Letter: Carcinoma of the oesophagus with "swallow syncope".

aetiology, largely as a result of the many publications on the subject to which the working party's report refers. Any reduction in the incidence and severity of the intraoperative cardiovascular disturbances is principally due to the careful preoperative assessment and preparation of the patients, the use, when indicated, of alternative operations which do not require methylmethacrylate, and the meticulous care and vigilance exercised by the surgeons and anaesthetists during the procedure itself. If the importance of these simple but effective steps is overlooked again, then plainly the risks of total hip replacement will increase once more. -I am, etc., RICHARD H. ELLIS Department of Anaesthesia, St. Bartholomew's Hospital, London E.C.1