1. Two normal subjects and ten patients with chronic renal failure were given 15 or 20 g of calcium carbonate in the morning and 5·6 or 8·4 g of calcium phosphate in the evening for 13-41 days.2. During the high calcium and phosphate intake there was a rise in calcium and phosphate absorption from the gut in the normal subjects and to about the same extent in the patients with chronic renal failure.3. The calcium and phosphate balances became positive while there was a rise in plasma calcium and a fall in plasma phosphate. There was also a fall in urinary phosphate excretion.

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Individual finger tourniquets are appropriate to the management of a wide range of conditions presenting to an accident and emergency department. They are simpler and more comfortable to use than upper arm pneumatic tourniquets and commercially available digital tourniquets are not readily available in the accident and emergency unit. However, if a finger tourniquet is overlooked, ischaemia of the digit results, and gangrene may follow if the problem is not defused early enough, leading to potential disaster. We present one case where a digit was salvaged after 4 days of tourniquet application, using medicinal leeches.

The number of women with stage IV disease who have breast reconstruction is small. The primary aim of this study was to examine opinions as to the appropriateness of breast reconstruction in this group. The Association of Breast Surgeons (ABS) and the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) were invited to take part in an online survey. Of the respondents, 78.7% would operate on the primary tumour. Plastic surgeons showed a propensity for immediate reconstruction compared to their breast surgery colleagues, and 26.3% of breast surgeons would not offer reconstruction at all. Immediate latissimus dorsi (LD) flap and implant were the favoured method in early stage disease with delayed LD and implant the most popular option for stage IV disease. As survival figures continue to improve, the number of patients requesting reconstruction is likely to increase. Further debate will be necessary in anticipation of future service development.