurrent clinical importanceand welcomes review articles with extensive, up-to-date bibliographies as guides to further reading.Several symposia are published each year, eachdevoted to a single subject and written byspecialists in different disciplines. Most issuesinclude authoritative current surveys of clinicalproblems, well documented reports ofcases ofparticular interest, and book reviews. Aninternational Postgraduate Diary is also includedeach month.

The Fellowship of Postgraduate Medicine wasfounded by a group ofLondon consultants afterthe First World War to assist postgraduates,particularly those coming to London from theCommonwealth, to pursue their studies. TheFellowship first published the PostgraduateMedical Journal to give information aboutlectures, conferences and courses and to provide a

monthly review of all branches ofmedicine.

© 1986 The Fellowship ofPostgraduate MedicineISSN 0032-5473

Manuscripts and all editorial correspondence,including books for review should be sent to: TheEditor, Postgraduate Medical Journal,6 St Andrew's Place, London NW1 4LB, UK.Telephone: 01-935 5556.A 'Notice to Contributors' is published on theinside back cover of this issue. The Editor reservesthe right to make changes which may clarify orcondense papers where this is considered desirable.The Journal is covered by Current Contents,Biological Abstracts, ASCA, ISI/BIOMED andScience Citation Index.

All business correspondence, reprint requests andenquiries concerning advertising space & ratesshould be addressed to the Scientific & MedicalDivision, The Macmillan Press Ltd, Houndmills,Basingstoke, Hampshire RG21 2XS.

Subscription price per volume of twelve issues: UKand Eire £68.00; USA & Canada US$155.00($200.00 Airmail); Rest of the World £85.00(£120.00 Airmail) or equivalent in any othercurrency. Orders must be accompanied byremittance. Cheques should be made payable toMacmillan Journals, and sent to: The MacmillanPress Ltd, Farndon Road, Market Harborough,Leicestershire, LE16 9NR, UK. Whereappropriate, subscribers may make payments intoUK Post Office Giro Account No. 519 2455. Fulldetails must accompany payment.

All rights of reproduction are reserved in respect ofall papers, articles, illustrations, etc., published inthis journal in all countries of the world.

Authorization to photocopy items for internal or

personal use, or the internal or personal use ofspecific clients, is granted by The Fellowship ofPostgraduate Medicine for libraries and otherusers registered with the Copyright ClearanceCenter (CCC) Transactional Reporting Service,provided that the base fee of $01.00 per copy, plus0.10 per page is paid directly to CCC, 21 CongressSt., Salem, MA 01970, USA.0032-5473/86 $1.00 + 0.10

Publishing Manager: Alex Williamson

Production & Editorial Services Manager:Nigel McNeil-Smith

Circulation Services: A.L. Clark

Filmsetting by Vantage Photosetting Co. Ltd.,Eastleigh and London and printed in Great Britainby Unwin Brothers Ltd, The Gresham Press, OldWoking, Surrey.

Whilst every effort is made by the publishers and editorial board to see that no inaccurate or misleading data, opinion or statement appears in this Journal, they wish tomake it clear that the data and opinions appearing in the articles and advertisements herein are the reponsibility of the contributor or advertiser concerned.Accordingly, the publishers and The Fellowship, the editorial committee and their respective employees, officers and agents accept no liability whatsoever for theconsequences ofany such inaccurate or misleading data, opinion or statement. Whilst every effort is made to ensure that drug doses and other quantities are presentedaccurately, readers are advised that new methods and techniques involving drug usage, and described within this Journal, should only be followed in conjunction withthe drug manufacturer's own published literature.

BOOK REVIEWS 815

Therapeutic Factors in Group Psychotherapy, Sidney Blochand Eric Crouch. Oxford Medical Publications. pp. x + 342.Oxford University Press, Oxford, New York, Tokyo, 1985.£16.00.

The group psychotherapist looking for a therapeutic cook-book will not find it here. What they will find is a scholarlyreview of the literature in a field which has not beenrenowned for its conceptual clarity or quality of research.These shortcomings of previous work are partly due to thesheer complexity of group phenomena, and partly to theoften noted resistance of group therapists to submit theirwork to research scrutiny, particularly when this concernsareas, such as therapeutic factors, which transcend and blurcherished theoretical boundaries.

