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The length of the gap between upper and lower oesophageal segments in oesophageal atresia is better discovered before rather than while operating. Surgeons in India have proposed a simple method (Journal of Pediatric Surgery1997;32:1453-4): 12 of 61 patients with tracheo-oesophageal fistula had long gap (more than two vertebrae) oesophageal atresia, and chest radiography showed that nine of these 12 patients—but none of the other 49—had 13 pairs of ribs. The suggestion is that having an extra thoracic vertebra stretches the gap between the oesophageal segments.

Passive smoking may increase the risk of meningococcal disease. A US case-control study (Pediatric Infectious Disease Journal 1997;16:979-83) found that, after statistical adjustment for confounding factors, maternal cigarette smoking was the strongest risk factor for invasive meningococcal disease in children, increasing the risk fourfold. Nearly 40% of cases were thought to be attributable to maternal smoking. There was a weaker association with paternal smoking.

Treatments aimed at subduing the inflammatory response in meningococcal septicaemia have generated much hope but little real joy. Now a protein found in the granules of neutrophils has shown some …

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