mains the prime therapeutic modality for gastric cancer, but over 80% of patients are over the age of 65 years at diagnosis, comorbidity is common, and as many as one in three patients have incurable disease at presentation [3]. In the recently published audit of the treatment of esophagogastric cancer in Wales, many surgeons undertook small caseloads, staging strategies varied widely, and open-and-close operations were common [4]. Stage-directed management, tailored to individual patients, is clearly desirable if the benefits of greater subspecialization and a multidisciplinary approach are to be realized [5]. Computed tomography (CT), endogastric ultrasound, and laparoscopy all have a role to play in the preoperative staging strategy of gastric cancer [6]. Although CT represents the most widely used imaging technique for the preoperative staging of patients with gastric cancer, the modality has limitations in detecting local invasion of tumors and lymph node metastases [7][8][9][10]. Moreover, we have shown previously that discrepancies exist, even among experienced radiologists, in the interpretation of subtle radiological signs, and that special interest radiology improves the perceived preoperative stage of gastric cancer [11].The aim of this study was to measure the accuracy of serial special interest CT over time and when enhanced by regular multidisciplinary team feedback, and to determine the relative benefit of progressive CT system technology and the magnitude of any learning curve in radiological interpretation. Patients and methodsBetween July 1, 1997, and April 30, 2004, our center managed 267 patients with gastric cancer. Of these, 100 patients underwent both preoperative CT and operative assessment. Each patient had a preoperative histological diagnosis of gastric adenocarcinoma established by gastroscopy and biopsy. The median age was 70 years

The Medicines and Healthcare Products Regulatory Agency stated in 2003 that doctors should endeavour to avoid using products in treatments not covered by their product licence. Foley catheters are commonly used in the management of epistaxis although their product licence does not cover this. We undertook a questionnaire survey of members of the British Association of Otorhinolaryngologists--Head & Neck Surgeons to study the extent of the use of these catheters and the knowledge that members had of their legal status. Most members appear to use Foley catheters in the management of epistaxis; however, many are not aware that the product is not licensed for this purpose. Because of this lack of knowledge, only half obtain verbal consent for treatment with this device and only a very small number obtain written consent from patients. In the era of increasing litigation, documentation of informed consent could be considered mandatory to protect us from possible legal action, and this needs to be known by all practising otolaryngologists.

An atraumatic clavicular fracture presented after radical treatment for laryngeal carcinoma. This presented a diagnostic dilemma. The differential diagnosis included metastatic bone disease and osteomyelitis as well as post-radiotherapy complications. After investigation, the cause was thought to be a post-radiation fracture of the clavicle and to the best knowledge of the authors, this is the first ever documented in a patient who had undergone a total laryngectomy with bilateral modified radical neck dissections and post-operative radiotherapy. Cases of a fractured clavicle post-radiation have been most commonly documented in patients with breast cancer and only a few cases have been documented in patients with laryngeal cancer treated with a total laryngectomy, bilateral radical neck dissections and radiotherapy.