Darent Valley Hospital is a 478-bed, acute district general hospital in Dartford, Kent, England. The hospital has an Emergency Department. The hospital is managed by the Dartford and Gravesham NHS Trust.
Primary mucinous adenocarcinoma (PMAC) of the urethra is an exceptionally rare subtype of primary urethral carcinoma, with limited published data to guide diagnosis or treatment. Most literature consists of isolated case reports, and the non-specific presentation often delays diagnosis. This report presents two further cases and a review of the literature with a view to expand current understanding. We report two cases of PMAC. The first involves a 67-year-old male with progressive lower urinary tract symptoms initially treated as benign prostatic hyperplasia. Histology following a transurethral resection of the prostate revealed invasive mucinous adenocarcinoma with enteric features. He underwent radical prostatectomy, chemotherapy and radiotherapy for metastatic disease. The second case is a 52-year-old female with chronic urinary symptoms and a urethral mass initially misattributed to being from gynaecological origin. However, a biopsy later confirmed mucinous adenocarcinoma of the urethra. She underwent chemotherapy and radiotherapy, with partial response, but later developed further metastatic spread and is now undergoing palliative chemotherapy. PMAC is aggressive, often presents with non-specific urinary symptoms and lacks standardised diagnostic or treatment protocols. These cases highlight the importance of early detection through biopsies, immunohistochemical analysis and a multidisciplinary approach. Broader awareness and further reporting of cases are essential to develop evidence-based diagnostic and treatment guidelines for this rare malignancy.
This report details the case of a 72-year-old woman with a 5-year history of anorexia nervosa, whose presentation challenges the conventional presentation of anorexia nervosa. She was admitted under the Mental Health Act (MHA) of England and Wales because of escalating behavioural disturbance, including aggression and disinhibition, together with a long-standing pattern of restrictive eating and distorted body image. She presented with a markedly low body mass index, compulsive exercise and profound lack of insight, complicated by dilutional hyponatraemia, a less commonly reported but potentially life-threatening compensatory behaviour. Particularly noteworthy was the close temporal association between olanzapine discontinuation and the recurrence of severe weight loss and behavioural disturbance. Further complicating her assessment was the presence of encopresis and enuresis. Treatment involved multidisciplinary collaboration, thorough investigation to rule out age-related differentials, structured refeeding and cautious medication management, including olanzapine titration. This case highlights the diagnostic and therapeutic challenges of anorexia nervosa in older adults.
Abstract Objective The study aims to assess whether the use of a peritoneal flap (PF) during robotic‐assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND) reduces the incidence of lymphoceles compared to the standard surgical approach without a flap. Methods The review was prospectively registered on PROSPERO (CRD420251052120). A systematic search of PubMed, MEDLINE, Embase, Scopus, Web of Science, CENTRAL and Google Scholar was performed up to May 2025. Eligible studies were randomised controlled trials (RCTs) or observational studies comparing PF use with the standard surgical technique without the flap during RARP with PLND. Primary outcomes were symptomatic, asymptomatic, total lymphoceles and lymphoceles requiring intervention. Secondary outcomes included complications, operative time, blood loss, positive surgical margins and hospital stay. Results Fourteen studies (six RCTs, eight observational) including 7316 patients were analysed, with 2997 receiving the PF and 4319 receiving the standard technique. PF use was associated with a significantly lower incidence of symptomatic, asymptomatic, total lymphoceles and lymphoceles requiring intervention. PF use reduces overall complications without significantly increasing operative time, hospital stay or positive margins. Intraoperative blood loss was slightly lower in the standard group. Conclusions PF use during RARP with PLND significantly reduces the incidence of lymphoceles and postoperative complications without compromising oncological or perioperative outcomes. These findings support PF use as a safe and effective technique for preventing lymphoceles.
Lung cancer remains the leading cause of cancer-related mortality worldwide, largely due to late-stage diagnosis. Low-dose computed tomography (LDCT) screening has demonstrated significant mortality reduction in high-risk populations; however, its widespread implementation is limited by high false-positive rates, inter-reader variability, and substantial workflow burden. Artificial intelligence (AI) has emerged as a promising adjunct to address these challenges by enhancing diagnostic consistency, efficiency, and risk stratification in LDCT-based screening. This narrative review aims to synthesize current evidence on AI methodologies, clinical applications, validation studies, and translational challenges in LDCT-based lung cancer screening. A structured literature search was conducted across PubMed, Scopus, Embase, and the Cochrane Library for studies published between January 2010 and September 2025, using relevant keywords related to AI, radiomics, and lung cancer screening. Studies were selected based on their focus on AI applications in LDCT, including detection, characterization, risk prediction, and workflow optimization. Recent advances in deep learning and radiomics have enabled automated detection, segmentation, and characterization of pulmonary nodules with performance comparable to expert radiologists. Hybrid AI models that integrate imaging-derived features with clinical and demographic data further improve individualized risk prediction and support tailored screening strategies. AI-supported workflows have demonstrated improved efficiency by reducing interpretation time while maintaining diagnostic accuracy. Despite these advances, translation into routine clinical practice remains inconsistent due to limitations in external validation, generalizability, interpretability, and workflow integration. Radiologists' trust and human-AI interaction further influence real-world adoption. This review highlights the need to shift focus from algorithmic performance to clinical integration and human-AI collaboration to ensure meaningful improvements in lung cancer screening outcomes.
