One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer.

BACKGROUND: A pathologically involved margin in rectal cancer is defined as tumour within 1 mm of the surgical resection margin. There is no standard definition of a predicted safe margin on magnetic resonance imaging (MRI). The aim of this study was to assess which cut-off (1, 2 or 5 mm) was the best predictor of local recurrence based on preoperative MRI assessment of the circumferential resection margin (CRM). METHODS: Data were collected prospectively on the distance between the tumour and mesorectal fascia for patients with documented radiological margin status in the MERCURY study. Positive margin and local recurrence rates were compared for MRI distances from the tumour to the mesorectal fascia of 1 mm or less, more than 1 mm up to 2 mm, more than 2 mm up to 5 mm, and more than 5 mm. The Cox proportional hazard regression method was used to determine the effect of level of margin involvement on time to local recurrence. RESULTS: Univariable analysis showed that, relative to a distance measured by MRI of more than 5 mm, the hazard ratio (HR) for local recurrence was 3·90 (95 per cent confidence interval 1·99 to 7·63; P < 0·001) for a margin of 1 mm or less, 0·81 (0·36 to 1·85; P = 0·620) for a margin of more than 1 mm up to 2 mm, and 0·33 (0·10 to 1·08; P = 0·067) for a margin greater than 2 mm up to 5 mm. Multivariable analysis of the effect of MRI distance to the mesorectal fascia and preoperative treatment on local recurrence showed that a margin of 1 mm or less remained significant regardless of preoperative treatment (HR 3·72, 1·43 to 9·71; P = 0·007). CONCLUSION: For preoperative staging of rectal cancer, the best cut-off distance for predicting CRM involvement using MRI is 1 mm. Using a cut-off greater than this does not appear to identify patients at higher risk of local recurrence.

Thorascopic sympathectomy performed using laser.

INTRODUCTION: Thorascopic sympathectomy is accepted as an effective treatment for palmar hyperhidrosis, facial blushing and to a lesser extent for digital ischaemia and axillary hyperhidrosis. PATIENTS AND METHODS: Data were collected retrospectively on patients undergoing thorascopic sympathectomy at St Peter's Hospital between 1987 and 2006. Patients were followed up by telephone interview. RESULTS: A total of 233 thorascopic sympathectomy procedures were performed by a single operator in 123 patients. Ages ranged from 9-71 years and 75 were women. In patients, 105 had a bilateral and 13 a unilateral procedure, 5 patients had a bilateral procedure performed in two stages. In 6 upper limbs, the procedure could not be done. Overall, 110 patients (90%) had the procedure performed for palmar hyperhidrosis, 8 (6%) for facial blushing and in 5 (4%) patients the operation was performed for digital ischaemia with tissue loss. There were no deaths and all patients were discharged on day 1 following the procedure. Complications included bleeding (2), pulmonary oedema (1) and failed procedure (2); however, no incidences of Horner's syndrome occurred. Only 40 of 123 (32.5%) patients gave follow-up information. Of this small group, 33 of 40 (83%) were cured, 4 of 40 (10%) were better, 2 of 40 (5%) were unchanged and 1 patient was worse. Only 22 out of 40 (55%) of these patients were troubled by compensatory sweating, with only 4 of 40 (10%) reporting this as a major problem. CONCLUSIONS: Thorascopic sympathectomy is safe and can be carried out as a single bilateral procedure in the majority of cases. The laser allows the use of a single port, requires less dissection than surgical or clipping techniques, is more precise than diathermy and may be less likely to cause a Horner's syndrome.

An audit of job application forms in response to adverts in the British Medical Journal.

OBJECTIVE: The aim of this study was to examine the speed of response of human resources departments to requests for job application forms for posts advertised in the British Medical Journal (BMJ). Of particular interest was the closing date for applications, postage cost, and the period to reply. DESIGN: Twenty posts were randomly selected and application forms requested by telephone and then 20 by letter on two separate dates from the BMJ Classified (issues of 21 July 2001 and 28 July 2001). During the first week the forms were requested by telephone on receipt of the BMJ (Friday afternoon). During the second week the forms were requested by first class post. All letters were sent out on Saturday morning. OUTCOME MEASURES: The date of receipt of the application form/information pack, the cost of postage, and the closing date for application were recorded for each position. RESULTS: Fifteen forms were received after the telephone application and 18 forms after the letter applications. One trust sent two replies spaced one week apart for the same job and two replies contained job application forms for the wrong job. The response rates to telephone requests varied from four to 10 days and by letter from three to 12 days. The minimum time between the reply being received and the closing date was one day, and the maximum 21 days. The time between the closing date for applications and the start date of the job varied from minus one week (closing date before advertisement) to three months. Thirteen replies gave no indication of the start date of the job. The cost of postage varied from 27p to pound 1.90. Thirty one trusts used first class postage. CONCLUSION: There is very limited scope to return job application forms on time, and significant delays in sending out application forms and information packs compound this problem. It is recommended that trust human resources departments place advertisements early and respond promptly to requests for application forms.

Case report: An unusual arrival of a hydrocoele.

Acute hydrocoele is a previously unreported complication of herniography that may be explained on the basis of inguinal-scrotal embryology.