The most common intracranial lesions are metastases and malignant (e.g., astrocytomas) or benign (e.g., meningiomas, acoustic neuromas) primary tumours. Primary benign brain tumours and malignancies are much less common than brain metastases. Stereotactic radiosurgery has become an accepted treatment option for patients with meningiomas, vestibular schwannomas and pituitary adenomas.

Each year, thousands of patients worldwide undergo radiosurgery for these benign tumour types. In many ways, patients with benign tumours are ideal candidates for radiosurgery. Primarily, unlike malignant gliomas, these tumours rarely invade the adjacent tissue and therefore highly focused and precise treatments such as stereotactic radiosurgery can be used to completely treat the entire tumour. Secondly, benign tumours are typically well visualized by magnetic resonance imaging (MRI). This permits a clear delineation between the tumour and nearby structures so unnecessary radiation exposure to healthy tissue can be minimized. Lastly, radiosurgery of benign tumours makes good use of the radiobiologic principles.

For benign tumours, both the target and the adjacent nervous system act as late responding tissues due to their slow rate of proliferation. Consequently, dose fractionation adds little theoretical benefit compared to conformal, single fraction radiation delivery. SRS is especially attractive to patients with malignant brain tumours because of its minimally invasive nature and the fact that no recovery period is required after the procedure is completed.

The new urine sample collection system is most urgently needed in the ante-natal setting where pregnancy provides a particular challenge. However, it will also ease the fuss for most other patients including the disabled and for children.

This has led to people spending 21 days of every year on pain relief medication, or 1,649 pill-popping days over an average life span of 78.5 years. And the average person is forced to seek medical attention for their ailments at least three times a year.

The poll shows the most common complaint suffered across the nation is frequent bouts of cramp. Cramp affects individuals up to 19 times a year – or 1,492 times over the average life span of 78.5 years. People can also expect to have at least 16 headaches during the course of one year – which equates to 1,256 over a lifetime. And the third ailment most likely to impair every day life is back pain – endured by Brits 14 times a year and an agonising 1,099 times in total.

Click here for an authoritative article on the latest treatment options for Endometriosis by UCL senior Gynaecological Consultant Ertan Saridogan.

In stage I non-small-cell lung cancer (NSCLC) standard treatment is still surgery, in younger patients sometimes followed by systemic chemotherapy. For those patients in early NSCLC stages with pre-existing co-morbidity, advanced age or refusal of operation definitive radiation therapy alone may be the standard treatment option. High biologically effective radiation doses are generally of advantage with regard to tumour cell kill and local tumour control. Patients with clinically T1-2 N0-tumours seem to be the ideal candidates for CyberKnife hypofractionated Stereotactic Radiosurgery (hSRS). Initial data report on local control rates of up to 90%, with favourable results especially for patients who are otherwise in good general condition.

There exist four conventional methods of treatment for cancer:

• surgical intervention,
• chemotherapy,
• immunotherapy
• radiation therapy

Radiation therapy becoming treatment of choice – why and how?

The development of Image-guidance in the delivery of radiation therapy (IGRT) has provided the capability of real-time imaging and real-time adjustment of the therapeutic beams to compensate for target motion. From this evolution in therapeutic radiation delivery and imaging techniques has emerged a technology which allows highly conformed and precisely delivered radiation treatment, recognised as stereotactic radiosurgery. SRS is a technique in which a single ablative dose (or 2-5 fractionated doses) of highly collimated radiation is delivered to one or more targets with submillimeter precision. SRS differs from conventional radiotherapy in that the efficacy of radiotherapy depends primarily on the greater sensitivity of tumour cells to radiation relative to normal tissue. Therefore, with all forms of radiotherapy, the spatial accuracy with which the treatment is focused on the tumour is a secondary concern because the normal tissues are protected by administering the radiation in fractionated doses. In contrast, radiosurgery requires much greater targeting accuracy since with SRS; normal tissues are protected by selectively targeting only the abnormal lesion, and using cross-firing techniques to minimize the exposure of the adjacent anatomy. Since highly destructive doses of radiation are used, any normal structures and tissue within the targeted volume are subject to damage as well. Although the radiobiology of radiosurgery is still evolving, it is held that the high radiation dose delivered to the target volume by radiosurgery may result in tumour control through direct early effects of apoptosis and mitotic death, late vascular changes, and stimulation of immune response.

