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Introduction: The direct anterior approach (DAA) for hip arthroplasty has gained popularity in recent years with numerous articles suggesting that short-term outcomes are advantageous over alternative approaches. The ‘bikini’ inguinal crease line incision is a novel variant of the DAA, which reduces the scar. Methods: We conducted a retrospective cohort study to assess functional and general health outcomes and complications of the two different surgical incisions used in DAA total hip arthroplasty (i.e. ‘bikini’ and longitudinal incisions). Results: We found no statistical difference between the novel bikini incision and the traditional DAA hip arthroplasty. Conclusion: This approach offers a cosmetically improved scar with no compromise in outcomes.

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To establish the healthcare factors that contribute to testicular torsion adverse events (orchidectomies) and 'near misses'. The secondary objective was to identify areas suitable for impactful quality improvement initiatives to be undertaken by National Health Service (NHS) healthcare providers nationally. Materials and MethodsThis was a retrospective record review and analysis, carried out in four phases. We applied the well-validated London Protocol patient safety incident analysis framework to all eligible serious incidents related to testicular torsion submitted by English NHS Trusts over a 12-year period to the Strategic Executive Information System database. Clinical reviewers established the incident population (Phase 1), were trained and piloted the feasibility of using the London Protocol (Phase 2), applied the protocol and themed the identified contributing factors linked to adverse events (orchidectomies) and nearmisses (Phase 3), and reviewed the evidence for improvement interventions (Phase 4).

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We present a rare case of a four-year-old boy with a botyroid embryonal rhabdomyosarcoma of the right middle ear. Rhabdomyosarcoma is a soft tissue malignancy which is thought to originate from embryonic mesenchymal cells of striated skeletal muscle.  It is a disease primarily of children and is exceptionally rare in parameningeal regions.  The diagnosis is often delayed and easily misdiagnosed as aural polyp. Therefore, advanced disease is common at the time of diagnosis.  A four-year-old boy presented with a four-month history of recurrent left ear blood and pus discharge, otalgia and fevers. He attended his GP three times and paediatric A&E 13 times where he received antibiotics for presumed otitis media and externa. He was eventually referred to the otolaryngology department and underwent an examination under anaesthesia of ear and excisional biopsy of a suspicious aural polyp.  Staging chest CT and PET scan showed no loco-regional spread or distal metastasis. Magnetic resonance imaging demonstrated absence of invasion into adjacent organs.  Histology confirmed embryonal rhabdomyosarcoma, botryoid subtype.  Subsequent to the initial excision of the polyp, he was started on an ifosfamine, vincristine and actinomycin (IVA) chemotherapy regime in three weekly cycles for nine cycles with concomitant radiotherapy. Two weeks subsequent to his first chemotherapy dose he presented with a House-Brackmann II-III facial nerve palsy but no other middle ear complications. He was started on intravenous antibiotics and dexamethasone. The facial nerve palsy incompletely resolved with treatment.

We present a rare case of a four-year-old boy with a botyroid embryonal rhabdomyosarcoma of the right middle ear. Rhabdomyosarcoma is a soft tissue malignancy which is thought to originate from embryonic mesenchymal cells of striated skeletal muscle.  It is a disease primarily of children and is exceptionally rare in parameningeal regions.  The diagnosis is often delayed and easily misdiagnosed as aural polyp. Therefore, advanced disease is common at the time of diagnosis.  A four-year-old boy presented with a four-month history of recurrent left ear blood and pus discharge, otalgia and fevers. He attended his GP three times and paediatric A&E 13 times where he received antibiotics for presumed otitis media and externa. He was eventually referred to the otolaryngology department and underwent an examination under anaesthesia of ear and excisional biopsy of a suspicious aural polyp.  Staging chest CT and PET scan showed no loco-regional spread or distal metastasis. Magnetic resonance imaging demonstrated absence of invasion into adjacent organs.  Histology confirmed embryonal rhabdomyosarcoma, botryoid subtype.  Subsequent to the initial excision of the polyp, he was started on an ifosfamine, vincristine and actinomycin (IVA) chemotherapy regime in three weekly cycles for nine cycles with concomitant radiotherapy. Two weeks subsequent to his first chemotherapy dose he presented with a House-Brackmann II-III facial nerve palsy but no other middle ear complications. He was started on intravenous antibiotics and dexamethasone. The facial nerve palsy incompletely resolved with treatment.

Introduction Multi-parametric magnetic resonance imaging (mp-MRI) is currently used to triage patients with suspected prostate cancer, before deciding on prostate biopsies. In our study, we evaluated normal and equivocal pre-biopsy mp-MRIs to see whether it is safe to avoid biopsy with such findings. Methods A retrospective study was conducted at a district general hospital in the UK between August 2017 and July 2018. Patients with negative and equivocal prebiopsy mp-MRI with high clinical suspicion of cancer had proceeded to biopsy. MRI reports with prostate imaging reporting and data system (PI-RADS) scores 1, 2, 3 and normal MRI were evaluated against the transrectal ultrasound-guided prostate biopsy (TRUS-PB) outcomes to demonstrate benign pathology, clinically insignificant or clinically significant cancer (csCa). CsCa was defined as Gleason score (GS) ≥3 + 4. Results Out of 265 mp-MRIs studied, five (1.9%) were PI-RADS 1, 109 (41.1%) and 84 (31.7%) were PI-RADS 2 and 3 lesions respectively; 67 (25.3%) were reported as normal. Seventy-five (27.3%) patients did not have biopsies following their MRI and 73.3% (51/75) of them had benign feeling prostate. Negative MRIs (PI-RADS 1, 2 and normal MRI) showed 8.8% and PI-RADS 3 lesions demonstrated 11.9% csCa. Negative predictive value for normal MRI was 91.2%. Mean PSA density (PSAD) among the benign, GS 3 + 3 and csCa was 0.14, 0.16 and 0.27 ng/ml/ml respectively and this was statistically significant ( p < 0.001). The average percentage of cancer found in GS 3 + 3 and csCa was 3.2% and 20.1%, respectively. Conclusion Avoiding TRUS-PB following normal or equivocal mp-MRI should carefully be decided as 18.5% of cancer was demonstrated in this group and 9.8% of those who were diagnosed with cancer were csCa. PSAD and DRE findings provide additional information to help with this decision.