THANKS to OUR REFEREES It Is Once More a Pleasure to Acknowledge the Enormous Help Given by Referees up to 30June 1989

THANKS TO OUR REFEREES It is once more a pleasure to acknowledge the enormous help given by referees up to 30June 1989. In an effort to improve the standard of published papers we have placed an increasing burden on the reviewers. Our success is reflected in the enormous increase in proffered articles and we accept only about 30% of those we see. Thank you for your help. Please continue to act as referees. R M KIRK, Editor Anthony Adams Jean-Claude Gazet Michael Owen-Smith John Alexander-Williams Alan Gilston Roger Parker Patricia Allen Frederick Given Simon Paterson-Brown Tim Allen-Mersh Malcolm Gough John Payne Alan Apley John Groves John Pepper Douglas Arthur Robert Gumpert Richard Plummer Brian Sterry Ashby David Hamer Alan Pollock Michael Handley Ashken George Hamilton Roy Pounder Mike Baddeley Jack Hardcastle Grant Radcliffe Peter Baird Arthur Hargreaves David Ralphs Roger Baird Don Harrison Andrew Ransford Michael Baum David Hatch John Rennie John Beaugie David Hay John Rickett Peter Bell Peter Heath Paul Rogers Eddie Benson Brian Heather Tony Rubin George Bentley Tom Hennessy Geoffrey Rushman Donald Bethune Penelope Hewitt Chris Russell Roger Blamey Edmund Hoare Roger Sage John Blandy Michael Horrocks GeoffSagor John Bolton Michael Hubbard Richard Sainsbury John Bradbeer David Hunt John Sale Tom Brennan Clem Imrie John Samuel Philip Britton Miles Irving Ivor Schraibman Ivor Broomhead Georges Jantet Frank Schweitzer Ashley Brown PatrickJeffery John Scurr Colin Brown Alan Johnson Jonathan Secker-Walker Norman Browse BarryJones William Shand Tim Bucknall GarethJones John Shaw Michael Burke Amir Kaisary Robert Shearer Ian Calder Vijay Kakkar Derek Sibson Bruce Campbell Leon Kaufman David Skidmore Roger Celestin Malcolm Keene Maurice Slapak Peter Cole Michael Keighley Robert Souhami Martin Cooper Alan Kerr Joe Smith Richard Corbett Michael Kettlewell Roger Springall John Craven Norman Kirby Geoffrey Stamatakis Rodney Croft Mark Kissin Michael Stearns Michael Crumplin Peter Lee Philip Stell David Dandy Sam Leinster Chris Stoddard John Dark Peter Lord Joe Stoddart Dai Davies John Lumley Kenneth Stone John Davies Charles Mann Ted Sumner Nicholas Davies Paul Marks Peter Sykes John Dawson Henry Marsh Brent Tanner Thomas Dehn Peter McElvie Irving Taylor Brendan Devlin Ian McGregor Lee Taylor Peter Dickinson James McKinna Hamish Thomson John Dixon Douglas Meikle James Thomson James Dooley Kenneth Mills Tom Treasure Hugh Dudley Sam Mitchell Andrew Turnbull Nick Dudley Gaynor Moncur Chris Ward David Dunn Kenneth Moore Mike Ward Richard Earlam Brian Morgan Anthony Watson Richard Ellis Robert Morgan Chris Wastell Terence English Neil Mortensen Tony Watson Harry Espiner John Mosley James Wellwood Oswald Fernando David Negus Harvey White Cyril Fisher John Neman John Wildsmith Ray Fitzgerald John Neoptolemos Tony Wildsmith Duncan Forrest John Norman David Williams Murray Foster Mitch Notaras Steven Williams John Foulston Joe O'Brien Robin Williamson Ian Fraser Tom Ogg David Wilson Richard Gardham Neil Orr John Wolfe Michael Gear David Osborne John Wyllie INDEX TO VOLUME 71 JANUARY-NOVEMBER 1989

Author Index The first figure indicates the issue; the second figure indicates the page

A Briggs M, see Poole MD, (3)187 Ackery DM, see Hunt TM, (1)11 Bristow A, and Orlikowski C, Subcutaneous ketamine Addison NV, see Ingoldby CJH, (4)211 analgesia, (1)64 Al-Janabi T, see Al-Saleem T, (6)366 Britton D, see ChesterJ, (6)370 Al-Saleem T, and Al-Janabi T, Schistosomal cholecystitis: six Britton J, see Bickerstaff KI, (6)384 cases, (6)366 Britton JP, and Ferro MA, DoubleJ ureteric catheter Alexander D, see Madan M, (4)273 insertions, (Comment), (3)205 Alexander-Williams J, see Heyen F, (2)101 Broome GD, see Eardley I, (5)278 Allan RN, see Heyen F, (2)101 Brough S, Surgery in a geriatric population, (Comment), Allan SM, and Heddle RM, Prolene plug repair for femoral (4)273 hernia, (4)220 Brough W, see Kune GA, (1)23; see Kune GA, (4)269; and Allen-Mersh TG, see Miles AJG, (4)225 Tweedle D, Oesophagojejunal anastomosis using EEA Allum RL, see Jones JR, (1)40 Premium stapling gun, (5)322 Aluwihare APR, Rectourethroanoplasty for imperforate anus Broughton NS, Personality assessment and aptitude testing in male children, (1) 14 in selection of surgical trainees, (Comment), (1)73 Ambrose NS, see Heyen F, (2)101 Brunt AM, see Barr LC, (6)390 Amery AH, see Anderson PE, (2)124 Bryan AJ, et al, Unilateral digital ischaemia secondary to Anderson PE, et al, Fibreoptic endoscopic dilatation of embolisation from subclavian atheroma, (2)140 oesophageal stricture, (2)124 Bull JC, see Upadhyay AK, (3)204 Appleton GVN, et al, Angiography in surgical management Bunker T, Shoulder arthroscopy, (4)213 of pancreatic disease, (2)92 Burd RM, see Sharpe DT, (3)175 Armstrong CP, and Whitelaw SJ, Death from unsuspected Burden RP, see Foster MC, (1)44 colorectal cancer, (1)20 Burtles R, Analgesia for 'bat ear' surgery, (5)332; Subclavian Askew AR, et al, Early postoperative sphincterotomy for vein catheterisation for parenteral nutrition, (Comment), retained common bile duct stones, (6)359 (4)268 Atkinson RS, Book review, (5)280 Aveling W, see Tan PSK, (2)81 C B Cahill J, et al, Monofilament versus PTFE sutures for Baer S, Securing nasogastric tubes, (Comment), (1)74 inguinal herniorrhaphy, (2)128 Baigrie RJ, see Cobb RA, (5)299 Callander CC, and Mousdale S, Diagnosis and anaesthetic Barker SGE, et al, Intraoperative testing of colorectal management of cardiac tamponade, (Comment), (2)147 amastomoses, (Comment) (5)338 Celestin R, Assessor's comments, (5)310 Barlow AP, et al, Surgery in a geriatric population, (2)110 Chamsi-Pasha H, et al, Two-dimensional echocardiography Barr LC, et al, Primary management of breast cancer: in diagnosis of cardiac complications of total parenteral conservation, (6)390 nutrition, (2)120 Bathurst NCG, see Appleton GVN, (2)92 Chan TYK, and Smedley FH, Improved method for securing Bell BA, MRI in measurement of brain water changes, nasogastric tubes, (Comment), (3)204 (6)375 Chapman RW, see Bickerstaff KI, (6)384 Bennett JG, Oedema after lower limb revascularisation, Cheesman AD, et al, Craniofacial resection for orbital compartment syndrome and, (Comment), (2)146 tumours, (5)333 Bentley BG, see Barker SGE, (5)338 ChesterJ, and Britton D, Elective and emergency surgery for Berry AR, see Bickerstaff KI, (6)384; and Cussons PD, colorectal cancer, (6)370 Massive colonic haemorrhage. The case for right ChesterJF, et al, Efficacy of wound perfusion with hemicolectomy, (Comment), (6)409 bupivicaine in postoperative pain, (6)394 Beynon J, Rectal endosonography in rectal cancer, (2)131 Chung SC, see Park KGM, (5)324 Bhamra M, see Ferris BD, (2)115 Clarke AM, and Horrocks M, Polytetrafluoroethylene loop Bickerstaff KI, et al, Endoscopic sphincterotomy for bile duct grafts in haemodialysis, (Comment), (3)204 stones, (6)384 Coad NR, and Hain WR, Caudal anaesthesia for Bishop H, see Hands LJ, (5)306 postoperative pain in children, (4)245 Blamey RW, see Foster MC, (1)44 Cobb RA, et al, Effects of cuts in services on work of a Blaquiere RM, see Hunt TM, (1)11 surgical unit in a district general hospital, (5)303; et al, Bolton J.see Khoury GA, (1)50 Workload of a surgical unit in a district general hospital, Bracey DJ, Acute traumatic haemarthrosis of the knee, (5)299 (Comment), (4)270 Cook A, see Anderson PE, (2)124 Bradley PJ, Improved method for securing nasogastric tubes, Cook AJ, see Barker SGE, (5)338 (Comment), (2) 144 Cook JA, et al, Radomised comparison of two postoperative Brennan L, see Fell M, (1)7 fluid regimens, (1)67 Briffa NP, Diagnosis and anaesthetic management of cardiac Cooling CI, The twist drain, (Comment), (1)72 tamponade, (Comment), (2)146 Cooper C, see McLaren MI, (2)77 412 Author Index

Cooper DKC, et al, Pathological effects of brain death on Ferris BD, et al, To stitch or not to stitch the fat?, (2)115, donor organs, (4)261 (Comment) (6)410 Cooper MJ, see Appleton GVN, (2)92 Ferro MA, see Britton JP, (3)205 Corbett R, and Jayakumar KN, Tourniquet use in varicose Flowerdew ADS, see Hunt TM, (1)11 vein surgery, (1)57 Foate JA, et al, Bupivacaine squirting, (Comment), (1) 72 Cotton RE, see Foster MC, (1)44 Forty J, see Everett WG, (1)28 Coupland RM, Amputation for antipersonnel mine injuries Fossard DP, see Cook JA, (1)67 of the leg, (6)405 Foster MC, et al, Late results of renal transplantation and Cowen AE, see Askew AR, (6)359 chronic rejection as cause of graft loss, (1)44 Cox RG, Anaesthetic management in free flap reconstructive Fraser IA, see Cook JA, (1)67 surgery after resection of head and neck neoplasms, (Comment), (2)143 G Cranston D, see Davies AH, (6)368 Gajraj HA, Intravenous urography after acute urinary CrispJC, see Perry EP, (6)341 retention, (2)79 Crofts TJ, see Park KGM, (5)324 Giddings AEB, see Wetzig NR, (5)316 Crumplin MKH, see Barlow AP, (2)110 Gilbert JM, and Trapnell JE, Intraoperative testing of Cundy JM, Subcutaneous ketamine analgesia, (Comment), integrity of left-sided colorectal anastomoses, (Comment), (4)271 (2)143 Cussons PD, see Berry AR, (Comment), (6)409 Giles GR, see Kashi H, (6)387 Godfrey AM, Lower limb trauma: primary treatment and D reconstruction, (3)200 Davenport M, and Talbot CH, Thyroidectomy for Graves' Goldman M, and Kenchington G, PTFE femoropopliteal disease, hypothyroidism and, (2)87 bypass grafts, prospective and retrospective data Davies AH, et al, Catheterisation for nephrectomy, (6)368; compared in, (4)243 see Scott DJA, (4)229 Goodacre TEE, see Sanders R, (6)349 Davies DM, Plastic and reconstructive surgery, (editorial), Goodman AG, see Barr LC, (6)390 (3)149 Griffiths RW, Skin malignancy and reconstructive plastic Dawson A, see Ingoldby CJH, (4)211 surgery, (3)150 de la Hunt M, see Kanwar VS, (4)268 Grogono JSB, Anterior spinal tuberculosis: paraplegia after Deakin M, et al, Surgery for gastro-oesophageal reflux, laminectomy in, (Comment), (5)339 (4)249 Guyer PB, see Umpleby HC, (5)285 Dennis MJ, et al, New ultrathin disposable choledochoscope, in choledochoscopy via the cystic duct, (5)320 H Dennison AR, see Hands LJ, (5)306 Hain WR, see Coad NR, (4)245 Devlin HB, (Book review), (6)365; see Fell M, (1)7 Hale JE, Viaable intraluminal tumour cells and local/ Dewar EP, see Tulloch DN, (6)347 regional tumour growth in experimental colon cancer, Dewbury K, see Hunt TM, (1) 1 1 (Comment), (4)271 Dickson GH, Circular stapled anastomoses of rectum and Hale P, see Barker SGE, (5)338 oesophagus, (1)59 Hands LJ, et al, Dilatation and antireflux therapy for peptic Dixon AR, and Holmes JT, Intraoperative testing of oesophageal strictures, (5)306 integrity of left-sided colorectal anastomoses, (Comment), Hardy PAJ, and Wells JCD, Coeliac plexus block and (2)143 cephalic spread of injectate, (1)48 Dorairajan N, Integrity of left-sided anastomoses, (Comment), Harris DL, Cosmetic surgery, (3)195 (1)72 Harvey IA, see Jones MW, (1)1 Doran J, see Dennis MJ, (5) 320 Heddle RM, see Allan SM, (4)220 Dormandy T, see Ferris BD, (2)115 Heyen F, et al, Enterovesical fistulas in Crohn's disease, Downing R, et al, Unilateral digital ischaemia secondary to (2)101 embolisation from subclavian atheroma, (Comment) (5)339 Heywood AJ, et al, Perioperative mortality in Zambia, Drury A, see Barr LC, (6)390 (6)354 Duce G, see Marks RJ, (6)397 Hickey NC, see Downing R, (5)339 Dykes PW, see Heyen F, (2)101 Hicks E, see Bryan AJ, (2)140 Higgins AF, To stich or not to stitch the fat, (Comment), E (6)410 Eardley I, et al, Plasma lignocaine levels during Holdsworth PJ, et al, Distal femoropopliteal bypass using transurethral prostastectomy, (5)278 composite graft of PTFE and non-reversed saphenous Edwards E, see Barlow AP, (2) 1 10 vein, (1)4 Ellis H, (Book review), (6)380; see Law NW, (1)70; see Barr Holmes JT, see Dixon AR, (2)143 LC, (6)390 Hopper W, see Fell M, (1)7 Evans JM, see Thomas DW, (5)311 Horrocks M, see Clarke AM, (3)204; see Scott DJA, (4)229 Evans M.see Pollock AV, (2)97 Horton J, see Ewart MC, (5)338 Everett WG, and Forty J, Pelvic ileal reservoir in familial Hunt TM, et al, Measurement of percentage hepatic adenomatous polyposis, (1)28; see Pollard SG, (5)293 replacement with colorectal metastases, (1)11 Everson NW, see Cook JA, (1)67 Ewart MC, and Horton J, Narcotics versus NSAIDS for I postoperative pain relief, (Comment) (5)338 Ingoldby CJH, et al, Caecostomy using endotracheal tubes, (4)211 F Irving M, see Chamsi-Pasha H, (2)120 Faber RG, see Cobb RA, (5)299, (5)303 FarrarJ, and Kapadia F, Cardiac complications of total J parenteral nutrition: two-dimensional echocardiography in Jackson SA, Book review, (4)228 diagnosis, (Comment), (4)273 Jacobson L, et al, Intrathecal diamorphine: a dose response Fell M, et al, Surgical glove failure rate, (1)7 study, (5)289 Author Index 413 James MJ, see Dennis MJ, (5)320 M Jarrett PEM, see Cahill J, (2)128 McCarthy JM, see Barlow AP, (2)110 Jayakumar KN, see Corbett R, (1)57 McCormick-Thommson LA, see Rae T, (6)361 Jenkinson LR, et al, Symptoms and endoscopic findings in McCue JL, and Thomson JPS, Operation for rectal stricture prediction of abnormal nocturnal acid gastro-oesophageal after Ripstein rectopexy, (4)260 reflux, (2)117 McDonald PJ, et al, Tourniquet in varicose vein surgery, J0rgensen T, Cholecystectomy and development of colorectal (Comment), (4)271 neoplasia, (Comment), (4)270 Macfarlane R, see Pollard SG, (5)293 Johnson CD, Interrupted inversion PDS versus standard McGuire L, see Park KGM, (5)324 nylon sutures in abdominal skin closure, (Comment), McIntyre RL, see Hands LJ, (5)306 (2)145 McKelvey STD, see Moorehead RJ, (1)37 Johnston R, see Statham P, (4)273 Mackie DS, Cerebral complications of coronary artery Jones JR, and Allum RL, Acute traumatic haemarthrosis of bypass surgery, (Comment), (1)73 the knee, treatment of, (1)40 McLaren MI, and Cooper C, Bone mass in women with hip Jones MW, et al, Preoperative blood tests and cross fractures, (2)77 matching in paediatric orthopaedic surgery, (1)1 McLean CF, see FoateJA, (1)72 McMahon MJ, see Madan M, (4)273 Madan M, et al, Cardiac complications of total parenteral K nutrition: two-dimensional echocardiography in diagnosis, Kanwar VS, et al, Necessity of preoperative blood tests and (Comment), (4)273 blood cross-matching in paediatric orthopaedics, Madden GJ, and Robinson AC, Minitracheostomy, (Comment), (4)268 (Comment), (4)272 Kapadia F, see Farrar J, (4)273 Mahoney P, see Kanwar VS, (4)268 Kashi H, et al, Recurrent pyogenic cholangiohepatitis, Maimaris C, see Kirby NG, (4)267 (6)387 Markham NI, see Ross WB, (4)233 Keddie S, see Violaris NS, (2)144 Marks RJ, et al, Computerised administration in an intensive Keighley MRB, see Heyen F, (2) 101 care unit, (6)397 Kenchington G, see Goldman M, (4)243 Martin D, Bacterial colonisation of leg ulcers, success rate of Kettlewell MGW, see Hands LJ, (5)306 skin grafting and, (Comment), (2)144; and Tweedle DEF, Khalid K, see Ward CM, (4)226 Early postoperative endoscopic sphincterotomy for Khoury GA, and Bolton J, Age as a factor in Barrett's retained biliary stones, (Comment), (3)205 oesophagus, (1)50 Martin EWJr, see O'Dwyer PJ, (1)54 Kirby NG, and Maimaris C, Unilateral facet joint Mayer D, see Deakin M, (4)249 hypertrophy causing nerve root irritation, (Comment), Miles AJG, et al, Protection for left index finger whilst (4)267 operating on HIV positive patients, (4)225 Kirkali Z, DoubleJ ureteric catheter insertions, (Comment), Milewski PJ, and Schofield PF, Massive colonic (2)146 haemorrhage, case for right hemicolectomy, (4)253 Knottenbelt JD, Randomised comparison of two Milford CA, see O'Flynn PE, (4)218 postoperative fluid regimens, (Comment), (4)272 Mills JOM, see Moorehead RJ, (1)37 Knox RA, see Taylor TV, (1)31 Moore I, see Umpleby HC, (5)285 Kokri MS, seeJacobson L, (5)289 Moorehead RJ, et al, Cholecystectomy and colorectal Krikler SJ, Flexible urethroscopy in difficult male neoplasia development, (1)37 catheterisation, (1)3 Morgan AG, see Foster MC, (1)44 Kune GA, and Brough W, Surgical intervention in severe Morgan C, see Marks RJ, (6)397 acute pancreatitis, (1)23; et al, Cholecystectomy and Morris DI, see Dennis MJ, (5)320 development of colorectal neoplasia, (Comment), (4)269 Morrison MCT, Unilateral lumbar facet joint hypertrophy Kune S, see Kune GA, (4)269 causing nerve root irritation, (Comment), (1)74 an audit on rectal Morton ME, and Lewis DH, Rigid internal fixation for Kuruvilla MJ, Intraoperative air-testing; correction of mandibular prognathism, (Comment), (3)206 anastomosis, (Comment), (4)268 Mousdale S, see Callander CC, (2)147 Muirhead-Allwood W, see Ferris BD, (2)115 Murray A, see Eardley I, (5)278 L Murray DW, see Rae T, (6)361 Lam FT, see Kashi H, (6)387 Lane IF, see Scott HJ, (6)410 N Langridge CJ, Surgical intervention in severe acute Nardi GL, Pancreatic sphincteroplasty: indications and pancreatitis, (Comment) (5)338 outcome, (Comment), (4)268 Laurie R, Tourniquet in varicose vein surgery, (Comment), NeelyJAC, see Upadhyay AK, (6)381 (4)271 Neoptolemos JP, Persisting common bile duct stones in Law NW, and Ellis H, Transthoracic sympathectomy for severe gallstone pancreatitis, (5)326 palmar hyperhidrosis under age 16, (1)70 Newman SP, see Tan PSK, (2)81 Leach RD, see Cahill J, (2)128 NormanJEdeB, The broken nose, (Comment), (1)72 Leonard AG, Musculocutaneous flaps in head and neck Norris TL, see Jenkinson LR, (2)117 reconstruction, (3) 159 Northeast ADR, see Cahill J, (2)128 Leveson SH, see Holdsworth PJ, (1)4 Notcutt WG, Continuous intravenous morphine for pain Lewis A, Integrity of left-sided colorectal anastomoses, relief after abdominal surgery, (Comment) (5)339 (Comment), (4)272 Novitzky D, see Cooper DKC, (4)261 Lewis DH, see Morton ME, (3)206 Lewis MH, see Bryan AJ, (2)140 0 Li AKC, see Park KGM, (5)324 O'Dwyer PJ, and Martin EW Jr, Viable intraluminal Lloyd-Williams K, see Chester JF, (6)394 tumour cells and local/regional tumour growth in Lyle I, Book review, (5)288 experimental colon cancer, (1)54 414 Author Index

