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Birmingham, United States

An 84-year-old woman accidentally aspirated an iron tablet. She was successfully treated with early endobronchial removal of the iron tablet remnants, oral corticosteroids and antibiotics. We describe the bronchoscopic and histological changes over time following acute iron tablet aspiration and highlight the importance of early intervention to avoid complications.

Menon S.,Sandwell General Hospital | Jones B.J.M.,Russells Hall Hospital
European Journal of Gastroenterology and Hepatology | Year: 2011

BACKGROUND: Postinfective bile acid malabsorption comprises a group of patients with a history of an episode of acute gastroenteritis triggering chronic diarrhoea. We identified these patients retrospectively from our medical records and assessed their long-term clinical course. MATERIALS AND METHODS: We examined the records of 135 patients with 75 selenium-homocholic acid taurine results less than 10% (1 week retention). RESULTS: Twenty-five patients (13 female, 12 male) had a diagnosis of postinfective bile acid malabsorption established after extensive investigations. Cholestyramine was used to treat diarrhoea with a mean frequency of diarrhoea decreasing from 7.8 to 1.9 (P=0.001). The mean cholestyramine dose decreased from 8.2 to 5.4 g/day (P=0.005). Eighteen of 25 (72%) patients had a successful resolution of their diarrhoea by cholestyramine and have continued it to date. The median duration of outpatient follow-up was 1.58 years (range: 1-5 years). A further prospective telephone enquiry of these 18 patients revealed that 15 of 18 patients continued to take cholestyramine (median: 6 years, range: 1-15 years). There were no hospital admissions related to diarrhoea and there was no mortality in this group of patients. CONCLUSION: The long-term outlook of this group of patients is excellent. We have shown the chronic nature of this condition as evidenced by the continued requirement of cholestyramine. © 2011 Lippincott Williams & Wilkins, Inc.

McKenzie Y.A.,Nuffield Health The Manor Hospital | Alder A.,Royal Sussex County Hospital | Anderson W.,Locality | Wills A.,Southampton General Hospital | And 5 more authors.
Journal of Human Nutrition and Dietetics | Year: 2012

Background: Irritable bowel syndrome (IBS) is a chronic debilitating functional gastrointestinal disorder. Diet and lifestyle changes are important management strategies. The aim of these guidelines is to systematically review key aspects of the dietary management of IBS, with the aim of providing evidence-based guidelines for use by registered dietitians. Methods: Questions relating to diet and IBS symptom management were developed by a guideline development group. These included the role of milk and lactose, nonstarch polysaccharides (NSP), fermentable carbohydrates in abdominal bloating, probiotics and empirical or elimination diets. A comprehensive literature search was conducted and relevant studies from January 1985 to November 2009 were identified using the electronic database search engines: Cinahl, Cochrane Library, Embase, Medline, Scopus and Web of Science. Evidence statements, recommendations, good practice points and research recommendations were developed. Results: Thirty studies were critically appraised. A dietetic care pathway was produced following a logical sequence of treatment and formed the basis of these guidelines. Three lines of dietary management were identified. First line: Clinical and dietary assessment, healthy eating and lifestyle management with some general advice on lactose and NSP. Second line: Advanced dietary interventions to improve symptoms based on NSP, fermentable carbohydrates and probiotics. Third line: Elimination and empirical diets. Research recommendations were also identified relating to the need for adequately powered and well designed randomised controlled trials. Conclusions: These guidelines provide evidence-based details of how to achieve the successful dietary management of IBS. © 2012 The Authors. Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.

McBride T.J.,Sandwell General Hospital | Prakash D.,Sandwell General Hospital
Postgraduate Medical Journal | Year: 2011

In 2006 over 55 000 primary total hip replacements were implanted in the UK. A crucial aspect of follow-up for these patients is the assessment of the postoperative radiograph. Information gained from the initial radiograph includes assessment of the quality of implantation and hence the likelihood of long term success. Follow-up radiographs can be assessed for signs of component failure. Orthopaedic surgeons, radiologists, junior surgical trainees, general medical practitioners, and advanced nurse/extended scope practitioners may all be required to interpret these radiographs during clinical practice. The authors feel that certainly during orthopaedic surgical training, not enough time is allocated to formal training on the systematic assessment of such radiographs. This review aims to provide the reader with a systematic approach to analysing the initial postoperative total hip arthroplasty radiograph, and subsequent follow-up films. Basics of patient positioning for obtaining radiographs, types of prosthesis encountered, and terminology used are covered. Assessment of initial radiographs focuses on assessing leg length, acetabular and femoral positioning, and cement mantle adequacy. Follow-up radiographs are assessed for signs of component failure. A review of the literature provides evidence for the assessment and importance of adequacy of component positioning, and good cementing technique. Normal and abnormal follow-up radiographic features are outlined to allow assessment of loosening or impending failure of a prosthesis.

Menon S.,Sandwell General Hospital | Jayasena H.,Sandwell General Hospital | Nightingale P.,Wolfson Computer Laboratories | Trudgill N.J.,Sandwell General Hospital
European Journal of Gastroenterology and Hepatology | Year: 2011

Background: Barrett's oesophagus (BO) and oesophageal adenocarcinoma are more common with increasing age and among men. Symptoms of gastrooesophageal reflux disease are equally common in both sexes and at all ages. We hypothesized that reduced postmenopausal female sex hormone levels may remove protection from acid reflux injury, leading to increased oesophagitis and its complications in older women. Aim: To examine the incidence of gastrooesophageal reflux disease and its complications in men and women in a large endoscopy database. Methods: Anonymized data were extracted from endoscopy databases covering an 11-year period. Patients with an endoscopic diagnosis of reflux oesophagitis (RO), BO, hiatus hernia and benign oesophageal stricture and total number and indications for endoscopies were identified. Results: Out of 154 406 upper gastrointestinal endoscopies, 24 240 (15.7%) patients had RO {13 148 male, 11 092 female, mean age 59 [standard deviation (SD) 17] years}. The incidence of RO increased with age {odds ratio 1.029 [95% confidence interval (CI) 1.026-1.032], P<0.001} but this increase was more marked in women with increasing age [1.01 (1.01-1.02), P<0.001] compared with men. Increasing age was associated with an increased incidence of benign oesophageal stricture [1.02 (1.017-1.023)] and BO [1.02 (1.019-1.021)]. Although the increase in benign oesophageal stricture was more marked in women [1.024 (1.02-1.028) P<0.001] than in men, this was not the case in BO. Conclusion: RO and its complications, BO and benign oesophageal stricture increase with age. RO, BO and stricture are more common in absolute and relative terms among younger men than younger women. RO and stricture increase more rapidly in women than men so that the prevalence in elderly patients is similar in both sexes. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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