A case of torsion of a wandering spleen in an 8 year old girl is reported. The authors discuss the aetiology and management of this rare condition and review the literature. Wandering spleen is relatively more common in children than in adults. Under the age of 10 the sex distribution is even; over 10, females outnumber males by seven to one. In 66 children under 10 years, 50% of wandering spleens were lost through acute ischaemia. The authors recommend that early splenopexy replace conservative management.

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Oesophageal perforation at fibreoptic gastroscopy Perforation is the most serious complication of fibreoptic endoscopy.1 The commonest site of perforation during upper gastrointestinal endoscopy is the oesophagus,' but predisposing factors have not been fully documented. We report a retrospective survey of major endoscopy units in the United Kingdom and attempt to identify the factors associated with oesophageal perforation.

The aim of this study was to test the performance and labelling of garments that are in contemporary use for radiation protection. A significant proportion of garments failed to comply with international labelling standards and did not provide the protection claimed by manufacturers. In addition, garments labelled at the same lead equivalence performed vastly differently in attenuation of scatter. These findings were demonstrated in the real world setting, by testing garments that are in current use across multiple centres. The study highlights current concerns regarding radiation protection standards and the need to identify composites that can consistently provide better protection than lead. Objective: The aim was to determine whether lead containing and lead free composite garments in current use provide the level of radiation protection stated by manufacturers. Methods: Fifteen garments, produced by five different manufacturers using eight different composites, were randomly selected for testing from four hospitals in South Australia. Labelling, material composition, design, and condition of the garments were assessed by direct garment examination, garment label, and product information. Garment attenuation was tested in a simulated angiography suite using a Siemens Ysio Max digital Xray machine. The front and back panels of each garment were tested under direct beam at 100 kVp. A Perspex phantom was used to simulate the density and scatter properties of the human abdomen. The front panels of each garment were tested under scattered radiation at Xray tube voltages of 50 and 70 kVp. Results: Forty-seven per cent of front panels and 90% of back panels provided lower lead equivalence than claimed by the manufacturer. Twenty per cent of front panels and 62% of back panels tested did not meet the minimum International Electrotechnical Commission requirements for angiographic use. There was a 38 fold difference in front panel performance of garments to scatter radiation, which were all labelled 0.5 mm lead equivalence. 56% of garments had differences in scatter transmission of at least 49% when tested at 50 and 70 kVp. Conclusion: The results show that lead containing and lead free composite garments probably provide less radiation protection than manufacturer stated lead equivalence. The demonstrated wide variations in attenuation of scatter radiation are greater than previously reported. It was found that most garments failed to comply with labelling standards. The study highlights challenges in radiation shielding and the need to identify composites that consistently provide better attenuation per unit weight than lead.