O'Flynn PE, and Milford CA, Fasting in children for day Sandhu D, see Cook JA, (1)67 case surgery, (4)218 Schofield PF, see Milewski PJ, (4)253 Orlikowski C, see Bristow A, (1)64 Scott A, Diagnosis and anaesthetic management of cardiac Owen H, see FoateJA, (1)72 tamponade, (Comment), (2)146 Owen R, see Jones MW, (1)1 Scott DJA, et al, Risk factors in selected patients undergoing femoral embolectomy, (4)229 p Scott HJ, and Lane IF, Massive colonic haemorrhage. The Papavramidis S, see Hands LJ, (5)306 case for right hemicolectomy, (Comment), (6)410 Park KGM, et al, Intraoperative assessment of lymph node Shanahan D, see Chester JF, (6)394 involvement in gastric carcinoma, (5)324 Sharpe DT, and Burd RM, Tissue expansion, (3)175 Patrick JH, see Welton EAW, (2)144 Shearman C, see Downing R, (5)339 Payne-James J, et al, Catheter choice for acute urinary Shillito RG, see Barlow AP, (2)110 retention, (Comment), (2)145; and Rogers J, Prolene plug Shouler PJ, and Runchman PC, Varicose veins: repair for femoral hernia, (Comment), (6)409 postoperative compression, (6)402 Perry EP, et al, Changes in emergency surgical workload, Sibly F, see Ferris BD, (2)115 (6)341 Sinclair JR, see Heywood AJ, (6)354 Phillips RH, see Barr LC, (6)390 Smedley FH, see Chan TYK, (3)204 Phillips RKS, see Spigelman AD, (4)269 Smith FCT, see Downing R, (5)339 Pollard SG, et al, Surgery for recurrent colorectal carcinoma, Smith GMR, see Pollock AV, (2)97 (5)293 Smith MA, see Rand C, (2)105 Pollock AV, et al, Precisional intraparietal Augmentin in Solomons N, Flexible nasoendoscopy in adults with acute abdominal operations, (2)97 epiglottitis, (Comment), (2)145 Poole MD, and Briggs M, Cranio-orbital trauma: a team Soutar DS, Free flaps in reconstructive surgery, (3)169 approach to management, (3)187 Spigelman AD, and Phillips RKS, Functional result of pelvic Pridie AK, see Jacobson L, (5)289 ileal reservoir in familial adenomatous polyposis, Pugsley WB, see Tan PSK, (2)81 (Comment), (4)269 Pullan BR, see Taylor TV, (1)31 Sri-Pathmanathan R, and Railton R, Lymphoscintigraphy in detection of cervical metastases from oral carcinoma, Q (5)281 Quiney RE, see Cheeseman AD, (5)333 Stableforth PG, Book review, (4)221 Statham P, and Johnston R, Anterior spinal tuberculosis: R paraplegia after laminectomy, (Comment), (4)273 Rady MY, Diagnosis and anaesthetic management of cardiac Stokes M, see Chamsi-Pasha H, (2)120 tamponade, (Comment), (2)147 Suresh D, Bupivacaine squirting, (Comment), (6)409 Rae T, et al, Effect of starch glove powder on joint and other Sutton G, see McDonald PJ, (4)271 tissues, (6)361 Szczepanik AB, and Rudowski WJ, Extrahepatic portal Railton R, see Sri-Pathmanathan R, (5)281 hypertension: long-term results of surgical treatment, Rajapakse VPH, and Wijesekera S, Outcome of mechanical (4)222 ventilation in Sri Lanka, (6)344 Ramsay JWA, see Eardley I, (5)278 T Rand C, and Smith MA, Anterior spinal tuberculosis: Talbot CH, see Davenport M, (2)87 paraplegia after laminectomy, (2)105 Talbot R, Early postoperative endoscopic sphincterotomy for Rauscher LA, Continuous intravenous morphine after retained biliary stones, (Comment), (2)145 abdominal surgery, (Comment), (3)204 Taliadoros M, see Payne-James J, (2)145 Ravindranath K, see Chester JF, (6)394 Tan PSK, et al, Circulatory arrest and hypothermia Reece-Smith H, see Cobb RA, (5)299, (5)303 facilitating thoracic aortic surgery, (2)81 Rees S, Pain relief clinics under anaesthetic management in Taube M, see Gajraj HA, (2)79 Scotland, (Comment), (3)206; Unilateral lumbar facet joint Taylor HW, To stitch or not to stitch the fat, (Comment), hypertrophy causing nerve root irritation, (Comment), (4)273 (2)144 Taylor I, see Hunt TM, (1)11; see Umpleby HC, (5)285 Rickwood AMK, and Walker J, Overdiagnosis of phimosis in Taylor RS, see Chester JF, (6)394 boys, circumcision and, (5)275 Taylor TV, et al, Vertical gastric plication for gastro- Riddell PS, see Holdsworth PJ, (1)4 oesophageal reflux, (1)31 Robinson AC, see Madden GJ, (4)272 Temple JG, see Deakin M, (4)249 Robinson M, see Davies AH, (6)368 Thomas DW, and Evans JM, Lower oesophageal Rogers J, see Payne-James J, (2)145, (6)409 contractility monitoring during anaesthesia for cardiac Rosenberg M, Pancreatic sphincteroplasty: indications and surgery, (5)311 outcome, (Comment), (4)268 Thomson JPS, see McCue JL, (4)260 Ross WB, et al, Autotransplantation for renovascular Thomson WHF, To stitch or not to stitch the fat, (Comment), hypertension with renal artery occlusion, (4)233 (4)273 Rowe PA, see Foster MC, (1)44 Trapnell JE, see Gilbert JM, (2)143 Royle GT, see McDonald PJ, (4)271; see Umpleby HC, Treasure T, see Tan PSK, (2)81; see Venn G, (2)148 (5)285 Tulloch DN, and Dewar EP, Early return to work after Rudowski WJ, see Szczepanik AB, (4)222 vagotomy, (6)347 Runchman PC, see Shouler PJ, (6)402 Tweedle D, see Brough W, (5)322 Rushton N, see Rae T, (6)361 Tweedle DEF, see Martin D, (3)205 Tyrrell MR, and Vipond MN, Composite graft in distal S femoropopliteal bypass, (Comment), (4)269 Salaman JR, see Ross WB, (4)233 Sanders R, and Goodacre TEE, When radiotherapy offers no U more: surgical management of advanced breast cancer, Umpleby HC, et al, Preoperative diagnosis and management (6)349 of cystosarcoma phyllodes, (5)285 Author Index 415 Upadhyay AK, and Bull JC, Intra-operative air testing: an Wetzig NR, and Giddings AEB, Solitary thyroid nodule: audit on rectal anastomosis, (Comment), (3)204; and Neely audit of surgery for, cytological diagnosis and, (5)316 JAC, Cystic nephroma, (6)381 Wherry D, see Dennis MJ, (5)320 White BD, see Chester JF, (6)394 Whitelaw SJ, see Armstrong CP, (1)20 V Whitfield HN, see Eardley I, (5)278 Venn G, and Treasure T, Cerebral complications of coronary Wickens D, see Ferris BD, (2)115 artery bypass surgery, (Comment), (2)148 Wicomb WN, see Cooper DKC, (4)261 Violaris NS, and Keddie S, Improved method for securing Wijesekera S, see Rajapakse VPH, (6)344 nasogastric tubes, (Comment), (2)144 Wilkinson DJ, see Eardley I, (5)278 Vipond MN, see Tyrrell MR, (4)269 Williams J, see Fell M, (1)7 Virjee J, see Appleton GVN, (2)92 Williamson RCN, see Appleton GVN, (2)92 Wilson C, see Fell M, (1)7 w Wilson HK, see Moorehead RJ, (1)37 WalkerJ, see Rickwood AMK, (5)275 Wilson IH, see Heywood AJ, (6)354 Ward CM, Delayed reconstruction of the breast after Wilson NM, Minitracheostomy: proposed further mastectomy, (3)182; and Khalid K, Surgical treatment of development, (Comment), (1)73 grade III gynaecomastia, (4)226 Wilson WW, Cholecystectomy and development of colorectal Ward M, see Askew AR, (6)359 neoplasia, (Comment), (4)269 Warren AG, Surgical conservation of the neuropathic foot, Wood PB, Management of Fournier's gangrene, (Comment), (4)236 (3)206 Wastell C, see Miles AJG, (4)225 Wright JE, see Cheesman AD, (5)333 Watkin DFL, see Perry EP, (6)341 Wyllie JH, Surgery for gastro-oesophageal reflux, Assessor's Watson A, Book review, (4)212; seeJenkinson LR, (2)117; comments, (4)252 Oesophageal resection in the elderly, (Comment), (1)73 Watson LF, see Kune GA, (4)269 y WebsterJHH, see McDonald PJ, (4)271 Yerzingatsian KL, Thyroidectomy under local analgesia: the Wells JCD, see Hardy PAJ, (1)48 anatomical basis of cervical blocks, (4)207 Welton EAW, and PatrickJH, Posterior tendon rupture: brief report, (Comment), (2)144 z Wenham PW, see Foster MC, (1)44 Zarifa Z, see Barlow AP, (2)110 Subject Index The first figure indicates the issue; the second figure indicates the page

Assessment, of personality, in selection of surgical trainees, Abdomen, pain in, intractable, coeliac plexus block for, (Broughton) (Comment) (1) 73 cephalic spread of injectate, (Hardy and Wells) (1)48; Assessor's comments, Angelchik prosthesis versus floppy surgery of, preincisional intraparietal Augmentin in, Nissen fundoplication for gastro-oesophageal reflux, (Pollock et al)(2)97 (Wyllie)(4)252; Dilatation and antireflux therapy in Aged, Barrett's oesophagus in, (Khoury and Bolton)(1)50; peptic oesophageal strictures, (Celestin) (5)309 oesophageal resection in, (Watson) (Comment) (1) 73; Audit, combined surgical and anaesthetic, and perioperative surgery in a geriatric population, (Barlow et al)(2)1 10, mortality, in Zambia, (Heywood et al)(6)354; of surgery (Brough) (Comment) (4)273 for solitary thyroid nodule, (Wetzig and Giddings)(5)316; Amputation, for antipersonnel mine injuries of the leg, surgical unit workload in a district general hospital and, preservation of tibial stump, (Coupland)(6)405 (Cobb et al) (5)299; of workload in emergency surgery, Amputees, rehabilitation of, (Campbell and between 1973 and 1982, (Perry et al)(6)341 Thornberry) (Comment) (4) 58 Augmentin, preincisional intraparietal, in abdominal Anaesthesia, in cardiac surgery, lower oesophageal operations, (Pollock et al)(2)97 contractility monitoring during, (Thomas and Evans) (5)31 1; caudal, for postoperative pain in children, bupivacaine dosage regimens for, (Coad and Hain)(4)245; B for free-flap head and neck reconstructive surgery in Babies, neonate, primary perineal rectourethroanoplasty for neoplastic disease, (Cox) (Comment) (2)143; local, cervical imperforate anus, (Aluwihare) (1) 14 blocks in thyroidectomy, (Yerzingatsian)(4)207; local, for Barrett's oesophagus, age as an important factor in, postoperative pain, wound perfusion with bupivacaine for, (Khoury and Bolton)(1)50 (Chester et al)(6)394; and perioperative mortality, in Basal cell carcinoma, (see) Skin malignancy Zambia, (Heywood et al)(6)354; regional, coeliac plexus Bile duct stones, endoscopic sphincterotomy for, block for, cephalic spread of injectate, (Hardy and (Bickerstaff et al)(6)384; retained, early postoperative Wells) (1)48 endoscopic sphincterotomy for, (Askew et al)(6)359; Analgesia, for 'bat ear' surgery, (Burtles)(5)332; retained, endoscopic sphincterotomy for, postoperative, in children, bupivacaine dosage for caudal (Talbot) (Comment) (2)145, (Martin and anaesthesia in, (Coad and Hain)(4)245; postoperative, Tweedle) (Comment) (3)205 continuous intravenous morphine for, Blood tests, routine, in children, before orthopaedic surgery, (Rauscher) (Comment) (3)204, (Notcutt) (Comment) (5)339; (Jones et al) (1) 1, (Kanwar et al) (Comment) (4)268 postoperative, intrathecal diamorphine in, dose response Bone, bone mass in women with hip fractures, (McLaren in, (Jacobson et al)(5)289; postoperative, narcotics versus and Cooper)(2)77 NSAIDS for, (Ewart and Horton) (Comment)(5)338; postoperative, subcutaneous ketamine for, (Bristow and Orlikowski) (1)64, (Cundy) (Comment) (4)271 Anastomoses, colorectal, left-sided, integrity of, BOOK REVIEWS (Dorairajan) (Comment) (1)72, (Dixon and Accidents and Emergencies, (Kirby) (4)228 Holmes) (Comment) (2)143, (Gilbert and Clinical Science for Surgeons. Basic Surgical Practice, Trapnell) (Comment)(2)143, (Lewis) (Comment)(4)272, (Marshall and Ludbrook)(6)365 (Barker et al)(Comment)(5)338; rectal, intra-operative air Eighteenth century medics (subscriptions, licences, testing, (Upadhyay and Bull) (Comment) (3)204, apprenticeships), (Wallis and Wallis)(5)288 (Kuruvilla) (Comment) (4)268; stapled, circular, for rectum Illustrated Manual of Regional Anesthesia, (Raj et and oesophagus, (Dickson) (1)59; viable intraluminal al) (5)280 tumour cells and tumour growth and, (O'Dwyer and Operative Orthopaedics, (Chapman) (4)221 Martin) (1)54, (Hale) (Comment) (4)271 Surgery of the Oesophagus, (Jamieson), (4)212 Anastomosis, oesophagojejunal, improved technique for, The Peritoneum and Peritoneal Access, (Bengmark)(6)380 with EEA Premium stapling gun, (Brough and Tweedle) (5)322 Angelchik prosthesis, for gastro-oesophageal reflux, versus Brain, water content of, MRI measurement of, (Bell)(6)375 floppy Nissen fundoplication, (Deakin et al)(4)249, Brain death, pathophysiological effect on potential donor (Assessor's comments) (Wyllie) (4)252 heart and other organs, (Cooper et al)(4)261 Angiography, in surgical management of pancreatic disease, Breast, reconstruction of, delayed, after mastectomy, (Appleton et al)92 (Ward)(3) 182 Antibiotic prophylaxis, against infection in surgical Breast cancer, advanced, surgical management of, (Sanders wounds, preincisional intraparietal Augmentin in, and Goodacre)(6)349; primary management, conservation (Pollock et al)(2)97 in, (Barr et al)(6)390 Anus, imperforate, primary perineal rectourethroanoplasty Bupivacaine, dosage regimens for caudal anaesthesia with, for, (Aluwihare) (1)14 for postoperative pain in children, (Coad and Aorta, thoracic, surgery of, circulatory arrest and Hain) (4)245; squirting of, (Foate et al) (Comment) (1) 72, hypothermia for, (Tan et al)(2)81 (Suresh) (Comment) (6)409; wound perfusion with, for relief Arthroscopy, in acute knee injury, (Jones and Allum)(1)40, of postoperative pain, (Chester et al)(6)394 (Bracey) (Comment) (4)270 Bypass surgery, (see) structures involved Subject Index 4 17

