[Show abstract][Hide abstract] ABSTRACT: Early complications associated with percutaneous endoscopic gastrostomy are well documented. Late complications associated with retained gastrostomy flange are rare. It is unclear why some patients with retained gastrostomy flange (internal bumper) develop mechanical obstruction and others do not. We report a case of mechanical obstruction with perforation occurring 6 months after the tube was cut.
A 76-year-old hemiplegic patient with no swallowing reflex and who previously was on long-term percutaneous gastrostomy feeding tube underwent removal of the feeding tube but the internal bumper was left in situ due to encrustation.
Due to migration of the retained flange, the patient developed small bowel obstruction.
Retained internal bumper is potentially dangerous and we recommend endoscopic retrieval of such flange.
Annals of The Royal College of Surgeons of England 10/2007; 89(6):W1-5. · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It is generally accepted that antiphospholipid syndrome remains a major medical problem characterised by hypercoagulability, arterial and venous thrombosis and thrombocytopenia. It is unclear how best to treat these patients should they require emergency surgery. If a lupus anticoagulant is present, hypercoagulability may occur de novo but surgical interventions along with sepsis are two important predisposing factors. We describe three patients with primary antiphospholipid syndrome and discuss the implications for surgery.
Annals of The Royal College of Surgeons of England 08/2006; 88(4):370-4. · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Botulinum toxin is now an important therapeutic agent in various clinical specialties. Although a lot is known about its short-term effects, little is known about the long-term effects or delayed complications. Most of the therapeutic effects appear within a week and last for 10-12 weeks. In most cases, the side effects are mild and often self-limiting and tend to occur within the first week. Myofascial necrosis and delayed onset of side effects are rarely reported and present a new challenge for a drug that has been proclaimed as an anti-ageing drug by the lay press and is widely used outside the licensed indications.
European Journal of Internal Medicine 01/2006; 16(8):603-5. · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examines the incidence and outcome of complications requiring surgical intervention in a major vascular unit serving interventional radiology and interventional cardiology. Between April 2000 and March 2001, 2324 patients underwent angiographic examinations (male/female = 1579:745, mean age = 68 years, range 45-88). In non-stent patients, a 4-or 5-mm French (4-mm F, 5-mm F) guage nonheparinized arterial catheter was used, and in patients requiring stents a 6- or 7-mm French guage catheter was used. Pressure was applied to the puncture site for up to 6 min. Fifteen complications requiring vascular surgical procedure were recorded during in-hospital follow-up (9 males, 6 females). Our early operative (30-day) mortality rate was 0.086%. Although the number of major complications requiring surgical intervention after interventional or diagnostic cardiovascular radiology is diminishing, vigilance in these cases is still required. Where possible, a small catheter with a J-shaped guidewire should be used and prolonged compression should be brought to bear on the puncture site.
Annals of Vascular Surgery 08/2004; 18(4):470-3. · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A prospective study aimed at assessing the effect of introduction of a fast-tract referral system for patients with suspected breast cancer and the quality of GP referrals in Barnsley.
Between February and April 2001, 70 consecutive patients with symptomatic breast disorders were seen in the fast-access breast clinic. Mean age=46 years (range 18-84). Ten non-urgent referrals seen in the study period were included in the analysis to determine the appropriateness of such referrals. Three screening criteria were used to select high-risk patients and data were recorded prospectively. Patients were classified as urgent, soon or routine based on symptomatology.
Of the 70 patients seen, 20 were considered as urgent, 20 as soon and 30 as routine. Forty patients were seen within the '2-week wait' period. Twelve were classified on clinical grounds as malignant. Mean waiting time to see the GP was 2.2 days. Mean waiting time to see the specialist breast surgeon was 6.6 days.
A fast-track system for suspected breast cancer has led to a significant reduction in the time to diagnosis and initiation of a definitive treatment, with most made within 2 weeks. Fast-track referrals is not appropriate in all cases.
The Breast 11/2002; 11(5):430-3. · 2.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Among most patients attending a rectal clinic, rectal bleeding is a common presenting feature. In most patients, the cause is attributed to a benign lesion. In a small percentage, the cause is neoplastic, and for this reason, rectal bleeding merits further study. Left-sided tumors account for the majority of these tumors and are within the reach of a flexible sigmoidoscopy. This study aimed at examining the diagnostic performance of the one stop rectal clinic in Coventry. Between November 2001 and May 2002, 250 consecutive patients were seen in the one stop rectal bleeding clinic of a tertiary referral hospital. Patients were asked of the nature of rectal bleed and altered bowel habits and were examined by digital rectal examination, with a proctoscopy and rigid sigmoidoscopy before either a full colonoscopic examination or flexible sigmoidoscopy with a completion Barium enema. During the study period, colorectal cancer was detected in 4 patients (1.6%), adenomatous polyps in 36 patients (14.4%), and ulcerative colitis in 8 patients (3.2%). In 98 patients (39.2%), no abnormality was present, and in the remaining patients, diverticulosis (n = 60; 24%) and hemorrhoids were present (n = 44; 17.6%).
International surgery 91(5):288-90. · 0.25 Impact Factor