Royal Berkshire Hospital Research Articles

Management of Renal Cell Carcinoma

Surgery is the only treatment modality that offers a cure for kidney cancer. Increasing use of imaging in all branches of medicine (particularly ultrasound) has detected a large number of smaller solid renal lesions. Their nature may be uncertain and a proportion are benign. These incidental findings present difficult management problems for uro-oncology MDTs – the options are: to watch and wait, to biopsy, to excise locally [partial or nephron sparing surgery] or to undertake total nephrectomy. There is no clear answer for the smaller renal mass. The role of biopsy before surgery remains contentious and more complex radiological techniques do not often lead to a clearer diagnosis. Emphasis must be on adequate treatment for suspected cancer rather than technique, but partial nephrectomy is a proper, safe technique which preserves nephrons and has a low rate of local recurrence. The arguments for and against are well laid out in the following articles. Derek Fawcett Consultant Urological Surgeon, Royal Berkshire Hospital, Reading, UK; E: dpfawcett@msn.com

MENTORING IN LAPAROSCOPIC UROLOGY

BJU InternationalVolume 99, Issue 1 p. 7-8 MENTORING IN LAPAROSCOPIC UROLOGY Mark E. Sullivan, Mark E. Sullivan Departments of Urology, Churchill Hospital, Oxford, andSearch for more papers by this authorAdam Jones, Corresponding Author Adam Jones Royal Berkshire Hospital, Reading, UKAdam Jones, Royal Berkshire Hospital, Urology, Reading, UK. e-mail: [email protected]Search for more papers by this author Mark E. Sullivan, Mark E. Sullivan Departments of Urology, Churchill Hospital, Oxford, andSearch for more papers by this authorAdam Jones, Corresponding Author Adam Jones Royal Berkshire Hospital, Reading, UKAdam Jones, Royal Berkshire Hospital, Urology, Reading, UK. e-mail: [email protected]Search for more papers by this author First published: 06 December 2006 https://doi.org/10.1111/j.1464-410X.2007.06605.xCitations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume99, Issue1January 2007Pages 7-8 RelatedInformation

Laryngeal Mask Anesthesia: Principles and Practice, 2nd Edition.

Laryngeal Mask Anesthesia: Principles and Practice, 2nd Edition.

The casualty profile from the Reading train crash, November 2004: proposals for improved major incident reporting and the application of trauma scoring systems

Objective: To report the casualty profile of the major incident at the Royal Berkshire Hospital, Reading, following the Ufton Nervet Train crash, November 2004. To make further proposals regarding major...

Subspecialisation and its Effect on the Management of Rectal Cancer

To assess the impact of subspecialisation on surgical and oncological outcomes after rectal cancer surgery in a single surgical unit within a district general hospital. A total of 207 patients with rectal cancer treated surgically by two colorectal surgeons and four experienced general surgeons at the Royal Berkshire Hospital, Reading, England between January 1995 and December 1999 were studied. A retrospective case-note review of each patient's personal details, operative and histological findings, their subsequent clinical progress and oncological outcomes, including 5-year survival were recorded. In the study group, 127 patients were treated by a colorectal surgeon and 80 by general surgeons. Pre-operative radiotherapy was more likely to be given to patients treated by a colorectal surgeon. Fewer permanent stomas were performed by colorectal surgeons. Postoperative morbidity, transfusion requirements, anastomotic leak rates and 30-day mortality were not significantly different. Tumour-involved circumferential resection margins, local recurrence rates and risk of distant metastases were similar between the two groups of surgeons. Colorectal subspecialisation has resulted in an increased use of pre-operative radiotherapy and fewer permanent stomas. No significant improvement in surgical or oncological outcomes after rectal cancer surgery have been observed.

