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6 results on '"Kirwan WO"'

1. Second trimester hepatic rupture in a 35 year old nulliparous woman with HELLP syndrome: a case report

Author

O'Brien N, Ryan DJ, Kelly J, and Kirwan WO

Subjects
Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract The HELLP syndrome (haemolysis, elevated liver blood tests and low platelets) is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. Hepatic capsular rupture is a rare yet dramatic complication of HELLP syndrome. The majority of cases occur in multiparous women over the age of 30. Classically it presents with acute onset right upper quadrant pain in the presence of constitutional symptoms such as vomiting and pyrexia. However, symptoms and signs are usually non specific. Spontaneous hepatic rupture can be preceded by signs of hypovolaemic shock; yet the diagnosis is infrequently made prior to emergent laparotomy. We present the case of a 35 year old nulliparous woman with a second trimester gestational hepatic rupture associated with HELLP syndrome. We briefly discuss the aetiology, diagnostic difficulties and treatment options associated with this rare presentation.

Published
2009
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2. Post-traumatic tension faecopneumothorax in a young male: case report

Author

Kirwan WO, Condon ET, Kelly J, and Redmond HP

Subjects
Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Diaphragmatic rupture due to trauma is both well recognised and uncommon. The difficulties in diagnosing traumatic diaphragmatic rupture at the first admission are the most common causes of latent morbidity and mortality. Herniation of the abdominal viscera is the most common sequel with strangulation and perforation the most serious complication. This case outlines the delayed presentation of diaphragmatic rupture and herniation presenting as an acute tension faecopneumothorax. We review the relevant literature, with particular emphasis on the difficulties in diagnosis at presentation.

Published
2008
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4. Randomized clinical trial of adjuvant radiotherapy and 5-fluorouracil infusion in colorectal cancer (AXIS)

Author

Miller, R, Dewar, EP, Kapadia, CR, Nejim, A, Hutchinson, IF, McAdam, WA, Morris, IR, Deasy, JM, Irwin, ST, Oates, GD, O'Dwyer, STP, Dorricott, NJ, Stock, SE, Wilkinson, MJS, Ostick, DG, Hobbiss, JH, Farrands, PA, Ross, AHM, Sauven, P, Sandilands, DGD, De Castella, HC, McCarthy, D, Lee, P, Allen-Mersh, TG, Haynes, S, Bristol, JB, Donovan, IA, Neoptolemos, JP, Wolverson, RL, Silverman, SH, Lee, M, Backhouse, C, Millar, DM, Kirwan, WO, Edwards, P, Morran, CG, Maddox, C, Palmer, JG, Nicoll, J, Jacob, GH, Archbold, JAA, Bell, JC, Rennie, JA, Turner, AR, Turner, J, Fearon, KCH, Vaar, A, Ratsep, V, Nasmyth, DG, McKee, RF, Cooke, TG, McArdle, C, Stephenson, RF, Baxter, JN, Rew, DA, Thomson, WHF, Gear, MW, Allan, A, Pearson, HJ, Goldberg, PA, Kmiot, WAW, Irving, MH, Bancewicz, J, Mughal, M, Jones, DJ, Kipping, RA, Dudley, NE, Mortensen, NJ, Parker, M, Armistead, PR, Gillison, EW, Loughlin, V, Kelly, MJ, Mosley, J, Cade, D, Guy, A, Moorehead, J, Harvey, CF, Parisi, VP, Delrio, P, Jones, DRB, Bozzino, JM, Griffin, SM, Griffith, CDM, Bulman, A, Stebbings, WSL, Deakin, M, Adab, F, Goulbourne, IA, Berry, AR, Cunningham, FO, Ingoldby, CJH, Talbot, R, Burgess, P, Stamatakis, J, Offori, T, Cullen, PT, Logie, JRC, Thomson, A, Maybury, NK, Fozard, BJ, Cooper, MJ, Vellacott, KD, Shorthouse, AJ, Poston, GJ, Simkin, EP, McIntosh, HR, Karran, DR, Royle, GT, Karanjia, N, Marks, CG, Maxwell, RJ, Varma, JS, Simson, JNL, Burkitt, D, Johnson, CD, Steer, HW, Primrose, JN, McGinn, FP, Taylor, I, Zeiderman, MR, Sagor, GR, Hawley, P, Northover, JMA, Donaldson, DR, Scott, HJ, Gallagher, P, Crossling, FT, McKelvey, STD, Rickett, JW, Kingston, RD, Davidson, T, Boulos, PB, Smith, DC, Smith, IS, Gillespie, G, Kashi, SH, Grieve, RJ, Fraser, IA, Roberts, PN, Lam, FT, Parker, RW, Stockdale, A, Jurewicz, A, Woodward, DAK, Taylor, BA, Thomas, JM, Sarin, S, Reilly, DT, Stebbings, W, Hamer-Hodges, DW, Nixon, SJ, Saunders, JH, Macintyre, IMC, Yosef, H, Smith, AN, Lock, MR, Lake, SP, Smart, PJG, Grimley, R, Hall, R, Jamison, MH, Jenkinson, LR, James, RD, Donaldson, D, Gray, R, Stenning, SP, Garten, L, McQueen, A, Simnett, S, Johnstone, C, Cain, D, Lallemand, E, Peto, R, Finan, P, Slevin, M, Altman, D, and Collaborators, AXIS