C Coronary arteries, bypass surgery, cerebral complications Caecostomy, endotracheal tubes for, (Ingoldby et al)(4)211 of, (Mackie) (Comment) (1)73, (Venn and Carcinoembyonic antigen, as tumour marker in recurrent Treasure) (Comment) (2)148 colorectal carcinoma, (Pollard et al)(5)293 Cosmetic surgery, (Harris) (3)195 Cardiac tamponade, diagnosis and management, Cranio-facial resection, for orbital tumours, (Cheesman et (Briffa)(Comment)(2) 146, (Scott)(Comment)(2) 146, al) (5)333 (Callander and Mousdale) (Comment) (2)147, Cranio-orbital trauma, team management of, (Poole and (Rady) (Comment) (2)147 Briggs) (3) 187 Catheters, after nephrectomy, (Davies et al)(6)368; Crohn's disease, enterovesical fistulas in, (Heyen et comparison of in acute urinary retention, (Payne-James et al) (2) 101 al) (Comment) (2) 145; difficult male catheterisation, flexible Cross-matching, routine, in children, before orthopaedic urethroscopy in, (Krikler) (1)3; ureteric, double J, surgery, UJones et al) (1) 1, (Kanwar et al) (Comment) (4)268 (Kirkali) (Comment) (2)146, (Britton and Cystic nephroma, (Upadhyay and Neely) (6)381 Ferro) (Comment) (3)205 Cystosarcoma phyllodes, preoperative diagnosis and Cervical blocks, (see) Anaesthesia local management, (Umpleby et al) (5)285 Cholangiography, endoscopic cholangiopancreatography for bile duct stones, (Bickerstaff et al)(6)384; endoscopic D retrograde cholangiopancreatography, in acute Diamorphine, intrathecal, dose response in postoperative pancreatitis with persisting common bileduct stones, pain relief, (Jacobson et al)(5)289 (Neoptolemos) (5)326 Digital ischaemia, secondary to embolisation from Cholangiohepatitis, recurrent pyogenic, (Kashi et al)(6)387 subclavian atheroma, (Bryan et al)(2)140, (Downing et Cholecystectomy, and the development of colorectal al) (Comment) (5)339 neoplasia, (Moorehead et al)(l)37, (Kune et Drainage, the twist drain, (Cooling) (Comment) (1)72 al) (Comment) (4)269, (Wilson) (Comment) (4)269, Dysphagia, fibreoptic endoscopic dilatation for, (Anderson (J0rgensen) (Comment) (4)270; ultrathin disposable et al) (2) 124 choledoscope for, (Dennis et al)320 Cholecystitis, schistosomal, six cases, (Al-Saleem and E Al-Janabi) (6)366 Ears, 'bat ear' surgery, analgesia for, (Burtles)(5)332 Choledochoscopy, via cystic duct, ultrathin disposable Echocardiography, for cardiac complications in total choledoscope for, (Dennis et al)320 parenteral nutrition, (Chamsi-Pasha et al)(2)120, (Madan Cholelithiasis, schistosomal, six cases, (Al-Saleem and et al) (Comment) (4)273, (Farrar and Al-Janabi) (6)366 Kapadia) (Comment) (4)274 Circulatory arrest, and hypothermia, for thoracic aortic Elderly, (see) Aged surgery, (Tan et al)(2)81 Embolectomy, femoral, risk factors for, (Scott et al)(4)229 Circumcisions, overdiagnosis of phimosis and, (Rickwood Embolism, from subclavian atheroma, digital ischaemia and, and Walker)(5)275 (Bryan et al)(2)140, (Downing et al)(Comment)(5)339 Coeliac plexus block, for intractable abdominal pain, Emergencies, changes in surgical workload in, from 1973 to cephalic spread of injectate, (Hardy and Wells) (1)48 1982, (Perry et al)(6)341 Colon, massive haemorrhage of, case for right Endoscopic retrograde cholangiopancreatography, (see) hemicolectomy in, (Milewski et al)(4)253, (Berry and Cholangiography Cussons) (Comment) (6)409, (Scott and Endosonography, in rectal cancer, evaluation of, Lane)(Comment)(6)410; obstruction of, caecostomy in, (Beynon) 131 endotracheal tubes for, (Ingoldby et al)(4)211 Epiglottitis, acute, flexible nasoendoscopy in, Colon cancer, (see also Colorectal cancer; experimental, (Solomans) (Comment) (2)145 viable intraluminal tumour cells and tumour growth, (O'Dwyer and Martin), (1)54, (Hale) (Comment) (4)271 F Colonoscopy, intraoperative, in hemicolectomy for massive Fat necrosis, fat stitches and, in hip replacement, (Ferris et haemorrhage, (Milewski et al)(4)253, (Berry and al)1 15, (Thomson) (Comment) (4)273, Cussons) (Comment) (6)409, (Scott and (Ferris) (Comment) (6)410, (Higgins) (Comment) (6)410 Lane) (Comment) (6)410 Femoropopliteal bypass, with composite graft of PTFE and Colorectal anastomoses, intraoperative testing, non-reversed saphenous vein, (Holdsworth et al)(1)4, (Dorairajan) (Comment) (1)72, (Dixon and (Tyrrell and Vipond)(Comment) (4)269; PTFE grafts in, Holmes) (Comment) (2)143, (Gilbert and prospective and retrospective data, (Goldman et al)(4)243 Trapnell) (Comment) (2)143, (Lewis) (Comment) (4)272, Fibreoptic endoscopic dilatation, in oesophageal stricture, (Barker et al)(Comment)(5)338 (Anderson et al)(2)124 Colorectal cancer, (see also Colon cancer; elective and Fine needle aspiration cytology, in preoperative diagnosis emergency surgery for, surgical training and patient of thyroid nodule, audit and, (Wetzig and survival rate, (Chester and Britton)(6)370; and liver Giddings) (5)316 metastases, measurement of percentage hepatic Fingers, digital ischaemia, secondary to embolisation from replacement with, (Hunt et al)(l)ll; and previous subclavian atheroma, (Bryan et al)(2)140, (Downing et cholecystectomy, (Moorehead et al)(1)37, (Kune et al) (Comment) (5) 339 al) (Comment) (4)269, (Wilson) (Comment) (4)269, Fistulae, enterovesical, in Crohn's disease, (Heyen et (J0rgensen) (Comment) (4)270; recurrent, surgery for, al) (2) 101 (Pollard et al)(5)293; unsuspected, death from, (1)20 Fluid regimens, postoperative, comparative study, (Cook et Compartment syndromes, oedema after lower limb al) (1)67, (Knottenbelt) (Comment) (4)272 revascularisation and, (Bennett) (Comment) (2)146 Foot, neuropathic, surgical conservation of, (Warren)(4)236 Compression stockings, optimum compression after surgery Fournier's gangrene, practical management, and sclerotherapy for varicose veins, (Shouler and (Wood) (Comment) (3)206 Runchman) (6)402 Free flaps, in reconstructive surgery, (Soutar) (3)169; for Computer software, system for administration of intensive resection of head and neck neoplasms, anaesthetic care unit, (Marks et al)(6)397 management, (Cox) (Comment) (2) 143 418 Subject Index G K Gangrene, Fournier's, management of, Ketamine, subcutaneous, for postoperative analgesia, (Wood) (Comment) (3)206 (Bristow and Orlikowski) (1)64, (Cundy) (Comment) (4)271 Gastro-oesophageal reflux, Angelchik prosthesis for, versus Kidney, cystic nephroma, (Upadhyay and Neely)(6)381 floppy Nissen fundoplication, (Deakin et al) (4)249, Kidney transplantation, autotransplantation, for renal (Assessor's comments)(Wyllie)(4)252; nocturnal, hypertension with complete renal artery occlusion, (Ross symptoms and endoscopic findings in prediction of, et al)(4)233; late results, and chronic rejection as cause of (Uenkinson et al)(2)117; vertical gastric plication for, graft loss, (Foster et al)(l)44 (Taylor et al)(1)31 Knee, haemarthrosis of, acute traumatic, expectant General surgery, in a district general hospital, effects of treatment or arthroscopy in, (Jones and Allum)(1)40, cuts on work in, (Cobb et al)(5)303; workload in a district (Bracey) (Comment) (4)270 general hospital, (Cobb et al)(5)299 Geriatric patients, (see) Aged L Glove powder, starch, effect on joint and other tissues, (Rae Laminectomy, in anterior spinal tuberculosis, paraplegia et al)(6)361 after, (Rand and Smith)(2)105, (Statham and Gloves, puncture of, protection for left index finger whilst Johnston) (Comment) (4)273, (Grogono) (Comment) (5)339 operating on HIV positive patients, (Miles et al)(4)225; Lignocaine, plasma levels of during transurethral surgical, failure rate of, (Fell et al)(l)7 prostatectomy, (Eardley et al)(5)278 Graves' disease, thyroidectomy for, hypothyroidism and, Limbs lower, trauma to, primary treatment and (Davenport and Talbot)(2)87 reconstruction, (Godfrey)(3)200 Gynaecomastia, grade III, surgery for, (Ward and Liver, colorectal metastases in, measurement of percentage Khalid) (4) 226 hepatic replacement with, (Hunt et al) (1)11 Lower limb, (see) Limbs lower Lumbar facet joint, (see) Spine H Lymph nodes, intraoperative assessment of involvement of Haemarthrosis, of knee, acute traumatic, expectant in gastric cancer, (Park et al)(5)324 treatment or arthroscopy in, Jones and Allum) (1)40, Lymphoscintography, in detection of cervical metastases (Bracey) (4)270 from oral carcinoma, (Sri-Pathmanathan and Haemodialysis, PTFE loop grafts as vascular access in Railton) (5)281 thigh for, (Clarke and Horrocks) (Comment) (3)204 Head and neck cancer, musculocutaneous flaps in reconstruction in, (Leonard)(3)159; resection of, free-flap M in, anaesthetic management of, (Cox)(Comment) (2) 143 Magnetic resonance imaging, in measurement of brain Heart, surgery of, lower oesophageal contractility monitoring water, (Bell)(6)375 during, (Thomas and Evans) (5)311 Mandibular prognathism, rigid internal fixation in surgical Heart transplantation, pathophysiological effect of brain correction, (Morton and Lewis) (Comment) (3)206 death on potential donor heart, (Cooper et al)(4)261 Mastectomy, delayed breast reconstruction after, Hemicolectomy, right, case for in massive colonic (Ward) (3)182 haemorrhage, (Milewski et al)(4)253, (Berry and Melanoma, malignant, plastic and reconstructive surgery Cussons) (Comment) (6)409, (Scott and and, (Griffiths) (3)150 Lane) (Comment) (6)4 10 Minitracheostomy, (Wilson) (Comment) (1)73, (Madden and Hernias, femoral, prolene plug repair, (Allan and Robinson) (Comment) (4)272 Heddle)(4)220, (Payne-James and Morphine, continuous intravenous, for postoperative pain, Rogers) (Comment) (6)409; inguinal, monofilaments (Rauscher) (Comment) (3)204, (Notcutt) (Comment) (5)339 compared with PTFE for herniorrhaphy in, (Cahill et Mortality, perioperative, in Zambia, (Heywood et al)(6)354 al)(2) 128 Mouth, (see) Oral cancer Hip, fractures of, bone mass and in women, (McLaren and Musculocutaneous flaps, in head and neck reconstruction, Cooper) (2)77 (Leonard) (3) 159 Hospitals, district general, surgical units in, effects of cuts in services on, (Cobb et al)(5)303; district general, workload N of surgical units in, (Cobb et al)(5)299 Nasoendoscopy, flexible, in acute epiglottitis, Human immunodeficiency virus, operating on patients (Solomans) (Comment) (2) 145 with, protection for left index finger, (Miles et al) (4)225 Nasogastric tubes, improved method of fixing, Hyperhidrosis, palmar, transthoracic sympathectomy for, in (Baer) (Comment) (1)74, (Bradley) (Comment) (2)144, children under 16, (Law and Ellis)(1)70 (Violaris and Keddie) (Comment) (2)144, (Chan and Hypertension, (see) Portal hypertension; Renovascular Smedley) (Comment) (3)204 hypertension Neck, innervation, of anatomical compartments, local Hypothermia, and circulatory arrest, for thoracic aortic anaesthesia for thyroidectomy and, (Yerzingatsian)(4)207; surgery, (Tan et al)(2)81 lymphoscintography in detection of metastases in, from Hypothyroidism, with thyroidectomy for Graves' disease, oral carcinoma, (Sri-Pathmanathan and Railton)(5)281 (Davenport and Talbot)(2)87 Neck cancer, musculocutaneous flaps in reconstruction in, Hysterectomy, postoperative subcutaneous ketamine for (Leonard) (3) 159 analgesia in, (Bristow and Orlikowski) (1)64 Nephrectomy, per- and postoperative catheterisation for, (Davies et al)(6)368 I Neuropathy, of limbs, surgical conservation of, Intensive care, unit for, computerised administration in, (Warren) (4)236 (Marks et al)(6)397 Nissen fundoplication, versus Angelchik prosthesis, for Intraluminal tumour cells, and local/regional tumour gastro-oesophageal reflux, (Deakin et al) (4)249, (Assessors growth, (O'Dwyer and Martin) (1)54, comments) (Wyllie) (4)252 (Hale) (Comment) (4)271 Non-steroidal anti-inflammatory drugs, for post-operative Intrathecal route, for diamorphine, dose response in pain relief, (Ewart and Horton)(Comment)(5)338 postoperative pain relief, (Jacobson et al)(5)289 Nose, broken, (Norman) (Comment) (1)72 Subject Index 419 Nutrition, parenteral, subclavian vein catheterisation for, Prostatectomy, transurethral, plasma lignocaine levels (Burtles) (Comment) (4)268; total parenteral, cardiac during, (Eardley et al)(5)278 complications in, (Chamsi-Pasha et al)(2)120, (Madan et Psychotherapy, benefits of cosmetic surgery, (Harris) (3)195 al) (Comment) (4)273, (Farrar and Kapadia) (Comment) (4)274 R Radiotherapy, necrosis after, surgical management of 0 advanced breast cancer and, (Sanders and Oedema, after lower limb revascularisation, compartment Goodacre) (6)349 syndromes and, (Bennett) (Comment) (2)146 Reconstructive surgery, (Davies) (editorial) (3) 149; in Oesophagojejunal anastomosis, improved technique with advanced breast cancer, (Sanders and Goodacre) (6)349; EEA Premium stapling gun in, (Brough and of breast, delayed, after mastectomy, (Ward) (3)182; free Tweedle) (5) 322 flaps in, (Soutar)(3)169; in lower limb trauma, Oesophagus, Barrett's oesophagus, age as an important (Godfrey) (3)200; musculocutaneous flaps in, factor in, (Khoury and Bolton) (1)50; lower oesophageal (Leonard) (3)159; skin malignancy and, (Griffiths) (3)150 contractility monitoring during anaesthesia for cardiac Rectal cancer, rectal endosonography in, evaluation of, surgery, (Thomas and Evans) (5)311; resection of in the (Beynon) (2)131 elderly, (Watson)(Comment)(1)73; strictures of, fibreoptic Rectum, anastomosis to, intra-operative air testing, endoscopic dilatation of, (Anderson et al)(2)124; strictures (Upadhyay and Bull) (Comment) (3)204, (Kuruvilla) of, peptic, dilatation and antireflux therapy for, (Hands et (Comment)(4)268; stricture of after Ripstein rectopexy, al) (5)306, (Assessor's comments) (Celestin) (5)309 operation for, (McCue and Thomson), (4)260 Oral cancer, lymphoscintography in dectection of cervical Renal artery stenosis, in renovascular hypertension, metastases from, (Sri-Pathmanathan and Railton)(5)281 autotransplantation for, (Ross et al)(4)233 Orbit, trauma to, team management of, (Poole and Renal transplantation, (see) Kidney transplantation Briggs)(3)187; tumours of, craniofacial resection for, Renovascular hypertension, severe, autotransplantation (Cheesman et al)(5)333 for, (Ross et al)(4)233 Organ donors, pathophysiological effect of brain death on Ripstein rectopexy, rectal stricture after, operation for, organs, (Cooper et al)(4)261 (McCue and Thomson)(4)260 Oriental cholangiohepatitis, (Kashi et al)(6)387 Orthopaedics, paediatric, preoperative blood tests and S cross-matching in, Jones et al) (1) 1, (Kanwar et Schistosomiasis, cholelithiasis in, six cases, (Al-Saleem and al) (Comment) (4)269 Al-Janabi) (6)366 Osteoporosis, bone mass in women with hip fractures, Shoulder, arthroscopy of, (Bunker) (4)213 (McLaren and Cooper)(2)77 Skin, expansion of in plastic surgery, (Sharpe et al) (3)175 Skin closure, see also Sutures Skin grafting, for leg ulcers, bacterial infection and, p (Martin) (Comment)(2)412 Pain, postoperative, (see) Anaesthesia; Analgesia Skin malignancy, plastic and reconstructive surgery and, Pain relief clinics, under anaesthetic management, (Griffiths) (3)150 (Rees) (Comment) (3)206 Sphincterotomy, early postoperative endoscopic, for Palmar hyperhidrosis, transthoracic sympathectomy for, in retained common duct stones, (Askew et al)(6)359; children under 16, (Law and Ellis) (1) 70 endoscopic, in acute pancreatitis with persisting common Pancreas, disease of, angiography in surgical management bileduct stones, (Neoptolemos)(5)326; endoscopic, for bile of, (Appleton et al) (2)92; ductal sphincteroplasty, duct stones, 272 cases, (Bickerstaff et al)(6)384; (Nardi) (Comment) (4)268, (Rosenberg) (Comment) (4)268 endoscopic postoperative, for retained biliary stones, Pancreatitis, severe acute, surgery in, (Kune and (Talbot) (Comment) (2)145, (Martin and Brough) (1)23, (Langridge) (Comment) (5)338; severe Tweedle) (Comment) (3)205 gallstone, persisting common bile duct stones and, Spine, lumbar, facet joint hypertrophy and nerve root (Neoptolemos) (5)326 irritation, (Morrison) (Comment) (1)74, Paralytic ileus, postoperative, two fluid regimens compared (Rees) (Comment)(2) 144, (Kirby and in, (Cook et al) (1)67, (Knottenbelt) (Comment) (4)272 Maimaris) (Comment) (4)267; tuberculosis of, anterior, Pelvic ileal reservoir, functional result with in familial paraplegia after laminectomy for, (Rand and adenomatous polyposis, (Everett and Forty)(1)28, Smith)(2)105, (Statham and Johnston)(Comment)(4)273, (Spigelman and Phillios) (Comment) (4) 269 (Grogono) (Comment) (5)339 Personality assessment, (see) Assessment Squamous cell carcinoma, (see) Skin malignancy Phimosis, overdiagnosis of, and circumcision, (Rickwood Sri Lanka, outcome of mechanical ventilation in, (Rajapakse and Walker)(5)275 and Wijesekera)(6)344 Plastic surgery, (Davies)(editorial)(3)149, (see also Cosmetic Staples, for circular anastomoses of rectum and oesophagus, surgery; skin malignancy and, (Griffiths)(3)150; tissue (Dickson) (1)59; in oesophagojejunal anastomosis, expansion in, (Sharpe et al)(3)175 improved technique with EEA Premium stapling gun, Polyposis, familial adenomatous, pelvic ileal reservoir in, (Brough and Tweedle)(5)322 (Everett and Forty)(1)28, (Spigelman and Starch, glove powder, effect on joint and other tissues, (Rae Phillips) (Comment) (4)269 et al)(6)361 Polytetrafluoroethylene grafts, in thigh for vascular access Stomach, cancer of, intraoperative assessment of lymph node in haemodialysis, (Clarke and Horrocks) (Comment) (3)204 involvement, (Park et al)(5)324 Portal hypertension, extrahepatic, long-term results of Subclavian vein, catheterisation of, for parenteral nutrition, surgery for, (Szczepanik and Rudowski), (4)222 (Burtles) (Comment) (4)268 Proctocolectomy, restorative with pelvic ileal reservoir, Surgeons, at risk, protection for left index finger whilst (Everett and Forty) (1)28, (Spigelman and operating on HIV positive patients, (Miles et al)(4)225; Phillips) (Comment) (4)269 personality assessment of in selection for training, Prolene, plug of in repair of femoral hernia, (Allan and (Broughton) (Comment) (1)73 Heddle)(4)220, (Payne-James and Surgery, perioperative mortality and in Zambia, (Heywood Rogers) (Comment) (6)409 et al)(6)354 420 Subject Index Surgery general, (see) General surgery Ureter, catheterisation of, double J, Sutures, comparison of in abdominal skin closure, pain and (Kirkali)(Comment)(2)146, (Britton and healing and, (Johnson)(Comment)(2)145; fat stitches and Ferro) (Comment) (3)205 fat necrosis, (Ferris et al) 15, (Thomson)(Comment)(4)273, Urethroscopy, flexible, in difficult male catheterisation, (Ferris) (Comment) (6)410, (Higgins) (Comment) (6)410; (Krikler) (1)3 monofilaments compared with PTFE, in inguinal Urinary retention, acute, catheter comparison in, (Payne- herniorrhaphy, (Cahill et al)(2)128 James et al) (Comment) (2)145; acute, intravenous Sympathectomy, transthoracic, for palmar hyperhidrosis, in urography after, (Gajraj and Taube) (2)79 children under 16, (Law and Ellis)(1)70 Urography, intravenous, after acute urinary retention in men, (Gajraj and Taube)(2)79 T Tendons, ruptures, posterior tibial, (Welton and Patrick) (Comment) (2) 144 V Thyroid, solitary nodule in, audit of surgery for, accuracy of Vagotomy, early return to work after, (Tulloch and preoperative cytology, (Wetzig and Giddings) (5)316 Dewar) (6)347 Thyroidectomy, for Graves' disease, hypothyroidism and, Varicose veins, surgery for, tourniquet in, (Corbett and (Davenport and Talbot)(2)87; local anaesthesia for, Jayakumar) (1)57, (MaDonald et al) (Comment) (4)271, anatomical basis of cervical blocks, (Yerzingatsian)(4)207 (Laurie)(Comment)(4)271; surgery and sclerotherapy for, Tissue expansion, in plastic surgery, (Sharpe et al)(3)175 optimum compression after, (Shouler and Tourniquet, use in varicose vein surgery, (Corbett and Runchman) (6)402 Jayakumar) (1)57 Ventilation mechanical, outcome of, in Sri Lanka, Tracheostomy, minitracheostomy, (Wilson) (Comment) (1)73 (Rajapakse and Wijesekera)(6)344 Training, in surgery, (see also General surgery; in surgery, Vertical gastric plication, for gastro-oesophageal reflux, and mortality rate after elective and emergency surgery (Taylor et al)(1)31 for colorectal cancer, (Chester and Britton)(6)370 Trauma, cranio-orbital, team management of, (Poole and W Briggs)(3)187; to lower limb, primary treatment and War injuries, amputation for antipersonnel mine injuries of reconstruction, (Godfrey) (3)200 the leg, (Coupland)(6)405 Triiodothyronine, depletion of in donor organs after brain Working Party on Management of Patients with Major death, (Cooper et al)(4)261 Injuries, (see) Commission on Provision of Surgical Tuberculosis, spinal, anterior, paraplegia after laminectomy Survices for, (Rand and Smith), (2)105, (Statham and Wound closure, ,(see also Sutures; fat stitches and fat Johnston) (Comment) (4)273, (Grogono) (Comment) (5)339 necrosis, (Ferris et al)(2) 115, (Thomson)(Comment)(4)273, Tumour markers, carcinoembryonic antigen levels and (Ferris) (Comment) (6)410, (Higgins) (Comment) (6)410 recurrent colorectal carcinoma, (Pollard et al)(5)293 Wound infections, prophylaxis against, preincisional intraparietal Augmentin in, (Pollock et al)97 U Ulcers, leg, bacterial infection and skin grafting in, z (Martin) (Comment) (2)412 Zambia, perioperative mortality in, (Heywood et al)(6)354 Instructions to Authors Authors submitting original scientific papers for publication in the Annals should consult 'Uniform requirements for manuscripts submitted to biomedical journals' produced by the International Committee of Medical Journal Editors and published in the British Medical Journal, 6th February 1988, 401-56. 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ROYAL VISIT

The President and Council are pleased to announce that Her Majesty The Queen and His Royal Highness The Duke of Edinburgh will visit The College on 21st November, 1989. The Queen is the College Visitor and both the Queen and the Duke are Honorary Fellows. They last visited the College on 7th November 1962.

The programme for their visit will stress the current and future roles of the College in research, teaching, training and maintaining standards and will refer to its great traditions.

A report and photographs will appear in a later issue of the Bulletin.

Reports and Comments

FINAL F.R.C.S., ENGLAND MANCHESTER MAY 1989

The Primary FRCS England examination has for many years been held in various cities overseas-Accra, Baghdad and Cairo currently-but the Final examination and admission ceremony has never taken place outside London until this year. For some time there has been discussion regarding the desirability of holding the Final Fellowship in a hospital setting rather than the traditional Examination Hall atmosphere of Queen Square or, latterly, Bonham Carter House, and last year one week of the Autumn examination took place at St. Mary's Hospital, London. This year, in May, the Court of Examiners Fig. I and staffofthe Examinations Department, together with robes, mace and diplomas travelled in sweltering weather to North Manchester General Hospital where the third week of the examination was held. The photographs show in progress the orals in pathology (Fig. 1), and the Court formally attired immediately before the admission ceremony for the successful candidates (Fig. 2). An enormous amount of effort went into the organisation, not least in the provision of large numbers of suitably varied patients for the clinicals on three successive days. Thanks for this are due to Richard Hartley, seen sitting in the centre of the photograph, and his local team. Barry Jackson

