West of England medical journal

at the Forte Posthouse Hotel in Deane Gate Avenue, Taunton. Twelve members of the Editorial Board were at the meeting. Readers will know from previous editorial material of the parlous financial plight of the Journal and that only one more issue of the Journal will be possible with our current finances. Many attempts have been made to obtain financial stability and viability for the future. This has not been forthcoming from any of the clubs or groups associated with the Journal, other than the Surgical Club of South West England who were willing to raise their subscriptions by ?10 per head. Other clubs and societies made generous offers of financial support as one off payments but these in themselves came nowhere

Professor Victor Neale was a leading paediatrician and respected teacher at a time when the specialty was growing rapidly and employing new professional skills, knowledge and attitudes. The benefits of these developments might be more fully realized by the establishment of a college of Paediatricians. But the consequential loss of affinity with the general medicine of adults and the Royal Colleges of Physicians could weaken the power of the medical profession to maintain the highest standards of medical practice.

All that said, this is still a book for dipping into. The American English is easily readable, and the tables are helpful. None the less, it defies the imagination to think that trainees in any clinical discipline should have to know that on chromosome 9 there are "genes in the breakpoint cluster region (bcr) of 22 cell lines established from CML expressing a new messenger RNA which reflects the chimeric gene produced by the fusion of the bcr and c-able genes". Don't let these random comments put you off. Here is a book framed in the new language of coded MCQ'ese. It is attractively produced in paperback, and well worth reading; that is if you are in the happy position of not having to sit an examination

The paramount role of radiology in the management of trauma has expanded with the development of new imaging modalities. A new text on the radiology of trauma is therefore welcome. Professor Sciafani has produced such a book, a glossy publication of 150 pages divided into two sections, skeletal and non-skeletal, trauma, that is well indexed and easy to use. The first section concerns the plain radiographic assessment of fractures with six chapters each concerned with a particular region of the body. There are anatomical drawings at the beginning of each chapter but these would be of more value accompanied by corresponding radiographs. The majority of common fractures are demonstrated and the use of CT in further evaluation, particularly of spinal and pelvic trauma, is emphasised. Unfortunately, the standard of reproduction of the many figures is poor and accompanying line drawings add little. A chapter of normal variants that simulate fractures, a minefield for junior radiologists and casualty officers, would have been of value. The second section on non-skeletal trauma is of greater interest. There are five chapters including useful but brief accounts of chest, abdominal and urinary tract injury. The value of CT is again made clear but the use of ultrasound is underplayed, particularly in the assessment of abdominal trauma. It is unclear as to which audience this book is aimed. It is too brief to be of value to radiology trainees but may be useful in a busy casualty department.

The basic reason why ethical problems have arisen in transplantation surgery is because a series of treatments have been established which are at best lifesaving and at the very worst, totally transform the lives of those who receive a graft. The kidney was the first vascularised organ to be successfully transplanted in the 1950's and the evolution of renal transplantation since then has been partly due to the efficacy of first haemodialysis and then continuous amulatory peritoneal dialysis which allowed patients in renal failure to be kept alive until such time as a suitable graft became available. In the last ten years similarly successful programmes of liver, heart, and heart/lung transplantation have become established. ORGAN PRESERVATION It is now possible, by simple cold storage, to keep a kidney viable for 48 hours, a liver for around 20 hours, a heart for six hours, and a lung for four hours. This preservation time allows an organ to be retrieved from a donor dying at some distance from the centre in which it will be transplanted and, in the case of kidneys in particular, for the donor kidneys to be transported to the best recipient within the United Kingdom. Evolving from this ability to preserve organs is an extensive network of sharing of transplantable organs between Transplant Centres within the United Kingdom. Good kidneys transplanted into good recipients will produce graft survival rates in excess of 80% at one year. The same survival can be expected for heart recipients and liver recipients and perhaps a little less for heart/lung recipients. Successful transplantation in good recipients has led to attempts to transplant patients who, a few years ago, would not have been considered. In renal transplantation, children and infants are regularly transplanted and people in their 70's are not disbarred from receiving a graft if otherwise reasonably fit. The upper age limit for heart and liver recipients keeps increasing. This relaxation of the criteria for accepting a potential recpient has increased the recipient pool and widened the gap between recipient need and donor supply. Recipient demand can sometimes lead to use of donors who are not ideal. IMMUNE SUPPRESSIVE AGENTS Modern immune suppression using cyclosporin, azathioprine, steroids, antithymocyte globulin, and monoclonal antibodies in varying combinations and sequences has produced a series of powerful weapons against the immune response so that a recipient's immune system can usually be suppressed sufficiently to allow retention of …