Laparoscopic ovarian drilling for women with anovulatory polycystic ovarian syndrome: a district general hospital experience

This is a retrospective study involving 100 anovulatory women with polycystic ovarian syndrome (PCOS) who had laparoscopic ovarian drilling (LOD) between January 1995 and May 2002 at the Royal Berkshire Hospital, Reading, a large district general hospital (DGH). The aim was to evaluate the efficacy of LOD in the treatment of women with anovulatory PCOS in a DGH setting. We also looked at the factors predicting the clinical outcome to be able to counsel the patients pre-operatively. The study showed that the spontaneous pregnancy rate after LOD was 32.46%. A further 28.5% conceived after induction of ovulation with clomiphene citrate (CC) or purified follicular stimulating hormone (Metrodin HP), with a cumulative pregnancy rate of 74%. We did not find a significant difference in the luteinising hormone to follicular stimulating hormone (LH:FSH) ratio of greater than 2.5, LH level of greater than 10 IU/l, body mass index (BMI), age or duration of infertility between the group of women who conceived and those who failed to conceive, in response to LOD.

A self-report-based study of the incidence and associations of sexual dysfunction in survivors of intensive care treatment

To determine the incidence and associations of sexual dysfunction in survivors of intensive care unit treatment in their first year after hospital discharge using a self-report measure. A prospective observational study. ICU Follow-up Clinic, The Royal Berkshire Hospital, Reading. One hundred and twenty-seven patients aged 18 years and over who spent 3 days or more in the intensive care unit. Demographic data; reported incidence of sexual dysfunction and post-traumatic stress disorder symptomatology; association between reported sexual dysfunction and age, gender, post-traumatic stress disorder symptomatology and length of intensive care unit stay; patient and partner satisfaction with current sex life. Fifty-two patients (43.6%) reported symptoms of sexual dysfunction. There was a significant association between sexual dysfunction and post-traumatic stress disorder symptomatology (p = 0.019). There was no association between reported sexual dysfunction and gender (p = 0.33), age (p = 0.8) or intensive care unit length of stay (p = 0.41). Forty-five per cent of patients and 40% of partners were not satisfied with their current sex life. No other medical practitioner had sought symptoms of sexual dysfunction during the study period. Symptoms of sexual dysfunction are common in patients recovering from critical illness and appear to be significantly associated with the presence of post-traumatic stress disorder symptomatology. The intensive care unit follow-up clinic is a suitable forum for the screening and referral of patients with sexual dysfunction.

The CobraPLA

We read with interest the response from Quinn [1] to a paper by Cook and Lowe [2]. We wish to correct the inaccurate references made by him to the two papers by Verghese and Brimacombe [3] and Bapat and Verghese [4], in his response. Both these studies were conducted at the Royal Berkshire Hospital. The first study [3] was a prospective study of 11 910 patients, in which positive pressure ventilation was used in 5241 patients (44%). The incidence of non-fatal aspiration was one in 11 910 (0.0083%). In the second paper [4], there were no aspirations in the 100 patients studied. Indeed, the authors discussed the relevance of a zero numerator and how it should be statistically interpreted. It is not clear how these findings were interpreted by Quinn as a 1% incidence of regurgitation with the laryngeal mask airway. Finally, a more recent study by Bernadini et al. [5] describes a cohort of 15 229 patients in whom the laryngeal mask airway was used, with an incidence of one non-fatal aspiration (0.0065%). In that study, positive pressure ventilation was used in 94% of the patients studied. The first reference cited by Patel and Chatterjee [1] was cited in our reply because it was used by Cook et al. to ‘support the overall safety of the laryngeal mask airway’[2]. We are in full agreement with Patel and Chatterjee that the laryngeal mask airway has had a remarkable record of safe use since its introduction. Indeed, later in our reply we note ‘the excellent track record of the classic laryngeal mask airway’[3]. The second reference [4] was cited because it more specifically studied the kind of patient which Cook et al. reported (Cook's first patient) having suffered aspiration; namely, a female undergoing gynaecological laparoscopy. Patel and Chatterjee are correct in stating that this paper reports a 1% incidence of regurgitation and not aspiration. However, we maintain that most clinicians would equate an occurrence of regurgitation with at least a substantially increased risk for aspiration. Thus the intent of citing these two papers was to reinforce the overall excellent safety record of the laryngeal mask airway while also questioning use of that and other supraglottic airways in patients who might be at increased risk of regurgitation. In any event, we maintain that any supraglottic airway should be able to be used safely in appropriately selected patients who require positive pressure ventilation if properly carried out (by limiting airway pressures to < 20 cm H2O), and the letter by Patel and Chatterjee certainly supports this for the laryngeal mask airway. The thrust of our reply to Cook et al. was to question why this would not be true for the CobraPLA as well. B. QuinnVice President Engineered Medical Systems Inc. (EMS) Indianapolis, IN, USA

Anatomy for Anaesthetists, 8th Edition.

