The Compact Midwave Imaging System (CMIS) is a wide field of view, multi-angle, multi-spectral pu... more The Compact Midwave Imaging System (CMIS) is a wide field of view, multi-angle, multi-spectral pushframe imager that relies on the forward motion of the satellite to create a two-dimensional (2D) image swath. An airborne demonstration of CMIS was successfully completed in January-February 2021 on the NASA Langley Research Center Gulfstream III. The primary objective of the four-flight campaign was to demonstrate the capability of this unique instrument to perform stereo observations of clouds and other particulates (e.g. smoke) in the atmosphere. It is shown that the midwave infrared (MWIR) spectral bands of CMIS provide a unique 24/7 capability with high resolution for accurate stereo sensing. The instrument relies on new focal plane array (FPA) technology, which provides excellent sensitivity at much warmer detector temperatures than traditional technologies. This capability enabled a compact, low-cost design that can provide atmospheric motion vectors and cloud heights to support...
The aberrant right subclavian artery is present in 0.4 per cent of the population. It is usually ... more The aberrant right subclavian artery is present in 0.4 per cent of the population. It is usually asymptomatic and only rarely causes symptomatic esophageal compression, a condition known as dysphagia lusoria. It was diagnosed in one of 920 patients undergoing diagnostic endoscopy (223 for dysphagia) and characterized by CT scan. It is important for clinicians to be aware of this condition and that the artery may be visible at endoscopy.
Pelvic exenteration for locally recurrent rectal cancer (LRRC) is associated with variable outcom... more Pelvic exenteration for locally recurrent rectal cancer (LRRC) is associated with variable outcomes, with the majority of data from single-centre series. This study analysed data from an international collaboration to determine robust parameters that could inform clinical decision-making. Anonymized data on patients who had pelvic exenteration for LRRC between 2004 and 2014 were accrued from 27 specialist centres. The primary endpoint was survival. The impact of resection margin, bone resection, node status and use of neoadjuvant therapy (before exenteration) was assessed. Of 1184 patients, 614 (51·9 per cent) had neoadjuvant therapy. A clear resection margin (R0 resection) was achieved in 55·4 per cent of operations. Twenty-one patients (1·8 per cent) died within 30 days and 380 (32·1 per cent) experienced a major complication. Median overall survival was 36 months following R0 resection, 27 months after R1 resection and 16 months following R2 resection (P < 0·001). Patients who...
Rotator cuff tears are a common cause of shoulder disability and pain. Excellent outcomes can be ... more Rotator cuff tears are a common cause of shoulder disability and pain. Excellent outcomes can be obtained with surgical treatment although this outcome is affected by several factors. We sought to investigate the effect of hand dominance on subjective functional outcome post rotator cuff repair. All patients who had rotator cuff repair over a calendar year were identified and followed up at 3 years post operatively. Patients were consented for inclusion in the study and demographic data, hand dominance and functional outcome data was collected. L'insalata shoulder questionnaire was used for outcome data collection. SPSS version 22 was used for statistical analysis where appropriate. 144 patients were included in this study. Mean age was 63 +/- 10.1 years in the dominant side group and 62 +/- 8.6 years in the non-dominant group. 92 patients had dominant side surgery and 52 had non-dominant side surgery. There was a statistically significant correlation between dominant hand and o...
Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and ... more Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.
World journal of gastrointestinal surgery, May 27, 2017
Acute calculous cholecystitis (ACC) is the most frequent complication of cholelithiasis and repre... more Acute calculous cholecystitis (ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72 h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence ...
Journal of public health (Oxford, England), Jan 29, 2016
Exercise Referral Schemes (ERS) are a prevalent method of increasing physical activity levels. Ho... more Exercise Referral Schemes (ERS) are a prevalent method of increasing physical activity levels. However, they suffer from participant dropout and research predicting dropout or barriers to adherence are limited. This study aimed to focus upon the effect of referral characteristics on dropout, dropout predictors and whether self-reported barriers to exercise predict dropout. ERS data from 2009 to 2014 were retrieved for analysis. Chi-squared and t-tests were used to investigate differences between referral characteristics, and logistic regression used to investigate dropout predictors. Of 6894 participants, 37.8% (n = 2608) dropped out within 6 weeks and 50.03% (n = 3449) by the final 12th week. More males adhered (P < 0.001) with dropouts being significantly younger (P < 0.001). Dropout predictors were smoking (OR = 1.58, 95% CI: 1.29-1.93) or being a Tier 3 referral (OR = 1.47, 95% CI: 1.25-1.73). Increasing age (OR = 0.98, 95% CI: 0.98-0.99), drinking alcohol (OR = 0.82, 95% ...
