Background Dissociative seizures are paroxysmal events resembling epilepsy or syncope with characteristic features that allow them to be distinguished from other medical conditions. We aimed to compare the effectiveness of cognitive behavioural therapy (CBT) plus standardised medical care with standardised medical care alone for the reduction of dissociative seizure frequency. MethodsIn this pragmatic, parallel-arm, multicentre randomised controlled trial, we initially recruited participants at 27 neurology or epilepsy services in England, Scotland, and Wales. Adults (≥18 years) who had dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous 12 months were subsequently randomly assigned (1:1) from 17 liaison or neuropsychiatry services following psychiatric assessment, to receive standardised medical care or CBT plus standardised medical care, using a web-based system. Randomisation was stratified by neuropsychiatry or liaison psychiatry recruitment site. The trial manager, chief investigator, all treating clinicians, and patients were aware of treatment allocation, but outcome data collectors and trial statisticians were unaware of treatment allocation. Patients were followed up 6 months and 12 months after randomisation. The primary outcome was monthly dissociative seizure frequency (ie, frequency in the previous 4 weeks) assessed at 12 months. Secondary outcomes assessed at 12 months were: seizure severity (intensity) and bothersomeness; longest period of seizure freedom in the previous 6 months; complete seizure freedom in the previous 3 months; a greater than 50% reduction in seizure frequency relative to baseline; changes in dissociative seizures (rated by others); health-related quality of life; psychosocial functioning; psychiatric symptoms, psychological distress, and somatic symptom burden; and clinical impression of improvement and satisfaction. p values and statistical significance for outcomes were reported without correction for multiple comparisons as per our protocol. Primary and secondary outcomes were assessed in the intention-to-treat population with multiple imputation for missing observations. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN05681227, and ClinicalTrials.gov, NCT02325544.

The technique of total three-stage oesophagectomy is described fully. Points of detail in the procedure of the abdominal, thoracic and cervical phases are emphasized. A brief note is made regarding the management of the respiratory situation at the end of the operation.

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SUMMARY BackgroundPatients attending for endoscopy are generally anxious and worried.

Pre- and postoperative arterial blood samples were analysed for oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2) in a consecutive series of 21 patients subjected to two- or three-stage oesophagectomy for carcinoma of the oesophagus. The forced vital capacity (FVC) was measured at the same time. On the second postoperative day the PaO2 showed a fall to 65 per cent of the preoperative value followed by a gradual recovery to 78 per cent on the tenth postoperative day. After 13 weeks the PaO2 had recovered to 95 per cent of the preoperative value. The PaCO2 decreased in the early postoperative period but had returned to the preoperative level by the tenth day. The FVC showed a trend similar to the PaO2 with a reduction to 33 per cent of the preoperative value on the second postoperative day, 52 per cent on the tenth day and 85 per cent after 13 weeks.