Mayo Clinic, Rochester, Minnesota. rorie.duane@mayo.eduAnatomy for Anaesthetists, 8th Edition. By Harold Ellis, C.B.E., M.A., D.M., F.R.C.S., F.A.C.S. (Hon.), Stanley Feldman, B.Sc., M.B., F.R.C.A., William Harrop-Griffiths, M.A., M.B., B.S., F.R.C.A., Andrew Lawson, F.F.A.R.C.S.I., F.A.N.Z.C.A., F.R.C.A., M.Sc. Williston, VT, Blackwell Publishing, 2004. Pages: 358. Price: $137.00.The first edition of this book was published 41 yr ago. Such longevity speaks well for the contributions it has made to the specialty of anesthesiology and indicates that the seven previous editions have been revised carefully and thoughtfully, or else the book would not now still be in use. With each revision, most books tend to grow in length as new information is added. Deciding what to delete is not easy. This edition is 18 pages shorter than the previous one but has 14 more figures than the fifth edition. It also has a new 11-page, four-figure concise chapter on anatomy of pain written by Andrew Lawson, F.F.A.R.C.S.I., F.A.N.Z.C.A., F.R.C.A., M.Sc. (Consultant in Anesthesia and Pain Management, Royal Berkshire Hospital, Reading, United Kingdom). No doubt this reflects the care and thoughtfulness with which the revision has been done. The new chapter is an important addition in that pain management is an area that has undergone substantial expansion in knowledge since the previous revision was done.Importantly, the illustrations, almost all of which were newly drawn or redrafted for the sixth edition, have been further revised for the current edition. This process has resulted in high-quality black-and-white line drawings with all nerves shown in bright yellow, as is traditionally done in gross anatomy books. Figure 140 is an exception to the typical high-quality figures in this revised book. It indicates surface landmarks that can be used to define the course of the sciatic nerve in the buttocks and upper thigh. It suggests that a line be drawn between the posterior superior iliac spine and the greater trochanter of the femur. From the midpoint of this line, a perpendicular line is drawn, and a point 4–5 cm down this line is said to lie over the sciatic nerve. What is different about the figure is that it shows the line terminating on the greater trochanter just above the shaft of the femur rather than on the highest point. This new location of termination is at variance with most other reports. A trip by this reviewer to the gross anatomy laboratory indicated that this small change in the termination of the posterior superior iliac spine to greater trochanter line moved the point of insertion of the needle away from the location of the sciatic nerve.This new edition, like previous ones, is not organized by chapters, but rather by parts (eight in all). These units perhaps more closely fit a system of regional organization of the body but typically include only those parts of the body or system that have special significance to the practice of anesthesiology.Finally, what is the purpose of this book, and who will it serve? In the Introduction, the authors indicate that the book is not intended to be a textbook for regional anesthetic techniques. Rather, it is an anatomy book written for anesthetists, keeping in mind the special requirements of their daily practice, one of which is a shortage of time. I find the book an excellent match for that goal. The book is organized to present anatomy that is of specific interest and needed for the practice of anesthesiology. Its organization and indexing allow a busy practitioner to quickly review areas of interest. The breadth and depth of the material covered and its concise presentation will allow the book to be a useful resource to those preparing for certification examinations in the specialty as well as for the difficult case coming to surgery in an hour.

