Measurements of the lower oesophageal sphincter pressure and gastric secretion were made in patients with dyspepsia but no reflux and in patients with a hiatus hernia and reflux in response to a near maximal dose of pentagastrin. Patients with hiatus hernia had lower resting sphincter pressures than those with dyspepsia. The magnitude of the pressure rise following pentagastrin was related to the resting tone of the sphincter. However, in terms of percentage increase over resting sphincteric pressure, patients with dyspepsia and patients with a hiatus hernia had similar response.

Life table analysis of early entry to this randomised blind trial of 318 patients has shown a significantly poorer survival for resected lung cancer patients treated with levamisole for three days before operation and three days a fortnight thereafter than for placebo-treated controls. This excess was largely due to deaths that had been attributed to operation or other causes (non-cancer deaths), most occurring in the six weeks after operation. In the 99 resected patients treated with levamisole there was a 15% excess of deaths in this category, compared with the placebo-treated controls. Extensive analysis excluded maldistribution of patients between the groups as a cause of this difference.Many more died in respiratory distress, mostly without clear cause, in the levamisole group. Antibody (lgG) reacting with myocardial sarcolemma or sarcoplasm was found in the only serum samples available for testing which were drawn from patients during the syndrome. The findings are in keeping with a primary effect on the heart, possibly involving an autoimmune mechanism. The effect has not been noted in other trials.

SUMMARY ThirtyIT seems widely accepted amongst clinicians that the surgical management of hiatus hernia has d limited success rate (Edwards et al., 1964). This has led some workers to doubt the significance of the anatomical presence of a hiatus hernia, arguing quite rightly that the patient's symptoms are due not to the hernia itself but rather to the occurrence of gastric reflux through an incompetent gastro-oesophageal junction. This argument has been reinforced to some extent by the increasing information available on the function of a physiological lower oesophageal sphincter.Cohen and Harris (1971) have suggested that the presence or absence of gastro-oesophageal reflux is strongly influenced by the resting tone and responses of the lower oesophageal sphincter to various stimuli. These workers were able to separate patients with gastro-oesophageal reflux from those without reflux on the basis of the resting tone of the lower oesophageal sphincter above the intragastric pressure. Their findings suggested that the presence or absence of a hiatus hernia was of secondary importance in the occurrence of reflux.From the work of Cohen and Harris (1971) it would seem that patients in whom the resting lower oesophageal sphincter pressure is less than 10 mm Hg will be prone to gastro-oesophageal reflux. It should follow that if the lower oesophageal sphincter is all--important in the control of gastro-oesophageal reflux, then the results of surgical treatment will be highly dependent upon the eventual tone and actions of this sphincter and that correction of the anatomical disturbance at the cardia is of secondary importance.We have examined retrospectively 36 consecutive patients who had undergone operation for symptomatic hiatus hernia. We have assessed the clinical results of the operation independently of the operating surgeon and correlated the results of this assessment with measurement of the resting tone of the lower oesophageal sphincter and with careful radiological examination of the gastro-oesophageal junction. Our ROZYCKI A N D G . R. GILES* findings do not suggest a simple correlation between the sphincteric pressures and the symptomatic results of surgery. Materials and methodsStudies have been carried out in 36 patients who had undergone repair of a hiatus hernia between 6 months and 3 years previously. A11 the patients were selected for surgery on the basis of a failure of medical treatment to control symptoms and on the demonstration of oesophagitis by endoscopy. All the operations were carried out by one of us ( Z . J. R.) using a standard

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