Reversible bone loss in anorexia nervosa.

should be encouraged. In the mean time dentists should follow all the recommended measures of asepsis, disinfection, and sterilisation beginning with, among others, handwashing and care ofhands and decontamination of instruments and environmental surfaces and ending with disposal of waste materials.3 Our findings are further evidence ofwidespread contamination by HBsAg-in areas where carriage rates are high and reinforce the view that vaccination against hepatitis B should be extended to everyone living in such an area. Such a mass vaccination programme would be prohibitively expensive, however, and we therefore suggest that certainly all children aged 3 months to 12 years should be vaccinated 'using the cheaper but equally effective protocol developed by us4'5 and accepted by both the French and Italian health authorities. Emergency phlebography service: is it worth while? Many patients present with suspected deep vein thromboses, and immediate confirmation of this diagnosis allows treatment to be started and patients to be discharged earlier, If the result of investigation is normal the patient can be sent home from the casualty department. For this reason an emergency phlebography service has been established at this hospital, but the radio-logists thought that too many normal phlebograms were being obtained. We undertook a prospective study to assess the value of the service. For seven months all patients referred for phlebography ofthe leg for suspected deep vein thrombosis were assessed by a radiologist for predisposing factors and physical signs of thrombosis. The findings and provisional diagnosis of the Deep vein thrombosis: radiologists opinion and result of phlebography Radiologist's opinion Result of phlebography Normal Thrombosis Normal 48 17 Thrombosis 5 50 radiologists and the results of phlebography were recorded. All phlebograms were obtained by injecting iopamidol into the foot. Altogether 120 patients (78 women, 42 men) were investigated; the age range was 17-90, 46 patients being over the age of 65. Normal phlebograms were reported in 65 patients; 12 of these were inpatients and 53 were referred from the casualty department and were subsequently discharged. The table summarises the results. Comment Confirmation of thrombosis is necessary before starting oral anti-coagulation and the most cost effective way of doing this is to use phlebography.' Sixty five of the 120 patients with deep vein thromboses suspected on clinical grounds had normal phlebograms; this correlates well with other published results.' 2 This does not bear out the impression that too many normal phlebograms were being obtained. Phlebography done before …