STOP!: a randomised, double-blind, placebo-controlled study of the efficacy and safety of methoxyflurane for the treatment of acute pain.

Objective: To evaluate the short-term efficacy and safety of methoxyflurane for the treatment of acute pain in patients presenting to an emergency department (ED) with minor trauma.

Methods: STOP! was a randomised, double-blind, multicentre, placebo-controlled study conducted at six sites in the UK. A total of 300 patients, 90 of whom were adolescent patients (age 12-17 years), were randomised 150:150 to receive either methoxyflurane via a Penthrox inhaler or placebo.

Acalculous Phrygian cap cholecystitis.

We report a case of a 53-year-old Caucasian woman who presented with symptoms of cholecystitis; an ultrasound and CT scans showed a mass lesion associated with the gallbladder and no gallstones. Laparoscopic cholecystectomy and further histological analysis confirmed acalculous cholecystitis in a Phrygian cap gallbladder.

Chronic Umbilical Discharge: An unusual presentation of endometriosis.

Umbilical endometriosis is an important differential diagnosis of any umbilical lesion. A 35-year-old type 2 diabetic woman presented with intermittent umbilical discharge which failed to respond to various antibiotics. An ultrasound scan and MRI scan failed to show any obvious abnormality.

A case report of a rare adnexal tumour: aggressive digital papillary adenocarcinoma.

We report the case of a 78-year-old Caucasian gentleman who presented with a painful swelling in the nail bed of the right middle finger. Following amputation of the right middle phalanx histopathology confirmed aggressive digital papillary adenocarcinoma (ADPA). Further surgical treatment was offered but declined.

Abdominal compartment syndrome--a fatal complication from a rectus sheath haematoma.

Rectus sheath haematoma is increasingly being seen in patients with anticoagulation therapy. Abdominal compartment syndrome is a rare complication of rectus sheath haematoma with only two cases reported in literature. The authors report a case of a young male who developed abdominal compartment syndrome from a rectus sheath haematoma secondary to anticoagulation therapy.

"Asymmetric scalloping of the regenerate": a radiological sign of pseudoaneurysm in distraction osteogenesis.

Pseudoaneurysm formation is an uncommon but well-recognised and important complication in limb reconstruction surgery. Postoperative diagnosis is usually clinical or an incidental finding. We present an 11-year-old girl, who underwent two-stage limb lengthening with a circular fixator, for a previously treated pseudoarthrosis of the tibia.

Axillary artery compromise in a minimally displaced proximal humerus fracture: a case report.

Minimally displaced fractures of the surgical neck of the humerus are rarely associated with axillary artery injury. The innocuous appearance of the x-rays can be misleading and a missed arterial injury in these fractures could potentially lead to disastrous consequences. We report the case of a patient who sustained a minimally displaced fracture of the proximal humerus with vascular compromise requiring immediate investigation and referral to vascular surgeons.

Radiofrequency remodelling of the endopelvic fascia is not an effective procedure for urodynamic stress incontinence in women.

The aim of this study was to assess the efficacy and safety of transvaginal radiofrequency remodelling of the endopelvic fascia as a primary procedure for urodynamic stress incontinence due to urethral hypermobility in women. It included 24 patients who had the procedure at two district general hospitals. Outcome measures included the pad test, urodynamic assessment, continence diary, pain scores and operative as well as post-operative complications and assessment was made on recruitment during hospital admission and at 3, 6 and 12 months follow-up.

Understanding foot ulceration in patients with diabetes.

Foot ulceration is a complication that affects a significant proportion of the ever-increasing number of people with diabetes in the UK. Nurses caring for patients with diabetes are ideally placed to contribute to diabetic foot management through assessment, education and appropriate timely referral. This article examines how pathophysiological changes associated with diabetes and the demanding functional role of the foot predispose individuals to foot ulceration, how to assess and classify the diabetic foot and the principles of preventive and curative management.

Primary malignant lymphoma of the appendix associated with acute appendicitis.

Malignant lymphoma comprises 1-4% of the malignant neoplasm of the gastrointestinal tract. Appendiceal lymphomas are extremely rare, reported in 0.015 percent of all gastrointestinal lymphomas.

Gastric stromal tumour.

This is a report of an old lady diagnosed with gastrointestinal stromal tumour (GIST) of the stomach with malignant potential and managed with subtotal gastrectomy. The patient showed good recovery. Four years postsurgery follow-up without any chemo-radiotherapy did not show any evidence of recurrent disease.

Falsely high glycated haemoglobin [HbA1C] because of haemoglobin OSU-Christiansborg.

Glycated haemoglobin (HbA1c) is routinely used to assess the degree of glycaemic control in diabetic patients. We report a case of a 73 year old diabetic woman who had an elevated HbA1c of 13.4%.

Superior dislocation of the patella. Case report and review of literature.

Superior dislocation of the patella is a rare diagnosis, which usually occurs after a trivial trauma. It usually requires manipulation with analgesics or may even need anaesthesia. We report a case of spontaneous reduction of the dislocation, which lead us to believe that this may be more common in the community than has been reported.

What are the beliefs and attitudes of paramedics to prehospital thrombolysis? A questionnaire study.

Background: The Ambulance Services have a critical role in the management of acute myocardial infarction (AMI). Paramedic delivered prehospital thrombolysis (PHT) has been proposed. To the authors' knowledge there has been no research carried out to ascertain the views of paramedics.

Comparing the urinary pancreolauryl ratio and faecal elastase-1 as indicators of pancreatic insufficiency in clinical practice.

Background: The urine pancreolauryl ratio (uPLR) and, more recently, the faecal pancreatic elastase-1, are widely used for the noninvasive diagnosis of exocrine pancreatic insufficiency. Both tests have previously been validated against 'gold standard' tests of pancreatic function, but their use in a clinical setting has never been directly compared.

Methods: We performed a comparative study of the pancreolauryl ratio (PLR) and the faecal elastase-1 (FE-1) test in patients with a clinical suspicion for pancreatic insufficiency.

Smoking and hormones in health and endocrine disorders.

Smoking has multiple effects on hormone secretion, some of which are associated with important clinical implications. These effects are mainly mediated by the pharmacological action of nicotine and also by toxins such as thiocyanate. Smoking affects pituitary, thyroid, adrenal, testicular and ovarian function, calcium metabolism and the action of insulin.

One-stop hysteroscopy clinic for postmenopausal bleeding.

Objective: To evaluate the role and feasibility of the "1-stop" clinic for management of postmenopausal bleeding, based on the use of transvaginal ultrasound and hysteroscopic examination under local anesthesia.

Study Design: A retrospective analysis of 308 patients referred to the clinic between October 2000 and May 2002 was carried out. Endometrial thickness of > 4 mm, as measured by transvaginal scan, was considered the cutoff limit for further investigation by hysteroscopy.