Acute appendicitis and retroperitoneal abscess: rare complications of sigmoid diverticulitis.

Diverticulitis is a common cause of an acute surgical abdomen and computed tomography has become an essential part of work up particularly to identify complications that commonly include intraperitoneal perforation, abscess and fistula formation. We report the case of an 81-year-old male who presented to the emergency department with acute lower abdominal pain and was found to have sigmoid diverticulitis with the rare complications of a diverticular abscess that had formed a sinus tract and perforated into the retroperitoneum and secondary acute appendicitis. Initial management was with intravenous antibiotics, a Hartmann's procedure and appendicectomy. Subsequently the retroperitoneal collection was drained percutaneously. The case was further complicated by the patient's multiple co-morbidities and unfortunately the patient died 6 weeks after admission from sepsis. This case highlights the role of computed tomography in the pre- and post-operative period to identify complications which are often clinically occult and require early surgical and interventional radiology management to optimize outcomes.

Do we know the cost of orthopaedic care?

INTRODUCTION: The increasingly complex care needs of an expanding and ageing population leave a growing dichotomy between demand and supply. With sustainable cost-efficiency gains paramount, this study explored awareness of trauma and orthopaedic (T&O) care costs among patients and health care providers, alongside the impact of greater cost awareness on care quality, experience, and equality. MATERIALS AND METHODS: Surveys were distributed over a 2-week period, at a single site, to in/outpatients and health care professionals allied to T&O. They evaluated (1) awareness of the costs of several common aspects of T&O care and (2) opinions on improved cost education. RESULTS: Most professionals and patients had limited and markedly variable awareness of costs. Expensive items (>£200) were commonly underestimated, and cheap items (≤£200) were overestimated. The majority reported greater cost awareness might influence their approach to care decisions. DISCUSSION: Cost ignorance restricts cost-efficiency and provision of equitable care. Given the widespread lack of cost education, there is unsurprisingly a lack of cost awareness among patients and professionals alike. Cost savings through "reduced waste" were a commonly highlighted potential benefit of greater cost awareness. Patients and professionals alike must become increasingly accountable for ensuring effective and efficient use of resources.

A transcriptomics resource for wheat functional genomics.

Grain development, germination and plant development under abiotic stresses are areas of biology that are of considerable interest to the cereal community. Within the Investigating Gene Function programme we have produced the resources required to investigate alterations in the transcriptome of hexaploid wheat during these developmental processes. We have single pass sequenced the cDNAs of between 700 and 1300 randomly picked clones from each of 35 cDNA libraries representing highly specific stages of grain and plant development. Annotated sequencing results have been stored in a publicly accessible, online database at http://www.cerealsdb.uk.net. Each of the tissue stages used has also been photographed in detail, resulting in a collection of high-quality micrograph images detailing wheat grain development. These images have been collated and annotated in order to produce a web site focused on wheat development (http://www.wheatbp.net/). We have also produced high-density microarrays of a publicly available wheat unigene set based on the 35 cDNA libraries and have completed a number of microarray experiments which validate their quality.