Fig. 2 87 SURGICAL AUDIT: A REVIEW. PROCEEDINGS tion to prophylaxis used, pulmonary embolism, clinically OF AN AUDIT SYMPOSIUM apparent anastamotic leakage, wound infection, duration of Edited by Mr Michael H. Thompson Consultant Surgeon post-operative stay and death. In this instance, marshalling Southmead Hospital, Bristol and analysing the information from the audit cards took 3 hours. INTRODUCTION Critical review of the results of surgical treatment is now a COMPUTER BASED AUDIT SYSTEMS mandatory requirement for recognition of surgical units for (a) Unit based systems training purposes by the Royal College of Surgeons. Audit Mr D C Dunn presented the experience ofhis firm' s audit in systems are being actively promoted, but there is clearly a need Cambridge over the previous 6 years, encompassing over 9000 to review the aims of audit and the benefits that might accrue patients. The first 3 years produced an evolving system which for both of these sometimes appear uncertain. To this end a remained stable for the next 3. A computer was found to be symposium was recently held in Bristol to bring together the beneficial because the programme design principally undertook several different methods of review already in practice in the the production of discharge summaries. Important principles city. The contributors are listed below. were that the system should be easy to use, demand minimal coding choices, benefit all staff who used it, be adaptable to different local needs and that the data collected should be kept CONTRIBUTORS to a minimum. A microcomputer was easier to use because of Mr C E Ackroyd, Consultant Orthopaedic Surgeon, South- bureaucracy associated with the use of the mainframe, mead Hospital, Bristol. Mr R N Baird, Consultant Surgeon, although this is possible later. The programme can run on any Bristol Royal Infirmary, Bristol. Mr D C Dunn, Consultant IBM compatible machine. Surgeon, Addenbrookes Hospital, Cambridge. Mr W K Data were best collected by Medical Staff onto a proforma, Eltringham, Consultant Surgeon, Bristol Royal Infirmary, the contents of which were validated at special weekly meet- Bristol. Mr H J Espiner, Consultant Surgeon, Bristol Royal ings. On these occasions patient management was discussed. Infirmary, Bristol. Mr M Horrocks, Consultant Surgeon, Each month one of three surgical firms presented its statistical Bristol Royal Infirmary, Bristol. Mr R H Kennedy, Senior analysis for the preceding 3 month period. It was found that Surgical Registrar, Southmead Hospital, Bristol. Mr I patient details needed to be presented: simple statistics were Marsland, District Computer Manager, Southmead Health not valuable. District, Bristol. Mr R W Motson, Consultant Surgeon, In the first 5 years of audit, statistically significant falls in Colchester General Hospital, Essex. Mr R M Nicholls, District complication rates occurred. It was also found that hospital General Manager, Southmead Health District, Bristol. Mr M statistics excluded 20-25 per cent of patients treated. The H Thompson, Consultant Surgeon, Southmead Hospital, system is such that changing houseman and secretaries have Bristol. Mrs J Tyndall, Regional Computer Centre, adapted quickly and successfully without formal training. South-West Regional Health Authority. Vascular surgery at Bristol Royal Infirmary has been audited for 5 years by Messrs Baird and Horrocks. An IBM 10 megabyte computer was used. A vascutrak system was not AUDIT WITHOUT A COMPUTER succesful and a D-base III progamme was used but it took one The simplest method of audit presented was that of Messrs year's programming to become satisfactory. Operative details Espiner and Eltringham. Each Friday, over lunch, the whole are recorded by the Surgeon on a single form on one side of A4 staff of this one surgical firm meets to identify and solve the paper. The theatre operating books are checked monthly. problems that have arisen in the course of the week's work. (Six Complications are recorded when discharge summaries are operating sessions, four outpatients and two days emergency completed and checked at monthly audit meetings. The vascu- work). lar laboratory technical staff and/or research fellows enter the Standard forms are completed by the House Surgeon giving data. the patients' demographic details, diagnosis, treatment and (b) Hospital based computer audit current management of every inpatient. The Senior House The computer service available in Southmead Health Officer and the Senior Registrar add detail and the Surgeon District and the South-West Regional Health Authority was presents the technical operative details. presented by Mr I Marsland and Mrs J Tyndall. The District A critical review ofcase management in a confidential setting has an integrated system running on 10 DEC minicomputers is then undertaken with particular reference to misdiagnosis, housed together. Access is gained from 450 terminals in offices, serious complications and death. It is often possible to stave off wards, laboratories and health centres by a system which uses impending clinical problems at this time. In particular, such telephone lines. Once this system is in place an audit system events as negative laparotomy and post-operative sepsis can be can easily be added. reviewed in some depth. The routine management of bowel The South-West Regional Health Authority has a Medical preparation, post-operative antibiotics, thrombo-embolic pro- Data Index system which allows medical staff access to patient phylaxis etc. can all be aired and reviewed. Copies of the forms details on the patient administration system (PAS), and to use are then filed. the PAS as part of their own audit system. The user has a An audit of operated cases was then presented by Messrs. password to enter the system and is helped through by a series Kennedy and Thompson. At the time of operation a card is of instructions displayed on the screen. No information is completed to include the patients' details and title of the recorded in the PAS system and so confidentiality is assured. operation performed. On the reverse side 46 boxes are available The Clinician can vary the system and the way he uses it to for coding of information about the operation, peri-operative suit his own particular requirements. The design also allows risk factors and complications. The cards are collected together much of the repetitive nature ofdata entry to be shortened. Any for review once weekly and at that stage, complications number of items can be selected for search purposes and these recorded. Following discharge the cards are filed under diag- are presented on the screen and can be printed. nostic categories. A surgical audit has been used in the Orthopaedic Operations for colo-rectal neoplasia over a 2 year period Department at Southmead Hospital by Mr Christopher E. were reviewed. The operations were divided into 8 different Ackroyd starting in 1981 with a laborious long hand method, a types and information on the following subheadings retrieved microcomputer system and now a full computerised audit from the cards for each type ofoperation: number ofoperations system using the Medical Data Index system developed by the (total 94), urinary infection, venous thrombosis and the rela- SWRHA. The diagnosis, operation and complications are 88 recorded in full, and incorporated in the discharge letter. A have taken a great interest in quality assurance, but the series of simple diagnosis and procedure codes have been National Health Service has rather failed to do so. The Griffiths designed for coding and analysis and the complications are also Report criticised the lack of evaluation in the Health Service coded. and this was again emphasized by the CEPOD Study when it The system is administered by the medical staff or the was noted that a widespread lack of organised audit meetings secretaries. It was thought important that information be was apparent. The demand/resource dilemma seems likely to entered on the system as near to the patient area as possible. be with us for a long time and will lead to questions about the Entry of the data from the clinical records takes about 4 use of resources in terms of the outcome and effectiveness of a minutes and a stylised discharge summary is automatically particular treatment. In surgical circumstances the use of produced for both notes and general practitioner. There is a expensive resources for operations which result in predictable search and enquiry facility enabling retrieval of information death might well be questioned. Conversely, it may be necess- and collection of data from the various fields entered. After 2 ary to demonstrate that financial constraints leading to reduc- years of operation it became apparent that an accurate record tion of facilities are causing clinical difficulties and a reduction of important complications had been kept; there were no in the quality of service in order to make some improvement significant differences in the complication rate between the available. different members of staff at senior and junior level. It also As the Government's concern over the service given by the became easy to investigate particular complications. professions increases, it will be important for the medical A number of problems were encountered but many have profession to be seen to have its own house in order. In general been solved, that which remains is to ensure the accuracy of Mr Nicholls felt the profession is altruistic, competitive and data entered by the House Surgeon. Further modification ofthe interested in the subject and has a tradition ofhigh standards of system is being undertaken in order to overcome this particular care to be practised. The Royal Colleges should be involved in problem. taking a lead. For managers an improvement in efficiency as a result of clinical audit will be expected, but most of all the will be more reassured about the outcome BUYING A SURGICAL AUDIT COMPUTER SYSTEM patient of his "OFF THE SHELF" treatment. Mr R W Motson presented his experience at Colchester General Hospital having bought a "Micro Med" system 2 years SUMMARY previously. The preliminary obstacles were finance, enlisting The work ofsurgical departments involves varying proportions the support of colleagues, and overcoming "computer fear" of investigation, diagnosis and treatment and the object of amongst secretaries. audit is to measure and monitor the outcome of this activity. It When choosing a system ease of use is paramount. One also serves as a secondary but important role in education, minute of extra time entering data for each patient will add up research and resource planning. to several hours of secretarial time a year. Errors need to be The different methods of audit described in this symposium easily and quickly correctable. In order to test a system it is gave varying contributions to the definition of workload and useful to record the time taken to enter the data for one real outcome and to the education of the surgical staff. patient. Irrespective of the audit system used, there is little doubt It was found beneficial at the onset to have one month of that weekly meetings specifically designed for the purpose are practice, then to erase those patients from the memory and ofprime importance, and the contributors used it in a variety of start afresh. Information concerning patients to be entered into different ways. For Messrs. Eltringham and Espiner this the audit is kept on record cards completed by the House Staff. meeting was seen much more as an educational exercise for the The transfer of data from patient record cards into the firm as a whole than a ritualistic method of collecting numeri- computer has been done by the secretary. It was felt that the cal information. Where other systems which rather more Registrar and Houseman were not sufficienty permanent fastidiously collect numerical information are used, the weekly members of the staff to become adept at operating the system. meeting becomes more important in ensuring the accuracy of In addition the secretary has a large amount of information the data collected. concerning patients readily accessible on the computer in front Some authors review the proforma on which the patient of her, and she can answer queries from patients quickly information is collected before it is entered into the computer, a without recourse to the case notes. When the secretary is ill or point strongly made by Mr Dunn and it does seem likely that as on holiday it is then very difficult for a temporary secretary to audit information is collected and challenged, then consider- take over her work. If, however, an entire department handles able efforts will have to be made to ensure the accuracy of the its information in this way, then others can help out at times of information being entered, for there is little point in defending difficulty. an audit result by suggesting that the houseman who made the Technical difficulties with the computer may happen and so original entry did not do so very accurately. Many auditors it is important to make duplicate copies of the information used a lunch or coffee break as a convenient time to meet, but stored in the computer. If one set is erased, the reserve is in some cases a lot of extra work was required for validation available. Failure ofthe printer coupled to the computer is very and if clinical audit is to represent a very accurate record of the frustrating because the production of discharge summaries is work of a surgical department, this point requires careful immediately halted. It is therefore wise to buy the highest consideration. quality of printer that can be afforded. Ifaudit information is to be easily processed, then its means Some discharge summaries will be too difficult for the of collection is important. Most contributors used a single secretary to enter and these need to be dealt with by the record card on which the information was recorded during the Registrar or Consultant as before. A computerised system does patient's stay and this record card can be designed to make not omit minor cases such as sebaceous cysts, ingrowing entry into a computer system easy for a secretary. It is also toenails etc, and so one can produce a complete record of the much easier to take record cards to a weekly meeting than 30 entire work of the Department. sets of patients' notes. In broad terms the audit systems discussed fell into 2 groups: MANAGERS VIEW OF CLINICAL AUDIT those which used computers and those which did not. There is The Managers view of clinical audit was expressed by Mr R M no doubt that the use of a computer helps in marshalling the Nicholls, District General Manager, who pointed out that the information collected. Although a card system was very cheap outcome of treatment is probably the factor of greatest concern and easy to use, it was very much more difficult to retrieve to patients. Many organisations, both clinical and otherwise, information rapidly from it than from a computer based 89 system. It seems that the use of a computer entails the original constitution of the A.P.S. its avowed objective was "to consumption ofmore time for entry and validation ofdata than provide a forum for the discussion of academic surgical policy a card based system, and there may be a temptation not to and to take necessary action". spend so much time on the educational aspects of audit. This 2. A important stimulus to the inauguration of the A.P.S. problem can be overcome by holding regular meetings at which was the formation of the 'Joint Committee for Higher Surgical only the results are presented, perhaps firm by firm, in a Training (J.C.H.S.T.)' which held its first meeting on 29thJuly hospital, so that discussions on policies relating to thrombo- 1968 (I I days after the formation ofthe A.P.S.). The A.P.S. has embolic prophylaxis, the use of prophylactic antibiotics and representation on the J.C.H.S.T. and the Specialist Advisory similar topics can be discussed. Committees (S.A.C.). Indeed if this kind of meeting does not take place, then it Just as the development of 'higher surgical training (HST)' would seem that one of the principle objectives of audit is lost. marked a watershed in the evolution of surgical education in For these meetings to take place a computer based system is the U.K. and precipitated a flurry of activity by Academic almost certainly going to be essential. Surgeons, so the more recent novel concepts embraced by In setting up a clinical audit there is clearly a requirement 'Achieving a Balance', 'Plan for Action,' 'F.R.C.S. regulations,' for financial investment. This means firstly buying a computer and the Government White Paper on the N.H.S., necessitate based system and several options are open to the prospective formal comment from the A.P.S.-hence this document. auditor. A simple desk top computer with a modified database 3. There can be little doubt that any manipulation ofjunior system can be used but Messrs. Baird and Horrocks found it hospital staff training and numbers will inevitably affect required a great deal of programming using a database undergraduate surgical tuition since in all teaching hospitals programme that was already commercially available to obtain and in many District General Hospitals, registrars (both a workable system. Two or three commercial systems are now 'junior and senior') are involved in clinical teaching of medical available using personal computers and it seems likely that in students. However, this document confines itself to postgradu- many hospitals this will be a popular choice. When introduced ate research activity and surgical training. at Colchester General Hospital by Mr Motson where such a 4. Research in Surgical Training Background facility had not existed in the past, computerisation has been (i) Most medical graduates wishing to pursue a surgical well received and has achieved the desired result. As more career do so because of an interest in and the excitement hospitals develop their own sophisticated information systems, generated by, the 'craft' of surgery. Basic surgical education it may be possible to graft clinical audit information onto the encompasses an acquisition of knowledge, attitudes and skills hospital programmes in a way outlined by Mr Marsland and commensurate with the individual's training and to a level Mrs Tyndall. The advantage of this system is that there is often which satisfies the criteria of the examining boards of the Royal experienced help available for the design and implementation Colleges. Such a 'core surgeon' is then regarded as suitable for of the system and very powerful computers to use. more specialised clinical training. On satisfactory completion The information yielded by audit needs to be kept in a of a recognised 'higher surgical training' programme the confidential system. If this fails to occur, then the users of the individual is 'accredited' and hence regarded as fully trained in system will cease to have confidence in it and the accuracy of the specialty. He/she will then be appointed a Consultant information put into the audit will lessen. As the whole object Surgeon and hold that position for approximately 30 years. of audit is an attempt to collect accurate and detailed infor- (ii) During the last 20 years the importance of a period of mation about patients, then another prime objective could research activity in surgical training programmes in the U.K. easily be lost. has been recognised by both trainees (perhaps initially moti- There is little doubt from the experiences presented in this vated by career advancement rather than advancement of the review that audit is feasible. The benefits fall into two broad frontiers of knowledge) and trainers. groups. Firstly by reviewing cases at a regular weekly meeting The consultant surgeon who has during training been evolving problems can be dealt with so there is an immediate personally involved in research (and teaching) finds that his benefit for that one patient and a useful learning experience for attitudes to knowledge and evidence are changed beyond the staff. It is important not to lose sight of this in the wish to recognition. The rate of accumulation and obsolescence of collect data on a computer. The second benefit is the ease of knowledge and techniques is now so great that education must handling large amounts of information about patient activity. continue throughout the 30 years of consultant practice. The Only the Cambridge experience gave any longer term view and most effective method of ensuring this attitude of self- there was an impact on the complications ofsurgical treatment. education, and the ability to teach as well as to maintain a high It will be most important in the years to come, as audit systems standard of practice with full appreciation of modern develop- are introduced, that their value is critically regarded because in ments, is to expose the 'young' receptive trainee to surgical order to establish and run clinical audit, a considerable amount research. of time will need to be devoted by everybody involved. Rhodes (1) has expressed this view succinctly. 'Consul- The determination of longer term response to surgical tants...... must increasingly consider what they are doing, why treatment in terms of graft patency, tumour recurrence and they are doing it, and for whom, and whether they ought to be patient survival is not possible by any of the methods currently doing all of the things that they do". The recent Government described. It is an undertaking of great importance and review on the N.H.S. highlights this aspect of assessment and proportions and clearly has a bearing on clinical practice. Short accountability as a major factor in improving health care term clinical audit will therefore be only one part of the standards. evaluation of surgical care. It is the view of members of the A.P.S. as well as most other individuals involved directly or indirectly in surgical training that a period of research activity has benefits not only in contributing to surgical science and knowledge per se but in RESEARCH AND SURGICAL TRAINING helping to ensure that the individual has both the ability and A Statement by the Association of Professors of Surgery motivation to continue to enhance his/her education through- 1. The Association of Professors of Surgery (herewith out his/her professional life and hence provide a higher referred to as A.P.S.) was formed inJuly 1968. Membership is standard of clinical care in the most cost-effective manner. open to all Professors with established or personal chairs in the (iii) An illustration of the widespread recognition of research British Isles. Chairs in all branches of Surgery are included in activity in surgical training can best be appreciated by analysis order to foster academic development of the surgical specialties of applications for Senior Registrar and Consultant posts (2). and to ensure that an academic voice is heard in the organisa- In a recent survey of senior registrar applications in general tion of surgical training in all its disciplines. Indeed, in the surgery in one region all short listed candidates had a higher 90 degree by thesis, and had spent a mean of 1.9 years in full time 6. Surgical Research-When? research. It is highly unlikely that an individual will be The period of essential research activity for 'general surgery' appointed to a consultant surgical post in general surgery in the should occur at an early stage in training. This should foreseeable future without a higher degree by thesis. commence either during the SHO period after Part I and Part There is little doubt that 'market forces' stimulated by II FRCS examinations or as an allocated period during 'Career intense competition for senior registrar and consultant posts in registrar' appointment. For the surgical specialties it is prefer- general surgery have been a major factor in research training. able for research activity to commence during the career Equally, few would doubt the long-term benefits which have registrar grade or H.S.T. accrued. If research activity takes place as an SHO then an indivi- (iv) It is against this background that the A.P.S. wish to state dual's achievements could be used as a criterion for allocation their views with regard to the role of research (and academic) of a career registrar 'number'. This would necessitate the endeavour in the training programmes of future surgeons. appointment of research S.H.O's by formal interview com- As previously mentioned this statement is precipitated by mittees involving both University and N.H.S. representation. changes in surgical training which are bound to occur as a As a career registrar he/she should continue his/her research result of the implementation of 'Achieving a Balance' over the and scientific interests within the confines of a clinical environ- next 10 years, and the altered format for fellowship examina- ment and accordingly progress 'in continuity'. This would be tions by all four Royal Colleges. The A.P.S. does not wish to assisted by ensuring that C.R's have regular study periods (1-2 comment on the general desirability or otherwise of these two half days per week). major innovations, but notes that both pay scant attention to It is important that there should be a reasonable academic the role of surgical research and to the advancement of surgical quota in the career registrar grade so that a proportion of such science in surgical education. individuals have the opportunity to pursue full-time surgical 5. Surgical Research-For Whom? research. On completion of C.R. training it is feasible that, in Accepting the importance of a period of research activity addition to clinical and technical skills, evidence of continuous both in the short and long term, one needs to consider whether academic endeavour will be used as a factor to assess appoint- all surgical trainees should be required, as part of formal ment to an H.S.T. 'number'. It is to be hoped that those training, to undergo such a period of full-time activity, or individuals showing academic prowess will enter lecturer posts whether this should be 'selective'. The results of a recent with a view to further advanced research activity. Hence questionnaire completed by members of the A.P.S. indicated University Lecturer Posts should, wherever possible, be used to that 80%of 'general surgical' Professors regarded research as encourage individuals wishing to pursue an academic path essential, irrespective of 'market forces'. Of the 18% who with a view to obtaining a Chair of Surgery. considered that research should be selective and hence concen- Consideration should also be given to the assessment (FRCS) trated on individuals who would wish to pursue an academic which will take place during the period of H.S.T. An indivi- career, half stated that it was nevertheless highly desirable for dual's research productivity either in the form of publications all trainees. Amongst the surgical 'specialties', 47% considered (in peer-review journals) or a higher degree by thesis could be research to be essential and 53% selective. This view reflects taken into account in the final assessment. This would be of the 'craft' emphasis in the surgical specialties. assistance in ensuring continuing contributions to surgical Accordingly, the majority of 'general surgical' Professors science throughout the period of training. regard research activity to be an essential pre-requisite for all It is to be hoped that such a scheme will continue to ensure surgical trainees. Within this broad framework a number of that academic activity and scientific endeavour parallel clinical specific items require consideration:- training so that consultant surgeons possess the background to (a) Normally full-time research activity should be for a provide high-class tuition of both undergraduates and post- minimal period of 1 year. Clearly individuals desirous of graduates throughout their professional life-time. In addition, pursuing an academic career should aim for a minimum 2 years it will ensure that British Surgery continues to make substan- training. tial contributions to surgical knowledge. There can be little (b) A measure of success in research endeavour could be doubt that major scientific and technical innovations will occur gauged by publications in peer-review journals. A higher and consultants should be able to harness them in the most degree by thesis (e.g. M.D., or M.S.) is highly desirable but cost-effective manner. may not be essential for all individuals. An M.Sc. or It should also be recognised that Regional Health M.Med.Sci. may be more appropriate for 1 year research. Authorities have an important responsibility for post-graduate (c) Individuals shown to excel at research and general education and the funding of 'SHO's' to pursue research scientific endeavour should be recognised and wherever poss- activity outwith the normal surgical 'service' is necessary ible encouraged to occupy lecturer posts aimed at promoting a rather than relying upon outside grants on an 'ad hoc' basis to career in academic surgery. They may wish to undergo a period provide support. In this context we would strongly support the of training in basic scientific (i.e. non-surgical departments) statement by the Academic Medical Group in stating that the before moving into a busy clinical post. 'N.H.S. should take a greater part in the support of research (d) There is an awareness of the importance of the 'New and development'. Fortunately the recent government white Biology' and it is necessary to ensure that a proportion of the paper 'Working for Patients' recognises this deficiency (4). In next generation of academic surgeons have adequate training the only paragraph related to medical education and research it and understanding in these disciplines. However, surgeons states 'The Government is fully committed to maintaining the have traditionally been leaders in the fields of clinical physio- quality of medical education and research. It recognises the logy and tissue biology and this should not be allowed to lapse. complexity and special needs of these areas'. Indeed, important contributions to cardiovascular, gastrointes- Irving Taylor (Honorary Secreta?y) tinal and respiratory physiology have been, and will continue Ivan D A Johnston (Chairman) to be made by surgeons. On behalf of the Association of Professors of Surgery. (e) In order to ensure continuation of training, research activity should be associated with surgical departments whe- never possible. References Conclusion-For whom? 1 Rhodes P. Educating the doctor: postgraduate, vocational A period of research activity is an essential requisite within and continuing education. Brit. Med. J. 1985; 290: 1808-10. the training programme of surgeons. The benefits are likely to 2 Taylor I., Clyne C.A.C. Senior Registrar applications in accrue throughout the professional life-time of a surgeon. General Surgery, Brit. Med. J. 1985; 291: 143-4. Hence it is important to ensure that every surgeon-in-training 3 The Academic Medicine Group Academic Medicine: has the opportunity to pursue full-time research for a minimum Problems and Solutions, Brit. Med. J. 1989; 298: 573-9. period of one year. 4 Working for Patients. Government White Paper, 1989. 91 Correspondence

3 August 1989 Events such as this are hardly likely to encourage young Dear Sir surgeons to spend a period working abroad. When asked for The letters from Mr Bem and Dr Ludington (College and advice by young surgeons, on this matter, I find that I can Faculty Bulletin, July) raised important points with which I really only advise them to work abroad, if they do so, from a can only full-heartedly, agree. Working abroad (whether in protected situation,with a job to which they may return after, developed or undeveloped countries) benefits the British sur- say, one year. During their year of absence, it often makes very geon, the country he visits, patients at home and abroad and good sense to fill the post with an overseas doctor. I feel that if often does much for the reputation abroad of British surgery. more senior surgeons had a more positive attitude to working It is unfortunate, that many members of the surgical estab- abroad, then many young surgeons' training would be consi- lishment do not give support and encouragement to British derably enhanced. surgeons wishing to work abroad. In fact often the opposite I make a plea, as Mr Bem does, for our College to encourage seems to be the case. periods spent working abroad. At a recent interview for a senior registrar post, 2 candidates Yours sincerely were short-listed and flew back to the United Kingdom for R D Spicer interviews at their own expense, one from Australia and one Consultant Paediatric Surgeon from the United States, but neither was appointed to the post.

College and Faculty Reports and Notices

MEETINGS OF COUNCIL The first Regent Travelling Scholarship was awarded jointly At an Extraordinary Meeting of Council held on to Mr H Gajraj FRCS and Mr C East FRCS. Wednesday, 12th July 1989, the following were admitted to Wing Commander B T Morgans CBE FRCSGlas was appointed the Fellowship by Election: Cade Professor of Surgery in the Royal Air Force. Mr George Pinker, CVO FRCSEd FRCOG, Surgeon The Porritt Fellowship for 1989 was awarded to Mr C Imray Gynaecologist to HM the Queen FRCSEd of the Department of Surgery, University of Mr Ian Capperauld, FRCSEd of Ethicon Limited Birmingham. Diplomas of Fellowship were granted in accordance with the Mr J M Brudenell FRCS FRCOG was appointed Invited pass list (see page 92) and also to Richard George Berrisford Member of Council representing the Royal College of (Leeds) Obstetricians and Gynaecologists with effect from 14th Sir Robert Kilpatrick, CBE FRCP, President of the General September 1989. Medical Council, delivered the Address to the new diplomates.

