T C See

Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, United Kingdom

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Publications (18)40.09 Total impact

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    ABSTRACT: Peripherally inserted central catheters are often positioned blindly in the central circulation, and this may result in high malposition rates, especially in critically ill patients. Recently, a new technology has been introduced (Sherlock 3CG Tip Positioning System) that uses an electro-magnetic system to guide positioning in the superior vena cava, and then intra-cavity ECG to guide positioning at the cavo-atrial junction. In this observational study, we investigated how the Sherlock 3CG Tip Positioning System would affect peripherally inserted central catheter malposition rates, defined using a post-insertion chest radiograph, in critically ill patients. A total of 239 catheters positioned using the Sherlock 3CG Tip Positioning System were analysed. When an adequate position was defined as low superior vena cava or cavo-atrial junction, 134 catheters (56.1%; 95% CI 50–62%) were malpositioned. When an adequate position was defined as mid/low superior vena cava, cavo-atrial junction or high right atrium (≤ 2 cm from cavo-atrial junction), 49 (20.5%; 95% CI 16–26%) catheters were malpositioned. These malposition rates are significantly lower than our own historical data, which used a ‘blind’ anthropometric technique to guide peripherally inserted central catheter insertion.
    Anaesthesia 07/2014; · 3.49 Impact Factor
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    ABSTRACT: Hepatolithiasis, whilst endemic in East Asia, is rare in the West, where prevalence is less than 1% of all cholelithiasis(1). The aetiology is incompletely understood, but biliary stasis, infection and excessive mucin production appear to be important factors(1, 2). Hepatolithiasis is associated with significant morbidity, often characterised by recurrent cholangitis that can result in the development of life-threatening sepsis, hepatic abscesses, secondary biliary cirrhosis and cholangiocarcinoma(1). The management of hepatolithiasis is challenging, with high rates of treatment failure and recurrence. Although the standard approach to managing this condition is hepatic resection(2, 3), percutaneous transhepatic cholangioscopic hepatolithotomy (PTCHL) offers a safe and minimally invasive alternative treatment option(1, 4-7).This article is protected by copyright. All rights reserved.
    Transplant International 06/2014; · 3.16 Impact Factor
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    ABSTRACT: This review will describe the indications for the various small bowel containing transplants. The importance of early referral will be highlighted. Radiologists play a central role in assessing these complex patients prior to transplantation. Furthermore, in the postoperative period, radiologists play an important part in diagnosing and treating complications.
    Clinical Radiology 06/2013; · 1.66 Impact Factor
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    ABSTRACT: Peripherally inserted central catheters are increasingly used to provide access to the central venous circulation. They are commonly positioned 'blind' using a variety of anthropometric techniques and operator experience to direct insertion length. Malposition rates are poorly defined because of differing insertion techniques, difficulties defining anatomical tip position on chest radiographs, controversy over what constitutes an adequate catheter position and possible differences between patient groups. We have developed a reproducible method to define catheter positions on chest radiograph and have applied this in a retrospective analysis of 256 ICU and 243 non-ICU catheter insertions over a 6-month period. Two different definitions were used for adequate position. 'Blind' positioning of peripherally inserted central catheters was associated with a definition-dependent malposition rate of 42-76%. Malposition rates were significantly higher in ICU patients. Emerging technologies may assist in reducing these high rates.
    Anaesthesia 03/2013; · 3.49 Impact Factor
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    ABSTRACT: To evaluate whether virtual unenhanced (VU) computed tomography (CT) images generated of the aorta were of sufficient quality to replace the conventional unenhanced (CU) images. Forty-nine patients undergoing examination of the thoracic or abdominal aorta were examined using a dual-energy protocol. VU images were generated from the arterial phase images and compared to the CU images. Objective analysis was performed by drawing paired regions of interest (ROIs) within the thoracic and abdominal aorta and measuring the radiodensity in Hounsfield units attenuation within the ROIs. Subjective analysis was performed by two experienced readers evaluating the VU images in terms of noise, quality, calcium loss, and overall acceptability. The attenuation was significantly higher in the VU images compared to the CU images within the thoracic aorta (p < 0.01) but not within the abdominal aorta (p = 0.15). Overall the VU images of the abdominal aorta were deemed acceptable as replacements for the CU images in 93% of cases. For the thoracic aorta, the VU images were deemed acceptable in only 12% of cases, primarily due to pulsation artefact. VU images of the abdominal aorta are acceptable as replacements for the CU images in the vast majority of cases; however, they are not suitable as replacements for the CU images of the thoracic aorta.
    Clinical Radiology 12/2011; 67(5):461-7. · 1.66 Impact Factor
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    ABSTRACT: Almost half the patients with colorectal cancer will develop liver metastasis at some stage during their disease. Potentially curative surgical resection is possible in some of these patients. In those patients unsuitable for surgery, treatment with systemic chemotherapy and external radiation therapy is relatively ineffective. Many studies have described the successful use of selective internal radiation therapy (SIRT) with 90Y-SIR-Spheres microspheres in patients with inoperable liver metastasis. The authors report on a patient who has been in complete remission for 1 year after treatment with SIRT.
