The workload of aortic surgery in a district increased fourfold over 10 years as the incidence of aneurysm rupture rose from 7 to 17/100,000. Of 260 patients with ruptured aneurysms 101 reached hospital alive (38 per cent) of which 52 (52 per cent) survived, an overall survival rate of 19.8 per cent. Despite increasing experience, mortality after emergency surgery did not improve, suggesting outcome was largely determined by the patient's condition and age. Only 5 of 90 patients aged over 75 survived aortic rupture at home. In consequence overall community mortality did not improve in the period studied. Survival after elective surgery was 95 per cent, suggesting that efforts to improve survival should be directed towards identifying and treating the disease before rupture occurs. The commonly stated figure of 50 per cent survival for ruptured aortic aneurysms is an overestimate, due to neglect of patients dying at home.

No abstract

Radionuclide techniques for determining relative renal function are well established. One simple method uses the count rate from static images obtained using 99Tcm-dimercaptosuccinic acid (DMSA). We have reviewed 277 DMSA scans and shown that it is important to obtain the geometric mean of counts from the anterior and posterior views in order to correct for the different amounts of attenuation for each kidney. If counts were obtained from the posterior view only, erroneous results would be obtained in 8% of children under 13 years, in 28% of patients aged between 13 and 20 years and in 32% of patients over 20 years of age.

No abstract

A series of 40 consecutive patients with proven stress urinary incontinence underwent Stamey endoscopic bladder neck suspension. There were 5 cases of detrusor instability and the results were poor in this group. Excluding these patients, 77% were cured and 12% reported significant improvement. There were 4 unpredictable failures; all but 1 occurred within 3 months of surgery and the fourth before 6 months. There were no late failures up to the mean follow-up period of 21 months (range 9-33 months; 35 cases greater than 12 months); 3 of the failures had the same procedure repeated but it was again unsuccessful. The Stamey procedure is quick, entails minimum high dependency nursing and has a short hospital stay (mean 7 days). As assessed in the medium term, it represents a useful addition to the surgical procedures available for the relief of stress urinary incontinence.