Histories of twentieth-century surgery have focused on surgical ‘firsts’ – dramatic tales of revolutionary procedures. The history of tonsillectomy is less glamorous, but more widespread, representing the experience and understanding of medicine for hundreds of children, parents and surgeons daily. At the start of the twentieth century, tonsillectomy was routine – performed on at least 80 000 schoolchildren each year in Britain. However, by the 1980s, public and professional discourse condemned the operation as a ‘dangerous fad’. This profound shift in the medical, political and social position of tonsillectomy rested upon several factors: changes in the organisation of medical institutions and national health care; changes in medical technologies and the criteria by which they are judged; the political, cultural and economic context of Britain; and the social role of the patient. Tonsillectomy was not a mere passive subject of external influences, but became a potent concept in medical, political, and social discourse. Therefore, it reciprocally influenced these discourses and subsequently the development of twentieth-century British medicine. These complex interactions between ‘medical’ and ‘non-medical’ spheres question the possibility of demarcating what is internal from what is external to medicine.

Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non‐steroidal anti‐inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student‐ and trainee‐led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre‐specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non‐selective cyclo‐oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.

The objective of this study is to evaluate stapes surgery in patients with otosclerosis and ''profound'' hearing loss. This means they meet hearing threshold criteria for cochlear implantation (CI). We performed a retrospective study and patient questionnaire. The results from 33 patients (35 ears) were recorded (mean age: 63.6, range: 40-85). The primary outcome measure was hearing thresholds recorded before and after surgery at 0.5, 1, 2, 3, and 4 kHz. Hearing thresholds at 2 and 4 kHz were also analyzed. Glasgow Benefit Inventory (GBI) was used in 21 patients to assess life quality changes. Hearing thresholds improved in 80% of ears (mean improvement, 26.3 dB), were unchanged in 11.4%, and worsened in 8.6%. Mean GBI score was þ20.7. Hearing aid use decreased in 23.8% and ceased in 28.6%. One patient subsequently underwent CI. For patients with profound otosclerosis, stapes surgery provides a quantitative improvement in hearing thresholds and improvement in quality of life, with reduced reliance on hearing aids. This avoids CI, auditory rehabilitation, and a change in quality and tonality of sound.

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Objectives: To synthesise existing evidence for the diagnostic accuracy of chest radiographs to detect lung malignancy in symptomatic patients presenting to primary care. Methods: A systematic review was performed and reported in accordance with the PRISMA framework, using a protocol prospectively registered with the PROSPERO database (CRD42020212450). Nine databases were searched for relevant studies. Data were extracted and chest radiograph sensitivity and specificity calculated where possible. Risk of bias was assessed using a validated tool. Random effects meta-analysis was performed. Results: Ten studies were included. Sensitivity meta-analysis was performed in five studies which were not the high risk of bias, with summary sensitivity of 81% (95% CI: 74–87%). Specificity could be calculated in five studies, with summary specificity of 68% (95% CI: 49–87%). Conclusions: The sensitivity of chest radiographs for detecting lung malignancy in primary care is relatively low. Physicians and policymakers must consider strategies to attenuate the possibility of false reassurance with a negative chest radiograph for this significant pathology. Options include widening access to cross-sectional imaging in primary care; however, any intervention would need to take into account the medical and financial costs of possible over-investigation. Prospective trials with long-term follow-up are required to further evaluate the risks and benefits of this strategy. Advances in knowledge: The chest radiograph has a sensitivity of 81% and specificity of 68% for lung malignancy in a symptomatic primary-care population. A negative chest radiograph does not exclude lung cancer, and physicians should maintain a low threshold to consider specialist referral or cross-sectional imaging.