A career in surgery has always been a highly desired pathway for trainee doctors. However, cutbacks in training posts and limitations imposed on junior doctors as a result of the European Working Time Regulations mean that a surgical career is quickly becoming an even more intensely competitive (and somewhat daunting) pathway to embark upon. Are these factors discouraging medical graduates before they even embark on their foundation training?

Obesity is fast becoming one of the world's leading health problems and together with its many associated medical sequelae significantly increases morbidity and mortality. In this review, we briefly explore the history of bariatric surgery, the benefits of surgery and the various procedures carried out.

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In this study, incidental findings were discovered in 26.7% of patients with known oesophagogastric cancer. A second primary cancer or premalignant lesion was found in 8.4% of patients with incidental findings. Patients with these findings should be investigated to rule out further malignancy. There were a high proportion of false positive results in our study. It is recommended that each patient is considered on an individual basis and assessed with simultaneous PET and computed tomography.

INTRODUCTION Primary hyperparathyroidism (PHPT) is a common condition (250 per million population per year) with significant associated morbidity and mortality. 1 Surgery is the only curative option for PHPT; results from medical treatment remain disappointing. 2 The aim of this study was to evaluate the referral patterns of patients with PHPT and identify the number of missed cases with a biochemical diagnosis of PHPT. MATERIALS AND METHODS All chemistries for Worcestershire were performed and analysed at the Worcestershire Royal Hospital. Patients with chronic renal failure were identified and excluded. Routes of patient referral were identified and missed cases documented. General practitioners (GPs) were contacted by letter for all patients not referred or treated. Outcomes of diagnosis and specialist assessment were recorded. RESULTS A total of 102 cases of PHPT were identified: 64 (62.7%) remained untreated and without a specialist referral in place, 36 (35.3%) had undergone parathyroidectomy and 2 (2.0%) were being monitored. The GP response rate was 90% (46/51). Of these, 30 (65%) were subsequently referred, 9 (20%) underwent repeat tests with a view to referral and 7 (15%) were lost to follow up. CONCLUSIONS A significant proportion of patients with PHPT remain in the community untreated and having not seen a specialist. All patients should be referred to a specialist for assessment and consideration of surgical treatment and follow-up. Improvements in GP education and referral systems are required if patients are to benefit.