5 Scott DJA, Vowden P, Beard JD, Horrocks M. Non-invasive estimation of peripheral resistance using pulse generated runoff heforefemorodistal bypass. BrJSurg 1990; 77: 391-5. 6 Beard JD, Scott DJA, Evans JM, Skidmore R, Horrocks M. Pulse-generated run-off: a new method of determining calf vessel patency. Br J Surg 1988; 75: 36 1-3. 7 Roedersheimer LR, Feins R, Green RM. Doppler evaluation of thepedalarch.AmJSurg 1981;142:601-4. 8 Altman DG. Pmctical Statistics for Medical Research. London: Chapmanand Hall, 1991. 9 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancer 1986; i: 307-10. 10 Campbell WB, Fletcher EL, Hands U. Assessment of the distal lower limb arteries: a comparison of arteriography and Doppler ultrasound. Ann R Coll Surg Engl1986; 68: 37-9. 11 O'Brien TS, Thomas H, Crow A, Lamont PM. Calf vessel preservation in peripheral vascular diseaseangiography versus pulse generated run-off. EurJ Vasc Surg 1993; 7: 177-9. 12 Simms MH, Hardman J, Slaney G. The relevance of pre-bypass pedal arch assessment. BrJSurg 1984; 71: 381 (Abstract).13 Shearman CP, Gwynn BR, C u m F, Gannon MX, Simms MH.Non-invasive femoropopliteal assessment: Is that angiogram really necessary? BMJ 1986; 293: 1086-9.

Medical therapy of Ménétrier’s disease is often unsatisfactory and may lead to surgical treatment. Two cases, previously unreponsive to H₂ antagonists, are presented showing a marked response to omeprazole.

A 53 year old woman developed a cutan-ẽ ous tumour implant in the needle track after transcutaneous fine needle biopsy of a pulmonary adenocarcinoma. The tumour implant was completely excised.The value of fine needle biopsy in the diagnosis of discrete lung shadows seen on chest radiographs is firmly established."2 The procedure is not, however, entirely without immediate or long term risk. Case reportA nervous 53 year old housewife presented withjoint pains, a dry cough, and a chest radiograph showing a left upper zone mass. Computed tomography showed the mass to be irregular, 3 cm in diameter, and in the periphery of the left upper lobe. There was no evidence of enlarged mediastinal nodes or invasion of local structures. Despite the typical appearances of a primary carcinoma of the lung, the patient would not consider thoracotomy without histological proof of malignancy and consequently a fine needle biopsy was performed by an experienced radiologist, using a 20 gauge screw biopsy needle and an anterior approach. The procedure was difficult as the patient's cooperation was poor and both histological and cytological appearances were inconclusive. The patient eventually agreed to thoracotomy two months later and the left upper lobe was removed. Subsequent histological examination showed a completely excised, poorly differentiated adenocarcinoma.Two months after leaving hospital the patient was referred back with a painful and rapidly enlarging lump on her anterior chest wall (figure). This had appeared at the exact site of puncture for the fine needle biopsy and seemed to be attached to the scar from the biopsy. A wide surgical excision of this lesion was performed. Histological examination of the resected specimen showed invasion of subcutaneous fat by a metastatic, poorly differentiated adenocarcinoma identical in appearance to that removed from the lung two months previously. Excision was complete.The patient remained symptom free until her death, one year later, from a myocardial infarct. Necropsy showed no evidence of recurrence of the tumour.

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