Leeds Teaching Hospitals NHS Trust

Elbow injuries resulting from acute trauma or repetitive overuse are a common source of pain and functional limitation in both athletes and the general population. This review presents a radiologic approach to the evaluation and management of these conditions. It describes the roles of key imaging modalities and provides practical guidance for assessing traumatic injuries such as fractures, ligamentous disruptions, and tendon avulsions. Common overuse conditions, such as medial epicondylitis, lateral epicondylitis, and nerve compression syndromes, are reviewed with attention to characteristic imaging features and diagnostic challenges. The article also explores the role of image-guided interventions, particularly ultrasound-guided injections, in both diagnosis and treatment. By consolidating imaging strategies and emphasizing the strengths of each modality, this review will help radiologists and clinicians achieve an accurate diagnosis and manage elbow injuries effectively, ultimately promoting better outcomes and a timely return to activity.

Renin-angiotensin-aldosterone system inhibitor (RAASi) therapies are a cornerstone of guideline-directed medical therapy in the management of cardiorenal disease, including chronic kidney disease and heart failure. Management guidelines state that these therapies should be prescribed at the maximum licensed or tolerated dose in order to prevent disease progression and adverse events. However, both cardiorenal disease and RAASi therapies increase the risk of hyperkalaemia. When hyperkalaemia occurs, clinicians often down-titrate or discontinue these important RAASi therapies, leaving patients at risk of adverse cardiorenal outcomes. Eleven cardiorenal experts considered how hyperkalaemia can act as a barrier to optimised RAASi therapy in patients with cardiorenal disease and how these issues could be mitigated. Four key areas of suboptimal and variable clinical practice were identified: optimisation of RAASi therapy; definition and management of acute hyperkalaemia; secondary to primary care communications; and patient education. In this podcast article, two of the experts discuss the clinical challenges and principles of optimal care for each of the four areas identified. The experts agreed that hyperkalaemia should be considered a predictable and manageable condition, requiring a pre-emptive and long-term approach. When hyperkalaemia occurs, down-titrating or discontinuing RAASi therapy should be a last resort, after all other management approaches have been employed. Healthcare professionals in secondary and primary care must communicate and collaborate to ensure effective, consistent management of patients with cardiorenal disease. Finally, patients should be educated to understand their cardiorenal disease and its management and the importance of optimal RAASi therapy. Supplementary file1 (MP4 173853 KB).

Abstract Background Idiopathic granulomatous mastitis (IGM) is a rare, benign breast disease characterised by granulomatous inflammation. Current literature mainly comprises of small-sized retrospective studies with no well-designed clinical trials and limited representation of UK population. With no consensus to guide clinical practice there is a significant risk of delayed diagnosis and variation in management strategies that may adversely affect patient outcomes Methods ENIGMA is a multi-stage programme of work aiming to develop guidelines for the diagnosis and management of IGM in the UK. A scoping review will assess the range and quality of existing evidence, focusing on its relevance to UK practice. Findings from this review will inform a national practice questionnaire (NPQ) to capture current approaches to IGM care across the UK. These data, combined with a modified Delphi process involving experts and stakeholders, will support guideline development and help define priority research questions to advance best practice. Progress The scoping review identified 225 papers, involving 13 062 patients, mostly from Turkey, the USA, and China. Only three studies, covering 25 patients, originated from the UK. Commonly reported ethnic groups were Hispanic and Turkish. Risk factors include smoking and hormonal influences such as oestrogen and prolactin. Reported treatment strategies range from conservative approaches to medical therapies (antibiotics, steroids, immunosuppressants) and surgical interventions (drainage or excision). Preliminary results of the NPQ highlight substantial heterogeneity in UK diagnostic and management practices. Once the NPQ analysis is complete, the working group will initiate the Delphi process to establish consensus and inform guideline development.

With more patients now consulting with non-GPs there is a strong rationale for enabling non-medically qualified (NMQ) clinicians to request CXR in accordance with National Institute for Health and Care Excellence guidance.However, wider uptake requires reducing bureaucratic barriers and provision of access to proportionate and relevant IR(ME)R training.

Bioimpedance and absolute blood volume measurement are objective assessments of volume status. However, uncertainties remain in their application at extreme body habitus. We aimed to compare blood volume and bioimpedance-based volume status at extreme body habitus and explore normalisation of blood volume in this context to support incorporation of these tools into fluid management decisions. We defined two common extreme volume-status phenotypes in haemodialysis: obese and bioimpedance-dry (n = 29) and lean and bioimpedance-wet (n = 29). Control subjects were haemodialysis patients who were haemodynamically stable with normal volume status (n = 20). We compared post-dialysis blood volume at clinical "target weight", measured by dialysate dilution, in the obese/dry and lean/wet groups with controls. We explored normalisation of blood volume (n = 98) by body mass, lean tissue mass and an anthropometric-based estimate of blood volume determined by Lemmens' formula. Post-dialysis blood volume normalized for body mass (specific blood volume) was lower in the obese/dry (57.9 mL/kg; P = 0.02) and higher in the lean/wet group (84.5 mL/kg; P = 0.001) than in controls (68.0 mL/kg). These differences were not present for lean tissue mass-normalised or Lemmens' formula-normalised blood volume. Normalising blood volume to body mass results in differences by sex and body mass, whereas normalising to Lemmens blood volume, which accounts for fat mass variation, does not. Setting target weights to achieve fixed reference bioimpedance or blood volume values may not be appropriate at extreme body habitus, reinforcing the need for individualised approaches. Normalising blood volume to body mass may exacerbate established measurement bias observed with bioimpedance.

Traumatic brachial plexus injuries (TBPI) are life-changing and can lead to permanent changes in function and pain within the arm and hand. Historically, TBPI research has reflected the priorities of researchers and clinicians rather than those with personal experience of living with a TBPI. The James Lind Alliance (JLA), supported by the National Institute for Health Research, has developed a rigorous methodology for increasing public engagement in research by giving an equal voice to patients, carers, and healthcare providers to ensure that their concerns are represented in future health research programmes. These projects are called priority setting partnerships (PSPs). A JLA PSP, comprising patients, carers and clinicians, was created and completed to agree future research priorities in adult TBPI. The JLA PSP methodology was followed throughout. One-hundred and fifty-four respondents replied to an initial survey generating 704 questions. These were assessed, grouped and combined to create 68 summary questions or 'uncertainties'. Three were excluded after literature review suggested they had already been answered by research. Seventy-nine respondents answered an interim prioritization survey, choosing their top ten from the summary questions. In a workshop, nine patients, two carers and 11 clinicians met, discussed and ranked the top 22 questions from the interim survey to identify the top 10 research priorities. Psychology, physical therapy treatments and management pathways were among the top ranked priorities. These results will inform researchers and funding bodies about research priorities for patients, carers and clinicians to direct future research on TBPI. V.