    Case Reports 01/2011; 2011.
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    ABSTRACT: Percutaneous transhepatic biliary drainage (PTBD) is commonly used in the management of cholangiocarcioma. Major and minor complications of PTBD such as cholangitis, haemorrhage and catheter dislocation are well documented. A lesser reported complication are cutaneous metastases following PTBD for cholangiocarcinoma.We report a case of a 79 year old man who presented with right upper quadrant pain, jaundice and weight loss, with dilated intra-hepatic bile ducts on imaging. The cytology results from a sample taken during endoscopic retrograde cholangiopancreatography were highly suspicious of cholangiocarcioma. A PTBD was subsequently performed and bilateral metal biliary stents were placed without external drainage. Five months after the PTBD he was found to have a hard nodule under the PTBD puncture site. The nodule was excised and the histology confirmed a cholangiocarcinoma metastasis.A review of the literature identified twelve cases of cutaneous metastases from cholangiocarcinoma, following PTBD. In addition, tumour seeding along the catheter tract following PTBD, with metastatic deposits on the abdominal wall, peritoneoum, chest wall, pleural space, and liver parenchyma have also been reported.Health care professionals should be aware of this rare complication and offer appropriate management options to patients.
    International Journal of Surgery Case Reports. 01/2010; 1(3):33-36.
  • Gut 02/2009; 58(1):59, 144. · 10.73 Impact Factor
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    ABSTRACT: Pseudoaneurysms are uncommon and their aetiology is varied. They occur in numerous anatomical locations and present with a multitude of clinical presentations sometimes life-threatening. This review describes the causes, sites, and presentations of uncommon pseudoaneurysms, as well as illustrating their diagnostic appearances and endovascular management.
    Clinical Radiology 12/2008; 63(11):1254-64. · 1.66 Impact Factor
  • American journal of orthopedics (Belle Mead, N.J.) 06/2008; 37(5):E99-E102.
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    ABSTRACT: Acute appendicitis is a diagnosis that can be made on clinical symptoms and signs but can often be extremely challenging. Difficulties arise particularly when the presentation is atypical, and this can lead to untoward sequelae. In this review, we present the range of presentations of atypical appendicitis, the variety of management options and the potential value of CT.
    Journal of Medical Imaging and Radiation Oncology 05/2008; 52(2):140-7. · 0.98 Impact Factor
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    ABSTRACT: To demonstrate the use of a commercially available branch stent graft system, designed to preserve the internal iliac artery (IIA) in common iliac artery (CIA) aneurysms (CIAA) in two patients, who had undergone previous abdominal aortic aneurysm (AAA) surgery.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 05/2008; 35(4):436-8. · 2.92 Impact Factor
  • Umar Sadat, Nadim Noor, Teikchoon C See, Paul D Hayes
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    ABSTRACT: An interesting case of an intravenous drug abuser who had endovascular management of an arteriovenous fistula and concomitant pseudoaneurysm, resulting from recurrent puncture of the femoral artery is reported in this study.
    Vascular and Endovascular Surgery 04/2008; 42(3):293-5. · 0.88 Impact Factor
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    ABSTRACT: Peripheral arterial embolism from a malignant tumour is an uncommon manifestation of a neoplasm. Here, we present a case of acute upper limb ischemia due to an embolus originating from primary lung malignancy invading the left atrium.
    Lung Cancer 09/2007; 57(2):237-9. · 3.39 Impact Factor
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    ABSTRACT: Aneurysms of the peroneal artery are infrequent and consist mainly of pseudoaneurysms. This report describes an unusual case of peroneal pseudoaneurysm developing after thromoboembolectomy with a Fogarty catheter. It was managed successfully using an endovascular technique consisting of selective catheterization and coil embolization. The coils were placed in the peroneal artery, both proximal and distal to the pseudoaneurysm. Endovascular technique can be successfully used to treat pseudoaneurysms in difficult settings.
    BMC Surgery 01/2007; 7:4. · 1.97 Impact Factor
  • Clinical Radiology 07/2005; 60(6):718-22. · 1.66 Impact Factor
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    ABSTRACT: Pulmonary arteriovenous malformations (PAVMs) are rare. We discuss a case of an 81-year-old female who attended hospital with a haemothorax. Ultrasound not only demonstrated an echogenic effusion in the right pleural space, but also identified an associated tubular structure. Doppler was applied to this structure, which exhibited pulsatile flow. This raised the possibility of a PAVM, which was subsequently confirmed on CT and angiography. Although, PAVM is a rare cause of haemothorax, the diagnosis should still be considered and transpleural ultrasound can detect these malformations non-invasively by the bedside.
    British Journal of Radiology 08/2004; 77(919):620-2. · 1.22 Impact Factor
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    ABSTRACT: Acute appendicitis has extremely varied clinical presentations. A delayed or missed diagnosis may result in severe adverse consequences. Helical CT is evolving as an important diagnostic aid, but the CT signs can be varied and can easily be overlooked by the unwary. This pictorial review illustrates the spectrum of radiological signs and appearances of appendicitis on helical CT.
    British Journal of Radiology 10/2002; 75(897):775-81. · 1.22 Impact Factor

Publication Stats

61 Citations
40.09 Total Impact Points


  • 2014
    • Cambridge University Hospitals NHS Foundation Trust
      Cambridge, England, United Kingdom
  • 2008
    • University of Texas MD Anderson Cancer Center
      Houston, Texas, United States
  • 2002
    • University of Cambridge
      • Department of Radiology
      Cambridge, ENG, United Kingdom