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Forty-nine patients with the Klippel-Trenaunay syndrome have been studied. Sixty-eight per cent have a superficial, embryological venous channel on the lateral aspect of the limb, 25 per cent have had one or more severe spontaneous haemorrhages from dilated varices and 22 per cent have suffered a venous thrombo-embolism. Twenty-nine per cent have had episodes of rectal bleeding or haematuria associated with pelvic angiomas. Foot volumetry (n = 31) showed that calf emptying was decreased in only five patients and only one of these had phlebographic evidence of deep venous obstruction, which conflicts with previous findings. The rate of calf refilling was increased in 81 per cent and phlebography demonstrated incompetent communicating veins in 45 per cent of patients. No patient had clinical evidence of an arteriovenous fistula, and arteriography (n = 22) and calf blood flow (n = 33) were normal, but lymphangiography (n = 14) showed lymphatic hypoplasia in 55 per cent of limbs. Eighty-eight operations have been performed on 38 patients but symptoms persist in 90 per cent. We suggest that surgery should be limited to the excision of localized symptomatic abnormalities and that the best form of control is provided by graduated compression stockings.

In the hope that some varieties of the post-phlebitic syndrome might be treated by implanting a preserved vein valve, studies have been made of the mechanical properties of vein valves and vein wall before and after preservation with glutaraldehyde. The ultimate tensile strength (breaking stress) and strain (extensibility) of strips of vein wall and valve leaflet were measured with a Nene tensiometer. The ultimate tensile strength of valve leaflet was found to be twice that of vein wall. Preservation in glutaraldehyde (0.2 per cent, pH 7.4, for 7 days) with valve cusps closed by a minimum head of pressure caused no change in breaking stress or extensibility.

practice; all branches of pathology except haematology; radiology; radiotherapy and oncology; ear, nose, and throat surgery; ophthalmology; clinical pharmacology; and others. Service in one or other of these would often be more socially valuable than attempting to struggle into the ranks of general physicians, surgeons, and obstetricians and gynaecologists, where competition may be unnecessarily fierce and unrewarding. Satisfying and valuable careers are to be had in all of these shortage specialties. They are all important in the nexus of medicine. Basic medical sciencesThe basic medical sciences of anatomy, physiology, biochemistry, psychology, genetics, and sociology as applied to medicine all lack teachers who are medically qualified. Together with pharmacology, these subjects are taught more and more to medical students by scientists, none of whom have clinical experience and so must teach their subjects as pure science. Medically qualified teachers see the basic sciences more in relation to patients because they have had clinical experience. This is attractive to medical students, who see medicine as applied science and want what they learn of the basic medical sciences to be relevant to their future work, which is more likely to be clinical than not.

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