wvei uie pasi coupie oi yeais aueiuiun nas oeen increasingly focused on greater use of day surgery. It has been estimated that up to 50% of surgical cases could potentially be treated as day cases. At the same time we have seen the emergence of "minimally invasive surgery". Essentially based on laparoscopic techniques, this rapidly developing concept has certainly caught the imagination and an increasing number of operations are being performed via the laparoscope, either as day cases or with an overnight stay. Operations include cholescystectomy, appendicectomy and hernia repair, oophorectomy, salpingectomy and even hysterectomy and nephrectomy. We now have Associations for those with a particular interest in day surgery and minimal invasive surgery. The advantages of these techniques to the patient are obvious, with a much shorter stay in hospital and, where minimal invasive techniques are used, there are smaller scars. The benefits to the hospital are rather less clear cut. Certainly there is potentially a lesser need for nursing staff at night and weekends but day surgery techniques demand a high level of expertise from both surgeon and anaesthetist and, unless one is going to appoint additional staff, it is not going to make a major impact on the waiting list, as one is merely transferring the patient from one operating list to another. The "minimally invasive" techniques demand a much greater level of expertise and after the initial explosion of interest and "band wagon" effect, we are now beginning to see notes of caution sounded as the complications become apparent (Observer Sunday 22 September 1991). One also hears increasingly of complications which Gynaecologists were experiencing 20 years ago when laparoscopy was introduced into that speciality and which prompted the report published by the Royal College of Obstetricians and Gynaecologists in 1977. There is no doubt that laparoscopic surgical techniques in general take much longer than the traditional laparotomy procedures, thus far less operating can be performed on each operating list. This is likely to have an adverse effect on waiting lists. During the time these developments have been occurring, we have heard little of the "traditional" surgical techniques for these operations which are now being offered laparoscopically. They still represent the majority of day to day surgery and will probably continue to do so. There may have been a slight reduction in the length of post operative stay but, in general, laparotomies are associated with a significant …

Epidemiology anatomy and physiology of the lower urinary tract urinary incontinence pathophysiology diagnosis and urodynamic investigations management of urinary incontinence drugs voiding regimens surgery other aspects of management faecal incontinence.

a General Duty and Regimental Medical Officer, but in Belgium collected an MC (for 'liberating a case of champagne for the Officers' Mess') and also married the sculptress Jacqueline Heyse. On demobilisation he grasped his chance, and for the next ten years worked successively as Registrar and Surgical Tutor in Professorial Units in Bristol, Edinburgh, Baltimore USA, Oxford and Leeds; so by 1955 he had had as wide and detailed

country. The idea developed from a request by World Orthopaedic Concern (W.O.C.) to explore the possibilities of Orthopaedic training in Ethiopia. British Council in Addis Ababa gave every support, but the actual funding came from the Overseas Development Administration (O.D.A.). The department started to function in 1987 at the height of the civil war. The first three trainees passed their Final Examination in 1991, and at this point O.D.A. support was withdrawn, so that future funding is a problem, especially as there are 12 or 15 trainees in the pipeline, at various stages. W.O.C. is trying to make provision for this, but requires more general support both in manpower and finance. Volunteers for overseas work with W.O.C. will find it a rewarding and educational experience whatever their status, from Senior Registrars to retired Consultants.

in 1987 decided to produce an edited version of the minutes of the society from its inception in 1908. The result is a narrative that is surprisingly readable and records faithfully what the medical fraternity in Bath were thinking and writing papers about, the clinical cases they presented and how they conducted their affairs. The book which runs to 248 pages was obviously a labour of love for its compiler and will be of great interest to members of the Clinical Society of Bath. Leafing through its pages my interest was constantly aroused by expressions of current opinion on current practice as recorded in the discussions often enlivened with flashes of wit. Not all the entries record 'parish affairs'. Some of the speakers were of international eminence on subjects of cosmic inportance. Sir Fred Hoyle spoke to the Society in 1979 on his theory of the continuous creation of virus particle in outer space, how they cause episodes of influenza and why he thinks life must have started extraterrestially. It is the sort of archive from which the medical historian of the future will be able to learn how medicine progressed in the greater part of the twentieth century. It contains no index and that diminishes its usefulness to anyone wishing to research a specific interest, otherwise a model which other medical societies could well emulate.

