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Objective To test the hypothesis that somatosensory evoked potentials (SEP) and results of arterial photoplethysmography (PPG) predict outcome after surgery for thoracic outlet syndrome. Design A retrospective case series which correlated surgical outcome with preoperative SEP and PPG results using Fisher's exact test. PPG results were considered abnormal when there was complete loss of arterial pulsation, and SEP results when amplitudes were reduced and latencies delayed. Setting Royal Prince Alfred Hospital, between March 1984 and February 1992. Patients Forty-six consecutive patients with clinically diagnosed thoracic outlet syndrome were admitted for surgery; sixteen underwent bilateral operations (total of 63 limbs). Interventions After SEP and PPG tests, all patients underwent thoracic outlet decompressive surgery--excision of the first rib, of the cervical rib (where present), and of other congenital anomalies associated with thoracic outlet syndrome--by the axillary approach. Main outcome measures Surgical outcome was graded as good when symptoms improved and the patient returned to work or pre-illness activities. It was graded as poor when symptoms remained unchanged or worsened, or when there was continued inability to work or engage in usual activities. Results The follow-up period ranged from 1.9-9.8 years (mean, 5.7 years). Significantly more limbs with abnormal SEP or PPG results had a good outcome (49 of 53 limbs; 93%) than limbs with normal SEP and PPG results (six of 10 limbs; 60%) (P = 0.02). Conclusions Abnormal SEP and PPG results correlated with a better postsurgical outcome. These tests may therefore aid in determining prognosis of surgery for thoracic outlet syndrome.

Objective To review the outcome of endoluminal repair of abdominal aortic aneurysm. Patients Twelve patients with abdominal aortic aneurysms (mean diameter, 5 cm; range, 4.4-7.8 cm) were selected according to strict criteria relating to the morphology of the aneurysm and iliac arteries. The aneurysms all had a proximal neck between the renal arteries and the aneurysm and a distal neck between the aneurysm and the bifurcation of the aorta. The iliac arteries were not tortuous and were 8 mm or greater in diameter. Intervention The aneurysm was repaired with a graft stent device introduced into the aorta via a sheath in the femoral artery. Results Successful endoluminal repair was achieved in 10 of 12 patients (83%). The two patients in whom the endoluminal repair was abandoned were treated by standard open repair. All patients have since had an aortogram and duplex ultrasound examination to confirm exclusion of the aneurysm from the general circulation (mean period of follow-up, seven months). There have been no deaths. Conclusion Abdominal aortic aneurysms conforming to strict morphological criteria can be treated safely and successfully by this minimally invasive endoluminal method.

In a prospective randomized clinical trial to compare treatment with cyclosporin A to conventional treatment with azathioprine, prednisone and antithymocyte immunoglobulin in cadaveric renal transplantation, 34 patients were entered into both treatment groups and were examined regularly for seven to 43 months. Renal graft survival at one year was 72% among patients receiving cyclosporin A therapy and 75% among those receiving conventional therapy. Rejection was a frequent complication of both treatments; irreversible rejection occurred in six patients receiving treatment with cyclosporin A and in 10 patients receiving conventional therapy. The nephrotoxicity of cyclosporin A was its main side-effect. A similar proportion of kidneys in both groups (65% and 69%) were initially affected with post-transplant oliguria, but recovery of function took significantly longer in the group receiving cyclosporin A therapy (median, 29 days versus 11 days, P less than 0.001). The results of this pilot study suggest that cyclosporin A can be used safely in patients with post-transplantation oliguria, and indicate that long-term graft survival with cyclosporin A is comparable to that achieved with azathioprine, prednisone and antithymocyte immunoglobulin.