During general anaesthesia normal thermoregulatory control is impaired, and patients having long operations commonly experience a fall of 1-2°C in their core temperature. A paper in JAMA (1997;277:1127-34) has now shown that this fall in temperature is associated with an increased risk of perioperative cardiac events (relative risk 2.2). Additional warming is recommended for patients known to be at risk of coronary heart disease.

Exercise induced asthma is well recognised, but Minerva had not come across urticaria as a result of exercise until she read a report in the Mayo Clinic Proceedings (1997;72:140-7). In cholinergic urticaria the flushing and pruritic wheals are a response to a rise in the core body temperature. In exercise induced anaphylaxis the urticaria is followed by choking, stridor, nausea, and vomiting. Treatment is with epinephrine.

The Swedish rectal cancer trial randomised 1168 patients with resectable tumours to preoperative radiotherapy followed by surgery or surgery alone (New England Journal of Medicine 1997;336:980-7). After five years 11% of the patients given radiotherapy had had a local recurrence as against 27% of those treated by surgery alone. Overall survival rates were 58% and 48% in the two groups respectively. Further trials of radiotherapy and chemotherapy before and after surgery are under way in the United States and Germany.

Data …