The Journal of clinical endocrinology and metabolism, Mar 9, 2016
Pioglitazone reduces cardiovascular risk in non-diabetic patients after an ischemic stroke or tra... more Pioglitazone reduces cardiovascular risk in non-diabetic patients after an ischemic stroke or transient ischemic attack (TIA) but is associated with increased risk for bone fracture. To characterize fractures associated with pioglitazone by location, mechanism, severity, timing, and sex. Patients were 3876 non-diabetic participants in the Insulin Resistance Intervention after Stroke trial randomized to pioglitazone or placebo after an ischemic stroke or TIA and followed for a median of 4.8 years. Fractures were identified through quarterly interviews. At 5 years, the increment in fracture risk between pioglitazone and placebo groups was 4.9% (13.6% vs. 8.8%; hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.24-1.89). In each group, approximately 80% of fractures were low-energy (i.e., resulted from fall) and 45% were serious (i.e., required surgery or hospitalization). For serious fractures most likely to be related to pioglitazone (low-energy, non-pathological), the risk inc...
To examine whether the timing of delivery of intravenous antibiotics following open limb fracture... more To examine whether the timing of delivery of intravenous antibiotics following open limb fractures has an effect on deep infection rates and other outcomes. We published an a priori study protocol in PROSPERO. Our search strategy combined terms for antibiotics, timing of administration and fractures. Two independent reviewers screened, selected, assessed quality and extracted data from identified studies. We searched five electronic databases with no limits and performed grey literature searches. Randomised and non-randomised controlled studies, prospective and retrospective observational studies in which the effect of the timing of delivery of antibiotics on the outcome of deep infection in open fractures was considered were included. Eight studies were included according to the above criteria. There were no randomised or non-randomised controlled trials. None of the included studies provided data on patient reported or health-related quality of life. The overall deep infection rat...
Renal trauma accounts for 5% of all trauma cases. Rare mechanisms of injuries including sports pa... more Renal trauma accounts for 5% of all trauma cases. Rare mechanisms of injuries including sports participation are increasingly common. Rugby-related trauma poses a conundrum for physicians and players due to the absence of clear guidelines and a paucity of evidence. Our series highlights traumatic rugby-related renal injuries in our institution, and emphasize the need for international guidelines on management. A retrospective review of all abdominal traumas between January 2006 and April 2013, specifically assessing for renal related trauma that were secondary to rugby injuries was performed. All patients' demographics, computerized tomography results, hematological and biochemical results and subsequent management were recorded. Five male patients presented with rugby-related injuries. Mean age was 21 years old. All patients were hemodynamically stable and managed conservatively in acute setting. One patient was detected to have an unknown pre-existing atrophic kidney that had ...
The Journal of bone and joint surgery. American volume, Jan 2, 2015
Scoliosis is a feature of several genetic disorders that are also associated with aortic aneurysm... more Scoliosis is a feature of several genetic disorders that are also associated with aortic aneurysm, including Marfan syndrome, Loeys-Dietz syndrome, and type-IV Ehlers-Danlos syndrome. Life-threatening complications of aortic aneurysm can be decreased through early diagnosis. Genetic screening for mutations in populations at risk, such as patients with adolescent idiopathic scoliosis, may improve recognition of these disorders. The coding regions of five clinically actionable genes associated with scoliosis (COL3A1, FBN1, TGFBR1, TGFBR2, and SMAD3) and aortic aneurysm were sequenced in 343 adolescent idiopathic scoliosis cases. Gene variants that had minor allele frequencies of <0.0001 or were present in human disease mutation databases were identified. Variants were classified as pathogenic, likely pathogenic, or variants of unknown significance. Pathogenic or likely pathogenic mutations were identified in 0.9% (three) of 343 adolescent idiopathic scoliosis cases. Two patients ha...
