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The aim of this study was to validate a novel inexpensive training device as a means of improving the psychomotor skills involved in the manipulation of a fibreoptic endoscope. Seventy-five subjects attempted to pass a fibreoptic endoscope through the device five times, with each attempt timed to the nearest second. Although prior clinical experience of fibreoptic intubation was associated with better performance, all groups showed improvement with each attempt. Qualitative feedback indicated that the device required subjects to use similar skills to those used in clinical practice. This study supports the use of such a device in training and assessment although further studies will be required to determine whether the skills learned on the device can be transferred to the clinical environment.

In 1951 a fortuitous accident of seating at a dinner party brought together Hugh gainsborough, a gastroenterologist at St george's Hospital, and Harold Hopkins, a young physicist working at Imperial College London. over dinner gainsborough lamented the inadequacies of the gastroscopic instruments of the time. The problem, he said, was that the existing rigid devices had blind spots. one could never be sure that one hadn't missed something when exploring a patient's stomach. What was needed was a flexible gastroscope that could see 'round corners'. Hopkins, a problem-solver by nature, was captivated by the notion and spent the next three years working on a design. By 1954 he had built a prototype of the world's first fibreoptic endoscope, a device that revolutionised the diagnosis and treatment of gastrointestinal ailments. It was the first, but not the last, of hopkins's great contributions to science and, in particular, to surgery.

Hysteroscopy has become a widely accepted technique in the diagnosis and treatment of various gynaecological conditions. The advent of the fibreoptic endoscope and distending media has largely been responsible for the increasing use of hysteroscopy. It is our aim in this article to review the literature on the frequently used distending media such as carbon dioxide, glycine, dextran, dextrose, sorbitol and mannitol and their anaesthetic implications.The endoscopist chooses the particular medium. Complications due to the distending media occur in4% of cases. Dilutional hyponatraemia and hypothermia are commonly encountered complications and, in addition, hyperglycaemia and volume expansion can occur. Less commonly encountered complications are embolism with carbon dioxide and pulmonary oedema, renal failure and in rare cases anaphylaxis and encephalopathy. Regional anaesthesia may offer an advantage over general anaesthesia in early recognition of fluid accumulation. Apropriate monitoring should include fluid balance, routine monitoring as well as temperature, electrolytes and blood sugar measurements. Precordial Doppler measurement, central venous and/or pulmonary artery pressure measurement may be of help in detecting as well as treating carbon dioxide and/or air embolism and fluid balance in high risk patients.There is no one commonly used medium and no one medium is devoid of complications. There have been no controlled studies comparing different anaesthetic techniques. Positioning of the patient can give rise to complications such as peripheral neuropathy. Hysteroscopy is a non invasive procedure which entails a short hospital course with minimal postoperative sequelae and may be cost saving.

BrMedJ 1990;301:683-7 If "Dr Present" (1990) were to meet "Dr Past" (1840) what would they make of one another? Clearly Dr Past was ignorant, his treatments useless and often hurtful: with hindsight leeches do not command respect (and I am one who has used them). And in 150 years from now how will doctors regard us? Surely in much the same way, as ignorant purveyors of poisonous drugs; and the fibreoptic endoscope will look as horrible to them as does the rigid gastroscope to us. Yet if these three doctors?Past, Present, and Future?were each to record a conversation with a dying patient the play backs might not sound so very different. The science of medicine advances, its humanity does not; and nor

Some clinical features of laryngeal hemlplegia in 127 horses arc described. Possible aetiologic factors were found in only 11% of affected animals. The onset of clinical signs was either sudden or insidious. The majority of cases were presented because of an abnkmal respiratory noise made at exercise. Other clinical signs, particularly those usually attributed to laryngopalatal dislocation, were observed in a substantial proportion of affected animals. In all cases surveyed the left arytenoid was affected, although in 3 animals a bilateral laryngeal dysfunction was noted. Thirty of 65 animals examined with a fibreoptic endoscope had other upper respiratory tract abnormalities in addition to abnormal arytenoid movements. Electrocardiographic examination of 45 affected horses did not reveal a significantly higher incidence ot abnormalltles than that observed in the racing population. The majority of haemograms taken from affected animals were also within normal limits.

