An Aberdeen knot tied with three throws and two turns is the ultimate Aberdeen knot.

It is felt that there may be a future for this treatment, either as primary treatment or as an adjunct to surgery in refractive cases. It could also be useful in preventing the growth of hairs into wounds that have been left open and allowed to granulate.

The clinical and pathologic features of 35 patients who had ipsilateral supraclavicular node (SCF) recurrence after radical mastectomy were reviewed. These were compared with the features of 70 patients who had a local skin recurrence after radical mastectomy, 48 of whom had a single nodule and 22 of whom had multiple skin nodules. There were no significant differences between age at diagnosis, disease-free interval, menstrual status, tumor type and grade, and extent and location of axillary node metastases in the three groups. Survival of the SCF group was intermediate between those of the single-nodule and multiple-nodule groups. SCF recurrence is an almost invariable signal of micrometastatic disease; thus, such patients are ideal candidates for trials of adjuvant therapy.

Risk-adjusted analysis of surgeon performance: a 1-year studySir With reference to the letter from Mr Copeland (Br J Surg 1996; 83: 136) in which he says that 'surgeon A is performing well within his confidence limits and therefore his death rate does not differ from that expected', I feel I should point out that the calculated ratio will always lie within the corresponding confidence interval. The important point to consider is whether the value of 1, which corresponds to no difference between observed and expected deaths, lies within the interval.