Bloch and Crouch are therefore to be commended forderiving from this conceptual morass a clear, well-organisedpresentation of the ten therapeutic factors which theyidentify from the literature, and their description of each ofwhich includes sections on the factor's definition, theoretical

basis, and relevant research. This they achieve by theiremphasis on precise definition of terms, e.g. the differentia-tion of therapeutic factors from conditions for change andtechniques. Each factor described is illustrated by quotesfrom group members' descriptions of their therapy; and asummary of each of the research investigations considered isincluded in an Appendix.As with any review of the research literature, one can

occasionally question the selection of the studies quoted,some of which are poorly designed or only reported inDissertation Abstracts, while some work of greater clinicalrelevance is not considered. However, this is a minor criticismof a book which is a major contribution to the grouppsychotherapy literature.

David WinterNapsbury Hospital,

London Colney,Nr St Albans,

Herts AL2 JAA.

Books Received

Aids to Undergraduate Obstetrics and Gynaecology, Christo-pher Sinclair and J. Beverley Webb. Pp. iii + 191, illustrated.Churchill Livingstone, Edinburgh, London, Melbourne,New York, 1986. £4.95.

Behavioral Neurology: a Practical Approach, Howard S.Kirshner. Clinical Neurology and Neurosurgery Mon-ographs. Vol.7. Pp. ix + 230, illustrated. Churchill Living-stone, New York, Edinburgh, London, Melbourne, 1986.£24.50.

Diagnosis Before First Aid: a Manual for Emergency CareWorkers, Second edition, Neville Marsden. Pp. xii + 225,illustrated. Churchill Livingstone, Edinburgh, London, Mel-bourne, New York, 1985. £6.95.

Food Additives, Erik Millstone. Pp. 163, illustrated. PenguinBooks, Harmondsworth 1986. £2.95, $8.95 (Australia), $9.95(New Zealand), $6.95 (Canada).

Infertility: Male and Female, edited by Vaclav Insler andBruno Lunenfeld. Pp. vi + 740, illustrated. Churchill Living-stone, Edinburgh, London, Melbourne, New York, 1986.£70.00.

Lecture Notes on Rheumatology, John Edmonds and GrahamHughes. Pp. vii + 307, illustrated. Blackwell ScientificPublications, Oxford, London, Edinburgh, Boston, PaloAlto, Melbourne, 1985. £8.50.

A Manual ofNeonatal Intensive Care, Second edition, N.R.C.

Roberton. Pp. xiii + 369, illustrated. Edward Arnold, Lon-don, 1986. £10.95.

Mental Handicap - a Handbook of Care, edited by EamonShanley. Pp. ix + 336, illustrated. Churchill Livingstone,Edinburgh, London, Melbourne, New York, 1986. £13.95.

The Oxford Companion to Medicine, 2 vols., edited by JohnWalton, Paul B. Beeson and Ronald Bodley Scott. Associateeditors and principal contributors S.G. Owen and PhilipRhodes. Pp. xxii + 1524, illustrated. Oxford UniversityPress, Oxford, New York, 1986. £55.00 set of 2 vols.

Practical Paediatric Problems, Sixth Edition, James H.Hutchison and Forrester Cockburn. Pp. xii + 727, illus-trated. Lloyd-Luke (Medical Books), London, 1986. £17.50.

Practical Pediatric Dermatology, Second edition, William L.Weston. Pp. xiv + 410, illustrated. Little, Brown, Boston,Toronto, 1985. £36.45.

Recent Advances in Rheumatology, No.4, edited by J.M.H.Moll and R.D. Sturrock. Pp. ix + 256, illustrated. ChurchillLivingstone, Edinburgh, London, Melbourne, New York,1986. £40.00.

Respiratory Medicine, N.McI. Johnson. Pocket ConsultantSeries. Pp. 369, illustrated. Blackwell Scientific Publications,Oxford, London, Edinburgh, Boston, Palo Alto, Melbourne,1986. £12.50.

Postgraduate Medical Journal (1986) 62, 816-818

Postgraduate Diary

British Postgraduate Medical Federation

Advanced plastic surgery course. September 1986-June 1989Training programme in medical rehabilitation-commencing

October 1986 for 10 monthsAdvanced course in nephrology 6-10 October 1986Colposcopy of sexually transmitted diseases 30/31 October

1986Liver disease course 15-19 December 1986Advanced pathology course starting October 1986Advanced course in gastroenterology 3-21 November 1986

(multicentre)Educational development courses - programme of coursesand workshops continuing until March 1987: Humandimensions in cardiological care - 15 September, 1986Human dimensions in cancer care - 19 September, 1986

Teaching techniques for hospital doctors 28 October 1986

Central Office, 33 Millman Street, London, WCIN 3EJ, UK.

Institute of Basic Medical Sciences

Courses in Basic Medical Sciences suitable for FRCSPrimary and FFA Part 2, in Basic Dental Sciences suitablefor FDS Primary, in Anatomy suitable for FRCS Primary,and in Physiology and Pathology suitable for FRCSPrimary.

IBMS, Royal College of Surgeons, Lincoln's Inn Fields,London WC2A 3PN, UK.

Institute of Cancer Research

Regular programme of seminars and teaching sessionsthroughout the year. Courses for DMRT (overseasstudents), FRCR etc

Information: The Dean, Institute of Cancer Research, DBlock, Clifton Avenue, Sutton, Surrey SM2 5PX

Cardiothoracic InstituteCourse for diplomas in Cardiac Medicine and Thoracic

Medicine - one year starting October 1986Pharmacology of asthma - starting November 1986Details: Cardiothoracic Institute, Fulham Road, London

SW3 6HP.

Institute of Child Health

Child Health and Nutrition - 6 weeks August/September1986

Developmental paediatrics- 1-2 weeks throughout the yearThe Dean's Office, Institute of Child Health, 30 Guildford

Street, London WCIN IEH

Institute of Dental SurgeryCourses for M.Sc in various aspects of dentistry, Diploma in

Dental Public Health, basic medical sciences etc.

Information: The Dean, Institute ofDental Surgery, EastmanDental Hospital, Gray's Inn Road, London WCIX8LD

Institute of Laryngology & OtologyPractical revision forDLO Part II - 2 weeks full time starting

OctoberDiagnosis and treatment of the deaf child - advanced course

3 days full time October

Applications and enquiries to the Dean, Institute of Laryn-gology and Otology, 330/336 Gray's Inn Road, LondonWC1X8EE

Institute of NeurologySandoz Foundation advanced lectures on clinical and ex-

perimental neurology. Each Wednesday evening through-out Academic Year

Details: Institute Registrar, National Hospital, Queen Square,London WCIN 3BG, UK.

Institute of Obstetrics and GynaecologyNeonatal course for senior paediatricians from abroad. 1-4December 1986

Multiple births - symposium 3 October 1986Advanced course for obstetricians and gynaecologists 7-10

October 1986

Details: The Secretary, Institute of Obstetrics and Gyn-aecology, Queen Charlotte's Maternity Hospital, GoldhawkRoad, London W6 OXG

Institute of OphthalmologyRefresher course for FRCS (Ophthalmology) - 3 weeks

fulltime starting SeptemberRegular courses in ophthalmology held throughout the year17/25 Cayton Street, London EC1V 9AT, UK.

Institute of OrthopaedicsM.Sc. in Orthopaedics - starting OctoberRadiodiagnosis demonstrations - Mondays at 5.00 p.m.

during the academic yearApplications and enquiries to Professor of Orthopaedic Sur-

gery, Jules Thorn Building, The Middlesex Hospital, Mor-timer Street, London WIP 7PN

Institute of PsychiatryLectures in preparation for DPM and MRCPsych. 10 weeks

part-time starting OctoberThe Dean's Office, Institute of Psychiatry, De Crespigny

Park, London SE5 8AF

Institute of UrologyDiploma course in urology September to JulyShort courses on aspects of urology and nephrology -

throughout the yearApplications and enquiries: The Dean, Institute of Urology,

172-176 Shaftesbury Avenue, London WC2H8JE

POSTGRADUATE DIARY 817

Royal Postgraduate Medical School

Regular courses on advanced topicsSchool Office, Royal Postgraduate Medical School, Hammer-

smith Hospital, Du Cane Road, London W12 OHS, UK.

Oxford Regional Committee for Postgraduate MedicalEducation and TrainingNeurosciences Course, Department of Human Anatomy,

Oxford. 15-19 September 1986.

Details: Regional Postgraduate Offices, Medical SchoolOffices, Level 3, John Radcliffe Hospital, OxfordOX3 9DU

International Union Against Cancer

Details of fellowship programmes from

3 rue du Conseil-General, 1205 Geneva, Switzerland.

Liverpool, Newsham General HospitalLunchtime meetings twice monthlySecretary, Postgraduate Centre, Belmont Road, Liverpool, L64AF, UK.

London School of Hygiene and Tropical Medicine

Courses in community health, occupational health andpreventive medicine

The Registrar, LSHTM, Keppel Street, London WCIE 7HT,UK.

European Conference on Sarcoidosis

Vienna, 27-29 August, 1986

Details from Dr D. G. James, Royal Northern Hospital,London N7 6LD

XI World Congress on Sarcoidosis

Milan, 7-11 September 1987

Details from Dr D. G. James, Royal Northern Hospital,London N7 6LD

10th International Subcellular Methodology Forum

Investigation of cellular derangements 1-4 September 1986Details: Dr E. Reid, Guildford Academic Associates, 72 TheChase, Guildford GU2 SUL, Surrey, U.K.

