Angioplasty and stenting in these high-risk patients may not confer any advantage over conventional surgery in terms of both haemodynamic ischaemia and embolization.

The last 30 years has seen a shift in surgical treatment of breast diseases to less invasive, more conservative treatment options. The mammotome equipment was originally introduced as a diagnostic tool, but advances in technology have extended its role to therapeutic procedures. The mammotome device (8-gauge) is inserted through a cosmetically placed 4-mm scar and breast tissue is resected sequentially using a suction facility without the need to remove the biopsy device. This is done under ultrasound guidance. Operative morbidity and postoperative score for cosmesis and patient satisfaction were recorded prospectively. Patients were reviewed in the clinic after 6 to 8 weeks. Five patients (4 unilateral, 1 bilateral) with idiopathic gynecomastia were treated. Mean age was 41.8 years (range, 16-88 years) with a median procedural time of 32 minutes. No postoperative morbidity was noted and mean cosmetic score was 9/10. The mammotome is an emerging minimal invasive tool that is safe and ensures excellent cosmesis and very high patient satisfaction rates.

in a unit performing a large number of angiograms only a small number of patients require out of hours emergency angiography and interventional vascular procedures. Our impression is that this is the result of a flexible and responsive in hour's service. At the present time extra-hospital referrals do not appear to generate large amounts of out of hours work. This level of out of hours activity has implications in the provision of vascular radiological services in the future.

Background: Previous studies reported both improved (enhanced cerebral perfusion after carotid endarterectomy (CEA)) and diminished (intraoperative ischaemic injury) cognitive function (CF) following CEA. These studies were not adequately controlled for anxiety, general health and learning (repeated testing), and the influence of anaesthetic technique was not assessed. Methods: This study assessed CF (trained psychologist, seven computerized tests) before operation, and at 5 and 90 days after CEA performed under local anaesthesia (LA) (n = 34) or general anaesthesia (GA) (n = 13). Similar measurements in patients undergoing lower limb revascularization (n = 14) and unoperated subjects with asymptomatic carotid stenosis greater than 70 per cent (n = 16) tested twice, 3 months apart, controlled for the effects of anaesthesia, surgery and carotid arteriosclerosis. Additionally, jugular venous S100 levels (neuronal protein released following cerebral injury) were measured (before carotid clamping, and 1, 4 and 24 h after clamp release) in 18 of these patients (nine LA, nine GA). Results: Compared with controls, test performance in patients who had CEA under GA improved in one (executive CF 90 days; P = 0·028), but deteriorated in another (working memory 90 days; P = 0·038) while patients who had LA improved in three of seven tests (executive function, working memory) at 5 days (P = 0·03, 0·048, 0·036) and 90 days (P = 0·01, 0·05, 0·006). Further, a greater than 25 per cent improvement in one or more tests was more likely 90 days after CEA under LA (22 of 34 versus four of 13; P < 0·04) with improved executive function, speed and accuracy. S100 levels were lower after CEA under LA (1 h: 0 (0–30) versus 29 (8–98) µg ml−1, P < 0·05; 4 h: 0 (0–6) versus 22 (2–95) µg ml−1, P < 0·05; 24 h: 0 (0–1) versus 35 (14–77) µg ml−1, P < 0·01). Conclusion: This study demonstrated improved CF following CEA under LA which was associated with lower jugular venous S100 levels (marker of cerebral injury). These differences may reflect improved cerebral oxygenation (preservation of cerebral autoregulation). © 2000 British Journal of Surgery Society Ltd

No abstract