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1.  Spontaneous cholecystocolic fistula and locoregional liver tumour ablation: a cautionary tale 
The British Journal of Radiology  2011;84(1008):e243-e245.
A liver abscess is a feared and potentially fatal complication following transarterial chemoembolisation (TACE) and radiofrequency ablation (RFA) of liver tumours. Iatrogenic bilio-enteric communications, such as bilio-enteric anastomosis, sphincterotomy and biliary stents, are considered major risk factors and are due to bacterial colonisation of the biliary tree with enteric flora. Naturally occurring spontaneous cholecysto-enteric fistula poses a similar risk as its iatrogenic counterparts but is rarely described in the literature. We present a case where abscess formation complicated a combined TACE and RFA in an unrecognised cholecystocolic fistula.
PMCID: PMC3473819  PMID: 22101592
2.  Mesenteric desmoid tumour masquerading as a fat-containing cystic mass 
The British Journal of Radiology  2010;83(994):e200-e203.
Mesenteric desmoid tumour (MDT) is an uncommon neoplasm that typically presents as a solid soft-tissue mass on cross-sectional imaging. MDT manifesting as a fat-containing cystic mass on CT has not been described in the literature. We report such an unusual case with clinicopathological correlation.
PMCID: PMC3473748  PMID: 20846976
3.  Multidetector row CT diagnosis of an infected right atrial thrombus following repeated dialysis catheter placement 
The British Journal of Radiology  2009;82(984):e240-e242.
Right atrial thrombus formation is a known complication of dialysis catheter placements. We describe the case of a 61-year-old woman with end-stage renal failure who presented with gram-negative septicaemia. A gas-containing filling defect was noted incidentally in the right atrium during a CT scan of the abdomen and pelvis, indicative of a thrombus infected by a gas-forming organism. The finding correlated with a positive blood culture of Klebsiella pneumoniae and the two-dimensional echocardiography finding of an echogenic atrial thrombus.
PMCID: PMC3473388  PMID: 19934063
4.  Critical limb ischaemia in a diabetic population from an Asian Centre: angiographic pattern of disease and 3-year limb salvage rate with percutaneous angioplasty as first line of treatment 
Lower extremity amputation prevention (LEAP) is an ongoing program in our institution aimed at salvaging limbs in patients with critical limb ischemia (CLI). Patients in the LEAP program with reconstructible anatomy on initial Doppler imaging received either bypass surgery or percutaneous transluminal balloon angioplasty (PTA). We present the 3 year limb salvage rate and angiographic disease patterns in 42 consecutive diabetic patients with CLI who received PTA in 2005.
Methods and Material:
26 women and 16 men with diabetes between the ages of 45 and 91 years old (mean age, 70.8 years) received PTA in 2005. Presenting symptoms were rest pain (n = 22), pre-existing gangrene (n = 17), non-healing ulcer (n = 16) and cellulitis (n = 2). The aim of the PTA was to achieve straight-line flow from the abdominal aorta down to the patent dorsalis pedis or plantar arch, with limb salvage as the ultimate outcome. Failure of treatment was defined as any amputation above the level of a Syme’s amputation or the need for further surgical bypass. Technical success was achieved in 90% (38 out of 42 patients).
Limb salvage rates were 93% at 1 month, 87% at 3 months, 82% at 6 months, 78% at 1 year, 69% at 2 years and 66% at 3 years. Mortality was 17% (n = 7) at 3 years. Of the 13 patients with failed therapy, 3 underwent bypass, 9 had amputations and 1 had bypass followed by amputation. Four of the cases required further intervention due to worsening gangrene and infection, while the remaining was due to persistent rest pain. The rest of the 32 patients had no lower limb related issues at the end of 3 years, with improvement of the presenting symptoms. Patterns of treated segments were aortoiliac occlusions (n = 3), pure infrapopliteal disease (n = 3), femoropopliteal with at least 1 good infrapopliteal run-off vessel (n = 14) and combined femoropopliteal and infrapopliteal disease (n = 25).
Involvement of infrapopliteal vessels that needs to be treated is common in Asian diabetics. While early limb salvage rates up to 1 year are similar, the 3 year limb salvage rates in Asian diabetics are lower than the western population.
PMCID: PMC3097802  PMID: 21611069
Limb salvage rate; lower limb vascular disease pattern; diabetics; Asian centre; percutaneous angioplasty

Results 1-4 (4)