: The Endotine device is effective, safe, and easy to use, and has high patient satisfaction. Problems included numbness, tenderness, and palpability. A preference for other fixation methods was indicated by some because of cost, length of surgery, and the amount of lift achieved.

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In response to legislation concerning the use of ionizing radiation, and to a case in which a patient developed multiple skin malignancies as a result of over-exposure to ionizing radiation, we set up an investigation to attempt to quantify the radiation dosage to which theatre personnel are exposed during X-ray fluoroscopy (screening) in hand surgery. It was found that the risk was small if sensible precautions were taken, but increased significantly if they were ignored. From these results specific measures are outlined which, when implemented, reduce the dose of scattered radiation to which theatre personnel and patients are subjected during screening in hand surgery.

In a study of 544 patients with symptomatic gallstones 158 subjects were aged greater than 70 years. Elderly patients had a significantly higher incidence of emergency presentation, jaundice, cholangitis, ductal stones, biliary drainage procedures, and acute complications requiring urgent or emergency surgery (P less than 0.001); they had more than twice the incidence of postoperative complications in comparison with patients aged less than 70 years. There was an increased perioperative mortality in the elderly (1.3 per cent after cholecystectomy and 2.9 per cent after bile duct exploration, P = 0.039). Conservative treatment in 11 per cent of elderly patients resulted in no mortality due to gallstones, but 3 of 17 patients had recurrent biliary symptoms. It was estimated that 38 per cent of the bile duct explorations in the elderly might have been avoided by referral for endoscopic sphincterotomy, but surgical treatment of gallstones in the district general hospital is relatively safe and specialist referral should be considered only in the relatively small number of 'high risk' cases.

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