There is controversy concerning the merits and safety of elastic versus inelastic compression in the treatment of venous leg ulceration. Thirty legs were randomized to elastic, minimal stretch and non-elastic (Circaid®) bandages. Pressure profiles (repeated thrice) were measured with the Borgnis MST device on bandage application and at 4 h, in both the standing and lying positions. All bandages produced significant graduated compression in the leg ( P < 0.001), in the standing position, with no significant difference in gradient between the bandages ( P = 0.5). However, 4 h after application the bandages collectively exerted less pressure than on application, though gradients were maintained. Elastic bandages, at 4 h, recorded a mean 94% of the initial level compared to 70% for minimal stretch and 63% for non-elastic ( P < 0.001) in the standing position. In the lying position the decrease at 4 h was 72% for elastic, 59% for minimal stretch and 44% for non-elastic compression ( P < 0.001). Elastic bandages provided the most sustained compression, but with the smallest margin of safety (least reduction of pressure on lying).

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Summary: A recent report by the National Audit Office found that only 50% to 60% of weekday operating time was being used. This report was examined by the Committee of Public Accounts and much of the blame for underutilization of operating theatres was attributed to poor working practices among surgeons. We investigated theatre utilization in our hospital and found underutilization on the same scale as the National Audit Office. Twenty-five per cent of theatre sessions were not allocated for use, 23% of general surgical lists were cancelled and, of the lists which did take place, a further 23% of theatre time was not utilized. The single largest cause of underutilization was understaffing. To increase theatre utilization higher levels of staffing and expenditure are needed rather than changes in the working practices of surgeons.

Fifty patients were identified who, following abdominal aortic operation, developed late complications affecting the vascular graft or endarterectomy and who underwent their first reoperation between 1979 and 1989. Thrombosis was the commonest complication affecting 28 (56 per cent) patients, followed by false aneurysm in 11 (22 per cent), enteric fistula in nine (18 per cent) and graft infection in two (4 per cent). The 30-day mortality rate for reoperation was 8 per cent; longer follow-up revealed mortality rates of 22, 50 and 63 per cent at 1, 3 and 5 years respectively. Thirty-four complications required reoperation within 5 years of the original surgery. Reoperation was needed for 35 patients whose original pathology was occlusive disease and for 15 whose original pathology was aneurysm. The nature of the complication was related to initial pathology; thrombosis was far commoner in those with occlusive disease, and enteric fistula and false aneurysm were commoner in those with aneurysmal disease.