Any doctor who has worked in an A&E Department will recall the relative ease with which clinical and radiological errors can occur; indeed all grades of medical staff are at risk. The medical defence organisations have been aware of this problem for many years and examples of A&E errors are highlighted in their annual reports. This excellent pocket size paperback written by an experienced A&E Consultant provides a timely analysis of the problem. The first 5 chapters discuss various aspects of diagnostic errors in general terms; the subsequent chapters go through each body region or part of a region in more detail, highlighting common and less common errors made and the reasons why. The last 2 chapters provide wise advice on what to do when a mistake is realised and how the situation can be handled. The text throughout is a model of clear lucid writing and thought, although the clarity of the radiographs reproduced is less than satisfactory. I would recommend this book to all doctors, of what ever grade, involved in the assessment of patients with injuries, including A&E doctors. General Practitioners and Orthopaedic Surgeons. Even senior and distinguished members of the medical profession will find many useful nuggets of information and wisdom in this excellent book. It should be part of any A&E or Fracture Clinic library and could also be used to form the framework for a series of tutorials and teaching sessions.

The Cornish miners of the 19th century travelled length and breadth of the USA, not only opening up valuable mines of silver, gold and other precious metals but creating local colonies of the Cornish blooded people who are still there today keeping alive the old Cornish customs. In preparing a BBC Television programme, based upon second generation Cornish in the USA, Ben Maile travelled over 20,000 miles to areas such as North Michigan, Missouri, Wisconsin, Texas, Arizona, California and Nevada. His paintings and television film depicted old ghost towns in the desert and on mountain tops, all of them at one time, either opened or developed by the expertise of the much sought after "Cousin Jack" the Cornishman's nickname worldwide. The presentation shows that, though the mines may now be past industries, the persistent, adventurous Cornishman has established proud colonies of descendants who, today, keep alive all the old Cornish customs and celebrations. Their one ambition

s of papers given at the Autumn Meeting held at the Royal United Hospital Bath October 23rd and 24th 1992 COLOUR DUPLEX SCANNING IN THE INVESTIGATION OF PERIPHERAL VASCULAR

Editorial ? The Last Post Sad news and hard luck stories abound in times of financial stringency and I am sorry to add the plight of the West of England Medical Journal to the list of woes. With the last issue of the journal we asked whether or not recipients would be willing to pay ?20 per annum to receive four quarterly issues of the journal. Unfortunately despite circularising 4,000 doctors we only received 113 responses (79 yes and 34 no). We have waited to see if more replies would be forthcoming but to no avail. England Medical Journal. It just remains for me to thank all who have been involved in running the journal, including the editorial committee and board.

The Southampton In Vitro Fertilisation Programme was established in 1986. Since that time the programme has maintained a clinical pregnancy rate of over 25 per oocyte retrieval. Embryos in excess of requirements for fresh transfer have been cryopreserved using controlled rate freezing and Propanediol as a cryoprotectant. Review of the first 75 frozen embryo transfers in natural or clomid induced cycles has produced only three pregnancies. A programme of pituitary down-regulation followed by preparation of the patient's endometrium with exogenous oestradiol valerate and progesterone was established in order to improve the success rate with cryopreserved embryos. The patients were treated with Buserelin for three weeks

The text is less daunting than the packaging, and, unusually, Nancy Baker plunges into the subject on page 1 without any kind of preliminary fluff about imaging techniques or radiological philosophy. The illustrations are fine, especially the radiographs, and everything is set out very generously with expanses of blank page to flatter your reading rate with a break to put the kettle on you could still be finished in two hours: not enough for radiology registrars but probably good for orthopaedic juniors and very keen medical students. This 1st edition has multiple typographical errors to mar the otherwise impressive presentation pictures with the wrong captions,

enter the notorious Japanese Prisoner of War "camp" at Changi Gaol after the liberation. On demobilisation he returned to UCH and then moved to Bristol as a surgical registrar. In 1952 he travelled the USA in company with his wife, visiting gynaecological and surgical centres. Having passed the PRCS in 1953 he decided to enter general practice and joined the practice in Keynsham where he continued for 35 years. With beds at Keynsham Hospital he was able to practice midwifery. He was also Clinical assistant to Mr. Bourns at the Bristol Royal Infirmary for many years and a member of a Boarding Panel for War Pensioners and Industrial Injuries. His wife Marjorie was a consultant obstetrician and gynaecologist, they had a great love of Exmoor and for many years have had a thatched cottage at Porlock. In retirement they were able to enjoy to the full the country pursuits that Exmoor offers. Douglas followed the stag hounds and supported them as surgeon at point-to-points and local shows. He enjoyed rough shooting and particularly fishing at which he