University of CaliforniaSan Diego Imaging Symposium. October 30-November 1,1986.

Details: Dawne Ryals, P.O. Box 920113, Norcross, GA 30092-0113, U.S.A.

Conference: Motherhood and Mental Illness

Third International Conference of the Marc6 Society. Un-iversity of Nottingham Medical School, England. 27-29August 1986.

Details: Marce Society Secretariat, Bell Howe Conferences,Kingsley House, 104 Loughborough Road, West Bridgeford,Nottingham NG2 7JH

10th International Congress of PharmacologyAugust 23-28, 1987. Sydney, AustraliaDetails: The Secretariat, 10th IUPHAR Congress, GPO Box

2609, Sydney, NSW 2001, Australia

Computers in Health CareFirst National Conference on the use of computers in health

care, education and training. Keele University 22-24September 1986.

Details: CBT86, Open Software, 164 Windsor Road, Ashton-in-Makerfield, Wigan, WN4 9ES

University of Arkansas for Medical Sciences2nd International Symposium on the pharmacological effects

of copper complexes. August 11-15 1986Details: College of Pharmacy, University of Arkansas for

Medical Sciences, Slot 522, 4301 W, Markham, LittleRock, Arkansas, U.S.A.

12th World Congress on Fertility and SterilitySingapore - 26-31 October 1986

IFFS '86, c/o Obstetrical & Gynaeological Society of Sin-gapore, Kandang Kerbau Hospital, Hampshire Road, Sin-gapore 0821.

International College of Nutrition

The annual conference will be held in January 1987 atMadurai.

Details: Dr R.B. Singh, 398 Civil Lines, Moradabad-10, India.

Ear, Nose and Throat Diseases in Children13th Annual Symposium presented by Depts of Otolaryn-gology and Pediatrics, Children's Hospital of Pittsburgh.Palm Beach, Florida, December 3-7, 1986.

Information: Dept of Otolaryngology, Children's Hospital ofPittsburgh, 125 De Soto St, Pittsburgh, Pa., 15213, USA.

1987 International Symposium on Viral Hepatitis and LiverDiseaseThe Barbican Centre, London 26-28 May 1987

Information: Dr. R. Kohn, Advisory Services Medical Sym-posia Ltd., 79 Wimpole Street, London WIM 7DD

818 POSTGRADUATE DIARY

16th European Conference on Psychosomatic ResearchAthens, Greece 6-11 September 1986. Main topic - Psy-

chosomatic Medicine, past and future

Information: Professor G.N. Christodoulou, Athens UniversityDepartment of Psychiatry, Eginition Hospital, VasilissisSofias 74, Athens, 11528, Greece

12th World Congress of International Society for Research onCivilization Diseases and EnvironmentYokohama, Japan. Nov 4-6, 1986. 'Man and Environment-

Health in the Society of High Technology'Information: Secretary-General S.I.R.M.C.E., Mrs. F. Hen-

drickz, 61 Rue E. Bouillot bte 11, B-1060 Brussels, Belgium

South West Thames Regional Library Service

Course in Basic Library Skills. 18 September to 4 December1986. St Luke's Hospital, Guildford, Surrey.

Details: Helen Taylor, Assistant Regional Librarian, StLuke's Hospital, Guildford, Surrey GUI 3NT

Full details of the courses, meetings and symposia listedabove, and ofothers ofinterest to medical postgraduates, canbe obtained from the individual organizations.

News

St Andrew's Place Medical Precinct

i - K;~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~---------".I

The St Andrew's Place Medical Precinct ofthe Royal Collegeof Physicians was opened by H.M. The Queen on 11th June1986. The offices ofthe Fellowship ofPostgraduate Medicineand the Postgraduate Medical Journal are in the precinct, inHouse 6. The photograph above shows Houses 1-8, StAndrew's Place.

The Editor of the Postgraduate Medical Journal, Dr. B.I.Hoffbrand, who is also a Vice President of the Fellowship ofPostgraduate Medicine, was among those presented to HerMajesty.

Fellowship of Postgraduate Medicine

Professor Paul Turner, Professor of Clinical Pharmacology,St Bartholomew's Hospital Medical School, has been electedPresident of the Fellowship of Postgraduate Medicine on theretirement from office of Mr John Hopewell.

