24-Month Outcomes of Indirect Decompression Using a Minimally Invasive Interspinous Fixation Device versus Standard Open Direct Decompression for Lumbar Spinal Stenosis: A Prospective Comparison.

Purpose: An early-stage, multi-centre, prospective, randomised control trial with five-year follow-up was approved by Health Research Authority to compare the efficacy of a minimally invasive, laterally implanted interspinous fixation device (IFD) to open direct surgical decompression in treating lumbar spinal stenosis (LSS). Two-year results are presented.

Patients And Methods: Forty-eight participants were randomly assigned to IFD or decompression.

Lumbar spine radiographs - is it time for widespread adoption of posteroanterior projection?

Objective: Phantom studies and a prior patient study have shown up to 53% effective dose reduction when lumbar spine radiographs are acquired posteroanterior (PA) instead of anteroposterior (AP). Since November 2017, Taunton and Somerset NHS Foundation Trust has acquired all standing lumbar spine radiographs PA. The aim of this study was to locally evaluate dose and image quality in both projections and survey current UK practice.

A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy.

Purpose: Transforaminal endoscopic discectomy (TED) minimises paraspinal muscle damage. The aim of this trial was to compare clinical outcomes of TED to Microdiscectomy (Micro).

Methods: 143 patients, age 25-70 years and <115 kg, with single level lumbar prolapse and radiculopathy, were recruited and randomised.

The Role of Magnetic Resonance Imaging in the Investigation and Management of Invasive Lobular Carcinoma-A 3-Year Retrospective Study in Two District General Hospitals.

Invasive lobular carcinoma (ILC) accounts for 5-15% of breast cancers. In comparison to other types of breast cancer, ILC is more likely to be associated with multifocal and contralateral breast involvement as well as a tendency to a diffuse infiltrative growth pattern which can represent a diagnostic challenge. The National Institute of Clinical Excellence guidelines in 2009 recommended the use of magnetic resonance imaging (MRI) in the preoperative assessment of ILC.

Smartphone apps for spinal surgery: is technology good or evil?

Purpose: The increased utilization of smartphones together with their downloadable applications (apps) provides opportunity for doctors, including spinal surgeons, to integrate such technology into clinical practice. However, the clinical reliability of the medical app sector remains questionable. We reviewed available apps themed specifically towards spinal surgery and related conditions and assessed the level of medical professional involvement in their design and content.

Endoscopic transnasal surgery as a replacement for maxillotomy techniques to approach the central skull base: fewer complications and more acceptable to patients?

Objectives To compare the complication rates of endoscopic transnasal and open maxillotomy approaches for the central skull base. Design Retrospective review. Setting Single-center study, London, United Kingdom.

The prognostic significance of the insulin-like growth factor-1 ligand and receptor expression in breast cancer tissue.

Background And Objectives: Previous in vitro studies have suggested that IGF-1 stimulation can lead a more aggressive breast cancers and subsequent poor prognosis in breast cancer patients. We aim to how IGF-1 and IGF-1R mRNA levels in breast cancer are associated with disease-free survival (DFS) and other clinicopathological factors.

Methods: IGF-1 and IGF-1R mRNA levels were measured in breast cancer tissue from 132 patients using real-time PCR.

Measuring IGF-1, ER-α and EGFR expression can predict tamoxifen-resistance in ER-positive breast cancer.

In vitro studies have suggested that tamoxifen resistance may be due to altered expression and downstream signalling of insulin-like growth factor-1 (IGF-1) receptor (IGF-1l), oestrogen receptor-alpha (ERα), epidermal growth factor receptor (EGFR) and HER-2. We investigated which gene expressions could predict tamoxifen resistant breast cancer. Expression of IGF-1R, IGF-1 ligand (IGF-1), ERα, EGFR and HER-2 in 91 ER-positive breast cancer tumours were measured using real-time PCR and correlated with clinical outcome.

Septic shock after posterior spinal arthrodesis on a patient with Scheuermann kyphosis and multiple body piercings.

Study Design: A case report.

Objective: We report septic shock as postoperative complication following an instrumented posterior spinal arthrodesis on a patient with multiple body piercings. The management of this potentially catastrophic complication and outcome of treatment is been discussed.

The role of Herceptin in early breast cancer.

Herceptin is widely regarded as the most important development in the treatment of breast cancer since Tamoxifen and the development of the multidisciplinary team (MDT). It is particularly exciting from an oncological polint of view as it represents success in the emerging field of specific targeted therapies to specific molecular abnormalities in tumour cells. This review will focus on the nature of the Her2 overexpression and the role of herceptin in the treatment of early breast cancer.

Lymphangiogenesis and lymph node metastasis in breast cancer.

Introduction: There have been few studies on lymphangiogenesis in the past due to the lack of specific lymphatic endothelial markers, and lymphatic-specific growth factors. Recently, these limitations have been relieved by the discovery of a small number of potential lymphatic-specific markers. The relationship between lymphangiogenesis and regional or distant metastasis has not previously been investigated in humans.

The use of abbreviations in medical records in a multidisciplinary world--an imminent disaster.

Abbreviations are commonly used in the medical world to save time and space whilst writing in the patients' medical records. As various specialties have evolved, each has developed a collection of commonly used abbreviations within its practice, which may not be recognizable to those not working within the same field. The purpose of this study was to assess whether we, the multidisciplinary team members, correctly interpret the abbreviations used in the medical records.

Oestrogen producing enzymes and mammary carcinogenesis: a review.

There is a large and compelling body of epidemiological and experimental evidence that oestrogens are instrumental in the aetiology of breast cancer. Their mechanisms of action are varied, including stimulation of cellular proliferation through receptor-mediated hormonal activity, increasing genetic mutation rates through cytochrome P450-mediated metabolic activation, and induction of aneuploidy. The local biosynthesis of oestrogens especially in postmenopausal women is believed to play a very important role in the pathogenesis and development of hormone dependent breast carcinoma and the over-expression of regulatory enzymes seems to be associated with the development of a more aggressive disease and associated with poor outcome and increased local and distant recurrences.

Pagets disease of uncertain origin: case report.

Background: Pagets disease of the nipple presents as an eczematous lesion, occurs in 1 - 4% of all female breast carcinoma cases and is invariably associated with underlying malignancy either overt or occult. The majority of these cases are invasive disease although 40-45% are associated with DCIS.

Case Presentation: A 39 year old lady presented to our unit with a palpable lump in the right breast.

An unusual cause of chest pain:case report.

Background: Sarcomas form a heterogenous group of relatively uncommon malignant tumours which are derived from connective tissue components. In total they comprise approximately 1% of all new cancers diagnosed per year in the United Kingdom (UK). As subset of this, the 'Unclassified' Sarcoma forms approximately 4% of the total 1.

"About a cupful"--a prospective study into accuracy of volume estimation by medical and nursing staff.

In this prospective study, medical and nursing health care professionals were asked to visually estimate various fluid volumes. The aims were to assess overall accuracy, and to identify factors that caused error. The effects of fluid volume, colour and clinical experience were analysed.

Isolated fracture of the coracoid process associated with unstable shoulder.

We report on an unusual case where a seemingly trivial injury in a patient on immunosupressant therapy led to fracture of the coracoid and an unstable shoulder with a subscapularis tear. This was managed with open reduction and internal fixation. One year postoperatively, the patient had regained full function and range of motion.