S Sjölin

Repeated recurrence of Clostridium difficile-associated enterocolitis is uncommon but troublesome for the afflicted patient. The patient described here received vancomycin treatment several times but always had a relapse of C. difficile enterocolitis 2-3 weeks after discontinuation of treatment. She did not form serum antibodies to C. difficile cytotoxin (toxin B). Rectal infusion of enemas prepared from fresh faeces resulted in final cure.

Each of three families of northern European origin contains a mentally retarded son with hemoglobin H (Hb H) disease. One parent is a carrier of mild alpha-thalassemia and the other is normal, suggesting that this form of Hb H disease results from the interaction between an inherited defect of alpha-chain production and one member of the pair in chromosome 16 and a new mutation on the other. Restriction-enzyme analysis indicated that the new mutation was not the same in the other three patients, and demonstrated at least two hitherto undescribed lesions involving the alpha-globin gene cluster. Unless the association between the Hb H disease and mental retardation is fortuitous, the new mutations may also be related to the development changes in these children. Since the mutations only came to light because there was concurrent inheritance of an additional alpha-thalassemia determinant, this type of mutation of chromosome 16 may have been overlooked in other mentally retarded patients.

A method for plasma bilirubin determination is described. It is a modification of the Jendrassik and Grof alkaline diazo-coupling procedure and allows determination of both conjugated and unconjugated bilirubin in small amounts of plasma. Five commonly used diazo-coupling methods are compared with special reference to the influence of hemolysis in the sample. The Jendrassik and Grof method as modified by Nosslin and Michaëlsson is shown to have the smallest methodological error and to be insignificantly influenced by hemolysis in the sample, in contrast to the methods of Malloy and Evelyn, Lathe and Ruthven, Ducci and Watson, and Powell. The bilirubin standardization procedure, methodological errors, and the influence of hemolysis in the sample are discussed.

In 1972, 298 mothers representative of the city of Uppsala in general breast fed their babies for only a brief period of time despite a clear wish to continue--36% up to 8 weeks. The most common reason for terminating breast feeding was that the "milk dried up" (66%). More precise reasons commonly mentioned were anxiety of all kinds, lack of motivation, stress, tiredness and work outside the home. It was further found that mothers who enjoyed their breast feeding, were well educated, were older than 25 years and belonged to social class 1, tended to breast feed longest.

A prospective study of the course of breast feeding was carried out in 75 randomly selected women. Weekly interviews were performed from the day after delivery until the termination of breast feeding, but in no case for longer than 6 months. In each case a detailed analysis was made of the factors leading to transient lactation crises or to complete cessation of breast feeding. A second group of 71 mothers, also randomly selected, was interviewed in retrospect only, 6 months after delivery, and served as controls. Twenty-four weeks after delivery 47% of the mothers in the weekly interview group were still breast feeding. The corresponding figure in the control group was 38%. In both groups only few mothers terminated lactation for medical reasons, while about one fourth stopped for some other reason and about one half because of a combination of factors. Brief case reports are presented to illustrate how varying the factors were that threatened breast feeding.