243 ability to ketoacidosis and their more general perceptions of control of diabetes provided useful pointers to risks of subsequent ketoacidosis during use of continuous subcutaneous infusion. 1 Mecklenberg RS, Benson EA, Benson JW, et al. Acute complications associated with insulin infusion pump therapy. Report of experience with 161 patients.JAMA 1984;252:3265-9. 2 Peden NR, Braaten JT, McKendry JBR. Diabetic ketoacidosis during long-term treatment with continuous subcutaneous insulin

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... on. Diabetes Care 1984;7:1-5. 3 Knight G, Jennings AM, Boulton AJM, Tomlinson S, Ward JD. Severe hyperkalsenia and ketoacidosis during routine treatment with an insulin pump. BrMedJ 1985;291:371-2. 4 Knight G, Boulton AJM, Drury J, et al. A feasibility study of the use of continuous subcutaneous insulin infusion in a diabetic clinic: patients' choice of treatment. Diabeic Medicine 1984;1:267-72. 5 Bradley C, Brewin CR, Gamsu DS, Moses JL. Development ofscales to measure perceived control of diabetes mellitus and diabetes-related health beliefs. DiabeticMedicine 1984;1:213-8. We describe two cases ofpneumomediastinum which occurred in stowaways on a banana boat arriving at Avonmouth Docks, Bristol, from Columbia, South America. The voyage took 17 days, duringwhich time the two men ate and drnk very little. The temperature in the hold of the ship was 54-59CC. Case reports Case I-A 23 year old msn was hypothermic (34-r8C), moderately dehydrated, and, except for resting tachycardia of% beats/min, showed no abnormal cardiovascular or respiratory signs. There was evidence of cold injury to both feet. Investigations showed blood urea concentrations of 76 mmol/l (458 mg/100 ml),