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Background: Homeopathic pathogenetic trials (provings) are fundamental to homeopathy. Since most of the data from available provings have not been statistically evaluated, it is unclear how specific reported symptoms are and how they differ from those reported by people taking placebo. Method: We combine and analyse data from two different homeopathic pathogenic trials—including 10 and 11 provers, respectively, and both including 30% placebo—to test the null hypothesis that there is no significant difference between the number of symptoms in placebo and verum groups. Results: The principal results were: � Placebo reported less symptoms than verum groups. � Symptom distribution according to predefined classes (common symptoms increased in intensity and/or duration-, cured, old, new and exceptional) was statistically different between placebo and verum group at a high level of significance (Po0.001). Compared to verum, placebo provers reported less new and old but more common (increased in duration or intensity) symptoms. � Within repertory categories, other differences were detected. � The two groups differ in terms of the duration of each symptom and kinetics of symptoms: most symptoms were more persistent in verum than in placebo groups and verum provers recorded a decreasing number of symptoms with time. Placebo provers did not show such a temporal pattern. Conclusions: If confirmed by other studies these results would demonstrate the nonequivalence between homeopathic medicines in high dilution and placebo and contribute to the improvement of proving methodology and evaluation. Homeopathy (2006) 95, 123–130.

We report a case of severe cervical spinal stenosis due to ossification of the posterior longitudinal ligament (OPLL) whose clinical examination showed no symptoms or signs of neurological damage ("silent OPLL"). Questions about the diagnosis and the treatment of silent OPLL are discussed in the light of published data.

Relapse rates of 75 patients with previously untreated Hodgkin's disease with stages I and II nodular sclerosis were analyzed according to the mediastinal involvement. The overall relapse rate was 22.6%. The probability of relapse was much greater for patients with large mediastinal involvement (66.6%) compared with 17% for patients with small mass, and 11.7% of patients without mediastinal involvement (P less than 0.001). There was no significant difference in recurrence rates between patients without mediastinal mass and patients with a small mass, and in these patients adjuvant chemotherapy MOPP after radiotherapy showed an evident benefit in reducing the relapse rate. On the other hand, no beneficial effect of adjuvant chemotherapy was observed in patients with large mediastinal involvement. Finally, in the 17 relapsing patients, 'salvage' chemotherapy was less effective in patients with large mediastinal mass than in those with small or no mediastinal involvement.

A review of 2,092 patients who had sustained closed thoracic trauma or undergone mechanical ventilation was made in order to clarify the incidence, clinical picture, pathogenesis and prognosis of pneumomediastinum without pneumothorax or lesion of mediastinal organs. Air in the mediastinal space was observed in ten patients (0.5% of cases). Bronchial and esophageal lesions were excluded at bronchoscopy and esophagoscopy. The clinical presentation included subcutaneous emphysema of the neck, without signs of mediastinitis. No patient had pain or dyspnoea. Trauma or barotrauma were assumed to have caused sudden rise in the intrapulmonary pressure, leading to passage of air from the parahilar alveoli into the mediastinum along the peribronchial and perivascular spaces. Management was conservative and the prognosis good, with normalization of the chest radiogram usually within a week.

Percutaneous removal of renal stones is becoming an established procedure, especially for stones lying free in the renal pelvis. These techniques, which include: retrograde pyelography to facilitate a thorough understanding of caliceal anatomy and stone position in 3 dimensions; approaches for accurate placement of a nephrostomy tract for straightline access to the stone and stone removal are discussed.