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Biomedical subjects

M A Sampson

Publications and source records attributed to M A Sampson.

15 recordsLinked to original sources
PubMed2006

Computed tomography whole body imaging in multi-trauma: 7 years experience.

AIM: To assess the impact of the introduction of a computed tomography (CT) imaging protocol for multi-trauma patients on the workload, overall diagnostic yield, and effect on detection of cervical spine injury and pneumothorax. METHOD: Between February 1997 and April 2004, all patients presenting acutely to the Emergency Department (ED) with haemodynamically stable trauma (Abbreviated Injury Scale 3 or more) involving more than two body systems were imaged with a comprehensive pre-set helical CT protocol (including non-contrast head, cervical spine: cranio-cervical and cervico-thoracic junctions; and oral and intravenous contrast-enhanced thoracic, abdomen and pelvis) after initial triage and a standard trauma series of radiographs (chest, lateral C-spine and pelvis). Diagnosis of cervical spine fracture and pneumothorax was noted before and after the CT protocol was carried out and findings from all studies were recorded prospectively. RESULTS: Over the 7-year period 296 multi-trauma CT studies were completed of which 41 (13.8%) were negative. Of the positive cases there were 127 (43%) head injuries; 25 cervical spine fractures (8%); 66 pelvic fractures (22%);48 thoracic or lumbar spine fractures (16%); 97 pneumothoraces (33%); 22 mediastinal injuries (7%) and 49 intra-abdominal injuries (17%) with 19 (6%) splenic tears/ruptures. Positive findings included many unsuspected injuries, including 19 cervical spine fractures which were not demonstrated on the standard lateral radiograph from the resuscitation room. Of the 97 CT detected pneumothoraces, 12 were bilateral, 52 already had a chest drain in situ and 36 were not detected on initial supine chest radiography in the resuscitation room. One undetected case had bilateral tension pneumothoraces that were promptly drained on the CT table. Only three patients did not complete their multi-trauma examination because of deterioration in clinical condition and these were all immediately returned to the resuscitation room. CONCLUSION: Over the 7-year period in a large acute National Health Service (NHS) hospital trust currently averaging 85,000 ED attendances per year only 296 patients fulfilled the stated criteria for an immediate multi-trauma CT study. Although disruptive in the short-term, the overall impact on workload was small. A wide range of significant injuries were demonstrated rapidly, accurately and safely, including 19 cervical spine fractures and 26 pneumothoraces not detected on plain radiographs.

Abbreviated Injury Scale↗
PubMed2000

'Cable-maker's clavicle': stress fracture of the medial clavicle.

A 50-year-old man presented with a non-traumatic painful swelling over the medial clavicle. Radiographs showed a poorly defined fracture and the possibility of an underlying pathology was raised. Computed tomography suggested a stress fracture. This prompted a further, more detailed occupational history to be obtained from the patient, which revealed a hitherto undescribed cause of clavicular stress fracture and obviated the need for further imaging or biopsy.

Chronic Disease↗
PubMed1994

The small bowel follow-through: time to sit up.

It is common practice for patients to lie on their right side during small bowel barium follow-through examinations. The rationale is that this speeds up transit time and improves diagnostic usefulness. The results of a randomized, prospective study of 105 patients are presented. There was no significant difference in either transit time or diagnostic usefulness when the examination was carried out with the patient erect (sitting or ambulant) or when adopting the decubitus position. Abandoning the use of the right side down decubitus position allows a longstanding fiction to be discarded. Furthermore, lack of reclining space has been one factor which may limit the number of patients booked for this examination during a single session. Space for couches and trolleys need no longer be a barrier to the efficient organization of a small bowel screening session.

Adolescent↗
PubMed1994

How do general practitioners compare with the outpatient department when requesting upper abdominal ultrasound examinations?

The recent re-organization of the National Health Service has placed a new emphasis on reexamining the services that hospitals provide to General Practitioners (GPs). To assess the positive findings from an existing open access ultrasound service for GPs in a metropolitan District General Hospital, a retrospective study was performed of 300 consecutive patients referred by GPs compared with 300 consecutive patients referred from the general medical, surgical and geriatric Outpatient Departments--specifically with regard to upper abdominal ultrasound. The frequency with which the clinical indication for referral was associated with an ultrasound finding which could explain the patient's symptoms was measured and the similarities and differences in the two groups are discussed. The study did not attempt to assess the complete value of this service since that would have necessitated assessment of the importance of negative findings. In the two groups the total number of ultrasound abnormalities was similar. A total of 25.3% of GP referrals had an abnormality which could account for their symptoms. The corresponding figure for hospital outpatients was 33.6%. On this criterion, the provision of open access for abdominal ultrasound to GPs is justified.

Abdomen↗
PubMed1992

Need for open access non-screening mammography in a hospital with a specialist breast clinic service.

OBJECTIVE: Assessment of open access non-screening mammography in a hospital with a breast clinic. DESIGN: Retrospective analysis of patients sent for first mammogram to our open access service by general practitioners and breast clinic in the year April 1989 to March 1990. SETTING: District general hospital serving 200,000 people before the introduction of breast screening. SUBJECTS: 361 symptomatic women referred directly by general practitioners and 226 women referred by the breast clinic for first, non-screening mammograms. MAIN OUTCOME MEASURES: Radiographic reports on all patients. Final diagnosis in patients reported as having possible or probable neoplasm. RESULTS: Of the women referred directly by general practitioners one (0.2%) was reported as showing probable malignancy (later histologically confirmed) and 15 (4%) as showing possible malignancy (on follow up none had proved malignancy). Of the women referred by the breast clinic 38 (17%) were reported as showing probable malignancy (all had confirmed carcinomas) and 35 (15%) as showing possible malignancy (19 (54%) had proved malignancy). 18 of the proved malignancies were in women under 50 years old, 26 were in women over 64 years, and 14 were in women of screening age. 54 (93%) of the 58 patients with proved breast cancer and an abnormal mammogram had a discrete breast lump. CONCLUSIONS: General practitioners accurately divided women into low and high risk groups, resulting in few abnormalities being detected in patients referred directly for mammography. This suggests that an open access non-screening mammography service for general practitioners is unnecessary in an area with a specialist breast clinic. The large proportion of cancers in women outside of screening age emphasises the need for such clinics.

Adult↗
PubMed1990

Acute extradural compression due to an intraspinal synovial cyst: CT and myelogram appearances.

Intraspinal synovial cysts, sometimes referred to as ganglion cysts, are uncommon entities thought to be related to degenerative changes of the facet joints. They usually present with low back pain and sciatica of months or years duration. We report a case of acute extradural compression in a previously asymptomatic patient demonstrated on myelography and computed tomography to be due to a cystic lesion related to the apophyseal joint, shown at operation to be a synovial cyst. The literature on this condition is reviewed.

Acute Disease↗
PubMed1989

The prevalence and characterization of simple hepatic cysts by ultrasound examination.

To help assess the significance of liver cysts we have prospectively documented their prevalence and characteristics within a general population being referred for ultrasound. Simple hepatic cysts occur in 2.5% of the population, becoming increasingly common with age. They show a preference for women, the right lobe of the liver and are occasionally multiple. The differential diagnosis is discussed.

Adult↗
PubMed1988

Sacral arachnoid diverticula.

Three cases of sacral arachnoid diverticula causing bony erosion are described. Two of these filled with contrast medium after the initial myelogram was completed, and were only apparent on delayed CT.

Arachnoid↗