In recent years image guided radiofrequency ablation (RFA) has become the treatment of choice for many patients with small numbers of liver or lung metastases, and as an alternative to surgery for the treatment of some patients with primary lung tumours. 

There are several different types of hip replacement surgery, these are:

Metal on Plastic articulating hips

The success of total hip replacement was initially due to the pioneering work of Sir John Charnley forty years ago. After several failed designs he developed what then became the standard cemented hip replacement: a cemented plastic socket combined with a cemented metal stem. Over the past 40 years, there have been many improvements in both the materials and the methods used to hold the components in place. Today, the most commonly used bone cement is an acrylic polymer called polymethylmethacrylate (PMMA). 

Ceramic on Ceramic Bearings

Ceramics are several times harder than metal and wear is minimal (and hence produce much fewer wear particles. However, ceramics are brittle and early designs sometimes broke although the newer designs are now much more durable. The ceramic socket cannot be cemented into the pelvis and is fixed in a metal uncemented shell which press-fits into the natural hip socket. Unfortunately a small percentage (1 or 2) of ceramic bearings emit an audible squeak! 

Metal on Metal Bearings

A metal ball articulating with a metal socket was the first ever total hip replacement (implanted by the surgeon Philip Wiles at the Middlesex Hospital, London, in the 1930s). Metal bearings wear less than plastic but still generate wear particles and also release metal ions which can cause inflammation and problems for a small percentage of patients.

For more information on hip replacement surgery and hip preservation surgery please read the articles below.

See also the Total Health Guide to Hip Replacement

Carpal tunnel syndrome symptoms include intermittent "pins-and-needles" in the the hand. Often the thumb, index and middle finger but all fingers may be affected. Pain is generally worse at night than during the day. Patients may awaken with a burning pain or tingling that may be relieved with shaking of their hands. Pain may spread all the way up the forearm to the elbow and shoulder. Symptoms are most often in both hands, develop slowly, and progress.

In the early stages the nerve symptoms are reversible. If untreated, it can result in thumb muscle wasting, chronic hand weakness, and permanent numbness in the median nerve area of the hand. Carpal tunnel syndrome symptoms can be very disabling.

An HbA1ca test is blood test which indicates how much of the oxygen carrying red pigment in red blood cells is affected by glucose. The result is usually expressed as a percentage. An HbA1c below 6.5% indicates good glucose control over the previous 8 to 12 weeks. A high value of around 10% would mean that on average the blood levels have been high over the previous 2 to 3 months.  

A blood glucose level shows the level of glucose at a particular time, for example, before breakfast. The HbA1c gives a measure of glucose control over a much longer time period-two or three months. This is useful because, of course, blood results can vary enormously over the day and what is important is that, on average, the levels are not too high. HbA1c test levels show a strong correlation with complications of diabetes so that patients with values less than 6.5% have a much reduced risk of complications compared to those with high values.

For most people with diabetes, NICE recommends an HbA1c normal range to be below 6.5%. However targets do need to be individualised for the particular person bearing in mind the risk of hypoglycaemia, quality of life and any other factors such as co-existing medical conditions. In all cases, the patients’ views must be taken into account and the risks of high blood glucose levels balanced by the risks of the treatment.

Surgery to set back prominent ears (pinnaplasty) is the most common paediatric plastic surgical procedure in the UK. About 5% of the population have ears which stick out more than 20mm from the side of the head, although in a recent study, over 20% of adults admitted embarrassment about the shape of their ears to the extent that it affected their hairstyle or their behaviour.

Pinnaplasty is perceived as a simple procedure by doctors and the public alike. Mr David Gault's organisation, the British Association of Aesthetic Plastic Surgeons (BAAPS), states on their website that "the vast majority of patients... are well pleased by the result, and the procedure has a high satisfaction rate" but a detailed review shows a steady incidence of problems including:

• Pain and discomfort 4%
• Recurrence (ears sticking out again) 7%
• Haematoma (a collection of blood beneath the skin) 1%
• Infection 1% and keloid (raised and itchy) scars 1%

Whilst it is true that those that are pleased are very well pleased, those that are not are often devastated. 

However there is an alternative. Neonatal moulding of ears has been around for at least 20 years, but early splintage has yet to become routine despite excellent results and few complications.  Controlling the very soft cartilage of a newborn ear using a splint can reshape it as it hardens over the first few months of life, such that prominent or otherwise deformed ears are cured within a few weeks, but the technique is underused. 

There are great advantages in splinting to correct ear deformity. There is no teasing to prompt a referral for surgery. The cost of splinting is a mere fraction of the cost of surgery at £50 versus at least £800 within the NHS, assuming that funding is available, and around £4000 including surgical, anaesthetic and hospital fees for a general anaesthetic, day case stay in private practice. Almost 98% of splintage is performed by the parents themselves. Anaesthesia is not required, nor surgery, nor admission to hospital, nor is there a risk of post operative complications. 

The most common type of groin hernia is the ‘inguinal hernia’, which represents the bulk of groin hernia repairs performed across the world. Inguinal hernias are more common in men than women due to the passage of the structures supplying and draining out of each testicle passing through the layers of the groin muscles. This creates an area of potential weakness through which the hernia may form.

A hernia is quite simply a ‘hole‘ in the abdominal wall through which the internal organs may protrude. Inguinal hernia symptoms include a lump which is more obvious when the patient stands or coughs and disappears on lying down and are rarely painful. If there is severe pain the hernia has more than likely become ‘strangulated’. This is when the contents of the hernia are unable to return to their normal place and hence lose their blood supply. Most hernias are apparent on examination by an experienced clinician although in some circumstances it may be necessary to get a radiological assessment.

The principle of repairing inguinal hernias involves the placement of ‘mesh’, which is usually made of plastic. The mesh provides a durable reinforcement of the hernia defect and causes far less pain than previous non mesh repairs. The ‘mesh‘ repair has led to a drastic reduction in the recurrence rates of groin hernia repairs and is relatively easy to perform. 

Mr Simon Marsh, Consultant Breast Surgeon, The London Breast Clinic

In women aged from 20 to 30 years a breast lumps are most likely to be a fibroadenoma. These are benign lumps that can sometimes be painful or enlarge but they are not cancerous and do not turn cancerous. 

Between the age of 40 and 50 years breast cysts become more common. These are also entirely benign. They are collections of fluid within the breast and although they can also be painful they are not dangerous. 

From the age of 30 years onwards the gland tissue in the breast changes and it becomes more fibrous and nodular. The way the breast feels has been described as like a scaled down packet of frozen peas and occasionally, in just the same way that frozen peas can stick together to form a clump, so breast tissue can “stick together” to form a definite nodular area. These areas are also often tender but once again are not a sign of cancer. 

The rate of breast cancer begins to rise after the age of 40 years and increases with age. Of course, breast cancer can occur at any age and I have seen cases in women as young as 19 years and in their early 20s, but they are very, very rare.

The important message is, if you notice a change in your breast please get it checked.