Evaluation of the role of day assessment unit in the management of pregnancy induced hypertension

SummaryThis study is based on an audit designed to investigate observance of the guideline on pregnancy induced hypertension (PIH) and referral to the day assessment unit (DAU) at the Royal Berkshire Hospital. The audit included 60 patients; all were first time referrals, over a period of 4 months in 2003. The main sources of cases were the community (50%), followed by the antenatal clinic (ANC) 47%. The majority (67%) were referred with hypertension. A total of 28% had suspected symptomatic pre-eclampsia. About 94% of the patients were at ⩾32 weeks' gestation. After assessment in the unit, it was found that about 47% had a diastolic blood pressure of <90 mmHg and 77% had no proteinuria. Nearly all the cases referred with symptoms were found to be asymptomatic on review. The laboratory investigations were normal in over 92% of cases. In spite of these findings, 65% of patients were followed-up in ANC and DAU. The audit showed the need for the local guideline.

A 77-Kilobase Region of Chromosome 6p22.2 Is Associated with Dyslexia in Families From the United Kingdom and From the United States

Several quantitative trait loci (QTLs) that influence developmental dyslexia (reading disability [RD]) have been mapped to chromosome regions by linkage analysis. The most consistently replicated area of linkage is on chromosome 6p23-21.3. We used association analysis in 223 siblings from the United Kingdom to identify an underlying QTL on 6p22.2. Our association study implicates a 77-kb region spanning the gene TTRAP and the first four exons of the neighboring uncharacterized gene KIAA0319. The region of association is also directly upstream of a third gene, THEM2. We found evidence of these associations in a second sample of siblings from the United Kingdom, as well as in an independent sample of twin-based sibships from Colorado. One main RD risk haplotype that has a frequency of approximately 12% was found in both the U.K. and U.S. samples. The haplotype is not distinguished by any protein-coding polymorphisms, and, therefore, the functional variation may relate to gene expression. The QTL influences a broad range of reading-related cognitive abilities but has no significant impact on general cognitive performance in these samples. In addition, the QTL effect may be largely limited to the severe range of reading disability.

Nineteenth century amputations at the Royal Berkshire Hospital, Reading.

To describe 19th century amputations carried out at the Royal Berkshire Hospital, Reading. A retrospective analysis of hospital archives. Details of 276 amputations were analysed. The majority (86%) were in men and boys. The median age was 33 years. The ratio of leg:arm amputation was 2:1. Trauma accounted for 58% of amputations. Of 52 arm amputations, 42 were due to trauma, compared with 37 of 110 leg amputations (P < 0.001). Mortality was higher following amputation for trauma than for disease (P < 0.01). Mortality following leg amputation was 16% compared with 3.8% after arm amputation (P < 0.05). Death rate following compound fracture was 23%. Compared with today, the population undergoing amputation and the indications for amputation in the 19th century differ significantly. However, it is apparent that in those patients who were selected to undergo amputation acceptable survival figures could be achieved.

Latex allergy. A position paper of the British Society of Allergy and Clinical Immunology.

Clinical & Experimental AllergyVolume 33, Issue 11 p. 1484-1499 Latex allergy. A position paper of the British Society of Allergy and Clinical Immunology P. Cullinan, P. Cullinan Imperial College, London,Search for more papers by this authorR. Brown, R. Brown Royal Berkshire Hospital, Reading,Search for more papers by this authorA. Field, A. Field University of Liverpool,Search for more papers by this authorJ. Hourihane, J. Hourihane University of Southampton,Search for more papers by this authorM. Jones, M. Jones Imperial College, London,Search for more papers by this authorR. Kekwick, R. Kekwick University of Birmingham,Search for more papers by this authorR. Rycroft, R. Rycroft St Thomas' Hospital, London,Search for more papers by this authorR. Stenz, R. Stenz Royal Brompton and Harefield Hospital Trust, London,Search for more papers by this authorS. Williams, S. Williams Royal Free Hospital, LondonSearch for more papers by this authorC. Woodhouse, C. Woodhouse Institute of Urology and Nephrology, LondonSearch for more papers by this author P. Cullinan, P. Cullinan Imperial College, London,Search for more papers by this authorR. Brown, R. Brown Royal Berkshire Hospital, Reading,Search for more papers by this authorA. Field, A. Field University of Liverpool,Search for more papers by this authorJ. Hourihane, J. Hourihane University of Southampton,Search for more papers by this authorM. Jones, M. Jones Imperial College, London,Search for more papers by this authorR. Kekwick, R. Kekwick University of Birmingham,Search for more papers by this authorR. Rycroft, R. Rycroft St Thomas' Hospital, London,Search for more papers by this authorR. Stenz, R. Stenz Royal Brompton and Harefield Hospital Trust, London,Search for more papers by this authorS. Williams, S. Williams Royal Free Hospital, LondonSearch for more papers by this authorC. Woodhouse, C. Woodhouse Institute of Urology and Nephrology, LondonSearch for more papers by this author First published: 07 November 2003 https://doi.org/10.1046/j.1365-2222.2003.01818.xCitations: 61 Dr Paul Cullinan, Department of Occupational and Environmental Medicine, London National Heart & Lung Institute, Imperial College, Manresa Road, London SW3 6LR, UK. E-mail: p.cullinan@imperial.ac.uk Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume33, Issue11November 2003Pages 1484-1499 RelatedInformation

The effect of caffeine consumption and nausea on the risk of miscarriage.

Evidence for a harmful effect of caffeine intake on risk of miscarriage (spontaneous abortion) is inconsistent and nausea during pregnancy has been claimed to explain any association seen. The objective of this analysis was to determine whether caffeine consumption both before and during pregnancy influenced the risk of miscarriage in a group of pregnant women in the UK. We examined the association with maternal caffeine intake in a case-control study of 474 nulliparous women. Participants were recruited during the years 1987-89 from the Royal Berkshire Hospital in Reading and from a large group practice situated within the hospital's catchment area. Cases were 160 women with a clinically diagnosed miscarriage and controls were 314 pregnant women attending for antenatal care. Information on coffee/tea/cola consumption and potential confounders was collected by interview and caffeine content was assigned to individual drinks according to published data on caffeine content of beverages. Compared with a maternal caffeine intake of < 151 mg/day, we found evidence that caffeine consumption > 300 mg/day doubled the risk of miscarriage. Adjusted odds ratios were 1.94 [95% CI 1.04, 3.63] for 301-500 mg/day and 2.18 [95% CI 1.08, 4.40] for > 500 mg/day. This effect could not be explained by nausea in pregnancy. Nausea appeared to be strongly independently associated with a reduced risk of miscarriage (test for trend P < 0.0001). There was no evidence that prepregnancy caffeine consumption affected the risk. Our results indicate that high caffeine consumption during pregnancy (>300 mg/day), in particular coffee consumption, is an independent risk factor for increased risk and nausea is an independent protective factor for a lower risk of miscarriage.

Sexually transmitted infections in a young offenders institution in the UK.

According to the recently published National Strategy for Sexual Health and HIV, prisoners need targeted sexual health information. However, there is a paucity of published data on incidence of sexually transmitted infections (STIs) among prisoners in the UK. The aim of this study was to assess the sexual behaviour and spectrum of STI in a young offenders institution (YOI) in the UK. Case notes of all patients seen in a male YOI in Reading over a one-year period were reviewed. All were either self-referrals or referred by the prison staff. Age- and sex-matched patients attending the genitourinary medicine (GUM) clinic at the Royal Berkshire Hospital Reading during the same period served as a control group. A total of 177 patients aged 17-20 were seen in the YOI during the study period. Ninety (51.72%) had STI vs 95 (54.91%) in the control group (P = 0.5942). Three YOI patients and four GUM attendees declined STI screening. Twenty-nine (16.38%) patients in the YOI had >or=2 sexual partners in the preceding three months vs 41 (23.16%) in the control group (P = 0.0811). Fourteen (7.90%) YOI patients had a previous history of STI vs 25 (14.12%) in the GUM clinic population (P = 0.0618). Thirty-five (20.11%) YOI patients gave a history of having injected drugs vs none amongst GUM clinic attendees. Of the 35 patients with a history of intravenous drug use four were hepatitis C-antibody positive. This study showed high rates of STI in a YOI. Past history of high risk behaviour was common and a significant number had been intravenous drug users. This study strongly supports the need for immediate care, targeted sexual health information and STI prevention in YOI in the UK.

