Background: Referrals of men to breast assessment clinics are increasing. While most of the men will have benign disease, some of them will have breast cancer. Whichever pathology they have, men should be offered a service tailored to their needs, rather than being ‘shoe-horned' into a service designed to care for women. This paper explores the psychological impact on men of their condition and of attending a breast assessment clinic. Methods: The literature regarding male experience of breast problems is reviewed, and screening for psychological morbidity is discussed. Results of a survey regarding an all-male breast assessment clinic are reported, with a plan for future research. Results: Many of the 78 men surveyed described negative feelings relating to their condition although they did not want to be seen in an all-male breast assessment clinic if that meant a longer wait. Men reported feelings of anxiety, embarrassment, emasculation and even depression regarding their condition. Conclusions: Men are distressed by gynaecomastia and need psychological support for any breast-related presentation. More formalised research into this area is needed, although the men's distress does not translate into the desire to attend an all-male assessment clinic if this means a longer wait before being seen.

Guidewires are commonly used in clinical practice over a wide range of specialties. Their use has become more popular as a result of advances in endourology and interventional radiology, as well as in angiographic procedures. While there are many papers regarding individual guidewires and certain technical aspects, for the interested clinician there is little to give a generalized overview within the literature. This paper aims to review guidewires in terms of their make-up, applications and potential complications. Technical points are described, as well as rescue methods for complications, in the hope of preventing future litigation for those reading the paper.

Background: Pneumomastia is air within the breast parenchyma. A number of causes have been reported for this condition. This case report describes a new cause and details of the management strategy applied, together with a review of the literature. Case Report: We describe a case of acute breast swelling in a 40-year-old woman and its subsequent successful conservative management. Conclusion: Bronchopleural fistula after thoracotomy is a risk, and can cause pneumomastia. This is more likely to occur after redo thoracic surgery. Pneumomastia after repeat thoracotomy can be managed conservatively, even in the presence of a bronchopleural fistula.

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IntroductionIt is a common practice to subclassify patients with chronic constipation (CC) as having slow or normal transit using radio-opaque marker studies. However, the procedure has never been validated for construct validity and shows poor responsiveness. Recent reports have shown no correlation with symptoms or quality of life1; there is no correlation between transit and faecal loading2; and little value in assessing segmental transit3. Even so, perhaps it would be valuable in predicting outcome. The aim of this study was to assess outcome in patients with CC who had undergone a transit study.MethodsThe case notes of consecutive follow-up patients attending a specialist constipation clinic were surveyed. Patients for the study group were selected on the basis of fulfilling the Rome III criteria for chronic constipation (FC or IBS-C) and having colonic transit measured at the first clinic assessment. This was done using a validated radio-opaque marker technique. Details of treatments were recorded together with demographic details. Patients were divided into two groups depending on the type of treatment required to stabilise symptoms (conservative=laxatives, biofeedback, rectal irrigation; surgical=SNS, rectocoele repair, ACE, stoma, colectomy). Paired student t-test was used to calculate the difference between the colonic transit times of the two groups. Subject were divided into patients with slow transit constipation (STC) (>45 markers retained) and normal transit constipation (NTC). The significance of treatments provided in each group was calculated using Fisher's exact test.Results148 patients were included, aged 18–72 years (mean 42.2 years). There were 22 men and 126 women. 79(53%) patients were satisfactorily managed with conservative treatment and 69 (46%) required surgical treatment. The mean transit time for conservative group was 56.13 h (SD 18.10) vs 55.14 h (SD18.32) for the surgical group. Paired t test did not demonstrate any differences between the transit times of the two groups (two-tailed p value 0.4761). There were 108 patients with STC and 40 with NTC. 53/108 (49%) had biofeedback in STC group whereas 16/40 (40%) in NTC group underwent biofeedback. There were no differences between STC and NTC groups (p value 0.3581).ConclusionThere is no evidence from these data that transit times influence outcome. The use of slow transit to determine therapy has never been proven and further work is required to justify the validity of subclassification based on transit.

We present what maybe the only case of splenic infarction causing hyperamylasaemia in a patient with bacterial endocarditis. A 49-year-old gentleman presented a 24 hour history of vomiting, abdominal pain and fever. Clinical examination showed diffuse upper abdominal tenderness, a mild tachycardia and a low grade pyrexia. Blood investigations showed a hyperamylasaemia. His failure to improve on treatment for a provisional diagnosis of alcohol induced pancreatitis lead to a CT abdomen, which showed a splenic infarct and an echo showing aortic valve vegetation's as a source of emboli. He underwent urgent aortic valve replacement with a tissue valve following which he made an uncomplicated recovery.