As part of the Birmingham Community Aneurysm Screening Project, 3500 men aged 65-75 years from 20 urban general practices were invited for aortic ultrasonographic screening at their own general practitioner's surgery; 2669 (76.3 per cent) attended. Compliance rates varied between catchment areas, from 52.1 per cent for inner-city areas to 89.6 per cent for suburbs. Successful aortic imaging was achieved in 97.3 per cent of scans. Aortic diameter > 29 mm occurred in 219 patients (8.4 per cent) and 79 (3.0 per cent) with a diameter > 40 mm were referred for vascular surgical assessment; 140 patients with an aortic diameter of 29-40 mm are currently undergoing follow-up by serial ultrasonographic examinations at intervals of 3 months at their doctor's surgery. Risk factor analysis revealed ischaemic heart disease in 21.9 per cent of men with aneurysm, compared with 11.6 per cent in those without (P < 0.001); 18.3 per cent of men with aneurysm had had a previous myocardial infarction and 13.2 per cent had peripheral vascular disease, compared with 7.4 per cent (P < 0.001) and 8.0 per cent (P < 0.01) respectively of those without. No association was found between aneurysm and hypertension or diabetes. Community-based aortic screening is an inexpensive, effective method of diagnosis of aneurysm, with high compliance from the at-risk cohort of an urban population. Such screening programmes may help to reduce the mortality rate from aortic aneurysm rupture.

A review of the split-sternum approach to carcinomas in the superior mediastinal esophagus has been undertaken. During the 6-year period between July 1982 and September 1988, 14 patients had an esophagectomy performed using the split-sternum approach. Twelve of these patients had disease which had invaded adjacent structures at the time of presentation. Following a near-total esophagectomy, continuity was established by anastomosing the stomach to cricopharyngeus. There were 3 postoperative deaths: 1 each from mediastinitis, bronchopneumonia with multiple organ failure, and aspiration pneumonia. The mean survival of the group was 7 months. One patient is alive and well 18 months after surgery. One patient developed anastomotic recurrence. Ten of those discharged from hospital were able to eat a solid or semi-solid diet. Although carrying a significant mortality, this operative approach offers an effective means of palliation in patients with tumors at a site which is relatively inaccessible by surgery.

Rupture into the pericardium is a very rare complication of anterior mediastinal teratodermoid. There have been only four recorded cases, which either have been characterised by cardiac tamponade or have been an incidental finding at operation or necropsy. This report concerns a patient who presented with acute pericarditis and is considered to be unique. Case reportA 32-year-old woman was admitted to hospital with a threehour history of anterior chest pain. This was sudden in onset, radiated to the neck and arm, and was associated with nausea and vomiting. Before this episode, she had been entirely well.On admission no abnormality was found during the physical examination. The extension into the right side of the mediastinum. The skin incision was therefore extended across the midline and the sternum transected to allow removal. It was impossible to separate the cyst from the pericardium, so a large pericardial window was made and the cyst excised in toto.When the pericardium was opened both serous surfaces were noted to be grossly inflamed with patches of adherent fibrin. The pericardial sac contained hair with pultaceous material similar to that found in the cyst cavity. Although it was obvious that the cyst had ruptured into the pericardial cavity before operation, the point of communication was not found. The histological features were those of a benign mediastinal teratodermoid and the cyst contents were sterile on culture. The patient has remained in good health since the operation. DiscussionPerforation into an adjacent structure is an unusual but well recognised complication of anterior mediastinal teratodermoids. The bronchus is the most commonly affected site but rupture into the pleura, aorta, superior vena cava, and pericardium have also been described.' Marsten et al2 estimated that rupture into adjacent cardiovascular structures by benign teratodermoids occurred in less than 1% of cases. 863on 10 May 2018 by guest. Protected by copyright.