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We describe the use of proximal stacked wires for the removal of an intramedullary nail in the context of difficult extraction and failed attempts by conventional methods. This percutaneous technique is particularly useful for the extraction of narrow cannulated or solid intramedullary nails after failure of removal by extraction bolt devices.

I will be in my surgery on Christmas Day if ministers and researchers are at work tooEditor-A more plausible interpretation of the data presented by Rouse is that his researcher did not allow the telephone to ring for sufficient time to allow a member of the practice staff to answer it. 1 The table shows that the researcher made around 270 telephone calls to the 91 practices in the three days before Christmas. This equates to an average of one call every 4 minutes. In reality, the researcher must have allowed the telephone to ring for much less time than this.With regard to his exhortation to the health secretary to make me and my colleagues keep our doors open over Christmas, I would like to make Rouse an offer: I am willing to spend Christmas Day sitting at my desk in surgery if he will sit at his desk in his academic office and Frank Dobson at his desk in Westminster. Otherwise, unless I happen to be on call, I shall be spending Christmas Day with my family enjoying a break from the burgeoning public expectations being fuelled by politicians and epidemiologists in promoting a 24 hour a day "convenience store" mentality towards general practice.

-By implementing collaborative care for patients with alcohol misuse and alcoholrelated liver disease, the Royal Bolton Hospital aimed to improve and coordinate their care by recruiting a multidisciplinary team and placing the patient at the centre of all efforts. There has been a marked improvement in the accuracy of the drinking histories taken, detoxification, dietary documentation, and patient and staff attitudes and confidence, with enhanced satisfaction in patients, their families and staff and improved accessibility and communication. We observed a considerable increase in the number of inpatient and outpatient referrals and believe that it is more effective to work together in a joint gastroenterology/psychiatry team. There is a critical national need to establish steering groups of key clinical, managerial and commissioning personnel to address the growing problem of alcohol misuse. The appointment of dedicated alcohol health workers is central to this strategy. KEY WORDS: alcohol, collaborative care, liver disease BackgroundAlcohol misuse, particularly binge drinking in young people, and alcoholic liver disease (ALD) are major public health concerns. 1 Since the 1970s, alcohol consumption has increased by 50%, due to a number of factors, including falling prices, the aggressive marketing of drinks towards young people, growing affluence and more widespread availability. Already, alcohol-related diseases are costing the NHS about £1.7 billion every year. Around 17 million working days are lost annually because of alcohol misuse, costing our economy £6.4 billion. Seventy per cent of all weekend night time admissions to accident and emergency (A&E) departments are linked to alcohol. More than half of all violent crime is related to drink. 2 Britain is one of the worst countries in Europe for binge drinking -a third of all teenagers aged just 15 say they have been drunk at least once, compared to only one in ten in France and Italy. 3 Cirrhosis of the liver has risen tenfold since the 1970s, and is now an increasingly frequent cause of death. 1 Not only is cirrhosis getting more common, it is presenting at a younger age, and patients in their twenties and thirties with end-stage ALD are now being seen by liver specialists around the UK. The Chief Medical Officer highlighted the problem in Bolton, particularly with regards to bed occupancy, in his 2001 Annual Report. 1 Previous service offeredThe Royal Bolton Hospital appointed its first consultant gastroenterologist in 1990. Before this appointment, the care of patients with alcohol misuse was fragmented, due to a poorly developed liaison psychiatry service, only being equipped to manage presenting disease rather than concentrate on disease prevention or health promotion, and the lack of dedicated alcohol workers. Typically, patients were admitted under the care of a consultant, had a brief detoxification and were discharged, or selfdischarged, with no continuing care or follow up. There was also a large number of recurrent admissions with alcohol...