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Eighteen patients with symptomatic non-parasitic cysts of the liver were seen and treated at the Lahey Clinic Foundation between 1950 and1970.

During the performance of 2101 thyroid operations, 3496 recurrent laryngeal nerves were identified and exposed. Of the 1776 visualized nerves on the right side, 6 were found to be non‐recurrent. A brief survey of the literature relevant to this anatomical abnormality is included, and its importance in the performance of thyroid surgery is emphasized.

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SUMMARYThe 77 cases of malignant neoplasm of the extrahepatic bile-ducts treated at the Lahey Clinic between 1965 and 1969 are reviewed. Exploratory laparotomy was performed in 68 cases, although in 9 cases operation was not indicated because of the patients' poor condition. Of the 68 surgical patients, 24 (35 per cent) had a radical procedure, of which 17 survived for more than I year and 5 are still alive more than 3 years later, 3 having no evidence of recurrent disease. Forty-one patients had palliative treatment usually with some form of decompression procedure of the obstructed common bile-duct, and in 15 patients this was combined with hepatic artery infusion chemotherapy. Of these patients, 16 survived for more than I year, including 9 from the group treated by hepatic artery infusion chemotherapy. Only I patient is still alive after more than 3 years.Of all the patients, 44 per cent survived for more than I year, 23 per cent for more than 2 years, and 8 per cent for more than 3 years. The mean survival time was 13 months. These results compare favourably with those of the previous survey from the Lahey Clinic, and it is concluded that the improvement is the result of the increase in the radical resection rate from 18 to 31 per cent and in the institution of hepatic artery infusion chemotherapy in palliative cases.MALIGNANT tumours of the bile-ducts have been associated with a very poor prognosis despite the fact that the majority of these tumours tend to be slow growing without widespread metastases. This is mainly because of the difficulty of early diagnosis * Present address : Westminster Hospital, London. t Present address : Liverpool Royal Infirmary, Liverpool. 36and the proximity of these tumours to vital structures. Braasch, Warren, and Kune (1967) reviewed the total experience of the Lahey Clinic in treating neoplasms of the bile-ducts from 1920 to 1965 and reported 173 cases. Only 25 patients (14 per cent) were known to have survived I year or more and only 7 for more than 3 years.During the past 5 years an attempt has been made whenever possible to be more radical in the surgical management of this condition as suggested by Quattlebaum and Quattlebaum (1965). Hepatic artery infusion chemotherapy was first performed for non-resectable lesions in 1965. We have therefore reviewed the records of patients treated from 1965 to 1969 to determine whether this more radical surgical approach together with infusion chemotherapy for the non-resectable lesions has resulted in a better prognosis. RESULTSBetween 1965 and 1969 77 patients (44 men and 33 women) with primary malignant neoplasms of the bile-ducts were treated at the Lahey Clinic Foundation. T h e youngest patient was 31 years, the oldest 79 years, and the average age was 57 years. The peak incidence was in the sixth decade (Fig. I).The site of origin of the neoplasms is shown in Fig. 2. The commonest site was found to be the common hepatic duct (28 cases), followed by the retroduodenal portion of the bile-duct (18 cases) and the supraduodenal port...