Improving descriptive terminology using a descriptive algorithm as an educational intervention to improve referral accuracy.

The accuracy of clinical communication in referrals to dermatology has not been fully explored. Baseline analysis of inpatient ward referral to a dermatology service revealed that only 37% of referrals used accurate descriptive terminology. Theme analysis of individual descriptive terms used was performed to assess knowledge deficits and develop a novel intervention to improve descriptive accuracy.

Round ligament varicosity: a rare but important differential diagnosis of groin lumps during pregnancy.

Round ligament varicosity is rare and mainly reported during pregnancy. A systematic review of the literature identified 48 relevant studies reporting a total of 159 cases of round ligament varicosity, 158 of which were associated with pregnancy. Where reported, the mean age of the patients was 30.

Hypothyroid-associated sensorineuronal deafness.

A case of panhypopituitarism with hypothyroid-induced deafness in a man improving with hormone replacement is reported. A review of the medical literature reveals conflicting evidence regarding the underlying mechanism and prognosis of the defect in this context, but the association with hypothyroidism is more than spurious. Sensorineuronal hearing loss was initially evident, resolving both subjectively and on formal audiological evaluation after administering thyroxine.

An accountable fistula management treatment plan.

An accountable fistula management treatment plan focuses on combining effective medical and nursing treatment with effective and efficient pouching technique and equipment to ensure patient comfort. Small bowel fistula following abdominal surgery can provide challenges in patients' medical and nursing management. This article describes a case study of the successful medical and nursing management of a patient post-abdominal surgery.

Hypokalaemic paralysis precipitated by distal renal tubular acidosis secondary to Sjögren's syndrome.

A 43-year-old woman presented with a sudden onset of hypokalaemic paralysis requiring intubation and ventilatory support. Subsequent biochemical and clinical assessments established a diagnosis of distal renal tubular acidosis (RTA) in association with underlying Sjögren's syndrome as the aetiology of her profound hypokalaemia. Distal RTA is rare, but Sjögren's syndrome is one of the more common causes in adults and should be considered in the differential diagnosis of patients who present with hypokalaemic muscular paralysis.

The impact of ultrasound in suspected acute appendicitis.

Aims: To evaluate prospectively the impact of an appendix ultrasound (US) service on the clinical management of patients presenting with suspected acute appendicitis.

Materials And Methods: The referring clinician completed a proforma for patients presenting with suspected acute appendicitis. Two visual analogue scales assessed clinical suspicion before and after knowledge of laboratory results.

Biliscrotum and retroperitoneal biloma: spontaneous rupture of the biliary system presenting as an incarcerated inguinal hernia.

Spontaneous rupture of the biliary system is a well documented condition in infants but is rare in adults. We report the case of a 73-year-old gentleman who presented with clinical signs and symptoms mimicking that of a strangulated right inguinal hernia. At emergency operation the scrotum was found to contain bile.

Summary of inaugural meeting of the Skin Care in Organ Recipients Group, UK, held at the Royal Society of Medicine, 7 October 2004.

This summarizes a meeting held in London at the Royal Society of Medicine, which was brought together by Prof. Fenella Wojnarowska, Professor of Dermatology at Churchill Hospital, Oxford and cofounder of Skin Care in Organ Recipients, UK (SCOR.UK).

Loss of testicular volume associated with intratesticular varicocele.

Intratesticular varicocele is a rare entity and its clinical significance is not well established. We report a case of left-sided intratesticular varicocele associated with a significant reduction in left testicular volume at follow up. This association has not been previously reported.

Updates from the British Association of Dermatologists 84th annual meeting, 6-9 July 2004, Belfast, U.K.

Herein is a synopsis of the main research and clinical findings presented at the British Association of Dermatologists meeting held during 6-9 July 2004, in Belfast, U.K. The conference highlighted the progress that has been made in understanding the increasing biological, epidemiological and therapeutic advances that have been made recently in the field of dermatology.

PSA testing in general practice.

A questionnaire was sent to 400 general practitioners (GPs), concerning prostate-specific antigen (PSA) screening. Regarding the indications for PSA testing, 80% of GPs test men with urinary tract symptoms, 65% test men with a positive family history, 62% test on patient request, and 21% test men with unrelated symptoms. When PSA is measured, 91% of GPs inform their patient, and 71% discuss the significance of an abnormal result.

Corticosteroids for hospitalised children with acute asthma.

Background: Systemic corticosteroids are used routinely in the management of children with severe acute asthma. There is a lack of consensus regarding the agent, dose and route of corticosteroid administration.

Objectives: To determine the benefit of systemic corticosteroids (oral, intravenous, or intramuscular) compared to placebo and inhaled steroids in acute paediatric asthma.

Lignocaine gel: does it cause urethral pain rather than prevent it?

Objectives: To test the hypothesis that the chemical content of lignocaine gel is the cause of urethral pain during its instillation into the urethra.

Methods: A prospective, double blind study was designed to test whether plain aqueous gel caused less delivery discomfort in the male urethra than 2% lignocaine hydrochloride gel (Instillagel). 100 consecutive, consenting male patients attending for flexible cystoscopy were recruited and randomised to receive 11 ml of 2% lignocaine hydrochloride gel or 11 ml of plain aqueous gel.

Teledermatology: a review.

Teledermatology holds great potential for revolutionizing the delivery of dermatology services, providing equitable service to remote areas and allowing primary care physicians to refer patients to dermatology centres of excellence at a distance. However, before its routine application as a service tool, its reliability, accuracy and cost-effectiveness need to be verified by rigorous evaluation. Teledermatology can be applied in one of two ways: it may be conducted in real-time, utilizing videoconferencing equipment, or by store-and-forward methods, when transmitted digital images or photographs are submitted with a clinical history.

The analgesic efficacy of topical capsaicin is enhanced by glyceryl trinitrate in painful osteoarthritis: a randomized, double blind, placebo controlled study.

The aim of this study was to assess if the pain of osteoarthritis is reduced by topical capsaicin and to determine whether addition of glyceryl trinitrate has an effect on analgesic efficacy and tolerability of capsaicin. A randomized, double blind, placebo controlled study was carried out on 200 adult patients attending a Pain Clinic with osteoarthritis pain. Patients applied one of four creams topically over the affected joint over a 6 week period.