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A way to restore normal colonic flora and stop Clostridium difficile associated diarrhoea (CDAD) is described in QJM (2009;102:781-4, doi:10.1093/qjmed/hcp118). A Scottish team nasogastrically administered a “faecal transplant” to 15 patients with recurrent CDAD, managing to cure 11 of them with this technique. The donors were healthy individuals and the recipients were given vancomycin and proton pump inhibition to create a favourable gastric pH before the transplants. For readers with a strong constitution: fresh faecal material was obtained, blended with normal saline in a household blender, and then filtered to produce a liquid.



For patients with lymphadenopathy, delayed lymph node biopsy can have disastrous results. A two year audit of waiting times in a surgical department showed that 47% of patients were referred by letter, and 64% of these were seen in clinic before the biopsy was arranged. A personal referral between clinicians by direct discussion, email, or fax led to a mean wait of four days, compared to 51 days when the referral was sent by snail mail. The authors advise setting up fast track pathways to get these patients seen (Annals of the Royal College of Surgeons of England 2009;91:673-6,