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Needle-localised biopsy of impalpable breast lesions: a novel adjunct to surgical technique and specimen mammography.

Successful screening programmes have resulted in the more frequent detection of early impalpable breast tumours. Effective surgical management of impalpable lesions demands a precise approach to excision which is currently aided by radiologically guided needle-localisation of the lesion prior to operative removal. The surgical specimen procured is most commonly evaluated for tumour presence by specimen mammography intra-operatively or by histological analysis. The latter is more accurate but requires lengthy laboratory processing, which may result in re-operation if the primary excision is ina

Black pigmentation of bone due to long-term minocycline use.

Minocycline-induced dark pigmentation has been described affecting the oral cavity (teeth, mucosa, alveolar bone), skin, nails, eyes and thyroid. To date, there is no report of other bones being affected. We report a case of black pigmentation of the acromian in a patient who had used minocycline on a long-term basis for acne rosecea. Biopsy of the iliac crest revealed that the pelvis was also affected.

Epidermoid cyst in a solitary testis: a case for non-surgical management.

This is a case report of a 71-year-old man who presented with an incidental finding of a mass in a solitary right testis. A scrotal ultrasound scan showed the typical features of a testicular epidermoid cyst. Tumour markers were not elevated and the patient was managed non-operatively. On reviewing the literature, we found no previous report on the non-operative management of testicular epidermoid cysts

Autobanking of femoral heads for revision total hip replacement, a preliminary report of a new surgical technique.

BACKGROUND AND AIM: Conventional banking of bone allografts has been well documented in the literature. It relies on standardised screening and providing a sterile storage facility. We report a new surgical technique of banking the femoral head in a surgically fashioned subperiosteal iliac pouch and its use for the donor's own surgery. MATERIAL AND METHODS: Thirteen patients with an average age of 60 years and a diagnosis of osteoarthritis of the hip with a contralateral symptomatic loose hip replacement were selected. The femoral head was harvested and banked. On retrieval, histological anal

Fracture of the radial donor site after composite free flap harvest: a ten-year review.

The options for donor sites as a source of tissue for free vascularised osteocutaneous flaps are numerous, however, the radial forearm still has an important role. This series reports the largest published record of radial donor site fracture following the harvesting of osteocutaneous radial forearm free flaps used for reconstruction after ablative surgery for malignant disease. The relevant literature is reviewed. A retrospective review of cases treated using these flaps from 1991-2000 (inclusive) is carried out. Factors involved in the aetiology of fractures are discussed. Thirteen fractures

Diagnostic conscious pain mapping using laparoscopy under local anaesthetic and sedation in general surgical patients.

BACKGROUND: Patients in whom extensive investigations have failed to identify the cause of abdominal pain present a challenge to surgeons. We present our initial experience of using laparoscopy under local anaesthetic and sedation in the diagnosis of chronic abdominal pain. METHODS AND PATIENTS: Nine patients with chronic abdominal pain and multiple normal investigations underwent laparoscopy under local anaesthetic and sedation. By touching and grasping intra-abdominal viscera and peritoneum, an attempt was made to reproduce the patient's pain. RESULTS: Two patients were found to have pain

Management of congenital talipes equino varus in Scotland: a nationwide audit.

The Scottish Talipes Register is a record of all newly diagnosed cases of idiopathic congenital talipes equinovarus (CTEV) in Scotland over a four.year period. Two hundred and sixteen children were entered into the register, which recorded initial management and all subsequent interventions, both non-operative and operative. The data, therefore, represent a record of the different management regimens used within Scotland highlighting the variations in duration of conservative management and variations in surgical intervention following different methods of conservative management.

A review of surgical treatment for obstructive sleep apnoea/hypopnoea syndrome.

Surgical intervention and treatment of OSAHS and snoring has a considerable history, encompassing a number of operations all of which have the intention of reducing or by-passing the pharyngeal resistance that occurs during sleep. Review of the published literature presents some problems, however, due to the ethical difficulties of undertaking randomised controlled trials in surgery. Uncontrolled trials are less satisfactory due to the large 'regression to the mean' and placebo effects. However, there is a considerable body of literature available relating to surgical intervention.

Factors involved in abdominal wall closure and subsequent incisional hernia.

Incisional hernia is a frequent complication of abdominal wall closure with a reported incidence of between 5% and 15% following vertical midline incisions at one-year follow-up. Evidence from randomised clinical trials and meta-analysis indicate that a continuous running non-absorbable or slowly absorbed suture such as polydioxanone is the method of choice for abdominal wall closure. Continuous polydioxanone has a similar incisional hernia rate to its non-absorbable counterparts but causes less chronic pain and wound sinuses. Evidence from randomised clinical trials indicates that a lateral p

KTP laser fine fenestra stapedotomy with vein graft interposition in the surgical management of otosclerosis.

Otosclerosis is an hereditary disease of bone derived from the embryonic otic capsule. The exact aetiopathogenesis remains unclear. It can be associated with significant disability due to hearing impairment. Medical and surgical treatments, with varying degrees of effectiveness and complication rates, are available. The surgical method for the correction of the conductive hearing loss associated with otosclerosis continues to undergo technical refinement with the aim of improving results and minimising complications. The surgical technique of fine fenestra stapedotomy is well established. Here

Paediatric day-case otoplasty: local versus general anaesthetic.

