In the early 1950s, when the National Health Service (NHS) was still in its infancy, the British public was gripped by news reports of two attempts at the surgical separation of conjoined twins. The first operation involved one-year-old twin girls from Kano, Nigeria. The twins were xiphopagus (joined at the lower sternum) and shared a liver, separation was attempted at London’s Hammersmith Hosp...

There are many patient groups who may refuse blood products; the most well known amongst them is the Jehovah's Witness faith. Treatment of anaemia and bleeding in such patients presents a challenge to medical, anaesthetic, and surgical teams. This review examines the perioperative issues and management of Jehovah's Witnesses. The history and beliefs of Jehovah's Witnesses are outlined together ...

C holesterol granuloma (CG) of the petrous apex (PA) may be asymptomatic or enlarge to cause symptoms from compression of neural and vascular structures within the temporal bone. Surgical decompression may then be indicated. We present a case of PA-CG where the feasibility of decompression with a minimally invasive permeatal infracochlear approach was first assessed through 3dimensional imaging...

A prenatal diagnosis of ductal-dependent, complex congenital heart disease was made in a fetus with trisomy 18. The parents requested that the genetic diagnosis be excluded from all medical and surgical decision-making and that all life-prolonging therapies be made available to their infant. There was conflict among the medical team about what threshold of neonatal benefit could outweigh matern...

Surgery is an increasingly common and expensive mode of medical intervention. The ethical dimensions of the surgeon-patient relationship including respect for personal autonomy and informed consent are much discussed, but broader equity issues have not received the same attention. This paper extends the understanding of surgical ethics by considering the nature of evidence in surgery and its re...