• Parenchymal calcifications in chronic pancreatitis independently predict post-operative pain relief • Intraductal calculi and MPD dilation are not associated with post-operative pain relief • Better patient selection for pancreatic resection surgery in painful chronic pancreatitis.
Paediatric Crohn's disease can be a serious and complex condition which is not always easy to diagnose if it presents in an atypical manner. Although the pathological processes are the same in adults and children, the clinical presentation and disease distribution can be different in children. The impact of the disease can also be much more significant in a growing and developing child than in an adult. Numerous investigations are available to establish the diagnosis, define the complications and to demonstrate the extra-intestinal manifestations. Close cooperation is required between the clinician and radiologist when investigating a child suspected of having Crohn's disease or its symptoms to minimise the radiation dose and the psychological and physical trauma. We review the clinical and radiological aspects of Crohn's disease and discuss the imaging modalities available in diagnosing Crohn's disease and its complications and suggest an investigation pathway as used in our institution.
Acquired factor VIII deficiency is a rare disorder with a high rate of morbidity and mortality, commonly presents with bruises or bleeding in patients without previous bleeding diathesis. Presentation with thrombosis is extremely rare but if it presents with thrombosis then diagnosis and management become challenging. Balance in anticoagulation and monitoring for bleeding remains the cornerstone of treatment. We are presenting a case of 60 years old female who presented with left leg swelling and diagnosed as deep venous thrombosis and started on anticoagulation. She developed hematoma on the right arm and on further workup she was diagnosed with acquired factor VIII deficiency, treated with steroid and cyclophosphamide which resulted in a good response.
Table 1 Interventions INTERVENTIONS REFERRING HOSPITAL NWTS Intubation 22 4 Central Venous Access 6 7 Dinoprostone (PGE2) 20 2 Inotropes 7 10 Inhaled Nitric oxide 0 3 Seven patients had time critical cardiac surgical lesions. One patient required a second immediate transfer to surgical centre. Retrospectively, this could have been predicted from clinical picture. 68% patients had dinoprostone started by referring team following advice from cardiologist or NWTS. Inotropes initiated on advice or by NWTS. Conclusions Regional cardiac network can work effectively with improved communication particularly in acute scenario. Potential surgical cases may be predicted from clinical picture, especially if not resolving with full medical treatment.
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