BACKGROUND: Correction of prominent ears (otoplasty) is routinely done as an elective cosmetic procedure. The operation is typically performed under general anaesthesia, which is favoured in the paediatric population, being considered more 'humane' than local anaesthesia. AIM: Our aims were to demonstrate the feasibility of paediatric otoplasty as a day case procedure and to examine the relative efficacy of general versus local anaesthesia, paying particular attention to post-operative morbidity. METHODS: Data were gathered retrospectively from case notes, day case surgery pro-formas and dre

Flame bums: a forgotten danger of diathermy?

Diathermy and spirit-based skin preparations are both used on a daily basis in most hospital theatres. We report a case illustrating the potential hazards of this combination and discuss the management of its complications and possibilities of their prevention.

Acalculous biliary tract disorders: the value of fatty meal-cholescintigraphy.

BACKGROUND: The management of patients with symptoms consistent with biliary tract disease but without evidence of cholelithiasis is difficult. This study was undertaken to test the value of cholescintigraphy in predicting the success of cholecystectomy in patients with acalculous biliary tract disorders. MATERIAL AND METHODS: A prospective study was carried out on 73 patients presenting with recurrent upper quadrant pain without documented evidence of gallstones on ultrasound. Fatty meal-cholescintigraphy was performed on all patients and the gallbladder ejection fraction was calculated. Lap

Valorising and creating access to innovative medicines in the European union.

This Perspective describes (a) the current situation, (b) challenges and initiatives, (c) and formulates recommendations to valorize and create access to innovative medicines in the EU. We are currently still far away from optimal assessment of value for money in the EU. On the one hand, valorizing innovative medicines involves a local appraisal by health technology assessment (HTA) bodies and competent authorities about the value for money, the budget impact, and the local medical need that can be filled with new medicines. Therefore, local priorities and national health care policy environme

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… In Ireland, new medicines with an ICER below 45,000 € per QALY tended to be reimbursed. … Recent developments in pharmacoeconomic evaluation in Ireland. Expert Rev. Pharmacoecon. Outcomes Res. 10, 221–224 10.1136/bmj.326.7385.388 Van Wilder P., Dupont A. (2008). Introducing evidence-based medicine in reimbursement procedures: does it affect the outcome? …

Reimbursement of licensed cell and gene therapies across the major European healthcare markets.

ObjectiveThe aim of this research is to identify the pricing, reimbursement, and market access (P&R&MA) considerations most relevant to advanced therapy medicinal products (ATMPs) in the Big5EU, and to inform their manufacturers about the key drivers for securing adoption at a commercially viable reimbursed price.MethodologyThe research was structured following three main steps: 1) Identifying the market access pathways relevant to ATMPs through secondary research; 2) Validating the secondary research findings and addressing any data gaps in primary research, by qualitative interviews with nat

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… Although commissioning decisions made by NHS England influence those made by NHS Northern Ireland, NHS Scotland and NHS Wales, these UK regions maintain autonomy with respect to P&R&MA processes. … NICE guidance on service developments and therapies considered to be suitable for reimbursement within the NHS extend to Northern Ireland, albeit being subject to local review and funding. The early benefit assessment is a central part of the AMNOG P&R reform, which was introduced in 2010. …

Contradictory guidance, divided practice: a national survey of the compression screw in dynamic hip screw fixation.

BACKGROUND: The compression screw is an optional ancillary component of the dynamic hip screw construct. Guidance on whether to use it, and whether to retain or remove it, is contradictory between the AO, the manufacturers and the biomechanical literature, and no clinical study has compared the two. The aim was to establish current UK practice, understanding and training. METHODS: A ten-question electronic survey was distributed through Training Programme Directors in all 23 United Kingdom deaneries and through trainee networks, open from 20 April to 19 July 2025. Users were defined from the

Evaluating the potential ethical and legal challenges of transitional care in urological surgery - A tale of two continents.

Transitional urology services have been shown to be essential in promoting health, reducing morbidity and mortality, and lowering healthcare costs, with no ethical grounds for objection. There is a need for an integrative framework in transitional care, focusing on autonomy, trust, equality, and human rights, as well as to address disparities faced by adolescents with congenital and acquired urological conditions in countries without formalised transitional care. European countries without a formal transition and congenital adult service may find themselves in breach of the European Convention

Clinical effect of Acostream thrombus aspiration device on early acute superior mesenteric artery embolism.

OBJECTIVE: To investigate the feasibility, safety and efficacy of Acostream thrombus aspiration device in the treatment of early acute superior mesenteric artery embolism. METHODS: A total of 51 patients with ASEAE in our hospital from May 2020 to May 2025 were enrolled, and their clinical data were retrospectively analyzed. According to different surgical methods, 27 cases were treated with Acostream thrombus aspiration device ((PCDT group), 24 cases were treated with catheter thrombolysis (CDT group). Clinical efficacy and surgical complications were observed and evaluated. RESULTS: All pa

Metaplastic breast cancer: A single-centre retrospective experience.

BACKGROUND: Metaplastic Breast Cancer (MpBC) is a rare disease entity accounting for less than 1% of all breast cancers. There is limited data focusing on this aggressive disease. The aim of this study was to evaluate the incidence of MpBC at a UK centre and describe the demographic variables, clinical characteristics and treatment. METHODS: Between 2017-2024, we have reviewed 23 patients diagnosed with histologically proven MpBC from the hospital cancer database. RESULTS: A total of 2097 patients were diagnosed with breast cancer in our centre between 2017-2024, of which 23 patients were di