1. The results are presented of upper tibial osteotomy carried out in ten patients for osteoarthritis of the knee associated with lateral deformity. 2. The operation is indicated when there is severe pain, valgus or varus deformity, and a range of flexion of at least 90 degrees. 3. In every case pain has been relieved, and recovery of movement after operation has been easy.

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THE choice of treatment lies between arthrodesis of the terminal interphalangeal joint, tenodesis or restoration of tendon action by tendon grafting. The decision depends upon age, state of the finger, the occupation and the wishes of the patient. Tendon grafting is an operation of some magnitude for a comparatively small disability and should only be undertaken by the surgeon experienced in this work and when the patient is determined to seek perfection.Analysis of 33 consecutive cases operated upon by tendon grafting during the past eighteen years reveals 4 failures. Of the remaining 29 cases, 92 % attained 30 degrees or more flexion range at the terminal interphalangeal joint and 55% reached to within half an inch or less of the distal palmar crease. In no case was the finger harmed by surgical intervention.(A film demonstrating the technique of the operation was presented.) Tibial

1. A series of 226 upper tibial osteotomies is reviewed with special reference to the complications occurring in each of the six different operative techniques that have been used. 2 Wedge osteotomy above the tuberosity is the safest operation, but care must be taken to avoid a fracture into the joint. 3. Wedge osteotomy through the lowest part of the tuberosity may be indicated in the presence of large subarticular cysts or collapse of a tibial condyle. 4. The significance of weakness of dorsiflexion of the foot and the dangers of injury to the anterior tibial artery in osteotomies below the tuberosity are discussed.

This paper describes a prospective trial which was set up in order to decide whether after knee replacement it is better to remove the tourniquet (pneumatic cuff) before closure of the wound or to leave it on until compressive dressings have been applied. In 80 operations studied, there was less blood loss when the tourniquet was removed after closure and bandaging, but there was no difference in wound complications. The only statistically significant difference was attributed to the timing of tourniquet removal in those patients (about half) who were receiving low-dose heparin.

Summary An established chemical faecal occult blood test (Haemoccult prepared without rehydration) has been compared with a new immunological test (Hemeselect) in patients referred for investigation of lower gastro-intestinal symptoms.Hemeselect was shown to have a higher sensitivity for colorectal carcinoma (94.0% compared with 58.0%), the greatest difference in sensitivity between the two tests being for rectal cancers. Similarly Hemeselect was more sensitive than Haemoccult for colorectal adenomas (66.6% vs 33.3%), and for inflammatory bowel disease (88.9% vs 33.3%).However the enhanced sensitivity of Hemeselect for colorectal neoplasia and inflammatory bowel disease was accompanied by a significant increase in the overall rate of positive reactions (32.8% of patients had a positive Hemeselect reaction compared with 14.8% who had a positive Haemoccult test), and a reduction in specificity (84.1% for Hemeselect vs 96.0% for Haemoccult).Hemeselect is a more sensitive indicator of colorectal neoplasia in symptomatic subjects, trials of its use as a screening test for asymptomatic neoplasia appear justified.Faecal occult blood tests are potentially useful in the preliminary assessment of subjects with symptoms of colorectal disease (Leicester et al., 1983) and also for mass population screening for asymptomatic colorectal neoplasia. The test commonly used for screening, Haemoccult (Rohm Pharma) has an estimated sensitivity in the range 50-65% for asymptomatic cancers (Kewenter et al., 1988;Kronborg et al., 1989;Hardcastle et al., 1989) and has been noted to be particularly insensitive for rectal and caecal cancers, missing over 50% of malignancies at these sites (Kronborg et al., 1989;Hardcastle et al., 1989). In contrast over 70% of sigmoid cancers are detected. One of the proposed mechanisms for this discrepancy is that Haemoccult, which is essentially a test for the Haematin moiety of Haemoglobin, relies on an optimum degree of Haemoglobin degradation which is most commonly achieved by blood loss from sigmoid cancers.Immunological tests, not dependent on Haematin, should reliably detect bleeding from rectal cancers, although they may also be affected by excessive degradation of blood from caecal cancers. Hemeselect (Smith-Kline Diagnostics) utilises fixed chicken erythrocytes that have coated with an antihuman haemoglobin antibody. Faecal matter is smeared onto filter paper by the patients. Small discs of the paper are then used to obtain a dilute faecal solution to which the coated chicken erythrocytes are added, erythrocyte agglutination occurs in the presence of haemoglobin in the faecal solution.The The sensitivity of both tests was independent of tumour stage (Table II).A total of 26 adenomatous polyps were diagnosed in 21 patients (Table III) Nine patients were shown to have an inflammatory condition affecting the colon or rectum (Table IV), of these three (33.39%) had a positive Haemoccult test and eight (88.9%) a positive Hemeselect test (Fisher's test, P = 0.02).The specificity for neoplasia or inf...

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The usefulness of faecal occult blood tests is limited by their acceptability to patients. Standard tests require the collection of a stool sample which may inhibit compliance. Self-read tests which avoid this step have therefore been devised. Coloscreen Self-Test (CST) and Haemoccult, which may be regarded as the standard slide test, were offered to 450 consecutive patients attending surgical outpatient clinics with symptoms suggestive of lower gastrointestinal disease. Both tests were successfully completed by 383 patients. Although 262 (68 per cent) patients indicated that they preferred CST this was not reflected in the overall compliance to the two tests (CST 86 per cent, Haemoccult 90 per cent). CST gave a positive result in only eight out of 24 patients with a colorectal cancer (sensitivity = 33 per cent) compared with 13 out of 24 for Haemoccult (sensitivity = 54 per cent). CST had no advantage from increased compliance to outweigh its lower sensitivity.