Repair of abdominal aortic aneurysm (AAA) carries a considerable rate of morbidity and mortality, but little information exists on the quality of life following this procedure. During 1988 and 1989, in two hospitals, 211 patients (186 men and 25 women; median age 74 (range 48-87) years) underwent surgery for AAA. There were 77 ruptured aneurysms and 134 electively repaired. Of these, 38 patients died in hospital (27 ruptured, 11 elective); by the time of review a further eight (one ruptured, seven elective) had died from unrelated causes. Of the 165 survivors, 131 (45 ruptured, 86 elective) were reviewed and questioned as to their physical and mental state before and after surgery. Using the Rosser index, a value for quality of life before and after surgery was calculated (1.0, good; 0, dead). The value for the elective group was 0.94 before operation and 0.96 after, but in the ruptured group fell from 0.98 before surgery to 0.87 afterwards. This study shows that patients undergoing elective surgery for repair of AAA retain good quality of life. By contrast, patients surviving emergency surgery following this procedure seem to suffer a deterioration in life quality, which must be endured for the same expected lifetime as that for the elective group. These results support the need for a national AAA ultrasonographic screening programme.

A previously fit patient underwent laparoscopic cholecystectomy. During the procedure arterial oxygen saturation fell and clinical examination revealed signs of a right pneumothorax confirmed by chest X ray. Aspiration of the pleural cavity and analysis of the gas removed showed it to be composed entirely of carbon dioxide. Possible mechanisms of entry of carbon dioxide into the pleural space are discussed.

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Background Suturing of portals following arthroscopic shoulder surgery is the standard method of closure, but may be unnecessary. We carried out a randomised controlled trial to compare patients whose arthroscopic portals were closed by suturing and those that were covered by a simple dressing. We randomised 60 patients undergoing diagnostic shoulder arthroscopy, arthroscopic subacromial decompression and arthroscopic acromioclavicular joint excision. Methods At 10 to 12 days following surgery, patients attended the GP surgery for a wound check and removal of sutures as required. At 3 weeks and 3 months every patient was reviewed by a designated, blinded, observer and the wounds assessed. The patients completed a questionnaire including visual analogue scores to determine their satisfaction with wound appearance and any complications such as infection. Results At 3 weeks and 3 months no patients had needed antibiotics with no wound erythema or signs of infection. The number of dressings needed was comparable in both groups (p=0.73). The difference in the level of patient satisfaction was not statistically significant in either group (p=0.46). The wound cosmesis score was not statistically different in either group (p=0.66). Conclusion We conclude that both closure techniques were equivalent but the non‐suture technique is cheaper with lower morbidity. From our study there is no need to suture shoulder arthroscopy portal wounds.

A case is presented of severe abdominal pain around a healed scar following fracture of a heterotopically formed bone. This should be considered an unusual differential diagnosis in patients with acute pain of unknown origin who had open abdominal surgery in the past. To our knowledge, we have also reported the first case of hetertopic bone formation incorporating a prolene mesh.