Chagas disease is a rare condition but with an increasing incidence. Megacolon is a known sequela... more Chagas disease is a rare condition but with an increasing incidence. Megacolon is a known sequelae. Surgical management remains the only disease modifying treatment option; with variable long-term success. We highlight an interesting case to emphasize attention to this rare condition as a differential diagnosis in any patient presenting with massive intestinal dilatation.
In recent years, the management of synchronous colorectal liver metastasis has changed significan... more In recent years, the management of synchronous colorectal liver metastasis has changed significantly. Alternative surgical strategies to the classical colorectal-first approach have been proposed. These include the liver-first and combined resections approaches. The objectives of this review were to compare the short- and long-term outcomes for all three approaches. A systematic review of comparative studies was performed. Evaluated endpoints included surgical outcomes (5-year overall survival, 30-day mortality, and post-operative complications). Pair-wise and network meta-analysis (NMA) were performed to compare survival outcomes. Eighteen studies were included in this review, reporting on 3,605 patients. NMA and pair-wise meta-analysis of the 5-year overall survival did not show significant difference between the three surgical approaches: combined versus colorectal-first, mean odds ratio (OR) 1.02 (95% CI 0.8-1.28, P = 0.93); liver-first versus colorectal-first, mean OR 0.81 (95%...
Arterial thrombosis is rare in ulcerative colitis (UC). Our case report described a triad of arte... more Arterial thrombosis is rare in ulcerative colitis (UC). Our case report described a triad of arterial emboli in a UC patient who presented with bilateral lower limb claudication associated acute chest pain, confusion, ataxia and diplopia. Investigations confirmed bilateral femoral and popliteal artery occlusion, occipital infarct and a sub-endocardial infarct secondary to embolic disease.
World journal of emergency surgery : WJES, Jan 12, 2007
A 73 year old man presented with vomiting and pain due to a strangulated Morgagni hernia containi... more A 73 year old man presented with vomiting and pain due to a strangulated Morgagni hernia containing a gastric volvulus. Laparoscopic operation allowed reduction of the contents, excision of necrotic omentum and the sac, with mesh closure of the large defect. A brief review of the condition is presented along with discussion of the technique used.
World journal of emergency surgery : WJES, Jan 21, 2008
A case of acute caecal volvulus is presented where laparoscopy was used to avoid a major laparoto... more A case of acute caecal volvulus is presented where laparoscopy was used to avoid a major laparotomy. A technique is described for safe deflation of the caecum, which allowed a small incision for resection and anastomosis.
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Mirizzi syndrome is a rare complication of cholecystolithiasis characterized by jaundice due to c... more Mirizzi syndrome is a rare complication of cholecystolithiasis characterized by jaundice due to compression of the common hepatic duct. The diagnosis may not be immediately apparent, and management is controversial with open surgery still recommended by some authors. A case is detailed herein of a 67-year-old man who presented with abdominal pain, fever, and jaundice. A dilated bile duct was found on ultrasound, but the gallbladder could not be seen. The diagnosis of Mirizzi syndrome was made at ERCP, and a stent was placed through the papilla. Laparoscopic retrograde (fundus first) cholecystectomy was carried out utilizing a laparoscopic liver retractor. In this particular case, it was not possible at ERCP to get a guidewire and stent past the obstruction. A stent was left through the papilla, below the obstruction and this allowed primary duct closure during surgery. Acute Mirizzi syndrome should be suspected when a patient presents with acute cholecystitis and jaundice with dilat...
Torsion or rupture of an ovarian cyst may present as an acute abdomen. A case is presented where ... more Torsion or rupture of an ovarian cyst may present as an acute abdomen. A case is presented where the diagnosis was made at laparoscopy and laparoscopic resection was done. Controlled aspiration of the cyst contents allowed the cyst to be easily removed from the abdomen.
The Compact Midwave Imaging System (CMIS) is a wide field of view, multi-angle, multi-spectral pu... more The Compact Midwave Imaging System (CMIS) is a wide field of view, multi-angle, multi-spectral pushframe imager that relies on the forward motion of the satellite to create a two-dimensional (2D) image swath. An airborne demonstration of CMIS was successfully completed in January-February 2021 on the NASA Langley Research Center Gulfstream III. The primary objective of the four-flight campaign was to demonstrate the capability of this unique instrument to perform stereo observations of clouds and other particulates (e.g. smoke) in the atmosphere. It is shown that the midwave infrared (MWIR) spectral bands of CMIS provide a unique 24/7 capability with high resolution for accurate stereo sensing. The instrument relies on new focal plane array (FPA) technology, which provides excellent sensitivity at much warmer detector temperatures than traditional technologies. This capability enabled a compact, low-cost design that can provide atmospheric motion vectors and cloud heights to support...
The aberrant right subclavian artery is present in 0.4 per cent of the population. It is usually ... more The aberrant right subclavian artery is present in 0.4 per cent of the population. It is usually asymptomatic and only rarely causes symptomatic esophageal compression, a condition known as dysphagia lusoria. It was diagnosed in one of 920 patients undergoing diagnostic endoscopy (223 for dysphagia) and characterized by CT scan. It is important for clinicians to be aware of this condition and that the artery may be visible at endoscopy.
Pelvic exenteration for locally recurrent rectal cancer (LRRC) is associated with variable outcom... more Pelvic exenteration for locally recurrent rectal cancer (LRRC) is associated with variable outcomes, with the majority of data from single-centre series. This study analysed data from an international collaboration to determine robust parameters that could inform clinical decision-making. Anonymized data on patients who had pelvic exenteration for LRRC between 2004 and 2014 were accrued from 27 specialist centres. The primary endpoint was survival. The impact of resection margin, bone resection, node status and use of neoadjuvant therapy (before exenteration) was assessed. Of 1184 patients, 614 (51·9 per cent) had neoadjuvant therapy. A clear resection margin (R0 resection) was achieved in 55·4 per cent of operations. Twenty-one patients (1·8 per cent) died within 30 days and 380 (32·1 per cent) experienced a major complication. Median overall survival was 36 months following R0 resection, 27 months after R1 resection and 16 months following R2 resection (P < 0·001). Patients who...
Rotator cuff tears are a common cause of shoulder disability and pain. Excellent outcomes can be ... more Rotator cuff tears are a common cause of shoulder disability and pain. Excellent outcomes can be obtained with surgical treatment although this outcome is affected by several factors. We sought to investigate the effect of hand dominance on subjective functional outcome post rotator cuff repair. All patients who had rotator cuff repair over a calendar year were identified and followed up at 3 years post operatively. Patients were consented for inclusion in the study and demographic data, hand dominance and functional outcome data was collected. L'insalata shoulder questionnaire was used for outcome data collection. SPSS version 22 was used for statistical analysis where appropriate. 144 patients were included in this study. Mean age was 63 +/- 10.1 years in the dominant side group and 62 +/- 8.6 years in the non-dominant group. 92 patients had dominant side surgery and 52 had non-dominant side surgery. There was a statistically significant correlation between dominant hand and o...
Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and ... more Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.
World journal of gastrointestinal surgery, May 27, 2017
Acute calculous cholecystitis (ACC) is the most frequent complication of cholelithiasis and repre... more Acute calculous cholecystitis (ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72 h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence ...
Journal of public health (Oxford, England), Jan 29, 2016
Exercise Referral Schemes (ERS) are a prevalent method of increasing physical activity levels. Ho... more Exercise Referral Schemes (ERS) are a prevalent method of increasing physical activity levels. However, they suffer from participant dropout and research predicting dropout or barriers to adherence are limited. This study aimed to focus upon the effect of referral characteristics on dropout, dropout predictors and whether self-reported barriers to exercise predict dropout. ERS data from 2009 to 2014 were retrieved for analysis. Chi-squared and t-tests were used to investigate differences between referral characteristics, and logistic regression used to investigate dropout predictors. Of 6894 participants, 37.8% (n = 2608) dropped out within 6 weeks and 50.03% (n = 3449) by the final 12th week. More males adhered (P < 0.001) with dropouts being significantly younger (P < 0.001). Dropout predictors were smoking (OR = 1.58, 95% CI: 1.29-1.93) or being a Tier 3 referral (OR = 1.47, 95% CI: 1.25-1.73). Increasing age (OR = 0.98, 95% CI: 0.98-0.99), drinking alcohol (OR = 0.82, 95% ...
The Journal of clinical endocrinology and metabolism, Mar 9, 2016
Pioglitazone reduces cardiovascular risk in non-diabetic patients after an ischemic stroke or tra... more Pioglitazone reduces cardiovascular risk in non-diabetic patients after an ischemic stroke or transient ischemic attack (TIA) but is associated with increased risk for bone fracture. To characterize fractures associated with pioglitazone by location, mechanism, severity, timing, and sex. Patients were 3876 non-diabetic participants in the Insulin Resistance Intervention after Stroke trial randomized to pioglitazone or placebo after an ischemic stroke or TIA and followed for a median of 4.8 years. Fractures were identified through quarterly interviews. At 5 years, the increment in fracture risk between pioglitazone and placebo groups was 4.9% (13.6% vs. 8.8%; hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.24-1.89). In each group, approximately 80% of fractures were low-energy (i.e., resulted from fall) and 45% were serious (i.e., required surgery or hospitalization). For serious fractures most likely to be related to pioglitazone (low-energy, non-pathological), the risk inc...
To examine whether the timing of delivery of intravenous antibiotics following open limb fracture... more To examine whether the timing of delivery of intravenous antibiotics following open limb fractures has an effect on deep infection rates and other outcomes. We published an a priori study protocol in PROSPERO. Our search strategy combined terms for antibiotics, timing of administration and fractures. Two independent reviewers screened, selected, assessed quality and extracted data from identified studies. We searched five electronic databases with no limits and performed grey literature searches. Randomised and non-randomised controlled studies, prospective and retrospective observational studies in which the effect of the timing of delivery of antibiotics on the outcome of deep infection in open fractures was considered were included. Eight studies were included according to the above criteria. There were no randomised or non-randomised controlled trials. None of the included studies provided data on patient reported or health-related quality of life. The overall deep infection rat...
Renal trauma accounts for 5% of all trauma cases. Rare mechanisms of injuries including sports pa... more Renal trauma accounts for 5% of all trauma cases. Rare mechanisms of injuries including sports participation are increasingly common. Rugby-related trauma poses a conundrum for physicians and players due to the absence of clear guidelines and a paucity of evidence. Our series highlights traumatic rugby-related renal injuries in our institution, and emphasize the need for international guidelines on management. A retrospective review of all abdominal traumas between January 2006 and April 2013, specifically assessing for renal related trauma that were secondary to rugby injuries was performed. All patients' demographics, computerized tomography results, hematological and biochemical results and subsequent management were recorded. Five male patients presented with rugby-related injuries. Mean age was 21 years old. All patients were hemodynamically stable and managed conservatively in acute setting. One patient was detected to have an unknown pre-existing atrophic kidney that had ...
The Journal of bone and joint surgery. American volume, Jan 2, 2015
Scoliosis is a feature of several genetic disorders that are also associated with aortic aneurysm... more Scoliosis is a feature of several genetic disorders that are also associated with aortic aneurysm, including Marfan syndrome, Loeys-Dietz syndrome, and type-IV Ehlers-Danlos syndrome. Life-threatening complications of aortic aneurysm can be decreased through early diagnosis. Genetic screening for mutations in populations at risk, such as patients with adolescent idiopathic scoliosis, may improve recognition of these disorders. The coding regions of five clinically actionable genes associated with scoliosis (COL3A1, FBN1, TGFBR1, TGFBR2, and SMAD3) and aortic aneurysm were sequenced in 343 adolescent idiopathic scoliosis cases. Gene variants that had minor allele frequencies of <0.0001 or were present in human disease mutation databases were identified. Variants were classified as pathogenic, likely pathogenic, or variants of unknown significance. Pathogenic or likely pathogenic mutations were identified in 0.9% (three) of 343 adolescent idiopathic scoliosis cases. Two patients ha...
Chagas disease is a rare condition but with an increasing incidence. Megacolon is a known sequela... more Chagas disease is a rare condition but with an increasing incidence. Megacolon is a known sequelae. Surgical management remains the only disease modifying treatment option; with variable long-term success. We highlight an interesting case to emphasize attention to this rare condition as a differential diagnosis in any patient presenting with massive intestinal dilatation.
In recent years, the management of synchronous colorectal liver metastasis has changed significan... more In recent years, the management of synchronous colorectal liver metastasis has changed significantly. Alternative surgical strategies to the classical colorectal-first approach have been proposed. These include the liver-first and combined resections approaches. The objectives of this review were to compare the short- and long-term outcomes for all three approaches. A systematic review of comparative studies was performed. Evaluated endpoints included surgical outcomes (5-year overall survival, 30-day mortality, and post-operative complications). Pair-wise and network meta-analysis (NMA) were performed to compare survival outcomes. Eighteen studies were included in this review, reporting on 3,605 patients. NMA and pair-wise meta-analysis of the 5-year overall survival did not show significant difference between the three surgical approaches: combined versus colorectal-first, mean odds ratio (OR) 1.02 (95% CI 0.8-1.28, P = 0.93); liver-first versus colorectal-first, mean OR 0.81 (95%...
Arterial thrombosis is rare in ulcerative colitis (UC). Our case report described a triad of arte... more Arterial thrombosis is rare in ulcerative colitis (UC). Our case report described a triad of arterial emboli in a UC patient who presented with bilateral lower limb claudication associated acute chest pain, confusion, ataxia and diplopia. Investigations confirmed bilateral femoral and popliteal artery occlusion, occipital infarct and a sub-endocardial infarct secondary to embolic disease.
World journal of emergency surgery : WJES, Jan 12, 2007
A 73 year old man presented with vomiting and pain due to a strangulated Morgagni hernia containi... more A 73 year old man presented with vomiting and pain due to a strangulated Morgagni hernia containing a gastric volvulus. Laparoscopic operation allowed reduction of the contents, excision of necrotic omentum and the sac, with mesh closure of the large defect. A brief review of the condition is presented along with discussion of the technique used.
World journal of emergency surgery : WJES, Jan 21, 2008
A case of acute caecal volvulus is presented where laparoscopy was used to avoid a major laparoto... more A case of acute caecal volvulus is presented where laparoscopy was used to avoid a major laparotomy. A technique is described for safe deflation of the caecum, which allowed a small incision for resection and anastomosis.
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Mirizzi syndrome is a rare complication of cholecystolithiasis characterized by jaundice due to c... more Mirizzi syndrome is a rare complication of cholecystolithiasis characterized by jaundice due to compression of the common hepatic duct. The diagnosis may not be immediately apparent, and management is controversial with open surgery still recommended by some authors. A case is detailed herein of a 67-year-old man who presented with abdominal pain, fever, and jaundice. A dilated bile duct was found on ultrasound, but the gallbladder could not be seen. The diagnosis of Mirizzi syndrome was made at ERCP, and a stent was placed through the papilla. Laparoscopic retrograde (fundus first) cholecystectomy was carried out utilizing a laparoscopic liver retractor. In this particular case, it was not possible at ERCP to get a guidewire and stent past the obstruction. A stent was left through the papilla, below the obstruction and this allowed primary duct closure during surgery. Acute Mirizzi syndrome should be suspected when a patient presents with acute cholecystitis and jaundice with dilat...
Torsion or rupture of an ovarian cyst may present as an acute abdomen. A case is presented where ... more Torsion or rupture of an ovarian cyst may present as an acute abdomen. A case is presented where the diagnosis was made at laparoscopy and laparoscopic resection was done. Controlled aspiration of the cyst contents allowed the cyst to be easily removed from the abdomen.
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Papers by Michael Kelly