Endoscopic discision of Zenker's diverticulum

Being typically an elderly make, the patient with a Zenker's diverticulum quite uncommonly presents in the best condition for surgery. Optimal management should therefore minimize the operative risk, shorten the time of postoperative hospitalization, and simultaneously avoid postoperative recurrence of the disorder. Using an automatic stapling device, the sphincter of the diverticulum (consisting mainly of the cricopharyngeus muscle) is cut easily endoscopically, with reliable haemostasis and a wide opening of the pouch as result. Six cases operated on by us between December 1993 and August 1994, became completely free of symptoms. The surgical technique (actually a variety of the traditional Dohlman's procedure) is described. Postoperative results over a follow-up of 3-8 months, and details of one non-serious postoperative complication are reported. Our experience of this pilot series gives rise to positive expectations of a new, safe, and time-saving procedure for successful treatment of even elderly patients with Zenker's diverticulum.

Comparison of slow-release indomethacin and diflunisal in patients with arthrosis

A double-blind, crossover study was carried out in 44 patients with osteoarthrosis of the hip or knee to compare the efficacy and tolerability of treatment with a new slow-release formulation of indomethacin (50 mg) with that of diflunisal (250 mg). After a 1-week wash-out period, patients were allocated at random to receive 2 tablets daily of one or other preparation for 6 weeks before being crossed over to the alternative drug for a further 6 weeks. Aspirin was allowed as a rescue analgesic throughout the study. Subjective assessments of pain and objective assessments of joint mobility were made before the start of treatment and at the end of each period, and details were recorded of rescue analgesic usage and any side-effects. Analysis of the results from 42 patients showed that whilst both treatments helped to alleviate pain, patients' overall evaluation of efficacy at the end of the study indicated that indomethacin was slightly more effective than diflunisal and there was a significant preference for indomethacin. Both drugs were well tolerated and none of the side-effects, reported in about 15% of patients on each drug, resulted in any withdrawals.