Despite significant improvement over recent decades, oesophageal cancer survival rates remain poor. Neoadjuvant chemoradiotherapy followed by oesophageal resection is mainstay of therapy for resectable oesophageal tumours. Operative morbidity and mortality associated with oesophagectomy remain high and complications arise in up to 60% of patients. Management strategies have moved towards definitive chemoradiotherapy for a number of tumour sites (head and neck, cervical, and rectal) particularly for squamous pathology. We undertook to perform a review of the current status of morbidity and mortality associated with oesophagectomy, grading systems determining pathologic response, and data from clinical trials managing patients with definitive chemoradiotherapy to inform a discussion on the topic.

Purpose The purpose of this study was to evaluate the quality and readability of information online for patients searching terms related to arthroscopic Bankart repair (ABR). Methods Google, Yahoo and Bing were searched with terms related to ABR. The quality of information was assessed using the Journal of the American Medical Association (JAMA) Benchmark criteria, DISCERN Score, and the Flesch–Kincaid Reading Ease & Grade Level. The presence of the HONcode marker was noted. Additionally, we used a scoring system specific to content relating to the ABR (AB score), a 1–20 Likert scale. Websites were also categorised according to the source: academic institution, physician, allied healthcare, commercial, media or social media. Statistical analysis was performed using GraphPad Prism. Results Ninety-six unique websites were evaluated, with the most common website category being physician websites (52) and academic institution websites (24). There were nine websites with the HONcode marker. The average JAMA Benchmark criteria score was 1.95 (1–4), the average DISCERN score was 48.8 (20–78), with an average Flesch–Kincaid reading ease of 50.9 (11–96) and grade level of 8 (1–18). The average AB score was 5.9 (0–18), and there was a strong correlation with a higher DISCERN score (r=0.57), but not JAMA score (r=0.18) or Flesch–Kincaid grade (r=0.16). Websites with the HONcode marker did not score higher in any criteria than those without it (p>0.05). The quality of information on physician websites was better than (statistically insignificant) non-physician websites; however, the readability of information in the former was poorer (statistically significant) than the latter. Conclusion There was wide variability in the quality and readability online of the information on ABR, and the AB scoring system was shown to correlate strongly with increased quality.

BackgroundSutureless aortic valve prostheses are anchored by radial force in a mechanism similar to that of transcatheter aortic valve implantation (TAVI). TAVI is associated with an increased permanent pacemaker (PPM) requirement in a significant proportion of patients. We undertook a meta-analysis to examine the incidence of PPM insertion associated with sutureless compared with conventional SAVR.MethodsA systematic review was conducted in accordance with the Prisma guidelines (1). PubMed was searched by entering the following in the searching algorithm: sutureless AND aortic AND valve, tissue AND aortic AND valve, mechanical AND aortic AND valve. English was set as a language restriction. All searches were performed on August 10th2014.Studies between 2007 and 2014 were included in the search. A mixed-effects meta-regression with sutureless vs conventional as a fixed moderator variable was performed.ResultsIn total, 832 patients were included in the sutureless group and 3,740 in the conventional group. Permanent pacemaker implantation rate was higher in the sutureless cohort (9.1 vs 2.4% p = 0.025). Cardiopulmonary bypass and aortic cross clamp times were shorter in the sutureless group (64.9 vs. 86.7 min p = 0.002, 39.8 vs. 62.4 min p < 0.001). No statistically significant differences in PVR grades 1–4 were identified between groups (Grade 1: 3.6 vs. 1.4% p = 0.107, Grade 2: 0.9 vs. 0.3% p = 0.264, Grade 3–4 0 vs. 0.4% p = 0.942). There was no difference in 30-day mortality between sutureless and conventional cohorts (1.9 vs. 3.2% p = 0.146).ConclusionSutureless aortic valve prostheses are associated with a higher incidence of PPM insertion but shorter implantation time than conventional, with no difference in 30-day mortality. Further investigation as to the prognostic significance of pacemaker requirement following sutureless aortic valve replacement is required.

Introduction: Women with B5a (non-invasive) preoperative core biopsies upgraded to invasive disease at surgery have a high chance of needing further surgery. The average B5a upgrade rate across UK breast screening programmes is around 20%. Through this Scottish review, we aim to identify factors affecting upgrade rates and ways to improve our performance. Methods: This was a retrospective analysis of 1,252 cases of B5a biopsies from the Scottish Breast Screening Programme between 2004 and 2012. Final surgical pathology was correlated with radiological and biopsy factors. Results: B5a upgrade rates for the units ranged from 19.2 to 29.2%, with average of 23.6%. Mean sizes of invasive tumours were small (3 to 11 mm). Upgrade rate was significantly higher for cases where the main mammographic abnormality was mass, distortion or asymmetry, compared with microcalcification alone (33.2% vs. 21.7%) (P = 0.0004). The upgrade rate was significantly lower with use of large-volume vacuum-assisted biopsy (VAB) devices than 14-gauge core needles (19.9% vs. 26%) (P = 0.013). The upgrade Introduction: MRI is a common method for detecting breast cancer in women at high risk [1,2] These women may instead be diagnosed mammographically or present symptomatically. The aim of this study was to investigate how breast cancer is diagnosed in high-risk women and determine whether there are specific characteristics related to the type of presentation. Methods: A total of 125 high-risk patients with 134 breast cancers (69 BRCA, 65 family history) were managed at the Royal Marsden Hospital from 1994 to 2013. Following ethical approval, data were collected retrospectively for each presentation of breast cancer: method of presentation/diagnosis (MRI, mammography, symptomatic), age at diagnosis, cancer type, grade, size, presence of DCIS, lymphovascular invasion (LVI), nodal status and tumour subtype. Chi-squared and ANOVA analyses determined any association between the parameters, P < 0.05 was significant. Results: Ten breast cancers were MRI detected, 43 mammography detected and 81 symptomatic (mean age 41, 51, and 45 years (P = 0.008); mean size 17, 29, and 34 mm (P = 0.076) respectively).The majority of cancers were high-grade (68%) invasive ductal carcinomas (78%) without LVI (76%). MRIdetected cancers were triple negative in 60% (P = 0.03), node negative in 100% (P = 0.005) with DCIS in 70% (P = 0.007). Mammography-detected cancers were luminal in 77% (P = 0.03), node negative in 77% (P = 0.005), with DCIS in 81% (P = 0.007). Symptomatic cancers were luminal in 54%, triple negative in 41%, node negative in 56% and DCIS positive in 51%. Conclusion: In this high-risk cohort, MRI detects small, triple-negative, node-negative cancers in younger women, while mammography detects larger, luminal, cancers in older women that may be node positive. Introduction: Anisotropy is the directional dependence of the measurement of a property. As breast tissue structure and some breast diseases (DCIS) are anisotropic in structure, we aimed to establish ...