Iridium-192 implantation for T1 and T2a carcinoma of the tongue and floor of mouth: retrospective study of the results of treatment at the Royal Berkshire Hospital.

Carcinomas of the tongue and floor of mouth are relatively rare tumours, which may be treated using several modalities. We reviewed the results of iridium wire implants performed at the Royal Berkshire Hospital between 1994 and 2000. 24 patients had iridium wire implants as primary treatment for tongue and floor of mouth cancers. Four patients were treated after excision biopsy with close or involved margins. One patient was treated for a recurrence after surgery. The median age at treatment was 61 years. There were 18 men and 11 women. 21 patients had tumours of the tongue and eight of the floor of mouth. 13 had T1 tumours and 11 had T2a tumours. The median follow up was 42 months. The primary tumour was controlled in 22 of the 29 patients by the implant alone. Of the seven patients with local recurrence four were successfully salvaged with surgery. The acturarial 2 year survival rates were: overall survival 81%, disease specific survival 91%, local recurrence free survival 85% and nodal relapse free survival 76%. The recorded complication rate was low, one patient developing radionecrosis of the mandible at 7 years post implant. We believe these results show that brachytherapy remains a treatment option for patients with early tongue carcinoma with a high rate of local control and low toxicity.

The use of skull X-rays in the accident and emergency department.

The notes of all patients attending the accident and emergency department at the Royal Berkshire Hospital with a head injury from 1-30 September 1999 were analysed for the indications for skull X-ray, the report on film, and the outcome of the consultation. Using the existing Royal Berkshire Hospital guidelines, 50% (193/385) of all patients had skull X-rays performed. One fracture was detected. If the recent guidelines from The Royal College of Surgeons of England Working Party for the use of skull X-rays in institutions which possess a CT scanner were applied, the number of skull X-rays performed would reduce from 193 to 14 without detriment to any patient.

Efficacy and safety of penile biopsy in a GUM clinic setting.

The UK National Guidelines on Sexually Transmitted Infections recommend penile biopsy in patients with persistent balanitis and balanitis of uncertain aetiology. Many GUM clinics perform penile biopsy. However, few studies have looked at the usefulness and safety of penile biopsy in a GUM clinic setting. We assessed the spectrum of dermatological conditions seen in a penile dermatoses clinic and looked at the usefulness and safety of penile punch biopsy in a GUM clinic setting. We reviewed the case notes of patients who attended the penile dermatoses clinic at the GUM department, Royal Berkshire Hospital, Reading over a period of 18 months. A total of 87 patients were seen in the penile dermatoses clinic. Their ages ranged from 17 to 73 and 70 (80%) were uncircumcised. Twenty-four (28%) patients had biopsies and five (6%) declined. Forty-nine (56%) patients did not have a biopsy either because of a clinically apparent diagnosis (45) or lesions were close to the urethral meatus (4). Five were referred for circumcision and one was referred to a dermatologist. Three patients were lost to follow-up. Penile biopsy was performed to exclude malignancy in 17 (71%) cases and due to diagnostic uncertainty in seven (29%) cases. Histological diagnoses were consistent with initial clinical diagnoses in 17 (71%) cases. Four (17%) had minor complications following biopsy, two had wound dehiscence, one had bleeding and another had a wound infection. In conclusion, a wide spectrum of penile skin disorders were seen in the penile dermatoses clinic. The majority of patients had a clinically apparent diagnosis. The histological diagnosis was consistent with initial clinical diagnosis in most of the biopsied patients. The main indications for biopsy were to exclude malignancy and for diagnostic dilemma. Penile biopsy is a safe procedure with minimal complications.

