Endoscopic diverticulotomy (Dohiman's procedure) is a well-established and effective alternative to external diverticulectomy in the treatment of pharyngeal pouch. The division of the common septum between the pouch and the oesophagus is usually performed either with electrocautery or with a laser. We describe a new technique of endoscopic diverticulotomy using a linear cutter stapling gun. This technique has the advantages of being quick and bloodless, avoiding the need for a nasogastric tube, permitting oral intake as early as the first postoperative day and allowing early discharge from hospital. It also has the theoretical advantage over the electrocautery or the laser technique of reducing the risk of fistula formation, mediastinitis apd thermal injury to the recurrent laryngeal nerve.pouch, thereby achieving a cricopharyngeal myotomy. We describe a new technique using a linear cutter stapling gun introduced endoscopically to divide and simultaneously seal the cut edges of the common septum. We have operated on ten patients successfully using this technique and have found the procedure to be very effective, fast and safe. All the patients were allowed oral intake within 24 h postoperatively and most were discharged within 2 days postoperatively. There were no complications and all the patients described improvement in or complete relief of their symptoms at follow-up. Longer-term outcomes of the procedure are currently being evaluated prospectively. (Fig. 1) is introduced into the hypophar-

Lemierre syndrome, also known as postanginal sepsis, is an illness characterized by the development of a fusobacterial septicaemia with multiple metastatic foci following an attack of acute tonsillitis. It typically affects previously healthy adolescents and young adults who, following an attack of sore throat, become acutely ill with hyperpyrexia, rigors and multiple metastatic abscesses. The clinical picture tends to vary widely because of the possible involvement of a number of body systems and organs in the disease process. This serious complication of oropharyngeal sepsis had a mortality rate in excess of 90 percent in the pre-antibiotic era. Although now rarely seen and often forgotten, it remains a potentially life-threatening condition. We present four cases of post-tonsillitis fusobacterial septicaemia to illustrate the variability of the clinical presentation and stormy clinical course frequently associated with this rare syndrome.

Endoscopic stapling diverticulotomy is an increasingly popular treatment option for pharyngeal pouch. It has been our treatment of choice for the condition for over three years. Of the over 50 cases treated using the technique, three were performed for recurrent pouches – two following previous endoscopic stapling diverticulotomy and one following previous external excision. We describe these three cases to highlight the advantages and effectiveness of the technique in recurrence cases.

Circumferential PV isolation is effective in most patients with persistent or permanent AF. However, repeat procedures are frequently required. Late recurrences are common and not precluded by the absence of early post-procedural arrhythmias.