Read more about Cyberknife in an article  by Consultant in Clinical Oncology Dr Nick Plowman.

• Missed diagnoses
• Further investigations which turn out to be unnecessary
• Anxiety caused by recalls
• Treatment for conditions that would have never caused any problems if they had been left alone.

For breast cancer the only type of screening that has proven to be effective is regular routine mammography.   A mammogram is a breast X-ray so an additional problem with this type of screening is the exposure to radiation.  However breast cancer is a major health problem and an effective form of screening is desirable. It is the commonest type of cancer that affects women, with 1 in 9 females in the UK being diagnosed.  Screening for breast cancer should be particularly effective because it is one of those cancers where catching it at an early stage makes a huge difference to the chance of cure.  There are a number of reasons why the survival rates from breast cancer have improved steadily over the last thirty years, but it is thought that the most important factor has been early diagnosis.

Leading breast cancer consultant Mr Beechey-Newman provides the latest thinking behind the ‘why’s’ and ‘who’ to screen, plus answers common questions such as:

• What is a mammogram?
• Does breast screening work?
• The problem with mammograms
• Unnecessary treatment?
• Unnecessary anxiety?
• Who should be screened?
• What are the surgical benefits?

Read the Facts About Breast Screening.

Would routine catheterisation put patients off coming forward? The answer is probably yes, a catheterisation is not a dignified  procedure. So there needs to be a good alternative.

Working with their clinical colleagues, microbiology specialists are therefore seeking a better method and clinical trials to assess new systems are now underway. The forerunner is the Peezy urine collection system.

Already in use by leading Harley Street Gynaecologists, it is envisaged that this new, dignified urine collection system will modernise current archaic practice as it automatically and safely takes a clean, mid-stream sample without any fuss. Peezy was designed by NHS GP Dr Vincent Forte and subsequently won design awards with NHS Innovations. It is another example of how the UK is leading the world with fundamentally good, patient-centred medical progress.

The hospitals, The Wellington, The London Bridge Hospital, The Harley Street Clinic, The Portland Hospital for Women and Children, The Lister Hospital and The Princess Grace Hospital, have consistently achieved high standards of cleanliness in recent years.  In 2009 for example, there were no cases of hospital acquired MRSA in any of them.

The new e-QIT system uses special hand held computers loaded with a comprehensive database which includes the complete layout of hospital buildings from the largest wards and theatres to the smallest cupboards.  External inspectors can then use the tool to inspect, photograph, log and report on infection control, cleanliness, infrastructure, décor and health and safety issues – in real time.

e-QIT was developed by Infection Control Services Ltd, a company formed by six consultant microbiologists, in collaboration with HCA International Ltd.

Project leader for HCA, Sue Smith, who is also Chief Executive Officer of the Princess Grace Hospital, said that before e-QIT was developed, an inspection was only as good as the person who looked at the audit results.  “Until now systems of inspection and audit have really only been a paper trail and there was always a danger that things would be overlooked.  There was little or no accountability,” she said.

“Now we have a mobile, flexible tool with a huge database which includes current legislation and regulations and which demands that non compliant situations be dealt with immediately and under the responsibility specific manager.  The system, which automatically uploads findings onto our IT network, simply won’t allow problems to be left or forgotten,” she said.

The leader of the e-QIT development team at Infection Control Services, microbiologist Michael Shemko, said one of the goals was to make e-QIT future proof.  “Legislation is changing as new methods of improving hygiene and health and safety in healthcare become available.  When the goal posts change, e-QIT can be immediately upgraded and this in turn, modifies inspection and compliance criteria,” he said.

HCA International President and Chief Executive Officer, Michael Neeb, said he was delighted with the success of the new system.  “I congratulate everyone involved in this most important project.  This is an industry first and the result of an innovative partnership which will enable all healthcare providers to create and maintain a culture of constant high standards in infection control, cleanliness and health and safety,” he said.

Dr Nick Plowman explains the new treatment in his expert article. He says: “Hundreds of pencil beams aimed from various “node stations” located on a virtual sphere around the patient all concentrate the radiation on the target. This dosing is accurately delivered to exactly conform with the high dose deposition required around and within the perimeter of even the most irregular shaped target. There is also a fast dose fall off at the edge of the tumour, which means that healthy tissue is safe guarded. Therefore, tumours either in the head or body can now be accurately pinpointed and receive a high sterilising radiation dose.