No prophylactic antibiotics were given. A total of 13 wounds developed infection: seven sutured and six unsutured wounds (not statistically significant), giving an overall infection rate of 7 7%. Significantly (P < 0-01), more wound infections occurred in the hand in both groups compared to the rest of the body, indicating that particular attention should be paid to management of such wounds.It was concluded that dog-bite wounds should receive thorough surgical treatment and can be safely sutured at presentation. Special care should be given to hand wounds.

After amputation digital prostheses are infrequently used. With modern methods of fabrication both cosmetic and functional use are now possible. We have assessed the use of single digit prostheses in a district general hospital setting.

In a randomised double-blind trial comparing 1% lignocaine with 0.5% bupivacaine in digital ring block, the mean time of onset of complete anaesthesia was 5.8 minutes (range 5 to 10 minutes) for lignocaine and 11.2 minutes (range 8 to 20 minutes) for bupivacaine. The duration of action was 59.6 minutes (S.D. +/- 28.7 minutes) for lignocaine and 476 minutes (S.D. +/- 277 minutes) for bupivacaine. We describe how these differences can be exploited in clinical practice.

Flexible endoscopy was used to assess the intragastric residue after either ipecacuanha-induced emesis or gastric lavage in 30 self-poisoned patients. Of the 13 patients treated by induced-emesis, five (38.5%) had residual solid in the stomach; 17 patients were treated by gastric washout, and 15 (88.2%) of these had residual intragastric solid. The study provides direct evidence that the gastric decontaminating procedures employed, and especially gastric lavage, do not remove stomach contents completely.

SummaryA prospective, randomized, single-blind study was carried out to determine whether gastric content is forced into the small bowel when gastric-emptying procedures are employed in self-poisoned patients. They were asked to swallow barium-impregnated polythene pellets, immediately prior to either gastric lavage or ipecacuanha-induced emesis. A second group of patients, who did not require treatment, were used as controls. Sixty patients were recruited to the study. The data show a significant difference in the number of residual pellets in the small bowel of the treated group (n=40), when compared with the control group (P< 0.0001). There was no statistical difference in the number of pellets in the small bowel when the treated groups were compared with each other. In addition, the inefficiency of gastric-emptying procedures is highlighted; 58.5% of the total number of pellets ingested were retained in the gastrointestinal tract of the ipecacuanha-treated group, while 51.8% oftotal pellets ingested were retained in the gastric lavage-treated group. IntroductionThe value and effectiveness of gastric decontaminating procedures have been doubted by several authorities over the years':". There is controversy in the medical literature concerning the efficiency of gastric emptying procedures, and which, if any, is more usefulv".Significant residual quantities of the markers sucralfate and cyanocobalamin have been demonstrated in ipecacuanha-treated patientst-", Large residues of food and tablets have been demonstrated endoscopically after both techniques of emptying", Curtis et al. l o have demonstrated superiority using activated charcoal when compared with gastric lavage and ipecacuanha-induced emesis.It is theoretically possible that the use of gastricemptying procedures may force gastric content into the small intestine. Therefore, we decided to study the fate of radio-opaque polythene pellets in self-poisoned patients, in order to assess the effect of gastricemptying procedures on gastric content.