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Background and aims Endoscopy performance is dependent on the technical ability and experience of the operator. There is anxiety among surgical trainees that certification to perform independent endoscopy to agreed national standards by the date of award of certificate of completion of training is not achievable. The aim of this study was to evaluate the delivery of endoscopy training to UK-based general surgery trainees. Materials and methods An electronic survey of general surgery trainees holding a national training number or in a locum appointment to training post between July and September 2010 was undertaken. Results Two hundred and thirty-three trainees responded from all UK training regions. Stated subspeciality interests included coloproctology (47%), oesophagogastric/bariatric (22%) and hepatobiliary/pancreatic (10%) general surgery. 92% of trainees were training or planned to train in endoscopy, 62% of whom had registered with the Joint Advisory Group (JAG). Thirteen trainees had JAG certification in diagnostic upper GI endoscopy and eight in colonoscopy. There were high rates of dissatisfaction with endoscopy training nationally. Two thirds of trainees had no scheduled training lists. Conflicting elective/emergency commitments, competition and absence of training lists were the most common reasons for a failure to access endoscopy training. Conclusions Higher surgical trainees are failing to achieve national standards for endoscopy practice. There is an urgent need to address the deficiencies in endoscopy training to ensure a competent cohort of surgical endoscopists.

Jansen et al highlight the potential difficulty of diagnosing intraperitoneal bleeding and hollow viscus injuries in patients with blunt abdominal trauma.1 Despite an increasing use of point of care focused assessment with sonography for trauma (FAST), diagnostic peritoneal lavage continues to be taught on advanced trauma …

Introduction Septic arthritis of the sternoclavicular joint is rare, comprising approximately 0.5% to 1% of all joint infections. Predisposing causes include immunocompromising diseases such as diabetes, HIV infection, renal failure and intravenous drug abuse. Case presentation We report a rare case of bilateral sternoclavicular joint septic arthritis in an elderly patient secondary to an indwelling right subclavian vein catheter. The insidious nature of the presentation is highlighted. We also review the literature regarding the epidemiology, investigation and methods of treatment of the condition. Conclusion SCJ infections are rare, and require a high degree of clinical suspicion. Vague symptoms of neck and shoulder pain may cloud the initial diagnosis, as was the case in our patient. Surgical intervention is often required; however, our patient avoided major intervention and settled with parenteral antibiotics and washout of the joint.

Introduction There is sufficient evidence that blood group related Lewis antigens are tumour-associated molecules. The Lewisy and Lewisb antigens are complex carbohydrates that are over-expressed by breast, lung, colon and ovarian cancers. The SC101 mAb is a unique Lewisy/b binding antibody that binds to native and extended Lewisy and Lewisb haptens, displaying no cross reactivity with H type 1, H type 2, Lewisx or normal blood group antigens. Methods Immunohistochemical detection of Lewisy/b was performed on 660 formalin-fixed, paraffin embedded breast tumour specimens using a streptavidin-biotin peroxidase technique. Tissue from these patients had previously been included in tissue microarrays. This cohort comprises a well characterized series of patients with primary operable breast cancer diagnosed between 1987 and 1992, obtained from the Nottingham Tenovus Primary Breast Carcinoma Series. This includes patients 70 years of age or less, with a mean follow up of 7 years. Results Of the breast carcinomas, 370 of 660 (56%) were negative for Lewisy/b expression, 110 (17%) cases showed a low level of expression (75% of positive cells). We found significant positive associations between histological grade (p < 0.001), Nottingham Prognostic Index (p = 0.016), tumour type (p = 0.007) and the level of Lewis y/b expression. There was a significant correlation between the proportion of Lewisy/b positive tumour cells and survival in lymph-node negative patients (p = 0.006). Conclusion The unique epitope recognised by SC101 mAb on Lewisy/b hapten is over-expressed on breast tumour tissue compared with normal breast. In this large series of invasive breast cancers, higher expression of Lewisy/b was more often found in high grade and poor prognosis tumours compared to good prognosis cancers. Moreover, in lymph node negative breast carcinomas, over-expression of Lewisy/b hapten was associated with significantly decreased patient survival.