Collapse, hoarseness of the voice and swelling and bruising of the neck: an unusual presentation of thoracic aortic dissection.

A 66 year old woman presented to the accident and emergency department with history of collapse, hoarseness of the voice, and swelling and bruising of the neck. The diagnosis was not initially obvious because of the absence of chest pain. The findings on the radiograph of the soft tissue of the neck and chest radiograph suggested the need for computed tomography of the neck and chest.

An analysis of calls referred to the emergency 999 service by NHS Direct.

Introduction: NHS Direct was launched in West Yorkshire in April 1999. A 999 ambulance can be dispatched to the patient as a result of a call to NHS Direct. The aim of this study is to compare cases that had been referred by NHS Direct via the 999 service, with those who had dialled 999 themselves.

The effect of the introduction of NHS Direct on requests for telephone advice from an accident and emergency department.

Objectives: To assess the effect of the introduction of NHS Direct on advice seeking calls to an accident and emergency (A&E) department.

Methods: Review of departmental telephone advice logbook before and after the introduction of NHS Direct together with recording of the number of calls redirected to NHS Direct by the hospital switchboard and the A&E department.

Results: The number of advice calls responded to within the department fell by 72.

Early infective complications and late recurrent cancer in stapled colonic anastomoses.

Between 1978 and 1981, 73 patients with colonic or rectal cancer were randomized to have their anastomoses made by either a single interrupted layer of braided polyester sutures, or by a circular stapling instrument. Of these operations, 20 were considered to have been palliative, the remaining 53 being potentially curative. The incidence of local recurrence in the latter group was analyzed in relation to initial septic and anastomotic complications.

Antimicrobial bowel preparation. Oral, parenteral, or both?

It has been suggested that wound infection rates after colorectal operations are influenced more by the presence of adequate tissue levels of antimicrobials at the time of contamination than by the extent of bacterial colonization of the intestinal lumen. There are, however, theoretical grounds for the belief that both levels are important. The authors therefore conducted a random control trial in 119 consecutive patients undergoing elective colorectal operations, comparing the results in a group receiving purely parenteral antimicrobial prophylaxis with those in one having a combined oral and parenteral regimen.