Subjects
Adult, Male, medicine.medical_specialty, Antimetabolites, Antineoplastic, Colorectal cancer, medicine.medical_treatment, Gastroenterology, law.invention, Folinic acid, Randomized controlled trial, law, Internal medicine, Preoperative Care, medicine, Humans, Infusions, Intravenous, Survival analysis, Aged, Aged, 80 and over, Postoperative Care, business.industry, Heparin, Portal Vein, Rectal Neoplasms, Hazard ratio, Cancer, Anticoagulants, Middle Aged, medicine.disease, Survival Analysis, Surgery, Radiation therapy, Treatment Outcome, Fluorouracil, Colonic Neoplasms, Patient Compliance, Drug Therapy, Combination, Female, Radiotherapy, Adjuvant, business, medicine.drug, Follow-Up Studies
Abstract

Background Postoperative portal vein infusion (PVI) of 5-fluorouracil (5-FU) is a well tolerated and widely applicable treatment for colorectal cancer that might have an enormous public health impact, even if it produced survival benefits of just a few per cent. Very large trials are required to detect such differences, and the Adjuvant X-ray and 5-FU Infusion Study (AXIS) is the largest such trial yet reported. Methods Consenting patients with presumed colorectal cancer were randomized to surgery with or without 7 days of PVI (1 g 5-FU plus 5000 units heparin in 1 litre 5 per cent dextrose infused over each 24-h period). In addition, patients with rectal cancer could be randomized to radiotherapy or no radiotherapy to be given either before or after surgery. Results Between November 1989 and December 1997, 3583 patients were randomized with respect to PVI. The survival hazard ratios (95 per cent confidence interval (c.i.)) in all patients randomized and in the curatively resected subgroup (71·2 per cent of patients) were 1·00 (0·92 to 1·11) and 0·94 (0·83 to 1·06) respectively. Tests for heterogeneity suggested a greater treatment benefit for patients with colonic cancer than for patients with rectal cancer with respect to disease-free survival (hazard ratio 0·79 versus 1·03; P = 0·07), and there was a non-significant trend with respect to overall survival (hazard ratio 0·87 versus 1·03; P = 0·17). No survival benefit was seen in the 761 patients randomized with respect to radiotherapy; although not statistically significant, the impact on local recurrence rates was similar to that reported in the literature. Conclusion No overall benefit of PVI was established in AXIS when colonic and rectal cancers were considered together, but the evidence suggesting a differential treatment effect according to site of cancer in AXIS was strongly supported by a meta-analysis incorporating the previous trials. Combining the data gave hazard ratios of 0·82 and 1·00 for colonic and rectal tumours respectively (test for interaction, P = 0·024), equating to an absolute survival benefit for patients with colonic cancer of 5·8 (95 per cent c.i. 2·8 to 8·5) per cent, a level close to that seen for prolonged systemic therapy.

Published
2003

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