Summary We report our experience with the technique of lymphatic mapping using patent blue V dye in patients with limb malignant melanoma. The technique is based on the hypothesis that embolic metastases occur along lymphatic channels to a 'sentinel' lymph node: the draining lymph node nearest the site of the primary malignant melanoma. Patent blue V dye (0.5-1.0 ml) is injected intradermally around the site of the melanoma. Immediately the groin or axilla is opened and the blue lymphatic channels followed to the sentinel node. The node is removed and examined by both haematoxylin and eosin (H&E) and immunohistochemical staining. We have carried out this technique in 35 patients, all of whom had 'clinically assessed' stage I disease. In all 35 patients, sentinel nodes were identified, and nine were found to contain unsuspected micrometastases. Our initial evaluation of intraoperative lymphatic mapping is very promising. The technique is practicable and easy to master. If 25% of patients with cutaneous malignant melanoma who are clinically stage I have nodal disease, this has great importance not only for staging and treatment but also for all future therapeutic trials.

the wide inter-individual variability in AAA expansion rate is likely to reflect complex genetic and environmental interactions, but the lack of any relationship with ACE genotype suggests that differences in vascular ACE activity in aortic tissue are not major determinants of the variability in rate of AAA dilatation.

Nephrostomy has been the standard method of urinary diversion when placement of ureteral stents has failed in cancer patients. We describe our early experience with an alternative method of urinary diversion, the subcutaneous urinary diversion. This extra-anatomical urinary diversion was done in 5 patients during a 15-month interval. The diversion is created using a specially designed 7F double pigtail stent. The proximal end of the stent is inserted into the renal pelvis via a percutaneous nephrostomy puncture. A subcutaneous tunnel is created from the flank to the bladder down which the distal end of the stent is passed and via a suprapubic bladder puncture the stent is passed into the bladder. The stent is changed at 4-month intervals over a guide wire. Our early experience with this extra-anatomical method of urinary diversion suggests it to be a safe, effective and acceptable alternative to nephrostomy that improves quality of life.

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