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ABSTRACT: We report the third documented case of small bowel entrapment within a sacral fracture leading to small bowel obstruction. This important diagnosis is rare and difficult to make, even with current imaging methods. We report a case in which a segment of small bowel trapped in a Denis II fracture of the sacrum required laparotomy, small bowel resection, and an omental patch over the fracture site. In this case the outcome was favorable with no residual sequelae.
Journal of Orthopaedic Trauma 10/2006; 20(8):580-3. · 2.13 Impact Factor
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ABSTRACT: Angiomyolipomas are rare lesions, often arising in the kidney, and are part of a group of tumours with a diverse appearance and evidence of dual melanocytic and smooth muscle differentiation known as PEComas (tumours of perivascular epithelioid cell origin). This report describes an unusual case of a colonic PEComa in a 40 year old woman. Unlike most of the previous colonic angiomyolipomas/PEComas reported in the literature, this case formed a large, mainly extrinsic mass and was monotypic, and composed entirely of the myomatous component with no adipose tissue or typical vasculature.
Journal of Clinical Pathology 11/2005; 58(10):1107-9. · 2.31 Impact Factor
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ABSTRACT: Diagnostic peritoneal lavage (DPL) is used to detect intraperitoneal bleeding in patients sustaining blunt and penetrating abdominal trauma. The procedure should be performed by an experienced general surgeon, and the fluid obtained analysed by haematology technicians. Current Advanced Trauma Life Support guidelines are very clear on what constitutes a positive result, mandating laparotomy. The aim of this work was to assess whether DPL could actually be performed in practice.
A telephone survey was performed of a random selection of haematology technicians in 40 major trauma units in the UK, to assess whether they could actually analyse a DPL sample if it were sent to them. This was performed both during the day, and "out of hours". Secondly the experience of performing DPL was determined among 1797 general surgical trainees and consultants, by means of a questionnaire.
Between 9 am and 5 pm 29 of 40 haematology technicians questioned were able to analyse a sample of DPL fluid. This compared with a figure of 9 of 40 when the questionnaire was administered "out of hours". A total of 854 (48%) questionnaires were received from surgical trainees and consultants. Approximately 60% of those questioned had performed less than 10 DPLs throughout the whole of their careers.
These results suggest that UK surgeons have little experience in performing DPL, and even if they do it is unlikely that any haematology departments will be able to analyse the sample, especially if performed after 5 pm. ATLS guidelines should be changed, and this investigation abandoned in favour of abdominal ultrasound.
Emergency Medicine Journal 12/2002; 19(6):524-5. · 1.44 Impact Factor
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ABSTRACT: A statistically significant number of clinically important features are missed when radiographs are interpreted by holding an X-ray up against the window when compared with using an X-ray box. These findings are most probably accounted for by a quantifiable difference in light intensity.
Annals of The Royal College of Surgeons of England 12/2001; 83(6):435-6. · 1.23 Impact Factor
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British Journal of Surgery 09/1995; 82(8):1053. · 4.61 Impact Factor
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ABSTRACT: Diarrhetic shellfish poisoning (DSP) is a serious and globally widespread phytoplankton-related seafood illness. Although DSP is rarely life-threatening, it causes incapacitating diarrhea and vomiting with no known medical treatments. In addition, phytoplankton producing DSP toxins have been identified in temperate coastal waters worldwide, and their numbers may be increasing as a result of coastal eutrophication. The toxic effects of the major DSP toxins, okadaic acid and dinophysistoxin-1 (35-methylokadaic acid), appear to originate from their inhibitory activity against a family of structurally related serine/threonine protein phosphatases (PSPases). In particular, the inhibition of essential PSPases (e.g. PP1 and PP2A) has catastrophic consequences in most eukaryonic cells. Exploiting the potent inhibitory property of the DSP toxins, we have developed an enzyme-based assay (PP2A assay) capable of detecting both okadaic acid and dinophysistoxin-1 in nanogram amounts. The assay employs purified PP2A, which has an extremely high affinity for both DSP toxins. This provides the PP2A assay with a level of sensitivity comparable to, or surpassing, that of most monoclonal antibody probes. To evaluate the PP2A assay as a means of detecting contaminated shellfish, a series of spike recovery experiments was conducted. The findings from these studies suggest that the PP2A assay has the potential for development into a rapid and relatively simple method for detecting PSPase inhibitors in crude extracts produced from shellfish.
Toxicon 34(11-12):1385-92. · 2.51 Impact Factor
