We present an approach to the shoulder which is easily performed, offers unrivalled exposure for the accurate placement of prostheses or reconstruction of complicated fractures and is easily closed. We have used this approach since 1977 and report our results in 128 patients.

We report the results oflow friction arthroplasty in 72 old tuberculous hips and 42 hips with old quiescent septic arthritis. Follow-up was for a minimum oftwo years. Recrudescence oftuberculosis was seen in only one patient, but deep infection occurred in four of the hips with previous septic arthritis. The reasons for this are discussed. It is recommended that patients with old tuberculous hips should have a course of anti-tuberculous drugs before operation, that patients with previous septic infection should have prophylactic antibiotics and antibiotic-loaded cement and that the operation should be performed by an experienced surgeon.

The aetiology of Perthes' disease of the hip, avascular necrosis of the head of the femur, is unknown. Children with the disease have a generalised abnormality of growth. A similar disproportionate growth is found in chicks given a diet deficient in manganese. In Liverpool, which has the highest incidence of Perthes' disease reported anywhere in the world, children with the disease were shown to have lower blood manganese levels than controls. This is evidence that manganese deficiency around the time of birth may be a cause of Perthes' disease, but the results require confirmation.

The aetiology of acute epididymitis presenting to a surgical unit in a District General Hospital is presented. Patients over 45 years old frequently have a coliform urinary tract infection which may be associated with bladder neck obstruction. These patients require treatment with a suitable antibiotic (Co-trimoxazole) and further investigation. This condition occurs more commonly in patients under 45 years old in whom it is not associated with urinary tract infection. We have not demonstrated significant chlamydial infection and in a double blind study the antibiotic Co-trimoxazole did not hasten recovery. In this group the aetiology remains obscure.