Surgical manpower worldwide.

The essentials of manpower control are planning, production, and management. All countries need to control medical manpower in general and surgical manpower in particular, using both governmental and professional expertise and information. In many parts of the world, there is no health care whatever, in contrast to the abundance and often excess of health care personnel in western societies. This situation creates an unacceptable social imbalance. There is widespread imbalance of surgical manpower between urban and rural areas, and this imbalance is even more marked in developing countries. Manpower affects surgical training in many ways. The ideal is a well-structured program of training appropriate to the environment in which the surgeon will work. Finally, a considerable amount of surgery world-wide is still performed by unqualified surgeons, particularly in third world countries. The third world problem needs to be addressed by such health agencies as the World Health Organization.

Review of 210 autogenous vein by-pass operations.

This is a retrospective review, using the life table method, of 210 vein by-pass operations. Sixtythree percent of the operations were performed for limb salvage. Eightyeight percent of the operations were performed with the distal anastomosis below the knee joint. The longerm patency rates for those grafts with good run-off was significantly better (p = .036) than for those with poor run-off and the addition of a lumbar sympathectomy was found not to significantly alter the longterm patency rates. Re-operation for graft failure in the first 448 hours after operation was found to be worthwhile procedure giving a cumulative patency rate of 59.9% at five years. A five year cumulative patency rate of 57% is reported and autogenous vein bypass is considered a worthwhile procedure for limb salvage and some selected claudicants with femoro-popliteal arterial disease.

The morbidity of carotid endarterectomy.

The results of 72 carotid endarterectomy operations carried out by three consultant surgeons were analysed. Thirty-eight operations (32.8 per cent) were performed in patients with mild or resolving stroke and 33 operations (45.9 per cent) in patients with transient ischaemic attacks and/or amaurosis fugax. Five patients (7 per cent) died in the early postoperative period, 2 as a result of strokes and the others from cardiac causes. Seventy-six per cent of patients had a satisfactory long term result, remaining free from storke, blindness or recurrent transient ischaemic attacks over the follow-up period of 1--7 years. There were 10 patients (13.8 per cent), including 2 who died, who developed early postoperative neurological deficits; 4 (5.5 per cent) had transient defects and 6 (8.3 per cent) had permanent deficits. Of these patients, 4 had proved occlusions of the reconstructed artery. In 3 patients, cerebral embolization during operation was suspected as the cause. There were, in addition, 2 asymptomatic patients whose reconstruction was shown to be occluded on follow-up postoperative angiography. The continued absence of symptoms, therefore, is no guarantee that the reconstruction is patent and some more objective method of assessment is necessary if the results of carotid endarterectomy are to be critically analysed. The incidence of neurological deficits could, it is believed, be reduced by greater experience with the operation, the routine use of peroperative intra-arterial shunting and peroperative angiography to confirm the patency of the reconstruction.