Canal of Nuck abnormalities are a rare but important cause of morbidity in girls, most often those younger than 5 years of age. The canal of Nuck, which is the female equivalent of the male processus vaginalis, is a protrusion of parietal peritoneum that extends through the inguinal canal and terminates in the labia majora. The canal typically obliterates early in life, but in some cases the canal can partially or completely fail to close, potentially resulting in a hydrocele or hernia of pelvic contents. Recognition of this entity is especially important in cases of ovarian hernia due to the risk of incarceration and torsion. We aim to increase awareness of this condition by reviewing the embryology, anatomy and diagnosis of canal of Nuck disorders with imaging findings on US, CT and MRI using several cases from a single institution.

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• Patients often present with elevated liver function tests indicating cholestasis. • Patients may present with portal hypertension, and some progress to cirrhosis. • Though biopsy can be considered for focal liver lesions, most will regress. • Extent of intra-abdominal involvement may not correlate with severity of thoracic disease. • Liver disease may manifest alongside, prior to or significantly after initial diagnosis.

T here seems to have been a major error here. This has been put out as a model for timetables which says that it meets working time needs. This is totally wrong and it would be a disaster if people thought that this had College approval. The European Working Time Directive comes into effect by August 2004. This states very clearly that no-one may work more than 13 hours in a 24-hour period. The programme recommended by Louis Deliss totally ignores this. A morning off after 24 hours of work is completely inadequate as compensatory rest. It should be 11 hours and it counts as work time. The hours of duty that he recommends add up to the equivalent of 70 hours per week including prospective cover. It should be less than 56 hours. He is, therefore, recommending an already illegal rota. Response from the author Louis DelissChristchurch Park Hospital and Suffolk Nuffield Hospital, Suffolk, UK I am sorry my paper upset Mr Blair. I believe that it can be the basis for an SHO timetable that complies with the European Working Time Directive or at least much more closely than the majority I have seen as an HRC visitor. My object in writing the paper was to stimulate open discussion rather than let each hospital trying to work it all out alone. I accept full responsibility and the Editor never accepts that the views expressed in the Annals are 'official'. If my paper causes others such as yourself to make public better solutions I would count it a success. W e note in the authors' results that patients with evidence of duct stones who presented jaundiced had an average bilirubin of 97. We would agree that this figure is associated with common bile duct (CBD) stones based on our own study of bilirubin levels in patients presenting for endoscopic retrograde cholangiopancreatogram (ERCP). Our results showed an average total bilirubin of 109 in patients who were later found to have CBD stones at ERCP. We note that the authors are using a protocol to predict CBD stones 1 that uses a raised bilirubin as one of its criteria. We would add a caveat to this based on our study. A raised bilirubin > 150 is invariably due to malignant disease with a specificity of 86% even if gallstone disease is also present. Response to paper by SE Tranter & MH Thompson Letters and commentsContributors to this section are asked to make their comments brief and to the point. Letters should comply with the Notice printed on the inside back cover. Tables and figures should only be included if absolutely essential and no more than five references should be given. The Editor reserves the right to shorten letters and to subedit contributions to ensure clarity.

Agreement among five pediatric radiologists was moderate to substantial for SAR-AGA standardized impressions and fair to moderate for key imaging findings of pediatric and young adult CD.