Notice to Contributors

The Postgraduate Medical Journal considers manus-

cripts prepared in accordance with the guidelines laiddown by the International Committee of MedicalJournal Editors (Br Med J, 1982; 284, 1766-70). Allmaterial submitted is assumed to be submitted ex-

clusively to the Postgraduate Medical Journal unlessthe contrary is stated.Typescripts Two complete copies should be sent tothe Editor, Postgraduate Medical Journal, 6 StAndrew's Place, London NW1 4LB. Papers must betypewritten, double-spaced, on one side of paper notlarger than A4 (297mm x 210mm), with a 5 cm mar-

gin. The first page of the typescript should bear thenames of the author(s) and the name and address ofthe laboratory or institution where the work has beencarried out, in addition to the title of the paper. Thefull address of the principal author to whom proofswill be sent should be given as a footnote, as shouldany permanent changes of address and/or appoint-ment. A short (running) title of not more than 45characters should be given. All pages should benumbered including the title page.The principal author must ensure that any co-authorslisted agree to submission of the typescript. Anywritten or illustrative material which has been or willbe published elsewhere must be duly acknowledgedand accompanied by the written consent ofthe authorsand publishers concerned.Arrangement Papers should be divided into; (a) Titlepage, (b) Summary, (c) Introduction, (d) Materialsand methods, (e) Results, (f) Discussion, (g) Ackn-owledgements, (h) References, (i) Tables, (j) Figuresand captions. The summary should not exceed 250words and should state concisely what was done, themain findings and how the work was interpreted. In allsections of the paper numbered paragraphs should beavoided if at all possible.Style Abbreviations and symbols must be standardand SI units used throughout. Acronyms should beused sparingly and must be fully explained when firstused. Whenever possible drugs should be given theirapproved generic name. Where a proprietary (brand)name must be used, it should begin with a capitalletter. Statistical analyses must explain the methodsused. The use of footnotes is not permitted. Singlequotation marks should be used and words to beitalicized should be underlined. The Concise OxfordEnglish Dictionary is used as a reference for all spellingand hyphenation.References should follow the Vancouver format. In thetext, they should appear as numbers starting at 1. Atthe end of the paper they should be listed (double-spaced) in numerical order corresponding to the orderofcitation in the text. All authors should be quoted forpapers with up to six authors; for papers with morethan six authors, the first three only should be quotedfollowed by et al. Abbreviations for titles of medicalperiodicals should conform to those used in the latestedition of Index Medicus. The first and last page

numbers for each reference should be provided. Abs-tracts and letters must be identified as such.1. Clements, R. & Gravelle, I.H. Radiological

appearances ofhydatid disease in Wales. Postgrad,Med. J. 1986, 62: 167-173.

2. Greenbeerger, J.S. Long-term hematopoietic cul-tures. In: Golde, W. (ed) Hematopoiesis. Churchill-Livingstone, New York, 1984, pp 203-242.

Figures In the text Arabic numbers should be usedand all illustrations should be specifically referred to inthe text, e.g. (Figure 2). All illustrations should besubmitted at about 1½ times the intended final size andshould be numbered as figures whether they arephotographs, representational drawings or linediagrams and graphs.Photographs and photomicrographs should be un-mounted glossy prints and should not be retouched,and should be chosen to exclude technical artefacts.Magnification is best indicated by a line representing adefined length included within the photographs. Areasof key interest and/or critical reproduction should beindicated on a flimsy overlay attached to thephotograph or on a photocopy. All annotations andlettering should be indicated in the same way, andpreferably not included on the original print. Clearlycontrasted and focused prints are essential for ad-equate reproduction.Line diagrams and graphs should be on separate sheets;they must be drawn with black Indian ink on whitepaper, or supplied as photographic prints of suchoriginals. Lettering on figures should be minimal andmust not duplicate the legend. The use of symbolsshould be consistent within papers, and explanationsof symbols should be included in the caption, not onthe figure.A photocopy of all illustrations should be submitted.Tables These should be as few as possible and shouldpresent only essential data. They should be typewrit-ten on separate sheets, have a title or caption, andgiven Roman numbers.Proofs Two marked copies of the proofs will be sentto the principal author which should be read carefullyfor errors. One corrected copy must be returned to theeditor within 3 days. Major alterations to the textcannot be accepted.Copyright assignment The principal author mustcomplete and return to the Publisher the CopyrightAssignment Form enclosed with the proofs.Offprints Twenty-five offprints will be supplied freeofcharge to the principal author. Additional offprintsmay be ordered on the form accompanying proofs.The charges are necessarily higher if orders arereceived after the issue has gone to press.Drug side effects Manuscripts reporting adversedrug reactions should be accompanied by evidenceshowing that the reaction has been reported on a'yellow card' or to the appropriate drug licensingauthority, and to the drug manufacturer.