AbstarctA new surgical technuque for the tratementof mederate to large hypopharyngeal diverticula is described, The procedure particularly useful in debilitated patients that it is quick and guarnties closure of the party wall between the pouch and upper oesophagus.

The Ultracision harmonic scalpel (UHS) cuts and coagulates tissue with high-f requency ultrasound. We describe the results of our use of the UHS to perform tonsill ectomies in 59 pati ents. The mean opera tive blood loss was 7 ml (range : 0 to 75); 56% of patients expe rienced no measurable blood loss. The mean length of ope rating time was 8 minutes and 10 seconds (range: 3:45 to 20:25). Patients were assessedfor 2 weeksfor postoperati ve pain on the basis ofa IO-point linear analog scale. The mean pain score on postoperative day 1 was 4. 7; the score peaked at 6.0 on day 4 and fe ll to less than 3.0 by day 11. Patients returned to full fu nction in an average of 10.9 days (range : 3 to 15). Three patients expe rienced secondary hemorrha ge, one ofwhom required surgical intervention. Wefound the UHS to be a well-designed and easyto-use instrum ent. Operating time was short, blood loss was minimal, and the degree ofearly postoperative pain was low. We believe that our f indings are encouraging and that the UHS might well have a place in the surgical armamentarium for tonsillectomy.

The treatment of pharyngeal pouches by endoscopic stapling diverticulotomy has gained popularity over the last few years. We assessed the results of this technique in 44 patients by means of a clinical questionnaire and by reviewing case records. Thirty-six (82 per cent) patients commenced oral intake within 18 hours of the procedure and 37 (84 per cent) patients were discharged within 48 hours. Five patients had complications that included throat discomfort, a loose incisor tooth, shoulder pain, pharyngeal perforation and one mortality due to mediastinitis. Of the 37 patients that completed the questionnaire, nine (24 per cent) had some residual symptoms although only two (five per cent) felt that there had been no improvement at all following the stapling procedure. Thirty-five (95 per cent) of the patients stated that they would undergo the procedure again. It appears that pharyngeal pouches can be successfully treated by endoscopic stapling, with patients commencing oral intake within a few hours of surgery and having a short hospital stay. However, as there can be serious complications, we recommend that the procedure be performed by an experienced surgeon.

SUMMARYCS gas (2-chlorobenzylidene malonitrile) is widely used in an incapacitant spray that causes intense lacrimation, blepharospasm and burning sensations in the throat and nose. Questions have been raised about its safety. We obtained information on short-term and long-term symptoms, and performed ear, nose and throat examinations and respirometry at 8-10 months, in 34 young adults who had been exposed to CS spray in a confined space during a confrontation with police. The group was subdivided into those who had been sprayed directly on the face (n=10) and those exposed indirectly.At one hour, all but 2 individuals still had symptoms; respiratory and oral symptoms were significantly more prevalent in the directly exposed group. At one month, only oral symptoms were significantly more prevalent.At 8-10 months, symptoms were still reported but there were no differences between the groups and clinical examinations revealed no specific abnormalities.There was no convincing evidence of long-term physical sequelae from exposure to CS spray.

Invasive peri- and post-operative monitoring is being increasingly utilized, and a corresponding increase of concomitant complications are becoming apparent.Two cases of complete right vocal fold paralysis are reported as a possible complication of right central venous catheterization. The underlying aetiology of this complication is presumed to be either direct trauma at the time of introduction of the central venous catheter, or by thrombosis and fibrosis around the recurrent laryngeal or vagus nerve. It is suggested that multiple attempts at cannulation and leaving the central line in situ for long periods increases the risk of this complication.When the integrity of the left recurrent laryngeal nerve or vagus is jeopardized or must be sacrificed during surgery, it is suggested that ipsilateral central lines are inserted to minimize the risk of bilateral vocal fold paralysis.Cases of vocal fold paralysis secondary to central line insertion should be followed expectantly and surgical intervention only be considered after 12 months review.