Despite our initial concerns of damaging the venous conduit with a minimally invasive approach to saphenous vein harvest, EVH in our experience has resulted in a trend toward improved patency rates and decreased infectious wound complications while affording the benefit of improved cosmesis. An endoscopic approach results in smaller incisions, decreased interventions for occlusion, and improved outcomes compared with OVH. EVH is the procedure of choice for harvesting saphenous vein for femoral to below the knee arterial bypass surgery.

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Indifferent language of an alien shore, the journey was troubled but I am here: register me among your stepchildren

BackgroundThe surgical treatment of bone tumours can result in large peri-operative blood loss, due to their large sizes and hypervascularity. Pre-operative embolisation has been successfully used to downgrade vascularity, thus reducing peri-operative blood loss and its associated complications.MethodsPre-operative embolisation was successfully undertaken on twenty-six patients with a variety of primary and secondary bone tumours.ResultsMean blood loss was 796 mL and we experienced no complications.ConclusionPre-operative arterial embolisation of large, richly vascular bone tumours in anatomically difficult positions, is a safe and effective method of downstaging vascularity and reducing blood loss.

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Since the introduction of arsphenamine the Jari sch\x=req-\ Herxheimer reaction has been a much debated, frequently maligned and little understood phenomenon. In

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had been treated for extensive sputum positive pulmonary tuberculosis with a two stage thoracoplasty on the right, a phrenic nerve crush, and later plombage with a polystan pack on the left; she received three months' treatment with streptomycin and para-aminosalicylic acid.She was a lifelong non-smoker with a history of cough and sputum, increasing dyspnoea over five years, and very restricted exercise tolerance. Her forced expiratory volume in one second (FEV,) was 0 4 1 and forced vital capacity (FVC) was 0 5 1. Indirect laryngoscopy confirmed a left vocal cord paralysis and a chest radiograph showed a giant, rounded opacity in the left hemithorax (fig 1). Radiographs from 1982 and1986 showed the appearance to be unaltered. She developed stridor and, over the next week, superior vena caval obstruction and a fluctuant mass over the apex of the left lung posteriorly. Bronchoscopy confirmed the left vocal cord paralysis and external compression of the trachea, 10 cm below the vocal cords. Computed tomography showed a partially calcified, fluid filled cyst, 16 cm in diameter, displacing the aorta and mediastinal structures and compressing the trachea. There was no enhancement after contrast and the mediastinal vessels were not directly affected. Within the cyst there was an area of low attenuation, which was thought to be the original polystan pack. The 2nd, 3rd, 4th and 5th ribs were destroyed posteriorly. There was no hilar or mediastinal lymphadenopathy (fig 2).A percutaneous drain was inserted posteriorly and 2 litres of haemorrhagic fluid Figure I Chest radiographs of the patient at presentation: left-posteroanterior; right-lateral.