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In a randomized controlled clinical trial, the properties of low-frequency ultrasound in the treatment of chronic venous ulcers were investigated. Thirty-eight patients with chronic ulcerations of the legs caused by chronic venous insufficiency were randomly assigned to receive either conventional therapy alone or conventional therapy plus additional 30 kHz ultrasound treatment. Patients with other conditions that may impair wound healing such as diabetes mellitus or arterial disease were excluded. The ultrasound treatment consisted of 10 minutes of foot bathing with application of 30 kHz ultrasound 100 mW/cm(2) three times a week. Response was evaluated with the use of planimetry of the ulcer area and compared with controls after 3 and 8 weeks. After 3 weeks of treatment (and to a greater extent after 8 weeks of treatment) the ultrasound group showed a markedly better response than the control group. Although the control group showed a mean decrease of 11% in the ulcerated area after 8 weeks, in the ultrasound group the mean ulcerated area decreased by 41% (p < 0.05). There were only mild side effects in some of the patients treated with ultrasound. In conclusion, application of low-frequency ultrasound may be a helpful treatment option in chronic venous leg ulcers.

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Percutaneous endoscopic gastrostomy (PEG) is being used increasingly in the treatment of patients with neurogenic dysphagia to improve nutrition and prevent choking and aspiration pneumonia. PEG is used in a wide range of general medical conditions, but its role in clinical neurology is sometimes controversial. This paper reviews the place of PEG in the management of 32 patients with a variety of chronic and progressive neurological disorders. All the patients found it to be an effective and acceptable method of feeding that prevented weight loss, reduced chest infections, facilitated nursing care and improved their quality of life. PEG has an important role in neurological rehabilitation.

Thirty-one patients with thoracic outlet syndrome have been studied in detail in the neurological and vascular clinics at this hospital. The patients were classified on the basis of their presenting symptoms into four groups--predominantly vascular, neurological, combined vascular and neurological, and pain and paraesthesiae alone. The majority of patients had radiological abnormalities and all had structural lesions in the superior thoracic aperture seen at operation. All operations were carried out through a standard supraclavicular approach, enabling the compressive structures to be visualized. This would not have been the case had the commoner trans-axillary approach for first rib resection been followed and in fact none of the operations included removal of the first rib. The results of operation were evident in our patients with a marked relief in their vascular symptoms, their pain and paraesthesiae and a slight but definite improvement in muscle bulk and power.

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SYNOPSISThe clinical and thymic histological features of 23 patients who underwent thymectomy for myasthenia gravis have been examined and compared. Eighty-two per cent of patients with a nonneoplastic gland containing numerous germinal centres improved postoperatively, whereas 83% of patients with a non-neoplastic gland containing no germinal centres deteriorated or died. Glands with only slight involution and containing numerous germinal centres were more commonly seen in young female patients. The evidence relating thymic histological appearances with the postoperative progress of patients with myasthenia gravis is reviewed.An association between myasthenia gravis and the thymus gland was first suggested by Weigert in 1901. Although Schumacher and Roth (1913) reported the clinical improvement of a patient with myasthenia after removal of an enlarged non-neoplastic gland, it was not until the reports of Blalock et al. (1939) and Keynes (1949) that the beneficial effect of thymectomy was fully appreciated. Keynes concluded that, although the connection between myasthenia and abnormalities of the thymus gland was well established, there was no clue to how or why the gland acquired its abnormal function.Only recently have the histological appearances of the thymus gland and their relation to the clinical progress of patients after thymectomy received greater attention (Castleman and Norris, 1949;Mackay et al., 1968;Alpert et al., 1971;Seybold et al., 1971;Reinglass and Brickel, 1973;Vetters and Simpson, 1974). Opinions have varied from a clearly demonstrable association between thymic hyperplasia and postoperative improvement to a complete dissociation of these two parameters. It therefore seemed appropriate to make a clinical and pathological study of 23 myasthenic patients who had undergone thymectomy at the Manchester Royal Infirmary during the past 10 years. (Accepted 14 August 1975.) 38 METHODS PATIENTS Twenty-three patients with myasthenia gravis underwent thymectomy. Surgery was performed because of either increasing weakness despite treatment with anticholinesterases and in some cases steroids (19 patients) or the presence of a thymoma (four patients). At the time of operation all patients had evidence of ocular, bulbar, and limb weakness.The average age at onset of symptoms of patients without a thymoma was 32.6 years (range, 16-68 years) and the mean duration of symptoms before thymectomy was 4.9 years. The sex distribution showed a predominance of females with a ratio of 2.2: 1. Patients with a thymoma developed symptoms at 39, 49, 56, and 65 years and the mean preoperative duration of symptoms was 1.0 year. Three of these patients were male.HISTOLOGY Haematoxylin and eosin stained sections from all the paraffin blocks from each surgical section were examined by one of the authors (H.R.) without knowledge of the clinical details. The average number of sections to each specimen was three with a range of two to 10. The criteria used for assessment included the degree of gland involution, the overall ...

Objective:Planning of breast radiation for patients with breast conserving surgery often relies on clinical markers such as scars. Lately, surgical clips have been used to identify the tumor location. The purpose of this study was to evaluate the geographic miss index (GMI) and the normal tissue index (NTI) for the electron boost in breast cancer treatment plans with and without surgical clips.Material and Methods:A retrospective descriptive study of 110 consecutive post-surgical patients who underwent breast-conserving treatment in early breast cancer, in which the clinical treatment field with the radiologic (clipped) field were compared and GMI/NTI for the electron boost were calculated respectively.Results:The average clinical field was 100 mm (range, 100-120 mm) and the clipped field was 90 mm (range, 80-100 mm). The average GMI was 11.3% (range, 0-44%), and the average NTI was 27.5% (range, 0-54%). The GMI and NTI were reduced through the use of intra-surgically placed clips.Conclusion:The impact of local tumor control on the survival of patients with breast cancer is also influenced by the precision of radiotherapy. Additionally, patients demand an appealing cosmetic result. This makes “clinical” markers such as scars unreliable for radiotherapy planning. A simple way of identifying the tissue at risk is by intra-surgical clipping of the tumor bed. Our results show that the use of surgical clips can reduce the diameter of the radiotherapy field and increase the accuracy of radiotherapy planning. With the placement of surgical clips, more tissue at risk is included in the radiotherapy field. Less normal tissue receives radiotherapy with the use of surgical clips.