Varicosities of the valleculae: an unusual cause of hemoptysis?

Hemoptysis is a common respiratory symptom causing a great deal of anxiety. The cause is often apparent following a clinical history, upper-airway examination, bronchoscopy, and CT scanning of the thorax. We present a case of massive hemoptysis, the etiology of which was not readily apparent despite this conventional approach.

Assessment tools: are they an effective approach to implementing spiritual health care within the NHS?

Over the last 25 years, many nursing and palliative care journals have carried articles on the subject of 'spiritual' health care. The following is a review of National Health Service (NHS) guidelines and the work of various writers who have contributed to the debate on 'spirit' and 'spiritual needs' from within sociology, palliative care and nursing studies. However, 'spiritual' in the current usage should not be confused with 'religious' and is part of an understanding of what is known as holistic nursing (Dossey et al.

Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature.

Background: Asthma and chronic obstructive pulmonary disease (COPD) are common diseases of the airways and lungs that have a major impact on the health of the population. The mainstay of treatment is by inhalation of medication to the site of the disease process. This can be achieved by a number of different device types, which have wide variations in costs to the health service.

Involving patients in research: setting up a service users' advisory group.

Looks at some of the issues raised by patients' involvment in the research process. Uses the example of a service users' advisory group established as part of a diabetes service evaluation in the north of England. Key conclusions were: a precise role for the group should be specified at the outset; genuine user involvement is needed; wide and accurate representation of all relevant groups in society is essential; and, researchers must approach users with open minds with a view to shared decision making rather than control.

Insulin-like growth factor 1 measurement in diagnosis and management of acromegaly.

This article discusses the characteristic features of growth hormone secretion and insulin-like growth factor I (IGF-1) concentrations both in patients with acromegaly and in normal subjects. The therapeutic options for the treatment of acromegaly are briefly discussed, as are the current definitions of successful therapy. The article focuses on the use of serum and urinary growth hormone measurements along with the current and potential use of serum IGF-1, both at diagnosis and during long-term follow-up.

Do all patients in primary care who may benefit from eradication of Helicobacter pylori have access to effective care?

The purpose of this study was to identify those patients who would benefit from eradication therapy for Helicobacter pylori and to understand the scale of service changes needed to implement eradication therapy. All general practices in Bradford Health Authority were invited to take part in the study. Patients who had received more than one repeat prescription for proton pump inhibitors or H(2) receptor antagonists in the previous twelve months were identified using the repeat prescription systems in the participating practices.

A population-based study of the prevalence, clinical characteristics and effect of ethnicity in epilepsy.

Unlabelled: The aim of this study was to determine the prevalence and clinical characteristics of epilepsy and seizure disorders in Bradford. The method used was a community-based cross-sectional study. Case ascertainment was by review of medical records identified by searching practice databases using diagnostic codes and from repeat prescribing data.

Clinical governance: principles into practice.

This paper describes the early development of clinical governance in an acute NHS Trust. Three Trust-wide workshops and 17 individual departmental workshops were held between 1998-1999. The discussions in these workshops were used to define the key founding principles of clinical governance and the operational structure.

The Trust experience: eight years on.

In 1992 the author described her experience of working in a newly formed acute NHS Trust hospital. One of the key messages of the paper concerned the pace of radical changes experienced. Eight years on, the process of change has accelerated still further, and healthcare professionals working in the NHS face newer and tougher challenges with regard to funding, recognition and survival.

Systemic sclerosis and scleroderma renal crisis in association with carcinoma of the breast.

During recent years it has been shown conclusively that the incidence of malignancy in systemic sclerosis (SSc) is significantly increased and that rapidly progressive skin thickening, among other factors, is a strong predictor of scleroderma renal crisis (SRC). We present a case of carcinoma of the breast presenting concurrently with SSc that subsequently progressed to dialysis-dependent renal failure in just 1 month. We discuss the possible relationship between SSc and malignancy at a cellular level.

A circumcision service for religious reasons.

Objective: To review the results of a pioneering service introduced under National Health Service (NHS) cover, providing circumcision on religious grounds.

Subjects And Methods: The service was offered to all male babies aged 6-14 weeks. Circumcision was carried out using the Plastibell technique under 1% lignocaine ring block/penile block anaesthesia.

Death due to air embolism during sexual intercourse in the puerperium.

We describe the cases of two young women who died due to air embolism during sexual intercourse early in the puerperium.

Transthoracic needle biopsy for suspected thoracic malignancy in elderly patients using CT guidance.

There are few reports of transthoracic needle biopsy (TNB) in elderly (>70 years) patients although there is some evidence that age may be a risk factor in developing pneumothorax. We report our experience of 38 patients, age range 70-90 years, who underwent computed tomography (CT)-guided TNB for suspected malignancy of the chest, with particular reference to sensitivity and complication rate following the procedure. The biopsy was obtained using either a spinal needle or, if appropriate, a core of tissue was obtained using a cutting needle.

Improvements in long term phototherapy for patients with Crigler-Najjar syndrome type I.

Patients with Crigler-Najjar syndrome Type I are being treated with long-term blue-light phototherapy into childhood, adolescence and beyond. Phototherapy systems adapted from sunbed-type bases fitted with blue-emitting fluorescent tubes have been described. These systems provided higher irradiances and improved patient compliance compared with overhead therapy systems used in neonatal phototherapy.

Indications and restrictions of fluoroquinolone use in children.

Fluoroquinolones (FQs) have a proven record in adults against a wide range of organisms, but their use in children has been restricted because of the potential for causing damage to joints. Accumulated evidence suggests that FQs are effective, well tolerated and do not cause arthropathy in children.

Survey of the variation in ultraviolet outputs from ultraviolet A sunbeds in Bradford.

Concerns have been expressed for some time regarding the growth of the cosmetic suntanning industry and the potential harmful effects resulting from these exposures. Recently published work has appeared to confirm a link between sunbed use and skin cancer. A previous survey in Oxford some years ago demonstrated significant output variations, and we have attempted to extend and update that work.

A mechanism for professional and organizational audit of radiopharmacy departments.

An audit document is presented which can be used to assess the radiopharmacy service in a particular institute. It can be used for self-assessment or can form the basis for peer review. The document covers a wide range of aspects of radiopharmacy.

The Trust experience.

Since the introduction of 'The NHS and Community Care Act' in 1990, the National Health Service and the role of medical illustrators within it have undergone many changes. Following the new Act, a number of hospitals became National Health Service (NHS) Trusts in April 1991 with a second wave in April 1992. Whether the formation of NHS Trusts is regarded as an opportunity or a threat, it is estimated that most NHS hospitals in the UK will become Trusts within the next 5 years.