At the Quarterly Meeting of Council held on Thursday, 13th July 1989, Mr Terence English FRCS was admitted to the office of President for the ensuing year. ANNUAL MEETING OF FELLOWS AND Miss Phyllis George FRCS and Mr David L Evans FRCS were re- MEMBERS-13th December 1989 admitted and admitted respectively to office as Vice-Presidents AGENDA for the ensuing year. 1. To receive the printed Addresses from the President of the Mr R J Heald FRCS was admitted as member of Council Royal College of Surgeons of England, the President of the following the recent ballot of Fellows. College of Anaesthetists and the Dean of the Faculty of Dental Professor Carl-Gustav Groth of Huddinge Hospital, Surgery. Stockholm, Sweden was admitted to the Honorary Fellowship, 2. To receive the printed Annual Accounts of the College a citation having been delivered by Professor Sir Roy (available for inspection at the meeting) and a brief statement Calne FRCS FRS. from the Chairman of the Finance Board on the College's Mr Neville Davis FRCS of the University of Queensland, financial position. Australia was admitted to the Honorary Fellowship, a citation 3. To approve the increase in Home Surgical and Dental having been delivered by Professor Miles Irving FRCS. Fellows' subscriptions to £175 per annum with effect from Dr Michael Lea Thomas, Senior Physician in Radiology, October 1990, in accordance with the Resolution of Council St Thomas' Hospital, was admitted to the Fellowship by dated 11th May 1989. Election, a citation having been delivered by Professor N L 4. GREEN PAPER FOR DEBATE: Browse FRCS. 'Certification ofSpecialist Training and Continuing Medical Professor John Douglas Pickard FRCSEd, Professor of Education' Neurosurgery, Southampton General Hospital was admitted to Speakers: the Fellowship ad eundem, a citation having been delivered by (a) ProfessorJohn Alexander-Williams FRCS: 'The case for an Sir Keith Ross, Bt FRCS. indicative Specialist Register' The following were appointed Royal College of Surgeons (b) Mr Douglas Gentleman FRCS: 'Continuing Medical Surgical Tutors for a period of three years in the first instance: Education-A view from the GMC' N W Thames (c) Professor Miles Irving FRCS: 'Continuing Medical (Luton and Dunstable)-MrJ M Towler FRCS in succession Education-A view from the RCS England' to Mr R L Rothwell- Jackson FRCS. (d) Mr PJ Mulligan FRCS: 'Recertification-Advantages and Mersey disadvantages' (South Sefton-Walton)-Mr Andrew Wu FRCS in succession 5. Further motions, if any, received from Fellows by the to Mr I M Stevenson FRCS. prescribed date. 92 ELECTIONS TO THE STANDING COMMITTEE SPECIALTY EXAMINATION IN PLASTIC FOR WALES SURGERY Royal College of Surgeons of Edinburgh Notice is hereby given that there will be an election of four Royal College of Surgeons of England Members to the Standing Committee for Wales. Royal College of Physicians and Surgeons of Glasgow The current membership of the Standing Committee for Royal College of Surgeons in Ireland Wales is six. It has been decided that this should be increased to ten and accordingly an extraordinary election is to be held The next Intercollegiate Specialty Examination in Plastic on 31 January 1990. Surgery will be held in Bangour General Hospital, Broxburn, Election will normally be held in alternate years from West Lothian on Tuesday, 6 March 1990. January 1991 and members will serve for an initial period of Applications must be supported by written evidence that four years, whereupon they will be eligible for re-election for a candidates hold the Surgical Fellowship of one of the Royal further two years. Colleges of Surgeons of Great Britain or Ireland or an equiva- However, in this instance members elected in January 1990 lent Diploma and that they have completed three years of will be required to stand down at the election in 1993 but will training in centres recognised by the Specialist Advisory Com- be eligible for re-election for a further 4-6 year term. mittee in Plastic Surgery for training at Registrar or Senior Fellows wishing to stand for election must: Registrar level. At least one year of this period must be at hold the Fellowship of a Surgical Royal College in the Senior Registrar level in Great Britain or Ireland. The Ex- United Kingdom or Ireland or of the Surgical Colleges in amination will consist of clinical and oral components and will Australia, Canada or South Africa; contain a significant element of the Basic Sciences related to be resident in Wales; Plastic Surgery. be a Consultant Surgeon and actively engaged in Surgery in Surgeons working in the specialty of Plastic Surgery who the Principality. wish to enter for the Examination should apply to the Secretar- Fellows must satisfy all criteria to be eligible for election. iat, Intercollegiate Specialty Boards, 10 Hill Square, Edin- Further information and forms of nomination are obtainable burgh EH8 9DR for a copy of the Regulations and application from the Secretary of the College. form. Closing date for receipt of applications is Friday, 12 January 1990. R H E DUFFETT Fee: £230. Secreta'y EXAMINERSHIPS, F.C.ANAES, 1990/91 SYMPOSIUM ON APPROPRIATE CLINICAL Applications are invited for examinership vacancies in the INVESTIGATION IN SURGERY Parts 1 and 2, F.C.Anaes. for academic year 1990/91. At the A Symposium on Appropriate Clinical Investigation in Surgery time ofgoing to press, it is expected that there will be vacancies will be held at The Royal College of Surgeons of England on as follows: Friday 15 December 1989. Part 1, F C Anaes. 4 vacancies Contributors will include Dr Robert Brook and Dr Jac- Part 2, F C Anaes. 1 vacancy queline Kosecoff of the Rand Corporation, USA, and Dr J R Part 3, F C Anaes. No vacancies Hampton, Consultant Physician, Nottingham University Hos- Application forms are available from: The Secretary, College of pital. A series of presentations will also be given by Fellows of Anaesthetists, at the Royal College of Surgeons of England, the College on the appropriateness of particular types of inves- 35/43 Lincoln's Inn Fields, London WC2A 3PN. The closing tigation in Urology. Vascular Surgery and Gastroenterology. date for the receipt of applications is 31st December 1989. Full details of the programme will be available from the Department of External Affairs, at the College (Tel: 01 405 3474 ext 4172), from early October and will be publicised in ELECTION TO COUNCIL OF THE COLLEGE OF local post-graduate training centres. ANAESTHETISTS 1990 The official announcement of the election to fill vacancies on SPECIALTY EXAMINATION IN PAEDIATRIC the Council of the College ofAnaesthetists, 1990, will be found SURGERY in the British Medical Journal and The Lancet, issues dated 4th Royal College of Surgeons of Edinburgh November 1989. Royal College of Surgeons of England Royal College of Physicians and Surgeons of Glasgow REPORT, dated 25th May, 1989, of the COURT OF Royal College of Surgeons in Ireland EXAMINERS' The Court of Examiners reports to the Council that at the The next Intercollegiate Specialty Examination in Paediatric recent Final Examination for the Fellowship 37 candidates Surgery will be held in the Royal College of Surgeons of presented themselves for the Examination in Ophthalmology, England on Thursday, 15 March 1990. 10 of whom acquitted themselves satisfactorily; and 32 candi- Candidates must have been qualified for at least seven years dates presented themselves for the Examination in and hold a Surgical Fellowship of one of the Royal Colleges of Otolaryngology, 11 of whom acquitted themselves satisfactor- Surgeons of Great Britain or Ireland for at least three years; or ily; and 286 candidates presented themselves for the have held for a similar period an equivalent Diploma recog- Examination in General Surgery, 84 of whom acquitted them- nised by the Joint Conference of Surgical Colleges or have selves satisfactorily; Of the successful candidates, Richard acquired training and qualifications acceptable to the Joint George Berrisford and Neeraj Kumar Mediratta have not yet Meeting of Surgical Colleges. The candidate should have com- complied with the regulations. pleted two years of the required Specialty Training in posts acceptable to the Specialty Board, one year ofwhich must have The following are the names of the 103 candidates who are been at Senior Registrar level in Great Britain or Ireland. therefore entitled, subject to the approval of the Council, to the Application forms and a copy of the Regulations are avail- Diploma of Fellow:- able from the Secretariat, Intercollegiate Specialty Boards, 10 SIVAPRAGASAM, Sinnathamby (Sri Lanka) Hill Square, Edinburgh EH8 9DR. Closing date for receipt of ZAW, Lin (Rangoon) applications is Friday, 19January 1990. *MATHEW, Thomas (Kerala) Fee: £230 SALIM, Salaheddin Abdul Razzak (Mosul) 93 FIELDING, George Alexander (Queensland) *VIVIAN, Anthony James (London) OPPONG, Fielding Christian (Ghana) WALSH, Aideen Kathleen Mary (N.U.I.) tSOMJEE, Shehnaz (Karachi) WILSON, Yvonne Gillian (Nottingham) LUCARELLI, Pierino (Rome) ABERCROMBIE, John Forbes (London) SIKDAR, Tuhinangshu (Bengal) BANERJEE, Anjan Kumar (London) TAIWO, Claudius Bola (Ibadan) *BARTON, Keith (Belfast) IBRAHIM, Moheb Samir (Assiut) BIRCH, Nicholas Charles (London) tLANNIGAN, Francis Joseph (Leeds) BRUCE, Colin Ernest (Liverpool) tMcFERRAN, Donald John (Cambridge) CHAPMAN, Peter Geoffrey (London) tBUCKLEY, John Graham (Birmingham) CRAWFORD, Robin Alfred Florian (Cambridge) tCOURTENEY-HARRIS, Robert DAVIES, Nicholas (Birmingham) George (London) FISHER, Sheila Eunice (Manchester) *DAVISON, Charles Richard Norris (Cambridge) GIDDINS, Grey Edward Bence (Cambridge) MORLEY, Roland (London) GILBERT, Hugh William (Cambridge) SAUNDERS, Michael Peter (London) HASHEMINEJAD, Aresh (London) SHAH, Mamta Thakorlal (Gujarat) HILL, Susan Marion (London) tTOLLEY, Neil Samuel (Wales) HILLS, Michael William (Bristol) tWILLIAMS, Huw Owain Llewwellyn (Wales) HODGKINSON, Peter David (Manchester) *BISHOP, Paul Nicholas (Nottingham) JOHNSTONE, David James (London) BUTTERWORTH, Rosalind Jane (Leicester) JONES, Matthew Oliver (London) tCAMILLERI, Andrew Edward (Dundee) KOLOCASSIDES, Kyriacos CANAGASINGHAM, Bertram Georgiou (London) Devaseelan Carpenter (Colombo) MORTON, Dion Gregory (Bristol) tCHALSTREY, Susan Elizabeth (London) NAWROCKI, Jan Dominik (London) FIELD, Jeremy (London) NEWINGTON, David Peter (London) HOULDER, Alexander Robert (Dundee) NOORDEEN, Mohamed Hamza JEWELL, Francis Michael (Oxford) Hilali (Oxford) tJONES, Richard Henry Vaughan (London) OHRI, Sunil Kumar (London) *KNOWLES, Phillipa Joy (Cambridge) PAPANASTASSIU, Varnavas (Manchester) MASON, Rodney John (Witwatersrand) SEARLE, Adam Eric (London) SMITH, Alan Robert Clifton (London) WILLIAMS, Christopher Richard STANLEY, Paul Russell Walker (London) Philip (London) STEPHENSON, Brian Mark (London) WORSEY, Michael Jonathan (London) TAYLOR, Hugo Wheldon (London) UBHI, Sukhbir Singh (Leicester) *In Ophthalmology VRETTOS, Basil Christopher (Zimbabwe) tIn Otolaryngology tWAKE, Mark (Birmingham) *BAER, Roger Max (London) GIFTS *BRAY, Lindsay Charles (London) CHINEGWUNDOH, Francis RESPONSE TO COLLEGE APPEAL-25th June-24th Ikechukwu (London) August 1989 DICKINSON, Andrew John (London) During the past few weeks the following gifts have been DINGLE, Ann Frances (Birmingham) received/promised: DODDS, Richard David Allan (Cambridge) Gifts available for the general funds of the College and its DZIEWULKSI, Peter George (London) Hunterian Institute ECONOMOU, Panayiotis (Manchester) 15 Covenants, 2 Deposited Covenants & 14 Annual Payments FEWSTER, Stephen David (London) totalling ...... £22,110 FOROUHI, Parto (Edinburgh) 9 Legacies & 2 Further Bequests totalling ...... £176,937 FOWLIS, George Akindale (N.U.I.) Donations over £500 totalling...... £2,000 GARLICK, Nicholas Ian (London) Donations under £500 totalling...... £3,524 HALLIDAY, Katharine Elizabeth (Manchester) Gifts designated for special purposes within the college and its HARDY, John Richard Wickham (London) Hunterian Institute HOUSDEN, Philip Lionel (Wales) From the Wolfson Foundation the final promised payment to KREIBICH, David Neil (Newcastle) support NMR Unit...... £50,000 LAMBERT, Simon Martin (London) From Augustus & Frances Newman Foundation for Professor LATHAM, Jeremy Martin (Oxford) Piper's research into leukotrienes a further ...... £36,794 *LAWS, David Eamonn (Wales) From the Sir Isaac & Lady Wolfson Charitable Trust the final LEES, Timothy Andrew (Manchester) promised payment to support NMR Unit...... £20,000 LI, Raymond Shiu Ki (N. U.I.) From BP Gp ofCompanies 1st of2 promised payments towards LOEFFLER, Mark David (London) the cost of RCS Advanced Trauma Life Project...... £20,000 MORTIMER, Caroline Jane Denise (London) From Miss Cecilia Colledge a further donation to the Lionel OLIVER, Christopher William (London) College Memorial Fund...... £1,500 PARRY, Gareth Wyn (Wales) To cancer research...... £696 PATEL, Nilesh Vithalbhai (Glasgow) To asthma research...... £120 PICKARD, Robert Stephen (London) PLUSA, Stefan Murray (Leeds) MEMBERSHIP OF THE SOVIET SURGICAL SAYERS, Robert David (Birmingham) SOCIETY *SNEAD, Martin Paul (London) Mr Nadey Hakim, FRCS, was elected a member of the Soviet STAPLETON, Simon Robert St John (London) Surgical Society during a recent trip to the USSR as a THOMAS, Michael Graham (London) Travelling Scholar of the International College of Surgeons. It THORPE, Anthony Peter (Birmingham) is believed that this is the first time that a Fellow of the English TYRELL, Mark Richard (Witwatersrand) College has received this honour. 94 APPOINTMENT TO VICE-CHANCELLOR DEATHS Professor A P R Aluwihare, FRCS, has been appointed The Annals reports with regret the deaths of the following Vice-Chancellor of the University of Peradeniya, Sri Lanka. Fellows: ASHBY, William Bennett, FRCS APPOINTMENTS OF FELLOWS TO DALLAS, Stuart Henry, FFARCS CONSULTANT POSTS GARDNER, Dame Frances Violet ,FRCS GRIMOLDBY, John Roland, FRCS BAKER A R FRCS HENNY, Frederick A, FDSRCS Consultant General Surgeon, Frenchay Health Authority, PHILLIPS, Ralph Francis, FRCS South Western Regional Authority. SCOTT, Walter Henry Collins, FRCS BUTT K M H FRCS WALLACE, Patricia Elizabeth, FFARCS Professor and Vice-Chairman, Department of Surgery, New York Medical College, and Director of Transplantation and PORRITT FELLOWSHIP Vascular Surgery Services, Westchester County Medical Applications are invited for the eighth award of the Porritt Center, Valhalla, New York, USA. Fellowship given by the Winthrop Foundation in honour of the CARR N D FRCS Rt. Hon. the Lord Porritt, GCMG, GCVO, CBE, FRCS, to encourage Consultant General Surgeon, West Glamorgan Health the study of sports medicine and injuries in sport. Authority. The purpose of the Porritt Fellowship is to encourage study COX R FRCS of the physiology and biochemistry of sporting achievement Consultant Urologist, Cornwall Health Authority. and/or the aetiology, pathology, prevention and treatment of DUFFIELD R G M FRCS accidents and injuries associated with sporting activities. The Consultant Surgeon, Telford District General Hospital, work may be carried out in the UK or abroad, and should be Shropshire Health Authority. suitable for publication or form part of a thesis for higher EWEN A FCAnaes qualifications. StaffAnaesthetist, University of Manitoba, Winnipeg, Canada. A candidate must hold the Fellowship of a Royal College of GUVENDIK L FRCS Surgeons in Great Britain or Ireland, or of one of their Consultant in Cardiothoracic Surgery, East Yorkshire, Faculties or be a medically qualified member of the staff ofone Yorkshire Regional Health Authority. of their scientific departments. Successful candidates will HALL R I FRCS probably hold university, NHS or other salaried posts, and will Consultant General Surgeon for Derby Hospitals, Trent use their Fellowships to travel to centres at home or abroad to Regional Health Authority. study. HARDY P A J FFARCS The value of the Fellowship is £5,000 tenable normally for a Consultant in Anaesthesia and Pain Relief, Gloucestershire period of one year, from September 1990 and a Porritt Fellow Royal Hospital, Gloucester. may be invited to deliver a Porritt Lecture by the British HINTON C P FRCS Association ofSports and Medicine. The successful applicant is Consultant Surgeon, Telford District General Hospital, required to submit a report to the College on return from Shropshire Health Authority. abroad. HOAD DJ FFARCS Applications must reach the Secretary of the Royal College Consultant Anaesthetist, Nevill Hall Hospital, Abergavenny, of Surgeons of England not later than Friday 27th April Gwent. 1990 and must include the following: KIRBY I J FFARCS (a) curriculum vitae Consultant Anaesthetist, with a special interest in pain relief, (b) statement (max. 1000 words) of the study or research Southport and Formby Health District. project, including the location and facilities already KIRKPATRICK T FFARCS available for the project Consultant Anaesthetist with interest in Intensive Care, (c) particulars of the applicant's salary and of any addi- Doncaster Royal Infirmary, Doncaster Health Authority. tional financial support promised or applied for MASOOD A F M FRCS (d) names and addresses of two referees, one of whom Professor and Head of the Department of Paediatric Surgery should be the head of the department in which the and Orthopaedics, Bangladesh Institute of Child Health and applicant is working. Dhaka Shishu Hospital, Dhaka, Bangladesh. MAY P C FRCS REGENT TRAVELLING SCHOLARSHIP Consultant Trauma and Orthopaedic Surgeon, West Midlands Applications are invited by the Council for the second award of Regional Health Authority. the Regent Travelling Scholarship, founded by Regent Hos- PERKINS R D FRCS pital Products, part of London International Group plc. An Consultant Trauma and Orthopaedic Surgeon, West Midlands annual grant totalling £5,000 will be awarded to enable one or Regional Health Authority. two young surgeons to study abroad and to acquire surgical POZO J L FRCS expertise not readily available to them in the U.K. Consultant Orthopaedic & Traumatic Surgeon, Bath Health The scholarship is open to Surgical Fellows of the Royal District, Wessex Regional Health Authority. College of Surgeons of England who: SUMMERS B N FRCS -were born in the United Kingdom Consultant Trauma and Orthopaedic Surgeon, West Midlands -are aged between 25 and 35 years on 31st March 1990 Regional Health Authority. -wish to spend a period of 3 to 12 months studying abroad. TALBOT R W FRCS Applications must reach the Secretary of the Royal College Consultant in General Surgery, East Dorset Health District, of Surgeons of England not later than 31st March 1990 and Wessex Regional Health Authority. must include the following: THOMAS P B M FRCS (i) Brief curriculum vitae, including present appointment; Senior Lecturer in Traumatic Orthopaedic Surgery/ (ii) Proposals for visit to be made during the tenure of the Consultant Traumatic Orthopaedic Surgeon, University of scholarship; Keele and North Staffordshire Health Authority. (iii) Letters of support from the applicant's present consul- URWIN G H FRCS tant, (or if already a consultant, the name of an independent Consultant in Urology, York Heath Authority. referee in the United Kingdom) and the head(s) of depart- WATSON A P DORCS ment(s) to be visited. Consultant in Ophthalmology, Southport & Formby Health (iv) A statement of the expenses to be incurred and of Authority. available financial resources. 95 ETHICON FOUNDATION FUND NORMAN CAPENER TRAVELLING Applications are invited for grants from the Ethicon FELLOWSHIP Foundation Fund, which was established by the generosity of The Council invites applications for the fifth biennial award of Ethicon Limited for the purpose of promoting international the above Fellowship, the capital for which was subscribed by goodwill in surgery by providing financial assistance to Fellows friends and admirers of the late Norman Capener, past Vice- who are travelling abroad for research or training purposes. President and Honorary Medallist of the College. Applications are adjudicated upon by an Advisory Board The Travelling Fellowship will be awarded in March 1990 which meets twice yearly. The Board favours applications on the advice of a Selection Committee appointed by Council, which demonstrate that applicants are using their initiative to with representatives of the British Orthopaedic Association, obtain experience above and beyond that which they would the British Society for Surgery of the Hand, and a Trustee of derive from a routine exchange or secondment to an overseas the Medical Commission on Accident Prevention. It is centre. On occasions, grants may be made to senior applicants designed to enable the selected candidate to pursue a research who may be visiting an overseas centre to teach rather than project involving travel to or from the United Kingdom, learn. It does not, in general, favour grants to enable an commencing in 1990. applicant to attend a meeting or conference overseas, neither Preference will be given to applicants who are enrolled for does it favour grants to support the travel of an applicant's Higher Surgical Training in Orthopaedic Surgery, or who have family. Applications will only be considered from those who are recently completed a course in orthopaedic or hand surgery. Fellows ofthe Royal College ofSurgeons of England. Successful Applicants need not be Fellows of the Royal College of candidates will be asked to submit a report on return from their Surgeons of England. visit. Applications should be submitted to the Secretary of the Applications must include the following (6 copies of each) Royal College of Surgeons of England. They should be accom- (a) A letter of application, to include details of the nature, panied by a brief curriculum vitae, an account of the proposed purpose, and date of proposed visit. research project and where it is to be carried out, a statement of (b) Curriculum vitae, including a list of publications. the estimated costs to be incurred (including details of stipend (c) A letter of support from the head of department or or other resources available or applied for) and a letter of consultant under whom the applicant is working at support from the consultant under whom the applicant is present. working, or from a colleague in the case of consultants. (d) A financial statement showing (i) expenses to be Applications should reach the College by 1 January 1990. incurred, with special reference to the cost of travel, (ii) Those who are shortlisted for interview will be advised accord- financial resources already available, and (iii) other ingly. grants or fellowships being sought. (e) Please state where you saw the fund advertised. Applications for the next meeting should be sent to the Secretary of the Royal College of Surgeons of England not later than 1 December for the January meeting, and not later than 1 May for the June meeting.