Summary A group of racehorses in training was examined on several occasions with a fibreoptic endoscope and monitored for viral infection. Only equine herpes virus-2 (EHV-2) infection was detected. Pharyngeal lymphoid hyperplasia (PLH) was present in all horses and decreased in severity with age. There was no association between PLH severity and antibody titres to EHV-1, or with the isolation of EHV-2. Finishing position in races was not affected by PLH severity. Exercise induced pulmonary haemorrhage (EIPH) was evident on 23 out of 49 (47 per cent) examinations after maximal speed training exercise. Eighteen out of 19 (95 per cent) horses examined on at least two occasions had EIPH but its occurrence was not predictable. Observable mucoid or mucopurulent exudate was present in the trachea in 60 out of 118 (50 per cent) examinations and the amount seen was increased following exercise.

During the past decade some urologists and radiologists have doubted the existence of posterior urethral valves. It has been suggested that the primary lesion in patients thought to have urethral valves is bladder neck obstruction. During the past seven years we have seen an average of three new cases of posterior urethral valves per annum. In all cases the valves themselves, not the bladder neck, obstructed the urethra. The urologist may miss valves at urethroscopy, but use of the new fibreoptic endoscope has improved his chances of seeing them. Posterior urethral valves may not be demonstrated radiologically if the radiologist does not use a rapid recording device or if the patient does not micturate forcefully during micturating cystourethrography. Failure to detect the valves may lead to an erroneous diagnosis of bladder neck obstruction.

A feeding tube can be rapidly introduced into the small intestine through a makeshift 'external channel' of the fibreoptic endoscope. To prevent dislodgement of the feeding tube upon withdrawal of the endoscope, the former may be stabilized by means of the biopsy forceps introduced through its regular channel.

Total internal reflection of light within a glass fibre can be produced by coating with glass of a different refractive index. A bundle of these fibres may be used to illuminate the internal anatomy of the gastrointestinal tract and by means of a collimated bundle an image of the illuminated object can be produced. This is the principle of modern fibreoptic endoscopes. The addition of suction, insufflation and distal tip control enables a complete visual record to be obtained from almost all levels of the gastrointestinal tract and this may be supplemented by biopsy or cytological specimens taken through the endoscope. At the same time, it is possible to collect mucus, bile or pancreatic juice using suitable flexible tubing. The fibreoptic endoscope is undoubtedly the best diagnostic aid for delineating gastrointestinal pathology and in particular those conditions associated with abnormal mucus production.

Endoscopic ultrasound is a new technique in which highfrequency, high-resolution real-time ultrasound images are obtained from within the gastrointestinal tract by use of an ultrasound probe incorporated into the tip of a fibreoptic endoscope. Forty patients were scanned for gastrointestinal indications. In six patients the scans were technically unsuccessful, in three of these because of difficulties with the prototype instrument. New information was obtained in 20 patients, later confirmed by other means in 12. Endoscopic ultrasound did not provide any new information in 14 patients. The technique shows considerable promise in patients with pancreatic disorders and gut-wall malignancies. It has the ability to provide images with a spatial resolution unobtainable by other imaging methods.

Living in Hawaii, one becomes impressed by the Japanese. No one would attempt to categorize a race; there are as many variations in individuals as there are people. But over many years of observation one gains an overall impression that is inescapable. And words such as humility, industry, meticulousness, and integrity keep creeping into descriptions. In recent years the reborn Japanese nation has emerged as a successful international competitor in dozens of industrial enterprises. I have watched with interest the evolution of their medical publications, and I have noted the same ability to learn from others—and then improve upon it—and then make it cheaper—which has been the hallmark of their success in commerce. This book is a prime example: a remarkable compilation of gastrocamera color photographs, gross pathology photos, and diagrams. The fibreoptic endoscope is a Japanese invention; it has revolutionized gastrointestinal and bronchial endoscopy. In the past the principal