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Following the description of the antegrade continence enema (ACE) 7 years ago, it has become widely performed and accepted as the most successful treatment for intractable faecal incontinence. Modifications of the operative technique and enema regimen have been described, but the basic principle remains. This paper traces the evolution of the ACE and describes criteria for patient selection, operative technique and enema regimens.

We have analysed the results of repair of traumatic lesions of the musculocutaneous nerve in 85 patients, which were graded by Seddon's modification of the Medical Research Council system into three types of injury: open 'tidy', open 'untidy' and closed 'traction'. They were also correlated with associated arterial injury. There were 57 good, 17 fair and 11 poor results. The type of injury was the most important factor in determining the result; 12 of 13 open-tidy lesions gave good results compared with 30 of 48 closed-traction lesions. The results were better when the nerves were repaired within 14 days of injury and when grafts were less than 10 cm long. They were worse in the presence of associated arterial or bony injury.

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CF1 female mice were time mated and the embryos at each gestation day from 0.0 to 18.0 were x-rayed to l O O r and the young carried to four months at which time a skeletal study was made. With this exposure the litters were reduced in size, following irradiation at certain gestation ages, and there was neo-natal mor. tality so that this skeletal study is based upon the survivors to four months and represents the maximum development under the conditions of irradiation. The sex ratio was not altered by this irradiation. Male mice of this strain are always heavier than the females of the same age, and this exposure reduced the over-all average of either sex by 2.5 grams. The skeletal measurements were taken from 1,005 radiographs of the living animals, and the averages calculated for each gestation day. There were sex differences in stunting, even when x-irradiation occurred before day 9.0. When the differences were pronounced the female was the more adversely affected. The highest statistical significance in skeletal effects of seven measurements was between 11 and 13 days, when the embryo shows the earliest skeletal differentia. tion. Such mice were topographically well developed.

A 75-year old lady underwent a routine laparoscopic cholecystectomy during which stones were spilled into the peritoneal cavity. Despite peritoneal lavage the patient developed chronic right upper quadrant discomfort and a pleural effusion over several months. Following the production of a pigmented bilirubin stone in her sputum the patient’s symptoms resolved. Cholelithoptysis is a rare complication of laparoscopic cholecystectomy, the diagnosis should be considered in patients with prolonged chest symptoms after surgery.