LIONEL COLLEDGE MEMORIAL FELLOWSHIP IN OTOLARYNGOLOGY The next award or awards of the above Fellowship will be made for the year commencing 1st July, 1990. The maximum ERRATA award to any one Fellow will be £3,000. The following conditions are laid down by the Trust: EXAMINERS FOR THE MEMBERSHIP IN CLINICAL 1. Applicants must be United Kingdom born Fellows of the COMMUNITY DENTISTRY (MCCD) Royal College of Surgeons of England aged between 25 and 35 In the list of examiners for the MCCD, published in the July years at the closing date for receipt of applications who are issue of the Bulletin, the name of Mrs M H Seward was omitted senior trainees or recently appointed consultants, or of similar from the list. The entry should have read: Mrs M H Seward status, in otolaryngology. (Chief Examiner) Hon. Lecturer in Oral Surgery, The London 2. The subject of the award is head and neck surgery with an Hospital Medical College. emphasis on laryngology. 3. The Fellowship is tenable for a period of study or research COURT OF EXAMINERS in the Continent of North America. The Report of the Court of Examiners on page 75 of the Applications for the award or awards for 1990-91 must reach September issue of the College and Faculty Bulletin contained the Secretary of the Royal College of Surgeons of England, a number of errors. The corrected version is printed below: 35/43 Lincoln's Inn Fields, London WC2A 3PN not later than At an Ordinary Meeting ofCouncil held on 8thJune 1989 6th April 1990 and must include the following: the following were re-elected as members of the Court of (a) Name, qualifications and brief curriculum vitae, includ- Examiners in General Surgery for a period of three years ing present appointment; from July 1989: (b) proposals for the tour or visit to be made during the Professor L E Hughes tenure of the Fellowship; Miss Averil Mansfield (c) letters of support from the applicant's present consultant Mr J P S Thomson (or, if already a consultant, the name of an independent The following were elected as members of the Court of referee in the United Kingdom) and the head(s) of the Examiners in General Surgery for a period of three years department(s) to be visited; from July 1989: (d) a statement of the expenses to be incurred and of Mr M E Bailey available financial resources. Mr D M Davies Short-listed applicants may be required to attend for inter- Mr J D Shaw was elected as a member of the Court of view in London, in which case necessary travelling expenses Examiners in Otolaryngology for a period of three years from will be reimbursed. July 1989. 96 Other Notices

BRITISH ASSOCIATION OF ORAL AND INTERNATIONAL FEDERATION OF MAXILLOFACIAL SURGEONS SURGICAL COLLEGES IN OFFICIAL RELATIONS WITH WHO, VISITING Meetings to be held in 1990 under the Presidency of Mr PROFESSOR OF SURGERY TO THE William Simpson UNIVERSITY OF GEZIRA-SUDAN The Council of the International Federation of Surgical SPRING MEETING: MANCHESTER Colleges invites applications for its first Visiting Professor of Thursday 5 April-Sunday 8 April 1990 inclusive Surgery to a developing world university. The Professor will be Venue: Hotel Piccadilly and UMIST appointed for one year starting early in 1990, with the task of promoting and developing surgical training and research in the Faculty of Medicine, University ofGezira. This project is being AUTUMN MEETING: LONDON undertaken in collaboration with the University and WHO. Friday 5 October-Saturday 6 October 1990 The University and its associated teaching hospital, are Venue: Royal College of Surgeons of England situated in the rural town ofWad Medani, about 160 km south A Study Day for Senior Registrars and Consultants will be of Khartoum, the capital of Sudan. The medical school and its held on Thursday 4 October 1990. teaching hospital is community-orientated, with satellite rural Overseas colleagues will be particularly welcome to these health centres, and district hospitals, which is an ideal setting meetings. for the surgical training of general duty doctors working in Full details will be available from the Head Office of the isolation, as well as for aspiring surgeons and medical students. Association based at the Royal College of Surgeons of England The Council is seeking an experienced general surgeon for and from Mr J C Lowry at the Department of Maxillofacial this post, preferably with an academic background and ex- Surgery, Bolton General Hospital, Minerva Road, Farnworth, perience of surgery in the developing world, who would be Bolton BL4 OJR, U.K. interested in the challenging task of developing surgical training and education in the largest country in Africa. The University will provide a local salary, housing and EUROPEAN DIGESTIVE DISEASE WEEK transport. The Federation will provide air passages, and a hard 5-9 June 1990 in Vienna, Austria currency allowance. Arranged by the European Association for Gastroenterology Further particulars can be obtained from, and applications and Endoscopy. (in confidence) can be made to: Further information from Drs Pristautz and Petritsch, Professor William MacGowan, Honorary Secretary, Inter- Medizinische Universitatsklinik Graz, Auenbruggerplatz 15, national Federation of Surgical Colleges, Royal College of Sur- 8036 Graz, Tel: 0316/385/2648 or 0316/385/2815, Telefax: geons in Ireland, St Stephen's Green, Dublin 2, Ireland 0316/3062. Telephone No. 780200. Telex No. 30795 RCSI El. Fax No. Meeting secretariat, Mondial Congress, Faulmanngasse 4/ 782100 11, A-1040 Wien, Austria. Tel: 0043-(0)222/58 80 40, Telefax: 0043-(0)222/587/268. COLORECTAL DISEASE IN 1990: AN 3RD ANNUAL MEETING OF THE SURGICAL INTERNATIONAL EXCHANGE OF MEDICAL INFECTION SOCIETY AND SURGICAL CONCEPTS The third annual meeting of the Surgical Infection Society- 15-17 February 1990 at the Westin Cypress Creek Hotel in Ft. Europe will be held on 8-9 June 1990 in Antwerp, Belgium. Lauderdale, Florida. (approved for Category I Credit) For further information please contact the local organiser: Further information from Lynne Pender, The Cleveland Professor A Hubens, University Department of Surgery, Clinic Educational Foundation, Department of Continuing Stuivenberg General Hospital, Lange Beeldekenstraat 267, Education, 9500 Euclid Avenue, TT31, Cleveland, OH 44195- B-2008 Antwerp, Belgium. The deadline for submission of 52414 Tel: 44-5696 (local), 800-762-8172 (Ohio), 800-762-8173 abstracts is 1 December 1989. (outside Ohio) 97 College diary

NOVEMBER 1989 JANUARY 1990 Thursday 2 Monday I College of Anaesthetists Symposium BANK HOLIDAY-COLLEGE CLOSED Friday 3 Tuesday 2 College of Anaesthetists Symposium Revision Course in Anatomy begins Monday 6 Wednesday 3 Revision Course (Anatomy/Physiology/Pathology) for Sur- DO Examination begins geons begins Monday 8 Thursday 9 FCAnaes (Part III) Examination begins Edridge-Green Lecture Dr Robert F Hess, 'Vision at Low Final LDS (Part I) Examination begins Light Levels' Final FDS Examination begins Monday 13 Saturday 13 College of Anaesthetists (Part I) Examination begins Revision Course in Anatomy ends Thursday 16 Monday 22 Erasmus Wilson Demonstration-Professor Stephen Bloom, Primary Examination begins 'Regulatory Neuropeptides in Man': 4.30 pm Friday 26 Friday 24 FDS Clinical Study Day Revision Course (Anatomy/Physiology/Pathology) for Sur- Monday 29 geons ends MOrth Examination begins Monday 27 Tuesday 30 Primary FDS Examination begins FCAnaes (Part I) Examination begins. Wednesday 29 'The Role of the Royal College ofSurgeons of England in the Health Service today-a presentation to politicians' DECEMBER 1989 Monday 4 Primary FRCS Course begins Wednesday 6 Hunterian Lecture Professor N Parkhouse FRCS on "Inflam- matory Responses in Denervation and Neuropathy and their Clinical Significance" (5.00 pm) Wednesday 13 Annual Meeting of Fellows and Members Bradshaw Lecture T L Kennedy on 'Billroth to Black-A Century of Peptic Ulcer Surgery' (5.00 pm) Thursday 14 Meeting of Council John Kinmonth Lecture-Miss Averil Mansfield on 'An Artery and a Vein Dancing-The management of arteriovenous malformation' (5.00 pm) Friday 15 Symposium on 'Appropriate Clinical Investigations in Surgery' Primary FRCS Course ends Monday 24 COLLEGE CLOSED Tuesday 26 BANK HOLIDAY-COLLEGE CLOSED Wednesday 27 BANK HOLIDAY-COLLEGE CLOSED Thursday 28 COLLEGE CLOSED Friday 29 COLLEGE CLOSED 98

Annals Bulletin Subjects Index. Vol 71.

A FRCS Diploma, (Browse) (3)52; overseas doctors training Anaesthetists, College of, (2)24, (5)76; Council meeting, scheme, (Bevan and Evans) (4)65; place of research in (4)66; evolution of, (3)43, (Allison)(Comment), (4)60; surgical training, (Blandy et at) (4)64; role of Royal Colleges inaugural meeting of Council, (1)7 in training, (English) (3)53; specialisation in, survey, Annals of the Royal College of Surgeons, (Kay)(Comment), (Johnson) (3)48; symposium on surgical training, (Cossart) (2)33, (Ellis)(Comment), (4)60, (Wilson)(Comment), (4)60 (3)48 Annual Meeting of Fellows and Members, 1988, (1)10, (6)91 Gifts, (see) Donations Appointment of Fellows, (4)69; to consultant posts, (3)41, Guideline general surgical programme, (Collins) (3)45, (6)94 (Ross)(Comment), (5)74 Appointment to Vice-Chancellor, University of Peradeniya, Sri Lanka, (6)94 H Association of Surgeons in Training, symposium on surgical Helicopter emergency medical service, (4)60 training, (Cossart) (3)48 Hip prostheses, change in numbering of, (2)25 Audit, surgical, symposium on, in Bristol, (6)87 Honours, (1)11 B I Breast cancer screening, Intercollegiate statement on, (3)44 Intercollegiate statement, on breast cancer screening, (3)44 C J Charter of the Royal College of Surgeons of England, Junior surgical registrars, (Gentleman)(Comment), (1)18 extracts, (1)16 Cheselden tercentenary (2)27 William, of, L College report and comments, Helicopter emergency medical service, and improvement of trauma treatment, (Earlam and Library, periodicals sponsorship scheme, (Ratliff) (3)42 Wilson) (4)60 College reports and comments, (3)42; Overseas doctors M training scheme in surgery, (Bevan and Evans) (4)65; Place Mcnair TJ, retirement of, (2)25 of research in surgical training, (Blandy et at) (4)64 Commission on Provision of Surgical Services, Management 0 of Patients with Major Injuries, report of working party, Out-patient sessions, case times in, (Stoodley)(Comment), (Stuart)(Comment), (3)45, (Weston)(Comment), (3)45 (2)33 Council elections, (5)75 Overseas doctors, training scheme in surgery, (Bevan and Council meetings, (2)23, (3)39, (4)66, (5)75, (6)91, Evans) (4)65 (correction)(6)95; College of Anaesthetists, inaugural Overseas Doctors Training Scheme Day, (5)81 meeting, (1)7; RCS, (1)3 Council reports and comments, (2)30; The Supplemental p Charter of 1988, (1)15 Peart, Sir Stanley, Master of the Hunterian Institute, Council visits, Chichester, (1)11; proposed, to Reading, (4)71 (profile), (3)47 Court of Examiners, (2)24, (3)39, (6)92; re-election to, (5)75, Presidents' letter to The Lancet, (Chisholm et a), (2)32 (correction)(6)95 Profile, Master of the Hunterian Institute, Sir Stanley Peart, (3)47 D Deaths, (1)12, (2)24, (3)40, (4)69, (5)79, (6)94 Dental Surgery, Faculty of, (5)78; Diplomas of fellowship R awards and examiners, (4)67, (correction)(6)95; meeting of Research, surgical training and, (Blandy et a) (4)64, Board, (1)9 (Taylor)(6)89 Donations, (1)1, (2)24, (3)40, (4)69, (5)80, (6)93 Resuscitation, Royal College of Physicians Working party report on, (2)25 E Royal College of Surgeons of England, Commission on Examinations in surgery, (Kirk)(editorial), (2)29, Provision of Surgical Services, Management of Patients with (Chalmers)(Comment), (4)58 Major Injuries, report of working party, (Salsh)(Comment), (4)58, (Sutcliffe)(Comment), (5)74 F Royal Colleges, role in surgical training, (English) (3)53 Fellowship awards, RCS, Jan 1988, (1)4 Royal visit, November 1989, announcement of, (6)86 Fellowships in the Faculty of Dental Surgery, (3)40, (4)67 Forrest report, and breast cancer screening, (3)44 S FRCS examinations, (4)70; Final in Manchester, May 1989, Soviet Surgical Society, award of membership, (6)93 (6)86 Specialisation, in surgical training, (Johnson) (3)48 Surgeons, experience abroad for trainees, (Bem)(Comment), G (4)59, (Ludington)(Comment), (4)59, (Spicer)(Comment), (6)91 General posts, analysis of advertisements of in 1988, (Dehn) Surgical Colleges, joint meeting of, (English), (2)30 (3)44 Surgical manpower, (Dehn) (3)49 General surgery, curriculum vitaes in USA, Holland and UK Symposia, Appropriate Clinical Investigation in Surgery, compared, (McDonald) (3)51; Guideline general surgical (6)92; Surgical audit: a review, (Thompson), (6)87; Surgical programme, (Collins) (3)45, (Ross)(Comment), (5)74; new training, (Cossart) (3)48 99 T Trauma, report of Working Party on Management of Patients Training, surgical, experience abroad and, (Bem)(Comment), with Major Injuries, (Stuart) (3)45, (Weston) (3)45, (4)59, (Ludington)(Comment), (4)59, (Spicer)(Comment), (Saleh)(Comment), (4)58; treatment in London and four (6)91; surgical, role of Royal Colleges, (English)(3)53; Thames regions, (Earlam and Wilson) (4)60 surgical, specialisation in, (Johnson)(3)48; surgical, Symposium, (Cassart), (3)48

Annals Bulletin Author Index. Vol 71.

D K Duffett RHE, notice of elections to the Standing Committee Kay NRM, Annals of the Royal College of Surgeons, for Wales, (6)92 (Comment), (2)33 Kirk RM, Surgical examinations, (Editorials), (2)29 E R English TAH, The Joint meeting of Surgical Colleges 1982- Ross APJ, Guidelines for a general surgical programme, (5)74 1988, (2)30 S Spicer RD, Experience abroad for trainee surgeons, (Comment), (6)91 G Stoodley BJ, Out-patient session case times, (Comment), (2)33 Gentleman D, Junior surgical registrars, (Comment), (1)18 Sutcliffe AJ, RCS working party report on management of patients with major injuries, (5)74 J T Jackson B, FRCS examinations, final in Manchester, March Taylor I, Association of Professors of Surgery, statement on 1989, (6)86 research and surgical training, (6)89 Johnston IDA, Association of Professors in Training, Thompson MH, Symposium report, Surgical audit: a review, statement on research and surgical training, (6)89 (6)87 100 General information

College address for correspondence charged, but this can vary, depending upon the complexity of Royal College of Surgeons of England, Lincoln's Inn Fields, the search and the databases used. Searches of the older London WC2A 3PN (tel: 01-405 3474). Cables and tele- literature can also be made, but in all cases enquirers are messages: Collsurg, WC2, London. Facsimile 01-831 9438, recommended to discuss their requirements with the Library Telex 936573 RCSENG G. staff. Where requests for searches are made in writing it would be helpful to receive full details of the subject of the search, to Officers of the College know whether clinical or research papers are required, and if Secretary of the College and of the Trustees of the Hunterian there are any date or language restrictions. Photocopies of Collection: R H E Duffett MA papers retrieved by searches can be supplied if required. Senior Assistant Secretary and Secretary of theJoint Commit- Lists of books added to the Library are published from time tee for Higher Surgical Training: W Webber MA to time and may be obtained by writing to the Librarian. Finance Secretary: N Garland MA, FCA, IPFA The Hunterian Museum (Conservator: Professor J L Turk, Examinations Secretary and Secretary of the Examining Board George Qvist Curator: Miss E Allen) and The Odontological in England: J S West LLB Museum (Hon. Curator: Dr A E W Miles, Osman Hill Cura- Secretary for External Affairs, Secretary ofJoint Meeting of tor: Dr C Grigson) are open each weekday from 10am to 5pm. Surgical Colleges and of the Board of Surgical Specialties: They are closed on Saturdays and during August and on Bank C Duncan BA -5lidays and on other days when the College is closed. The Secretary of the Hunterian Institute: L F Blythe BA W ne Museums of Anatomy and Pathology are open Secretary of the College of Anaesthetists and of the Joint Juring-ndial working hours Mondays to Fridays only and are Committee for Higher Training of Anaesthetists: S N Alan LLB 4kloseA u agust, and on Bank Holidays, and on other BBA 7 day4.e heiwCt is closed. Secretary of the Faculty of Dental Surgery and of the Joint Committee for Higher Training in Dentistry: A C de Looze MA flo Ouse ;t Assistant Secretary (Administration): M Coomer BSc Appeal & Public Relations Secretary: R N Hickling BA, MBI? 9Wwn Huse, Downe, Knt BA6 7JT (tel: Farnborough MICFM *,t , PubhRe home 3nChMBles 9arwin in the possession and MICFderMca oqfthe Co4leg.. Vistors are welcome. Open daily Hunterian Institute noIm;sjon after 5.30 pm) except Mon- The Hunterian Institute coordinates the teaching and research days an ys. CTs d diwng February and on Christmas activities of the Departments of Anatomy, Pathology, Pharma- Eve, nd Bing Day. Open on Bank Holiday cology, Physiolo'gy and Surgical Sciences, and Biochemistry Mondays (except a Admission £1.50 for adults, 75p with the Research Departments of the College (Dental Scietce, for pensioners and30p for children. Taxis and buses (146) from Anaesthetics, and Physics in relation *'to Bromley North or South stations or taxi from Orpington. The .Ophthidmology ourses SurunSiiro'erv)t/-v TheCoeWelnmee,ncuslMus~euimsms. toterhertudtin withgiththe cses Enquiries should be addressed to the Custodian. run by the College; "ncluding, craft workshops and advanced courses for Consultants, also come under the aegis of the Nuffield College: residential accommodation Hunterian Institute. Subject to availability rooms may be booked for long or short Master: Professor Sir Stanley Peart, FRCP, FRS periods, including some rooms for married couples. Enquiries Examinations to the Residence Officer (ext 2000). All enquiries relating to Examinations of the Colleges and the College facilities for functions and conferences should be addressed to the Examinations Faculty Secretary. All enquiries to the Room Bookings Assistant (ext 2001). College facilities These include a common room for Fellows of the Colleges-'and Subscription Dinners Faculty and a cafeteria open for luncheon on weekdays to These are held on the first or second Wednesday in certain anyone having occasion to visit the College. months of the year. All Fellows and Members and other The Library and Museums diplomates of the Colleges and the Faculty are eligible to attend, with their guests. Details are available from the Room The Library (Librarian: I F Lyle ALA; Sub-Librarian: F K Bookings Assistant (ext 2001) at the College, to whom all Sherwood BSc: ALA MI InfSci) is open each weekday fromlOam enquiries should be addressed. Tickets£22, including drinks at to 6pm and is closed on Saturdays, Bank Holidays, throughout reception and wine at dinner. the month of August, and on other days when the collegeis closed. It is a refirence collection of both current and historical Hunterian and Arris and Gale lectures material with a stock of over 160,000 books, periodicals and Fellows and Members wishing to apply to pamphlets. Nearly 600 current periodical titles are received give a Hunterian or and in addition there are about 3,500 non-current periodical Arris and Gale Lecture are advised to obtain the regulations sets dating from the seventeenth century. The Library is from the Secretary. Applications are invited by advertisement particularly rich in the literature of surgery and all its speciali- in the medical journals in September each year. ties including anaesthesia and oral surgery, and of anatomy, physiology and general pathology. There are also large collec- Examinership tions of manuscripts, autograph letters, engraved portraits and Vacancies are advertised as follows: photographs. Court of Examiners (Final Membership and Fellowship)- All the collection is available for inspection in the Library. College and Faculty Bulletin, BMJ and Lancet, March and Items are not lent to individuals, but books, periodicals and September. pamphlets less than fifty years old are lent to other medical Primary Fellowship and surgical diplomas-BMJ and Lancet, libraries. Photocopies can be supplied at a cost oflOp per sheet February. plus postage, subject to copyright restrictions and to the condi- College of Anaesthetists-College and Faculty Bulletin, Novem- tion of the original. ber. Literature searches can be undertaken using MEDLINE and Faculty of Den'tal Surgery-BDJ, third Tuesday in Novem- other databases, for which a fee £10.00of per search is normally ber. Published as a supplement to on Annals of the Royal College of Surgeons of England Notes books Volume 71, Number 2, March 1989

