What a cornucopia of surgical and surgical related subjects Issue 5 of our Journal has produced.  From the fact that Arab women have breast cancer younger, eighty percent undergo mastectomy and the lack of radiation oncologists and radiotherapy centres in the Arab world (84 vs 1895 in the USA) to patient controlled epidural anaesthesia.  These subjects are as diverse as surgery itself with a paper showing the quality of life is satisfactory in young patients with diverticular disease treated conservatively to the feasibility of day-case laparoscopic cholecystectomy.  Paediatric surgery is covered with an excellent paper from Nigeria on the incidence of colostomies for ano-rectal malformations and their later presentation leading to treatment in older children.  It was pleasing for me especially to read about the increased complications following loop colostomies, having written a paper in the Lancet many years ago entitled “An Obituary to the Transverse Loop Colostomy: or Gone with the Wind”.

No Journal these days fails to have a paper on optimizing trainees training in the light of decreasing experience in the operating room.  Post-operative information from experts can certainly aid learning of surgery from well-written operation notes.  However, this paper informs surgeons what was needed in the operation notes with specific reference to one operation (Right Hemicolectomy) and how to expose the right ureter safely.  But I wonder if surgical trainees would gain such operative technique details from the usual operation notes scribbled by a Surgeon or even worse, by an Assistant.

Safety in the operating room usually centres on team working and the near misses that can occur.  However, a paper written from a neurosurgical aspect specifically deals with the actual possible procedural problems, such as wrong site surgery, leaving cottonoids and the prevention of intra-cranial granulomas and meningitis due to bone dust from drilling.  Transferring growth factor B in keloids opens a fascinating possible window into their useful therapeutic modalities in treatment.  Trauma sadly will always be with us and the paper on facial injuries in road traffic accident victims in Australia is a large study (409 patients), many of whom also suffered other injuries.