INTRODUCTION C-reactive protein (CRP) is used routinely in many hospitals to evaluate patients with an acute abdomen. We assessed CRP levels in non-specific abdominal pain (NSAP) and surgical conditions requiring operative or non-operative intervention. The aim of this study was to identify a level of CRP that can be useful in differentiating these three groups.PATIENTS AND METHODS All patients older than 25 years and admitted with acute abdominal pain other than those requiring emergency surgery were included. CRP within 24 h was assessed in all patients. Various cut-off values (< 6, > 6-50, > 50-100, > 100-150 and > 150 mg/l) were used to identify a useful diagnostic level of CRP in the 3 groups. RESULTS A total of 211 patients were prospectively evaluated -129 women and 82 men with a mean age of 62.4 years (range, 27-92 years). CRP was performed in 196 within 24 h of admission. Sixty had NSAP while 136 had a surgical condition, of whom 69 had an operation/intervention while the rest were treated non-operatively. The median and interquartile (IQ) range for the three groups were: NSAP, 16 mg/l and 7.75-85.75 mg/l; surgical non-operative group, 75 mg/l and 30.5-150 mg/l; and surgical-operative, 111 mg/l and 42-212 mg/l, respectively. These results were statistically significant (P = 0.001). NSAP was diagnosed in 61% of patients at levels < 6 mg/l compared to 39% of patients in the surgical groups. At levels > 150 mg/l, NSAP was diagnosed in 15% of patients compared to only 54% and 31% for the operative and non-operative groups, respectively. CONCLUSIONS Despite statistically significant differences between the three groups, no useful level of CRP could be identified to differentiate between patients with NSAP and those requiring operative or non-operative management. KEYWORDSC-reactive protein -CRP -Acute abdomen -Accuracy

SUMMARY A case of acute arterial thrombosis of the branches of the internal iliac, femoral and popliteal arteries is reported in a 38‐year‐old man receiving intravenous cisplatin‐vinblastine‐methotrexate therapy for carcinoma of the urethra. The patient had no angiographic evidence of atheromatous disease or tumour invasion of the occluded arteries and no source of emboli. Although cisplatin and vinblastine are known to cause a variety of vaso‐occlusive complications, acute large‐vessel arterial occlusion has not previously been reported with this combination of agents.

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Ann R Coll Surg Engl 2012; 94: 359-372Many lower extremity, pelvic and acetabular fractures require traction as first aid management prior to definitive fixation. While skin traction and Thomas splints are generally available, weights to provide countertraction are often missing or in parts of the hospital remote to the emergency department. A sharps bin (Sharpsguard ® orange 11.5; Daniels, Oxford, UK) filled two-thirds with tap water and tied via its bucket handle to skin traction (Fig 1) provides approx 8kg of traction. This can effect reduction and temporary traction until weights are available. We describe a simple method to help identify the correct plane for hepatic flexure mobilisation while simultaneously protecting the duodenum during a laparoscopic right hemicolectomy. The placement of a swab or nasal pack on top of the duodenum after medial to lateral dissection below the ileocolic pedicle and right mesocolon (Fig 1) allows clear identification of the hepatic flexure from above. This can then be divided safely with the Harmonic ® scalpel (Ethicon EndoSurgery, Cincinnati, OH, US) protecting the duodenum from thermal injury (Fig 2).