Brain Injury and Protection during Heart Surgery 1987 Yearbook of Surgery edited by Seymour I edited by Mark Hilberman. 173 pages, illustrated. Mar- Schwartz. 481 pages, illustrated. Yearbook Medical Pub- tinus Nijhoff Publishing, Boston. £40.95. lishers, Chicago. £40. Brain injury is a problem which has long troubled those Abstracts of key papers published in 1986 in some 70 journals involved with perioperative care of the cardiac surgical patient. (including this one) together with short editorial comment. The This book presents current thinking as to how this problem latest in a well-known series which will be widely purchased. might be avoided. A book of particular interest to anaesthetists as well as heart surgeons. Aspects of Recovery from Anaesthesia edited by Ian The Cavernous Sinus: A Multidisciplinary Hindmarch, J Gareth Jones and Edward Moss. 176 Approach to Vascular and Tumorous Lesions edited pages, John Wiley & Sons, Chichester. £23.50. by V V Dolenc. 414 pages, illustrated. Springer-Verlag, The enormous expansion of day case surgery over the past few Vienna. DM 240. years has been due in part to the introduction of short-acting inhalational and intravenous anaesthetic agents. This book A specialised volume for neurosurgeons detailing the manage- comprises a collection of papers directed towards the improvement ofvascular and neoplastic lesions of the parasellar region. ment of management ofday case patients in regard to the ways There are six sections: historical review, anatomy, diagnostic of reducing postanaesthetic morbidity. Stress is laid on the proc.dures, occlusion techniques, the surgery of vascular le- potential effects ofanaesthetic agents on memory, psychomotor sions and the surgery of tumours. and intellectual function and ways are described of avoiding this. Acute Aneurysm Surgery: Pathophysiology and Management by K Sano, T Asano and A Tamura. 289 The Medical Management of Breast Cancer by pages, illustrated. Springer-Verlag, Vienna. DM 220. Christopher J Williams and Roger B Buchanan. 246 The title of this book is somewhat misleading in that the text is pages. Castle House Publications, Tunbridge Wells. £45. concerned only with cerebral artery aneurysms causing sub- Although the major emphasis of this book is on the medical arachnoid haemorrhage. It will be of.interest to neurosurgeons, management of breast cancer, there is a full chapter on surgical not to peripheral vascular surgeons. Well illustrated, well options. As might be expected, much of the text relates to referenced and well printed. chemotherapy and radiotherapy but there are also interesting chapters on epidemiology and screening, prognostic factors Antibiotic Therapy in Head and Neck Surgery edited and psychological considerations. Male breast cancer is also by Jonas D Johnson. 291 pages, illustrated. Marcel covered. Very fully referenced, this book is a useful review of Dekker, New York. No price given. current thought on the subject. There are 14 chapters describing the rational use of antibiotics in head and neck surgery but strangely almost all are contri- Plastic Surgery in Paediatrics by Ian F K Muir. 194 buted by ENT surgeons rather than microbiologists. Neverthe- pages, illustrated. Lloyd-Luke, London. £49.50. less the book reads well, appears authoritative and is recommended for reading by those who operate on the head and A most readable book from Ian Muir and his colleagues at The neck. Royal Aberdeen Children's Hospital. Elegantly produced, nicely illustrated, adequately referenced and of interest to all 1987 Yearbook of Digestive Diseases edited by Nor- who operate on children, not only plastic surgeons. ton J Greenburger and Frank G Moody. 483 pages, illustrated. Yearbook Medical Publishers, Chicago. Abdominal Wound Dehiscence by Galen V Poole. 129 £37.50. pages, illustrated. Futura Publishing Company, New Over 250 abstracts of gastroenterological articles that have York. $24.50. been selected from more than 20000 published in the English This short monograph covers a subject of perennial interest to literature during the past year. Each abstract has an editor's general surgeons. It reviews the literature thoroughly including comment appended. Although many abstracts are principally many of the contributions made from this country. There are of interest to physicians, there are also many of interest to some interesting conclusions: closure of the peritoneum is a surgeons. useless ritual and can be abandoned; a non-absorbable suture is not superior to an absorbable suture; paramedian wounds Complications in Critical Care Medicine edited by are inferior to midline wounds; tension sutures are of no value; Philip D Lumb and Christopher W Bryan-Brown. 358 subcutaneous sutures are best avoided, and systemic illness pages, illustrated. Yearbook Medical Publishers, Chica- does not cause a burst abdomen. If you disagree with any of these statements you should read this book to see how the go. £41.50. author arrives at his conclusions. A book to interest surgeons, anaesthetists and others who work in intensive care units. Opening with a stimulating chapter by the senior editor on financial and ethical dilemmas in critical The Larynx by Harvey M Tucker. 311 pages, illus- care medicine, subsequent chapters cover complications asso- trated. Georg Thieme Verlag, New York. DM 148. ciated with mechanical ventilation, septic shock, renial failure, A comprehensive volume on laryngology aimed at both the cardiac dysrhythmias, drug therapy and organ transplantation. surgeon in training and the more established practitioner. The After each chapter there is an editorial comment, sometimes author has achieved the attraction to a dual readership by the provocative. David Sabiston contributed the foreword and extensive use of marginal notes containing the more detailed concludes that the text is a must for all involved in critical care aspects of the subject. The illustrations are clear if rather medicine. stylised. S 1 S 2 Notes on books Operative Approaches in Orthopedic Surgery and Clinical Transplantation: Current Practice and Traumatology by R Bauer, F Kerschbaumer and S Future Prospects edited by G R D Catto. 276 pages, Poisel. 326 pages, illustrated. George Thiemc Vcrlag, illustrated. MTP Press Limited, Lancaster. £45.00. Stuttgart. DM 398. This book has been written for the practising clinician rather This is an outstanding colour atlas of anatomical approaches than the research worker. There are chapters on kidney, liver, used by orthopaedic and trauma surgeons. The clarity of the heart, pancreas and bone marrow transplantation. They de- illustrations is truly remarkable and the text is succinct and monstrate that a basic knowledge ofimmunology is essential in relevant. The book is a translation from the German edition this field and will both educate and inform the reader. published in 1986 and there can be little doubt that it will be as widely appreciated by an English-speaking readership as it has Immunogenetics of Insulin-dependent Diabetes been in Germany. The format is large, the printing clear and edited by A H Barnett. 129 pages, illustrated. MTP the layout uncramped. A quality production. Press Limited, Lancaster. £25.95. This book critically discusses the major advances that have Primary and Secondary Brain Stem Lesions by G been made recently in our understanding of the aetiology of Csecsei, 0 Hoffman, N Klug, A Laun, R Schonmayr and insulin-dependent diabetes. Principally for diebetologists. J Zierski. 130 pages, illustrated. Springer-Verlag, Vien- na. DM 165. A Patient's Guide to Dialysis and Transplantation by Five papers from the Department of Neurosurgery in the Roger Gabriel. 3rd edition. 165 pages, illustrated, paper- University of Giessen in the Federal Republic of Germany. All back. MTP Press Limited, Lancaster. £7.50. relate to lesions of the brain stem. They are highly technical The third edition of a pocketbook written for patients either and will be of interest only to neurosurgical readers of this receiving dialysis or awaiting a kidney transplant. It is in- notice. tended to supplement information gained from doctors and nurses and will no doubt continue to be widely bought by Plasticity of the Central Nervous System edited by K patients. Medical students too would profit by reading this Sano and S Ishii. 125 pages, illustrated. Springer-Verlag, book. Vienna. DM 165. The Proceedings of the Second Convention of the Eurasian Ankylosing Spondylitis edited by John J Calabro and Academy of Neurological Surgery held in 1986. Most of the W Carson Dick. 143 pages, illustrated. MTP Prcss fifteen contributions originate from Japan, but Lindsay Symon Limited, Lancaster. £29.95. is a lone contributor from the United Kingdom, presenting a A concise review of the pathology, diagnosis and treatment of paper on the recovery of brain function after ischaemia. ankylosing spondylitis. Ultrastructure of the Digestive Tract edited by P M Near Visual Acuity Tests by M Sachsenweger. 62 Motta and H Fujita. 262 pages, illustrated. Martinus pages, illustrated. MTP Press Limited, Lancaster. Nijhoff Publishers, Boston. £63.95. £14.95. A book on electron microscopy. Fifteen chapters, international A series of charts for testing short vision containing different authorship, many electron photomicrographs, comprehensive type faces. Some braille charts are also included. review text. A book for anatomists, pathologists and cell biolog- ists as well as for gastroenterologists. Clinical Research in Gastroenterology edited by S Matern. 141 pages, illustrated. MTP Press Limited, Advances in Surgery Volume 21 edited by Ronald K Lancaster. £29.95. Tompkins. 302 pages, illustrated. Year Book Medical An update of recent research in selected areas ofgastroenterol- Publishers, Chicago. £45. ogy. Of surgical interest are the chapters on gallstone dissolu- tion, the use of lasers in gastroenterology and endoscopic The latest edition in a well-known and well established series of ultrasound examination of the upper gastrointestinal tract. surgical revision texts. Subjects covered in this volume include surgery for hyperthyroidism, progress in liver transplantation, sclerosing cholangitis, Barrett's oesophagus, intraoperative Atlas of Urologic Endoscopy: Diagnosis and Treat- ultrasound of the liver and pancreas, the clinical significance of ment by Hans Joachim Reuter. 288 pages, illustrated. gastrointestinal hormones and rectovaginal fistula. Georg Thieme Verlag, Stuttgart. DM 260. An outstanding atlas with beautiful colour photographs illus- A Colour Atlas of Fibreoptic Endoscopy of the Up- trating the endoscopic appearances of the anatomy and pathol- per Respiratory Tract by John D Shaw and Jack M ogy of the entire urinary tract. The clarity of reproduction and Lancer. 86 pages, illustrated. Wolfe Medical Publica- the colour balance are noteworthy. A large number of radio- tions, London. £25. graphs and a concise text combine with the colour photographs to give a book that will prove ofvalue to all urologists, whatever Over 250 high-quality photographs illustrate this atlas of en- their seniority. doscopic appearances. Part 1 covers the normal anatomy of the upper respiratory tract and Part 2 the various diseases that may occur. Non-ionising Radiation: Microwaves, Ultraviolet and Laser Radiation by H Moseley. 293 pages, illustrated. Adam Hilger, Bristol. £37.50. Tract edited D Brooks. 148 Urinary Infections by A book that deals with the medical aspects of non-ionising pages, illustrated, paperback. MTP Press Limited, Lan- electromagnetic radiation. The scope extends from radiofre- caster. £16.50. quency to ultraviolet radiation and takes in lasers en-route. It A pocketbook on infections of the urinary tract in men, women describes sources, interaction with biological tissue, medical and children. Aetiology, presentation and management are application and hazards. It contains a wealth of detail in covered. Principally for general practitioners. compact form. Notes on books S 3 Patient Care in Vascular Surgery by John W Hallett, Evoked Potentials in Intraoperative Monitoring by David C Brewster and R Clement Darling. 2nd edition. Aage R M0ller. 224 pages, illustrated. Williams & Wil- 335 pages, illustrated. Little Brown and Company, Bos- kins, Baltimore. £52.00. ton. £16.50. Intraoperative electrophysiological monitoring during neuro- Special attention has been given to new tests and techniques in surgery can be of great value to the surgeon in that it may vascular surgery including duplex scanning, magnetic reso- provide information about the effects of manipulation which is nance imaging, balloon angioplasty, angioscopy and laser tech- not otherwise available. It may also reduce the risk of com- nology. Each chapter contains new illustrations that emphasise plications. This book describes the methods of intraoperative important regional vascular anatomy. The references have monitoring of evoked potentials elicited by stimulating the been completely updated and the volume remains a useful receptors of sensory systems of peripheral nerves. Neuro- pocket-size manual of vascular surgery in compact form. surgeon readers should find it of interest. What's New in Anesthesiology edited by T H Stanley. Postmastectomy Reconstruction edited by Thomas D 218 pages. Martinus Nijhoff Publishers, Dordrecht. Gant and Luis 0 Vasconez. 2nd edition. 279 pages, £40.95. illustrated. Williams & Wilkins, Baltimore. £68.00. Printed from camera-ready copy the papers in this book repre- After preliminary chapters on philosophical approaches to sent the presentations at the 33rd Annual Postgraduate Course breast reconstruction, statistics on breast carcinoma and ap- in Anesthesiology that took place in Salt Lake City, Utah, in plied anatomy, this book goes on to discuss in detail the many February 1988. There are 26 contributions and it would be varied ways of reconstructing the breast after mastectomy. invidious to single out any for special mention. Completely Copiously illustrated with photographs and line drawings. up-to-date with many 1987 references this book should be looked at by anaesthetists everywhere. The Spinal Engine by Serge Gracovetsky. 505 pages, illustrated. Springer-Verlag, New York. DM 98. Key Developments in Gastroenterology edited by P R The human gait is traditionally believed to be the function of Salmon. 194 pages, illustrated. John Wiley & Sons, the legs. This book presents arguments and data that challenge Chichester. £26.50. that belief. The author proposes that the spine is the primary Most of the authors are physicians and the intended readership engine which makes us move and that this was inherited from is principally medical gastroenterologists. However, some our fish ancestors, having never been transferred to any ex- chapters will interest surgeons, notably those on bleeding tremity during our evolutionary process. The author claims oesophageal varices, liver transplantation and acute pancreati- that this theory provides a method for evaluating the function tis. of the spine in clinical terms and is helpful in diagnosis. An original concept which orthopaedic surgeons and others interested in spinal disease should know about. Peritoneal Dialysis edited by Karl D Nolph. 713 pages, illustrated. Martinus Nijhoff Publishers, Boston. £83.25. Health Care Provision under Financial Constraint: A comprehensive volume covering all aspects of peritoneal Need, Demand and Resources edited by T B Binns dialysis. Despite its high cost it is printed on poor quality and M Firth, 317 pages, paperback. Royal Society of paper, the illustrations reproduce indifferently and the printing London. lacks sharp definition. Nevertheless, it will no doubt find a Medicine, £20. ready market due to its comprehensiveness. The Proceedings ofan Anglo-American Conference held at the RSM in December 1986. Close on 50 distinguished names discuss the problems of the economics of health care provision Atlas of Amputation Surgery by Walther H 0 Bohne. against a background ofdiminishing resource allocation. It is a 230 pages, illustrated. Georg Thieme Verlag, New York. greaty pity that only one of the contributors has a surgical DM 148. background. Numerous clear line diagrams illustrate this atlas. Preliminary chapters relate to indications, preoperative considerations and Disorders of the Liver by Sanjiv Chopra. 249 pages, postoperative care. There are also chapters on postoperative illustrated. Lea and Febiger, Philadelphia. $27.50. complications. A single-author monograph covering liver disease both medical and surgical. The author has made a particular effort to keep A Colour Atlas of Extra Anatomic Bypass for Lower the book crisp, clear, coherent and clinically relevant. Limb Vascular Disease by John Chamberlain. 64 pages, illustrated. Wolfe Medical Publications, London. Gastroenterology by P W Brunt, M S Losowsky and £19.00. A E Read. 381 pages, illustrated, paperback. Hcinemann Axillofemoral and femorofemoral bypass are the two operations Medical Books, London. £12.95. illustrated and described in this colour atlas. Ninety-two opera- Mainly written for physicians attempting the MRCP but it tive photographs, all of the usual high quality, should prove of contains much of interest to surgeons attempting the FRCS interest to all young vascular surgeons in training. examination. Succinct and comprehensive it isjust the thing for last-minute revision. A Colour Atlas of Parathyroid Exploration by Andrew Gunn. 64 pages, illustrated. Wolfe Medical Prevention of Coronary Heart Disease and Stroke by Publications, London. £19.00. J T Hart and B Stilwell. 244 pages, paperback. Faber & Numerous colour photographs illustrate this atlas which is Faber, London. £5.95. another in the now well-known series of Single Surgical Proce- Some 80,000 people die of heart disease and stroke in the dures. The text and illustrations are intended as a guide to United Kingdom each year. Many of these deaths are prevent- surgeons who are not yet experienced in the field and as such able. This book, written by a general practitioner and a nurse, can be strongly recommended. Technical points are stressed discusses the ways ofscreening patients in the community so as throughout and cautionary tips are printed in heavy type. to detect high-risk patients in advance of their symptoms. S 4 Notes on books Reconstructive Microsurgery by Bernard McC Microsurgery in Trauma by William W Shaw and O'Brien and Wayne A Morrison. 540 pages, illustrated. David A Hidalgo. 407 pages, illustrated. Futura, New Churchill Livingstone, Edinburgh. £120.00. York. $87.50. The senior author of this magisterial book is known throughout After preliminary chapters on basic principles including mag- the world for his work on microvascular surgery. This latest nification, instruments and anastomotic techniques, the au- offering, although loosely based on a former book Microvascular thors go on to cover replantation of limbs, scalp, ear and penis. Reconstructive Surgery published in 1977, cannot be looked upon The next section relates to nerve injuries of varying kinds and as a second edition because the changes in the specialty have then follows a large section on tissue transplantation. been so extensive that a totally new work has been necessary. The book is of large format and ofpleasing design. Numerous For example, in the first book only one chapter was devoted to photographs in black and white and many outstandingly clear free flap surgery, while more than twenty chapters are now drawings by Dr Hidalgo complement a lucid text. An important needed. addition to the growing number of books on this developing Published on sound quality glossy paper, the book is illus- specialty. trated with an abundance of clear, high quality photographs, many in colour. The text is authoritative, the references many and up-to-date. Despite the high cost all departments of micro- Trauma, Sepsis and Shock edited by George H A surgery will need this book on the library shelves and many Clowes Jr. 587 pages, illustrated. Marcel Dekker, New individual surgeons will wish to own a copy. York. $150. The major part of this book is devoted to the physiological, Pediatric Tumors of the Genitourinary Tract edited metabolic and immunological responses of the body to trauma by Bruce H Broecker and Frederick A Klein. 336 pages, and infection. Subsequent sections cover monitoring and the illustrated. Alan R Liss, New York. $72.00 nutritional support necessary in treatment of patients in shock. Genitourinary tract tumours are responsible for between 25% The dynamic balance between the magnitude of cellular injury and 30% of cancers occurring during childhood. This clinical inflicted by trauma and the adequacy ofprotective responses is reference text contains the most recent information available on reviewed in detail. the management of children with these tumours. Emphasis is given to the most common-neuroblastoma, Wilms' tumour and rhabdomyosarcoma-but the rarer tumours of the adrenal, Short Dialysis edited by Vincenzo Cambi. 370 pages, kidney, testes and ovary are also covered. illustrated. Martinus Nijhoff Publishing, Boston. £66.50. For some years now a short dialysis time of some 12 hours Ophthalmic Echography edited by K C Ossoinig. 625 weekly has been used by many European centres for patients pages, illustrated, Martinus Nijhoff Publishing, Dor- with renal failure. This book provides an up-to-date and complete review of the subject with contributions from recog- drecht. £95.50. nised authorities. Of interest to transplant surgeons. The proceedings of the Tenth International Congress on Diagnostic Ultrasound in Ophthalmology held in Florida in 1984. Numerous papers; even more numerous authors. Four Heart Valve replacement and Future Trends in Car- parts entitled Biometric Ultrasound, Diagnostic Ultrasound of diac Surgery edited by Gregorio Rabago and Denton A Intraocular Disease, Diagnostic Ultrasound of Periorbital Cooley. 515 pages, illustrated. Futura, New York. Disease and Therapeutic Ultrasound. $65.00. Over ninety authors, many from North America but some from Coronary Circulation edited by J A E Spaan, A V G Europe, contribute 36 chapters in this book about heart valve Bruschke and A C Gittenberger-de Groot. 239 pages, replacement. Detailed, authoritative and well referenced. The illustrated. Martinus Nijhoff Publishers, Dordrecht. volume finishes with a section on future trends in cardiac £42.50. surgery devoted principally to transplantation. Produced from camera-ready copy this book presents the papers given at a Symposium on Coronary Circulation at the University of Leiden. New techniques in the study of the Illustrated Operation Notes: A Guide for Students coronary circulation, including computer models, radioisotope to General Surgical Procedures by Stephen White- labelling of natural substrates of the myocardial metabolism, head. 104 pages, illustrated, paperback. Edward Arnold, and nuclear magnetic resonance spectroscopy are covered, London. £4.95. together with studies on the micro-anatomy and embryologic A book for medical students, nurses and others who wish to development of the coronary arterial system. The editors have know exactly what is done during some of the commonly brought together scientists and clinicians so as to stress the performed abdominal operations. A full-page line diagram on multi-disciplinary approach to research in this field which they the right and notes on indications and operative details on the believe is mandatory for the effective study of unsolved prob- left of the opened page makes for easy understanding. lems relating to the coronary circulation. Urology edited by A R Mundy. 225 pages, illustrated. Diseases of the Esophagus edited by J R Siewert and Bailliire Tindall, London. £42.50. A H Hdlscher. 1400 pages, illustrated. Springer-Verlag, The aim of this book, one of the series entitled Current Operative Berlin. DM 398. Surgety, is to provide a reasonably priced volume of interest to a The Proceedings of the Third Triennial Congress of the Inter- general urologist who wishes to have detailed descriptions of national Society for Diseases of the Oesophagus held in less frequently used techniques. These include radical retropu- Munich in September 1986. The papers given, which number bic prostatectomy, retroperitoneal lymph node dissection and over 300, cover all aspects ofoesophageal disease. The first part hypospadias repair. There are twelve chapters beginning with of the Proceedings relates to oesophageal cancer and the second percutaneous nephrolithotomy and ending with urethral stric- part to benign diseases of the oesophagus. The aim of the book ture surgery. Each chapter provides a thorough description of is to contain the most up-to-date synopsis of knowledge about the operative steps and the other measures of importance to oesophageal disease. ensure a successful outcome. Published as a supplement to Annals of the Royal College of Surgeons of England Notes on books Volume 71, Number 3, May 1989

A Tribute to Professor Sir Robert Macintosh for his The Multidisciplinary Pain Center edited by J N 90th birthday edited by W D A Smith and G M C Ghia. 185 pages. Kluwer Academic Publishers, Boston. Paterson. 45 pages, illustrated. The Royal Society of £40.95. Medicine, London. £7.95. It is widely accepted that the effective management of chronic A souvenir volume of the birthday celebrations for Sir Robert pain necessitates a multidisciplinary approach. This book aims Macintosh given jointly by the Faculty of Anaesthetists, the to provide the necessary information as to how a multidisciplin- Association of Anaesthetists and the Section of Anaesthetics of ary pain clinic can be organised and run. The Royal Society of Medicine in October 1987. Surely every anaesthetist reader of this journal would wish to own a copy of this small inexpensive volume so as to learn something more of one of the truly great names in the history of anaesthesia. Practical Blood Transfusion by Douglas W Huestis, Joseph R Bove and John Case. 4th edition. 424 pages, The Foot edited by Basil Helal and Derek Wilson. 2 Little Brown and Company, Boston. £33.00. volumes. 1279 pages, illustrated. Churchill Livingstone, This edition has been completely rewritten and revised. It Edinburgh. £150.00. encompasses the full range of blood bank and transfusion practices. The practical applications are stressed throughout. Seventy authors from home and abroad contribute sixty-two chapters in these mammoth volumes which the editors hope will elevate the foot from the position of Cinderella to the importance that it deserves within orthopaedic surgery. They Progress in Surgery of the Liver, Pancreas and Bili- point out that it is only in relatively recent times that the foot ary System edited by S Bengmark. 430 pages, illus- has become the focus of organised scientific study and that the trated. Martinus Nijhoff Publishers, Dordrecht. £76.00. foot has now been recognised as important as the hand. An international team of authors contribute 26 chapters cover- Clearly written, amply illustrated, extensively referenced, ing recent advances in the field of hepato-pancreatico-biliary this work is an important contribution to orthopaedic surgery surgery. Among topics covered are the surgical treatment of and will no doubt be widely consulted by trainees and consul- chronic pancreatitis and pancreatic transplantation, liver re- tants alike. section for colorectal metastases, ultrasonic dissection in hepatic surgery and the management of common bile duct stones. The Political Economy of Health and Welfare edited Many general surgeons will find this book of great interest. by Milo Keynes, David A Coleman and Nicholas H Dimsdale. 250 pages, illustrated. Macmillan Press, Basingstoke. £35.00. An Atlas of Radiological Interpretation: The Bones Is prevention of disease better and cheaper than cure? Why do by John F Calder and Gwen Chessell. 287 pages, illus- manual workers live shorter lives than non-manual workers? trated, paperback. Wolfe Medical Publications Limited, Can we afford to pay generous pensions in future to our London. £20.00. growing numbers ofold people? Are people born to poverty, do This atlas comprises radiographs of bones at the side of which they acquire it or is it just luck? These are the sort of questions is a line diagram and a legend in explanation. Although that are addressed by the papers in this book which comprise principally for radiologists, orthopaedic surgeons also might the Proceedings of the XXIInd Annual Symposium of the study this volume with profit. Eugenic Society held in London in 1985.

