In the treatment of lumbar spinal stenosis, epidural injection of glucocorticoids plus lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine alone. (Funded by the Agency for Healthcare Research and Quality; ClinicalTrials.gov number, NCT01238536.).

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Correspondence longest followed up series of ulcer patients reported in the literature is that of the Edinburgh Western General Hospital described by Small'. Long-term complicated recurrences were not encountered in these 779 patients treated by either gastrectomy or vagotomy and drainage between 1947 and 1965.I would agree with Professor Johnston that highly selective vagotomy, or a closely related procedure, is the best option for elective ulcer surgical treatment, but preservation of the hepatic branches of the anterior vagus and the coeliac branches of the posterior trunk will probably allow pyloroplasty to be performed without dumping or diarrhoea and perhaps we should not condemn it too hastily on purist grounds. Perhaps, the process of evolution in peptic ulcer surgery has not stopped with pylorus preserving highly selective vagotomy. We seem to have reached another crossroads in ulcer surgery. T. V. TaylorManchester Royal Infirmary Manchester M I 3 9WL UK 1. McLean Ross AH, Smith MA, Anderson JR, Small WP. Late mortality after surgery for peptic ulcer. New Engl J Med 1982; 307: 5 19-22.