A case of myxoma of the mitral valve is reported. The clinical features were indistinguishable from left atrial myxoma with prolapse through the mitral valve. Because of the known tendency for these tumours to recur it was treated by wide excision which necessitated replacement of the mitral valve.

Our experience with the management of 28 patients with oesophageal perforation is reviewed. The majority of perforations ,followed oesophageal instrumentation. The occurrence of pain, ,fever or cervical crepitus following endoscopy should raise the suspicion of oesophageal perforation. Plain radiographs of the neck, chest and abdomen provided confirmatory evidence o f the presence o f a pecforation in 89 per cent of our cases.Contrast studies of the oesophagus demonstrated the site and extent ofthe leak in 21 of the 26 cases in which they were performed. The overall mortality for the series was 32 per cent. The mortality for thoracoabdominal perforations was nearly three times that for the cervical segment. Instrumental perforations were associated with a lower mortality than spontaneous perforations or those following paraoesophageal surgical procedures. The coexistence of an oesophageal obstruction with a perforation did not have an adverse effect on the outcome. The time lapse between the occurrence of the perforation and surgical intervention had a profound influence on the morbidity and mortality. Early closure of the perforation with drainage was associated with a 25 per cent mortality .for thoracoabdominal perforations and no complications in the survivors. A delay of over 24 h, on the other hand, was associated with a high incidence of septic complications in both cervical and thoracoabdominal perforations, a longer period of druinage and a 50 per cent mortality in the latter group. A plea is therefore made for early surgical intervention in both cervical and thoracoabdominal perforations.

It should have been suspected from the situation of the entry wound, the nature of the weapon used, the size of the haemothorax, and the clinical findings in the others. All 11 deaths occurred in that group in which early operation was indicated, and some could have been averted had the need for operation been suspected early. Seven patients developed an empyema; five were in the group that required immediate surgery and in the other two infection occurred in a clotted haemothorax. Early repair of the associated visceral injuries and complete evacuation of a haemothorax, either fluid or clotted, could reduce the incidence of empyema.

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