Perspectives in Colon and Rectal Surgery. Volume 1, Surgical and Conservative Foot Care by R Luke Number 1, edited by Theodore R Schrock. 152 pages, Bordelon. 185 pages, illustrated. Slack Incorporated, illustrated. Quality Medical Publishing, St Louis. No New Jersey. £39.65. price given. A concise text covering disorders of the foot and their manage- The first issue of a new twice-yearly hard cover publication. ment. An excellent introduction for medical students and house Pelvic floor disorders, familial adenomatous polyposis, tech- surgeons but the orthopaedic specialist may require a more niques ofstapled anastomoses and the prevention ofhepatitis B comprehensive text. in surgeons and their patients are just some of the topics covered. Glossy paper and a glossy image: not only the contributors but the entire Editorial Board have their photographs Tuberculosis of the Bones and Joints edited by prominently featured. Michel Martini. 219 pages, illustrated. Springer-Verlag, Berlin. DM 148. Microcomputers in Medicine edited by P D Coleridge H Scurr. illustrated. Bone andjoint tuberculosis is still common in many parts of the Smith and J 210 pages, Springer- world, although less so in the United Kingdom. Inexplicably, Verlag, London. £40.00. there has been no comprehensive textbook on the subject for The Proceedings of the 4th Medical Microcomputer Workshop some years and this book seeks to rectify that anomaly. Based held in London in 1986. Topics covered include the keeping of upon twenty years of experience and over seven hundred databases of patient details, clinical measurement systems and patients, this book is written by Professor Martini and his advisory programmes for technical details of patient manage- colleagues all of whom work in Algeria. It also surveys the ment and surgery. Many ofthe contributors, as well as both the literature on the subject published in other countries. An editors, are practising surgeons, which leads to the practical authoritative volume which should be ofvalue to many workers aspects being stressed throughout. in this field. S6 Notes on books The Right Ventricle edited by Marvin A Konstam and surgical management and chemotherapy. Fibrohistiocytic Jeffrey M Isner. 342 pages, illustrated. Kluwer tumours of bone, round cell tumours of bone and metastases Academic Publishers, Dordrecht. £76.25. are also covered in detail. Lavishly illustrated and printed on Congenital and acquired disorders affecting the entire right art paper throughout. heart and pulmonary circulation are covered in addition to discussion of the right ventricle. Mainly of interest to cardiolo- Local Analgesia in Dentistry by D H Roberts and J W gists, some sections will interest cardiac surgeons, especially those on heart-lung transplantation and peri-operative right Sowray. 3rd edition. 176 pages, illustrated, paperback. heart dysfunction. Wright, Bristol. £14.95. The latest edition of a well-known and popular book first Breast Cancer: Collaborative Management edited by published in 1970. It has been thoroughly revised and includes J K Harness, H A A S D D descriptions of the latest advances in drugs used and in the Oberman, Lichter, Adler and equipment for their administration. Well laid out and illus- R L Cody. 390 pages, illustrated. Lewis Publishers Inc., trated it will no doubt continue to have a wide sale. Michigan. £55.50. Based on the view that the contemporary management of breast cancer requires the partnership of surgeons, nurses, Eye Emergencies by Michael J Roper-Hall. 120 pages, social workers, oncologists and others with special training, this illustrated. Churchill Livingstone, Edinburgh. £17.50. book stresses the multi-disciplinary approach throughout. The A synopsis of the management of ophthalmic emergencies first section discusses past and present trends in the manage- written largely in short note form. Clear line illustr4tions ment ofbreast cancer; the second relates to diagnosis. A further supplement the text. A useful book for casualty officers as well extensive section covers psychosocial issues and rehabilitation. as nurses and first-aid attendants. Medical students also could profit by browsing through this book. Computing for Clinicians by Tim Chard. 136 pages, paperback. Elmore-Chard, London. £18.00. A Colour Atlas of Surgical Anatomy of the Abdo- There can be few readers of this journal who do not now accept that computers in medicine are here to stay. Many readers, men in the Living Subject by Roy Yorke Calne. 168 however, will have little knowledge as to their applicability to pages, illustrated. Wolfe Medical Publications Limited, their own practice. The purpose ofthis short book, written by a London. £35. practising cliniician, is to provide a basic understanding of Ofthe 469 illustrations in this colour atlas the vast majority are computers and their place in clinical medicine for doctors who photographs of the abdomen and its contents taken during have relatively little knowledge or experience of the subject. A surgical operations. The remainder are mainly radiographs useful addition to the library shelf. and CT scans to show essential points of abdominal anatomy. There are a few colour drawings and micrographs showing Orthopaedic Biomaterials in Research and Practice histology. Throughout, the author has considered anatomy 394 from the point ofview ofthe general surgeon and has attempted by Jonathan Black. pages, illustrated, paperback. to relate structure to function so that disturbance ofstructure in Churchill Livingstone, New York. £35.00. surgical disease can explain symptoms, signs and deranged This book deals with three aspects of biomaterials in ortho- function. The volume should nicely supplement standard ana- paedics: the properties of tissues, the properties of fabricated tomical texts and will prove of especial interest to medical materials and the interaction between natural and fabricated students. materials. The early chapters cover the principles of material science and require a knowledge ofphysics and engineering. To help the student, an extensive glossary of engineering terms is A Colour Atlas of Human Anatomy by R M H appended. An important book for modern orthopaedic McMinn and R T Hutchings. 2nd edition. 358 pages, surgeons written by a professor ofbio-engineering who works in illustrated. Wolfe Medical Publications Limited, Lon- the department of orthopaedic surgery in the University of don. £29.50. Pennsylvania. The first edition of this handsome and unique atlas has established itself throughout the world as a best-seller. This second Dilemmas in Otorhinolaryngology edited by D F N edition has been completely revised and contains over a hun- Harrison. 374 pages, illustrated. Churchill Livingstone, dred new illustrations together with a more lucid layout of text. Edinburgh. £45.00. The colour photographs, which are all lifesize, remain as clear Professor Harrison has produced an intriguing and novel book and vivid as before. Astonishing value for money. There can be which cannot fail to interest all who manage problem patients no doubt that this new edition will be widely studied by all in the field of otorhinolaryngology. He has posed 21 dilemmas, aspirants towards a surgical career and will be one of the most ranging from 'what is informed consent?' to 'adjuvant therapy thumbed volumes on the library shelf. for head and neck cancer-an unproven form of treatment?' Two authorities then give separate and individual opinions on Arthroscopic Surgery of the Knee by Johannes these selected problems over which there is considerable confu- sion. A third distinguished senior member of the specialty has Lohnert and Jiirgen Raunest. 161 pages, illustrated. then been persuaded to write a critique of the two papers and, Georg Thieme Verlag, Stuttgart. DM 168. in many instances, express his own view of the problem. Thus Experience gathered in over 10 000 arthroscopies and 6000 the reader can review the evidence and come to his own verdict. arthroscopic operations provide the basis for this attractive volume on arthroscopic surgery. Originally published in the German language it has been translated for the English- Bone Tumours edited by K Krishnan Unni. 250 pages, speaking reader and cannot fail to interest all those who illustrated. Churchill Livingstone, New York. £45.00. perform this type of endoscopy. A major feature of the book is Volume XI in the series 'Contemporary Issues in Surgical the exceedingly high quality of the numerous colour photo- Pathology'. The early chapters cover imaging, staging and flow graphs taken through the arthroscope showing clearly the cytometry. Several chapters on osteosarcoma cover pathology, various operations in progress. Notes on books S7 Ankle Arthroscopy: Pathology and Surgical Tech- Lasers in Skin Disease by Ronald G Wheeland. 142 niques edited by James F Guhl. 162 pages, illustrated. pages, illustrated. Georg Thieme Verlag, New York. DM Slack Incorporated, New Jersey. £67.45. 98. Examination of the ankle joint by arthroscopy is much less This volume, sponsored by the American Academy of Facial practised than examination of the knee joint or the shoulder Plastic and Reconstructive Surgery, concerns itself principally joint. It is therefore timely that this book should appear. The with the laser treatment of cutaneous lesions. Many before and author discusses the technique, the difficulties and, aided by after photographs are given but the approach throughout is many colour photographs, the various diseases that can be essentially anecdotal. It is a pity that the results of treatment, diagnosed. good or less good, are nowhere given. Tumours of the Hand byJ Glicenstein,J Ohana and C A Colour Atlas of Faecal Incontinence and Com- Leclercq. 229 pages, illustrated. Springer-Verlag, Berlin. plete Rectal Prolapse by M M Henry and N H Porter. DM 113. 61 pages, illustrated. Wolfe Medical Publications, Lon- A unique book based on a series of 471 tumours of the hand don. £19.00. managed by the authors, all of whom work in Paris. Part 1 Number 32 in the 'Single Surgical Procedures' series. The first deals with skin tumours, part 2 with tumours of soft tissues of part of the book illustrates the operations of post-anal repair the hand both benign and malignant, part 3 with tumours of and external sphincter repair. The photographs are of good bone, and part 4 with tumours of the nail and nailbed. Each of quality and each step of the operation can be followed with these tumours is discussed in terms of diagnosis, pathology, ease. The second half of the book illustrates Ivalon sponge presentation and treatment. Numerous colour photographs rectopexy performed for full-thickness rectal prolapse. complement the text. 1988 Yearbook of Vascular Surgery edited by John J Low-Level Laser Therapy: A Practical Introduction Bergan and James S T Yao. 328 pages, illustrated. Year by T Ohshiro and R G Calderhead. 143 pages, illus- Book Medical Publishers, Chicago. £34.00. trated. John Wiley and Sons Limited, Chichester. The latest in a well-known series. Abstracts, together with £30.50. editorial comment, are given of selected articles on vascular surgery published during 1986 and 1987. Most surgeons think of lasers as being instruments used for coagulating, vaporising and incising tissue. The last five years, edited L however, have seen the emergence oflow-powered lasers which Drug Delivery in Cancer Treatment by are non-invasive and cause no change in tissue structure or Domellof. 99 pages, illustrated. Springer-Verlag, Berlin. temperature. These are said to have a very wide range of DM 82. clinical applications including pain relief, acceleration of A detailed update of basic and clinical research into the wound healing, improving the take of skin grafts and the methods of drug delivery and cancer treatment. Special refer- treatment of cutaneous cosmetic defects. This book aims to ence is made to pain relief, nutritional support and treatment provide the reader with knowledge of the theoretical and with anti-cancer agents. clinical aspects of low-level laser therapy, a technique which is not yet widely accepted but which may have considerable Year Book of Surgery 1988 edited by S I Schwartz et therapeutic potential. al. 483 pages, illustrated. Year Book Publishers/Wolfe Medical, London. £38. edited Anne- This remains one ofthe best selections ofpapers from the world Neuropsychological Rehabilitation by literature. Important advances are summarised together with Lise Christensen and Barbara P Uzzell. 135 pages. authoritative confirmation or refutation of established ideas Kluwer Academic Publishers, Boston. £25.95. and practice. There is usually enough information to grasp the The Proceedings of a conference held on rehabilitation of main arguments. An editor adds a critical comment, often brain-damaged people held in Copenhagen in 1987. Of interest referring to other important papers on the subject. The whole to neurosurgeons. of general surgery is covered, together with thoracic and cardiac surgery, transplantation and burns. Modern Stereotactic Neurosurgery edited by L Dade An Atlas of Head and Neck Surgery edited byJohn M Lunsford. 519 pages, illustrated. Martinus Nijhoff Pub- Lore, Jr. 3rd edition. 1 186 pages, illustrated. W B Saun- lishing, Boston. £95.75. ders Company, Philadelphia. £85.00. This comprehensive volume on stereotactic neurosurgery is Fifteen years have elapsed since the last edition of this large divided into four sections: basic technqiues, morphological and comprehensive atlas of head and neck surgery. Virtually surgery, functional neurosurgery and stereotactic radiosurgery. every chapter has been enlarged and new chapters have been Copious illustrations, well referenced and authoritative. added. The 500 Plates are complemented by a detailed text, not only on the operative technique but also the indications and postoperative management. An extensive bibliography is given Otolaryngology-Head and Neck Surgery edited by to each section. A standard reference work which will continue D D DeWeese, W H Saunders, D E Schuller and A j to be a valuable addition to the literature. Schleuning. 7th edition. 627 pages, illustrated. C V Mosby Company, St Louis. £28.75. Atlas of Duplex Ultrasonography by S X Salles- The latest edition of a well-known textbook first published in Cunha and G Andros. 190 pages, illustrated. Appleton 1960. This revision includes new chapters on immunology, Davis Inc., Pasadena. £60.00. sleep disorders, laryngeal reconstruction, laser surgery, neck A comprehensive atlas of duplex ultrasonography with a large nodal disease and facial plastic and reconstructive surgery. The number of clear illustrations and a succinct text. Arteries, book retains its emphasis on evaluation and diagnosis but veins, arteriovenous fistulas and cysts are covered as well as a contains expanded discussion of treatment. section on real-time Doppler velocity colour mapping. S8 Notes on books

Revascularization for the Ischemic Brain edited by depict and why they should be exhibited. This attractively Donald L Erickson. 294 pages, illustrated. Futura Pub- produced book reproduces in full colour each painting and lishing Company, New York. $45.00. sculpture and gives a short eminently readable account of the EC-IC bypass is now less popular than a few years ago but subject. nevertheless seems to have a definite place in the treatment of some patients with cerebral ischaemia. This book covers all aspects of the operation and evaluates its present status. Common Perioperative Problems and the Anaes- thetist by G M Woerlee. 643 pages. Martinus Nijhoff Biology of Lung Cancer edited by S T Rosen, J L Publishers, Dordrecht. £65.50. Mulshine, F Cuttitta and P G Abrams. 362 pages, In this book the author presents his views on the assessment illustrated. Marcel Dekker Inc., New York. $1 19.25. and management of clinical problems commonly encountered in adult surgical patients during the perioperative period. Recent developments in basic cellular and molecular biology Clearly set out with headings in bold type and the avoidance of relating to lung cancer are surveyed and particular emphasis is long paragraphs it should have wide appeal. The need for placed on the newest monoclonal antibody techniques for understanding of the physiological basis of each problem is immunodiagnosis and immunotherapy. Of particular interest emphasised and the solutions set out are essentially practical. to oncologists. In Sickness and in Health: The English Experience Recent Advances in Surgery-13 edited by R C G 1650-1850 by Roy Porter and Dorothy Porter. 324 Russell. 318 pages, illustrated, paperback. Churchill pages. Fourth Estate Limited, London. £25.00. Livingstone, Edinburgh. £17.50. It is now taken for granted that most people are born healthy The editor writes in his preface that surgery today is about and will largely stay that way, at least until middle years. This questioning current concepts, about audit and application of was not the case in Georgian England however. Using material lessons learnt to daily practice. This is the basis on which he culled from diaries, letters and memoirs, the authors present has chosen the seventeen subjects discussed in this latest book the lay experience of sickness during this period. They do not in a well-known series. Within its pages there will be sections of survey medical provision or medical practitioners or practice interest to every reader of this notice whatever their specialty. nor do theyjudge how successfully doctors treated disease. The A book for established surgeons just as much as for examina- subject of the book is sick people. tion candidates. A book of interest for all doctors, physician and surgeon alike, as well as medical students, paramedics and social historians. Clinical Surgery edited by John H Davis. 3264 pages, illustrated. C V Mosby Company, St Louis. £80.00. Vascular and Multi-Infarct Dementia edited by J S Over three thousand pages of text contributed by over one Meyer, H Lechner, J Marshall and J F Toole. 276 pages, hundred authors lead to a reference volume for the library illustrated. Futura Publishing Company, New York. shelf. The book will be a competitor to the several other very $39.00. large textbooks of surgery published in the United States and Twenty-six chapters summarising the present state of know- the reader will need to browse through it in some detail to ledge of vascular and multi-infarct dementia. Aetiology, decide how it compares. pathophysiology, epidemiology, investigation and treatment There are seven major sections. The first relates to general are all covered. principles and includes a historical introduction, a discussion of the cost of health care and a very useful chapter on the critical Basic and Clinical of Colorectal evaluation ofdata. Part two is designed to review the biological Perspectives Polyps phenomena on which surgical practice rests. Such subjects as and Cancer edited by Glenn Steele, Jr, Randall W Burt, metabolic response to injury, inflammation, wound healing and Sidney S Winawer and James P Karr. 409 pages, illus- the principles of cancer biology are covered. The third part trated. Alan R Liss, New York. $76. describes the clinical manifestations of common surgical prob- The Proceedings of a meeting held in Boston, Massachusetts, lems, and part four covers various aspects of management. By in 1986. The various contributions have been printed from far the largest section then follows-some seventeen hundred camera-ready copy prepared with various type faces leading to pages-and deals in a systematic way with diseases of organs a somewhat untidy appearance. Nevertheless, the contribu- and systems. Part six covers the management of the injured tions are authoritative and will be of interest to coloproctolo- patient and finally there is a section dealing with a miscel- gists as well as to research workers in the field. laneous range ofsubjects such as organ transplantation, plastic surgery and paediatric surgery. Pancreas Transplantation edited by L H Toledo- By any account, the senior editor and his team must be Pereyra. 298 pages, illustrated. Kluwer Academic Pub- congratulated in getting such an enormous volume ever to see lishers, Boston. £80.25. the light of day. No doubt there will be many points of detail that will be changed in the next edition but, even so, the The first human pancreas transplant was performed in 1966. volume as it stands is to be strongly recommended. This volume outlines the present state of the art twenty-two years later. A number of distinguished transplant surgeons contribute the chapters which cover indications, technique, Clio Chirurgica: Liver Transplantation by T E results, complications and future prospects. Essential reading Starzl, C-G Groth and L Makowka. 363 pages, illus- for those working in the field. trated, paperback. Silvergirl Inc., Austin, Texas. $29.00. Royal Society of Medicine! Portraits, Paintings and The volumes in this series, of which this is number 15, reproduce papers that were seminal in the development of the Sculptures by Alex Sakula. 194 pages, illustrated. Royal subject under review. The first liver transplant (in animals) Society of Medicine, London. £20.00. was as recent as 1955. The authors here reproduce each of the Many readers will have glanced at the paintings on the walls of key articles published since then so as to create a unique The Royal Society ofMedicine and wondered who the portraits reference work. JOHN HUNTER 172-173

THE ROYAL COLLEGE OF SURGEONS OF ENGLAND

Guidelines to Clinical Audit in Surgical Practice

March 1989 Council has decided that from time to time the College should issue 'Guidelines' on matters ofparticular moment in surgical practice.

The College has been assiduous in promoting clinical audit without attempting to impose direction on local practice. However, following publication ofthe White Paper ('Working for Patients'), Council now considers that it is appropriate to promulgate its views on clinical audit.

Council recognizes that it is not practicable to implement all of these guidelines in every hospital. One important consideration is that there must be adequate funding to meet the additional demands placed on staffat all levels and toprovide suitable computer hardware and software. Nevertheless, the requirement for audit is here to stay and it is important that the Profession should take the lead.

Sir Ian Todd KBE March 1989

A. ROLES

The careofpatients isthe responsibility ofindividual consultants and the prime concern ofmedical staff. The Royal College ofSurgeons (the College) promotes clinical audit and quality control in order to ensure a high level ofcare ofpatients in surgical departments.

The roles ofthe College are

- to offerguidance to surgeons, health authorities and others striving to improve the standards ofsurgical care; - to ensure that surgeons are trained to high clinical standards; - to encouragemedical staffto develop and use critical faculties; - to promote the effective management ofresources.

B. AUDIT 1. DEFINITION

Audit is the systematic appraisal ofthe implementation and outcome ofany process in the context of prescribed targets and standards.

Clinical audit is the process by which medical staffcollectively review, evaluate and improve their practice. This should include

- the access ofpatients to care (appointments, investigations, admissions, waiting times); - the process and the outcome ofcare; - the administrative and fmancial constraints relevant to clinical practice.

The discipline ofthe process

- encourage change and improvement in clinical practice; - provides peer support for individual clinicians; - is an important educational process for both seniors andjuniors; - raises the overall quality ofclinical care in a department. 2. RESPONSIBILITY

Consultant surgical staffare ultimately responsible for initiating clinical audit. The College recommends that the Surgical Tutor should normally be responsible for

- ensuringthat the audit programmes are developed; - nominating within each department one consultant with overall responsibility for organising and developing the programmes.

2 3. ETHICS

Participants in clinical audit aremembers ofthe same profession carryingout a reviewofclinical practice and sharing responsibilities to provide high quality patient care.

Anonymity ofall sensitive data must be effected at the earliest opportunity.

Audit meetings should

- be absolutely confidential to the audit group; - be full, frank and truthful discussions ofclinical and administrative problems; - be educational and constructive; - result in agreement to act or recommend action to improve clinical results; - never be a 'witch-hunt'.

4. CONFIDENTIALITY

Open discussion cannot take place unless its confidentiality to the group is absolute. Ifthis basic principle is not respected, mutual trust will be lost and the consequences may be disastrous.

The importance ofanonymity cannot be over-emphasised. It should be remembered that

- any patient or relative (or their legal representative) is entitled to demand access to relevant medical (but not audit) records;

- Hospital Management will have access to thegeneral conclusions ofclinical audit meetings (see paragraph 5).

However, neither consideration should stand in the way ofthe clinical audit programme.

Acode ofpractice involving an understanding ofthe confidentiality and the ethical nature ofclinical audit meetings must be applied to all those attending.

5. RECORDS

A record ofaudit meetings should be kept and should include

- a list ofthose attending - the broad topics discussed - conclusions or recommendations reached.

Evidence will be sought during inspection ofhospitals by the College that

- effective audit meetings have taken place; - all surgical staffhave attended; - recommendations arising from audit have been implemented; - appropriate records havebeen kept.

Details ofarrangements and ofresponsibility for records should be developed locally.

6. PROCEDURE

It is suggested that, as far as possible, the following procedures should be adopted. a) Junior Staffshould be responsible for the accumulation and presentation ofdata and may need to make use ofaudit assistants and other personnel provided by Management. b) Consultants should take it in turn to chair meetings to ensure a diversity ofapproach. c) Each meeting should be presented by a different Junior Doctor in rotation. d) A suitable format ofpresentation should be developed and agreed locally. e) Although selected cases and topics will be chosen for discussion, a list ofall patients admitted since the last meeting, with diagnoses, should be appended. f) A record ofevery meeting should be kept (see above).

3 7. RESOURCES

The introduction ofclinical audit involves appreciable costs and District Health Authorities must provide adequate resources ifsuch an initiative is to be successful. There must be provision in their contracts forconsultants andjunior doctors to participate in clinical audit. The College recommends that one halfsession ofconsultant time should be devoted each week to clinical audit - even ifthis means a reduction in other commitments. The College will insist on reviewing local facilities to ensure that adequate management support is available. Secretarial assistance, audit assistance and computer systems are essential ifclinical audit is to be effective and the time available to clinicians is not to be wasted. C. MEETINGS

1. TOPICS Clinical audit meetings should address a variety oftopics. a) Access to treatment. Departments should endeavour to set targets to ensure equity ofsurgical care in their districts. Health Authorities already negotiate the number ofhigh cost operations(e.g. heart trans plants) to be done each year. This process could be usefully extended to other operations, paiticularfy where there are long waiting lists. b) Issues. The appropriateness and complications ofclinical investigations oftreatment, the use of re sources, out-of-hours operating and untoward clinical occurrences should all be addressed. c) Outcomes. Deaths and complications are traditionay considered but the quality oflife after surgery and the degree of patient satisfaction should also be assessed as far as possible. 2. FREQUENCY

A meeting of all consultants in each surgical department with all theirjuniors should be held each week, normally within working hours. These should last for 1-1.5 hours. In total the College requires meetings to occupy not less than halfa day a month for training purposes. It is recognised that how this is arranged will vary with local conditions. 3. RESULTS Experience ofsuccessful meetings at which discussion is open has shown that all staffcan benefit. Clinical problems are readily identified and most surgical departments should be able, with tact and humanity, to resolve even the most sensitive issues. Solutions can normally be found from within the surgical team and itwill only be in unusual circumstances that reference has to be made to external bodies. Evidence that adequate clinical audit has been routinely undertaken could provide a basis for successful medico-legal defence by surgeons actively participating in such peer review. D. NATIONAL AUDIT National audit ofsurgical practices is necessary because Districts are small units each with a limited number of surgeons. The National Confidential Enquiry into Perioperative Deaths (NCEPOD) will issue annual reports intended to improve standards ofsurgical practice. The reports will include guidelines for specific clinical situations. The College supports NCEPOD and hopes that all consultants will participate. The College attaches great importance to the routine quinquennial inspections by its Hospital Recognition Committee. This Committee has issued, and regularly updates, recommendations about the training environment and facilities that each hospital provides. Recommendations issued after inspections must be fulfilled ifaccreditation is to be maintained. From January 1990 the Committee will initiate a routine scrutiny ofhospital notes and audit records to ensure optimum standards ofsurgical care. Guidance will be subsequently issued to refine this aspect ofaudit.