A randomized controlled trial to compare alternative strategies for preventing infant crying and sleep problems in the first 12 weeks: the COSI study

This study was designed to test the hypothesis that a behavioural programme was used preventatively to try to reduce crying and improve night sleeping in 1- to 12-week old infants compared with educational support or existing services. The objectives were to develop strategies which can be used to inform, help and support parents of new babies. The study was a three-group prospective randomized controlled trial in West Berkshire and South Oxfordshire, making a comparison between a behavioural policy, an educational intervention and existing services. The participants were 610 mothers giving birth to term healthy infants at the Royal Berkshire Hospital, Reading between March and November 1997. The main outcome measures were interruption-free nights i.e., the number of nights each week when parents reported that their baby slept for a minimum of 5 hours; babies' fuss/crying patterns; and mothers' general well-being and approach to parenthood. There were no significant differences between the groups in the amount of fuss/crying, which gradually reduced during the 12 weeks. At 12 weeks of age, more mothers in the behavioural group reported their babies to have had seven interruption-free nights (61%), compared with the educational (53%) and the control groups (50%). This was significant at the P &lt; 0.05 level. The educational and control groups did not significantly differ at any age. At 6 and 12 weeks, mothers allocated to the behavioural policy were more structured in their approach to parenting and rated it more highly for convenience. At 9 months, their babies were more likely to have a regular bedtime routine. Where mothers followed a behavioural programme, 10% more babies slept for a minimum of 5 hours at night without disturbing their parents at 12 weeks of age. This improved sleeping pattern persisted up to 9 months of age. Mothers in this group also reported a greater feeling of control and increased confidence in their ability to cope. The more widespread adoption of a behavioural approach to the management of early infant sleeping should be considered.

Correspondence

Abstract The Seldinger technique for difficult transurethral catheterization: a gentle alternative to suprapubic puncture (Br J Surg 2000; 87: 1729-30) Letter 1 : G. Carmignani, F. Campodonico, Department of Urology, University of Genoa, Largo R Benzi 10, 16132 Genoa, Italy Letter 2 : R. G. Mason, I. D. C. Mitchell, L. H. Stewart, Department of Urology, Western General Hospital, Edinburgh EH4 2XU, UK Authors' reply : M. L. Lachat, Clinic for Cardiovascular Surgery, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland Gender differences in the longitudinal pressure profile of the anal canal related to anatomical structure as demonstrated on three-dimensional anal endosonography (Br J Surg 2000; 87 : 1674–9) A. P. Zbar, M. BeerGabel, Kaplan Medical Centre, Rehovot 76100, Israel Authors' reply : C. I. Bartram, St Mark's Hospital, Northwick Park2, Harrow HA1 3UJ, UK Rectal adenocarcinoma with liver metastases: management of the primary tumour (Br J Surg 2001; 88: 163–4) M. P. Donovan, S. T. Yeung, T. G. John, M. Rees, Department of Hepatobiliary Surgery, The North Hampshire Hospital, Basingstoke RG24 9NA, UK Epidemiology of abdominal aortic aneurysms in the Asian community (Br J Surg 2001; 88: 382–4) W. Jackson, P. Rutter, Department of General Surgery, Wexham Park Hospital, Wexham Street, Slough SL2 4HL, UK Letter 1 : K. Yorganci, Z. V. Kaynaroglu, Z. Oner, Department of General Surgery, Hacettepe University Faculty of Medicine, 06100 Sihhiye, Ankara Letter 2 : C. M. Pring, Division of Surgery, Clinical Sciences Building, St James's University Hospital, Leeds LS9 7TF, UK Authors' reply : W. K. Cheah, J. B. Y. So, P. M. Y. Goh, Minimally Invasive Surgical Centre, Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road2, Singapore 119074 The National Institute for Clinical Excellence and hernia repair J. Ord, Churchill Hospital, Headington, Oxford OX3 7LJ and H. Reece-Smith, The Royal Berkshire and Battle Hospital, Oxford Road, Reading RG1 5AN, UK Probiotics (Br J Surg 2001; 88: 161–2) R. J. Kennedy, S. J. Kirk, K. R. Gardiner, Department of Surgery, Institute of Clinical Science, The Queen's University of Belfast, Grosvenor Road, Belfast BT12 6BJ, UK