A double blind controlled trial of surgery for varicose veins was conducted on the legs of patients with bilateral symmetrical varicose veins. The two treatments, saphenofemoral ligation and avulsion of varices, with and without stripping of the long saphenous vein from ankle to groin, were randomly allocated among the legs of individual patients. At follow-up, between 2.5 and 3.5 years, an objective (observer) assessment was that stripping conferred a significant advantage, but the incidence of paraesthesia and pain biased patient's opinion against stripping.

Self, peer and staff assessments were made for 138 of 141 students, in two fourth-year surgery classes. Self assessments were significantly lower than peer assessments, which in turn were significantly lower than staff assessments. The highest correlation was between peer and staff assessments. Students with serious psychological problems identified themselves with failing self assessments. The study stimulated interest in assessment procedures amongst staff and students and the latter responded with an assessment of teachers and courses throughout the faculty.

SYNOPSIS Intramural plexuses were studied in 30 colons, and a plethora of ganglionic tissue was observed in specimens with diverticula when compared with a control series. This alteration in the ganglionic pattern is considered real rather than apparent; the changes are confined to the region of the colon where muscular hypertrophy is present.The formation of diverticula in the colon suggests that the intraluminal pressure may be raised, and Painter (1963) has induced abnormal pressure patterns with morphia in colons bearing diverticula. The association of muscular hypertrophy with diverticula formation in the colon has been described by Edwards (1939) and Morson (1963), but the fact that muscular hypertrophy may precede the evidence that diverticula are being formed is not universally appreciated. When the abnormality of muscle is studied it may also be seen to involve the colonic wall distal to the area affected by diverticula. These facts stimulated the idea of studying the intramural ganglia in cases with diverticula. METHODColons resected at operation were distended with 10% formol saline immediately after removal, distension being obtained by gravity, the head of the solution being constant for all specimens. The specimens were subsequently fixed in formol saline before section. When fixed, circumferential sections were cut from three sites: distal to diverticula but where hypertrophy was still evident, where diverticula and muscular hypertrophy were combined, and proximal to the region where muscular hypertrophy was evident. Sections were also obtained from similarly prepared control colons at comparable sites; these specimens had been resected for neoplasia. It was felt that a roughly quantitative comparison of the mural ganglia could thus be obtained.The representative segments were blocked in the ordinary manner and sections, 10,u in thickness, were cut and mounted, then stained by the silver method described byHolmes(1947). The method was slightlymodified by the use of 10 ml. of 1 % silver nitrate (AR), 5 ml. of pure pyridine, and by impregnating the sections at 40°C. These modifications in the strength of reagents and temperature of impregnation have been found to improve the quality of staining.

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