The management of patients with urinary tract stone disease has changed dramatically over recent years, with current treatment modalities focused on their minimal invasiveness. In this article we will discuss the recent advances in the field of urolithiasis management, with a focus on medical expulsive therapy, extra-corporeal shockwave lithotripsy and ureteroscopy.

Background Most medical liver biopsies in the UK are now taken in radiology departments using 18 g biopsy needles. Subjectively, the resulting biopsies are narrow and fragile. Aim To compare the quality of liver biopsy tissue sections obtained from 16 and 18 g biopsy needles. Method Fifty consecutive routine medical liver biopsies obtained with 16 and 18 g needles, processed identically in the same laboratory, were measured using digital pathology software. We recorded their fragmentation, length, width, area and number of portal tracts. Results Biopsies obtained with 16 g needles more often resulted in an intact core in tissue sections than those with 18 g needles (71% vs 24%, p<0.001) and were significantly wider (average width of tissue 0.88 vs 0.53 mm, p<0.001). The average total area of tissue per pass was 11.38 mm2 compared with 8.34 mm2 (p<0.001). The number of complete portal tracts per length of biopsy was very variable, but double for 16 vs 18 g biopsies. Routinely taking two passes with the 18 g needle compensated for the reduced area, but the resulting liver in tissue sections was fragmented and distorted. Conclusions Our results support the routine use of 16 g rather than 18 g biopsy needles for routine ultrasound-guided medical liver biopsies. A second pass should be considered if the first biopsy core is short, especially for investigation of disease stage.

Desmoid tumours are benign tumours originating from the musculo- aponeurotic structures of the body. They are mainly composed of collagen. These tumours commonly occur in post-partum women in whom they originate from the rectus abominus and in old surgical incisions. Here we present a case report of a young gentleman who presented with an acute surgical abdomen and subsequently underwent a laparotomy and was found to have an inflammatory mass. Histological analysis of this mass revealed mesenteric fibromatosis (desmoid tumour). I wish to present this interesting case because the patient was neither female nor someone who had previously undergone any surgery. It is rare for mesenteric fibromatosis to present with intestinal perforation and only one case been reported in the literature thus far (1). An important learning point from this case is that rare pathology can manifest itself with common signs and symptoms.

An American site from University of Pennsylvania specifically designed for trainees rotating to intensive care medicine-'Residents rotating through intensive care often complain that they are unfamiliar with the nomenclature and disease processes which they encounter'. The teaching topics are broken down into systems, which contain high-quality slides with appropriate diagrams. However, some of the tutorials are missing and linked to blank pages.** http://www.aic.cuhk.edu.hk/web8/novices.htm 'This is a series of ICU topics written for junior medical trainees and nurses who have no previous experience of intensive care'. Highly informative contents, well presented, tutorials, and covers a wide range of topics. Pitched at the right level for the surgical trainee. Assessment is available but questions are limited.****

eing a doctor, whether a physician or a surgeon, entails a good knowledge of radiology. Not all of us will acquire the same level of diagnostic interpretive skills as a radiologist, but having basic radiology knowledge will help clinicians to a great extent in their daily duties. In this article, we have reviewed six useful websites with free online radiology teaching material that will be of benefit to all clinicians.We performed a ''google'' search on the internet with the term ''radiology teaching files'' and this yielded 721 000 hits. We reviewed sites that seemed to be educationally orientated. Here are six of the most helpful sites that we consider to be useful to the junior medical practitioner. At the end, each site is rated out of five stars with five being the highest mark achieved. Our review criteria is not strictly based on the Darmoni principle but on our expectations as junior doctors and what we deem to be appropriate for our level. These encompass the following: