Hugh Burnett - Academia.edu (original) (raw)

Papers by Hugh Burnett

Clinical Radiology, May 1, 2010

Intestinal failure (IF) is the inability of the alimentary tract to digest and absorb sufficient ... more Intestinal failure (IF) is the inability of the alimentary tract to digest and absorb sufficient nutrition to maintain normal fluid balance, growth, and health. It commonly arises from disease affecting the mesenteric root. Although severe IF is usually managed in specialized units, it lies at the end of a spectrum with degrees of nutritional compromise being widely encountered, but commonly under-recognized. Furthermore, in the majority of cases, the initial enteric insult occurs in non-specialist IF centres. The aim of this article is to review the common causes of IF, general principles of its management, some commoner complications, and the role of radiology in the approach to a patient with severe IF. The radiologist has a crucial role in helping provide access for feeding solutions (both enteral and parenteral) and controlling sepsis (via drainage of collections) in an initial restorative phase of treatment, whilst simultaneously mapping bowel anatomy and quality, and searching for disease complications to assist the clinicians in planning a later, restorative phase of therapy.

Emergency Medicine Journal, Jul 1, 1999

The previous article by Robinson and Clancy examined the value of ultrasound in the international... more The previous article by Robinson and Clancy examined the value of ultrasound in the international perspective, placing the role of emergency department ultrasound in this country in the context of practice elsewhere in the world. This article seeks to explore the role of ultrasound in casualty-where it fits and where its limitations lie in relation to the advantages of alternative imaging modalities. The "who" of imaging will also be addressed-who should be performing ultrasound and who should train them. Anticipated future trends will be explored.

Case Reports, Jul 23, 2010

The authors report the case of a 48-year-old woman, with a 2-year history of prominent borborygmi... more The authors report the case of a 48-year-old woman, with a 2-year history of prominent borborygmi, nausea, abdominal discomfort after large meals and weight loss. Continuous, prominent, audible borborygmi were evident while the patient remained standing. However, these noises abated when she held her breath or when pressure was applied over the left hypochondrium. When lying flat, abdominal examination was normal. Gastroscopy, colonoscopy, small bowel follow-through, abdominal CT scan, small bowel transit study and laparoscopy were all normal. A barium meal showed that her stomach was normal when lying flat, but adopted an hourglass deformity in the sitting position due to compression from her left anterior ribs. Compression from the diaphragm, on inspiration, then resulted in audible borborygmi.

International Journal of Surgery Case Reports, 2017

INTRODUCTION: Duplication of the gallbladder (GB) is a very rare surgical encounter affecting 1 i... more INTRODUCTION: Duplication of the gallbladder (GB) is a very rare surgical encounter affecting 1 in 4000-5000 population that often eludes detection on preoperative ultrasonography, and might increase operative difficulty and risk. The H-type anomaly is the most common whereby each GB drains into the common bile duct via a separate cystic duct. PRESENTATION OF CASE: We report a young female patient with symptomatic gallstones who was incidentally found to have abnormal biliary anatomy on a CT colonography and an H-type duplication of the GB on MRCP. A challenging laparoscopic double cholecystectomy was performed uneventfully. DISCUSSION: Gallbladder duplication can be classified as a type-I anomaly (partiality split primordial gallbladder), a type-II anomaly (two separate gallbladders, each with their own cystic duct) or a rare type-III anomaly (triple gallbladders draining by 1-3 separate cystic ducts). Such anatomical variations are associated with increased operative difficulty and risks, including conversion to open cholecystectomy and common bile duct injury. CONCLUSION: A young female patient was pre-operatively diagnosed with a Harlaftis's type-II GB anomaly. Each gallbladder was drained by a distinct cystic duct (H-type anomaly). A laparoscopic cholecystectomy was performed with no complications afterwards. Awareness of this rare anomaly might require intraoperative cholangiography when initially suspected during a cholecystectomy to facilitate anatomical recognition and avoid missing a symptomatic pathologic GB and the need for a repeat cholecystectomy.

Clinical Radiology, 1999

Pseudosubluxation of C2 on C3 is a recognized physiological variant in the upper cervical spine r... more Pseudosubluxation of C2 on C3 is a recognized physiological variant in the upper cervical spine radiographs of normal children. The aim of this study was to determine the prevalence of this variant in children admitted with serious polytrauma, and to explore its significance in this setting. PATIENTS AND METHODS: A retrospective review was performed of 138 patients under 16 years of age admitted with polytrauma via The Helicopter Emergency Medical Service. All patients wore hard collars and underwent immediate horizontal beam lateral cervical spine radiography. Normal and C2/C3 pseudosubluxation groups were defined using standard criteria. The two groups were compared in terms of age, presence of an endotracheal tube, injury severity, and outcome. RESULTS: There were 108 (78.3%) children in the normal group and 30 (21.7%) in the C2/C3 pseudosubluxation group. No significant differences in sex ratio, intubation status, injury severity, or outcome were found. Patients in the pseudosubluxation group were significantly younger. CONCLUSION: In paediatric polytrauma it is essential to establish the integrity of the cervical spine promptly as this will deter unnecessary further imaging and investigation. In our study 21.7% of cases had C2/C3 pseudosubluxation on admission radiographs. We have shown that C2/C3 pseudosubluxation has no significant association with intubation status, injury severity, or outcome. We conclude that C2/C3 pseudosubluxation can be considered a benign variant even in the setting of polytrauma.

BMJ Case …, 2010

Clinical Radiology, 2002

To assess the place of computed tomography (CT) of the colon in frail or elderly patients with sy... more To assess the place of computed tomography (CT) of the colon in frail or elderly patients with symptoms suggestive of colon cancer. METHOD: A total of 195 patients (median age 76 years) underwent CT of the abdomen and pelvis following the administration of positive oral contrast medium but no bowel preparation. All had symptoms suggestive of colon cancer. CT ®ndings were classi®ed as normal/diverticular disease (DD), possible colon cancer, de®nite colon cancer or extracolonic pathology. Accuracy of CT was assessed against patient outcome. Association between symptoms and colon cancer was assessed by chi-squared test. RESULTS: There were 47 deaths and median follow up for those alive was 16 months. Overall sensitivity of CT was 100% and speci®city 87% for detection of colon cancer. One hundred and ten normal/DD CT examinations had no signi®cant bowel lesion on follow up. Of 12 cases de®ned as de®nite cancers' on CT, there were nine colon cancers, two extracolonic cancers, and one normal. Of 23 possible cancers' on CT, there were two colon cancers, three DD masses and 18 normal/DD. Fifty examinations had extracolonic ®ndings including 33 (17%) cases of signi®cant abdominal disease. CT ®ndings led to a halt in investigations in 115 cases (59%), colonoscopy in 18 (9%) cases and surgery in 16 (8%) cases. None of the symptoms present showed a signi®cant association with colon cancer (all P 4 0.05). CONCLUSION: Minimal preparation CT is a non-invasive and sensitive method for investigating colon cancer in frail or elderly patients. It has a 100% negative predictive value and also detects a large number of extracolonic lesions.