BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6974.270 (Published 28 January 1995) Cite this as: BMJ 1995;310:270

Surgeons at Stanford University in California have developed a technique for inserting metal stents as a treatment for aneurysms of the descending thoracic aorta (New England Journal of Medicine 1994;331:1729–34). The stents, constructed of self expanding stainless steel mesh covered in Dacron, are inserted through the femoral artery. So far 13 patients have been treated without serious problems—but the Stanford team acknowledges that long term follow up will be needed before a final verdict is possible.

Cancer of the pancreas is one of the common malignant tumours, but an average district hospital with a catchment population of 200000 will see only 20 or so new patients with the disease in a year. Probably only two would be suitable for resection. Plainly, says an article in the “British Journal of Surgery” (1995;82:111–5), such cases should be concentrated in the hands of specialist surgeons. That means considerably more cross referrals than occur at present.

Specialist surgeons in tertiary referral centres make part of their living from dealing with other surgeons' mistakes. A report from the United States (Surgery 1994;116:954–8) describes 47 consecutive patients having surgery for hyperparathyroidism. Seven of …

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