An international working team defined the irritable bowel syndrome as distinct from other functional bowel disorders. Symptom criteria for the irritable bowel syndrome are known as the Rome criteria. Since there is no pathophysiological marker for any of these syndromes we must rely on symptoms for their definition and classification. The Rome nosology is a step towards better understanding of functional gastrointestinal disorders because the disparate syndromes are likely to have different causes and treatments.

Tight blood glucose control has been speculated to reduce late complications in insulin-dependent diabetics but results from individual studies have been inconsistent. We have done a meta-analysis of sixteen randomised trials of intensive therapy to estimate its impact on the progression of diabetic retinopathy and nephropathy and the risks of severe side-effects. In the intensive therapy group, the risk of retinopathy progression was insignificantly higher after 6-12 months of intensive control (odds ratio [OR] 2.11). After more than two years of intensive therapy the risk of retinopathy progression was lower (OR 0.49 [95% confidence interval 0.28-0.85], p = 0.011). The risk of nephropathy progression was also decreased significantly (OR 0.34 [0.20-0.58], p < 0.001). The incidence of severe hypoglycaemia increased by 9.1 episodes per 100 person-years (95% Cl -1.4 to +19.6) in the intensively treated patients. The incidence of diabetic ketoacidosis increased by 12.6 episodes per 100 person-years (95% Cl, 8.7-16.5) in the patients on continuous subcutaneous insulin infusion. Long-term intensive blood glucose control significantly reduces the risk of diabetic retinopathy and nephropathy progression but long-term continuous subcutaneous insulin infusion was associated with an increased incidence of diabetic ketoacidosis, and intensive therapy may cause more severe hypoglycaemic reactions.

The uncomfortable awareness of a beating heart--palpitations--is a common complaint that can occur under normal or abnormal circumstances. For example, normal palpitations occur with exercise, emotions, and stress, or after taking substances that increase adrenergic tone or diminish vagal activity (coffee, nicotine, and adrenergic or anticholinergic drugs). Normal palpitations are recognised as such because individuals who experience them realise or are told that something happened to accelerate the normal rhythm of the heart. However, some people find sinus tachycardia troublesome enough to seek medical attention. In other situations palpitations are clearly abnormal. The heart beat which is felt for no apparent reason, may be fast, or strong and slow, or feel like a missed or extra beat. Although these abnormal palpitations usually point to a cardiac arrhythmia, this is not always the case. Moreover, many patients with arrhythmias do not have palpitations but manifestations such as syncope, shock, and chest pain (sudden death is also possible). We will discuss the approach to the patient who seeks medical attention because of a history of palpitations, with special emphasis on the history, physical examination, and 12-lead electrocardiogram (ECG) because they are simple and inexpensive diagnostic tools that are available to most physicians.

The intercellular connections that characterise advanced forms of life would not be possible without a mechanism to remove individual cells that are no longer needed, or that function abnormally. Such physiological cell death, in the absence of inflammation, is achieved by apoptosis, a structurally distinct programmed cell death pathway. Defective regulation of programmed cell death may play a part in the aetiology of cancer, AIDS, autoimmune diseases, and degenerative diseases of the central nervous system. The pharmacological manipulation of apoptosis offers new possibilities for the prevention and treatment of these illnesses.

Babies who are small at birth or during infancy have increased rates of cardiovascular disease and non-insulin-dependent diabetes as adults. Some of these babies have low birthweights, some are small in relation to the size of their placentas, some are thin at birth, and some are short at birth and fail to gain weight in infancy. This paper shows how fetal undernutrition at different stages of gestation can be linked to these patterns of early growth. The fetuses' adaptations to undernutrition are associated with changes in the concentrations of fetal and placental hormones. Persisting changes in the levels of hormone secretion, and in the sensitivity of tissues to them, may link fetal undernutrition with abnormal structure, function, and disease in adult life.

Faecal excretion of cysts known as cyanobacterium-like bodies (CLB) is associated with a diarrhoeal illness, which is often prolonged and severe. It is seen mainly in travellers and immunocompromised patients. Recently these cysts have been shown to be coccidian oocysts. We describe three patients who developed diarrhoea while travelling abroad. Stool samples from all three patients contained CLB. Jejunal aspirates from two patients also yielded CLB. Conventional histology of jejunal biopsy specimens confirmed that two patients had enteritis. Electronmicroscopy of the same biopsy specimens revealed intraepithelial coccidia. These findings suggest that the small bowel is the site of infection of this new coccidian disease.