Femoral nerve blocks for fractured neck of femur patients: A 'feel good solution' but a 'short-term fix'?

Objective: Femoral nerve blocks (FNBs) are commonly administered to patients with a fractured neck of femur (NOF). FNBs reduce complications associated with opioids and are effective for up to 24 h. However, the recognised 'gold standard' time to definitive treatment (surgery) in the patient with a fractured NOF is within 48 h.

Intrathecal Clonidine Pump Failure Causing Acute Withdrawal Syndrome With 'Stress-Induced' Cardiomyopathy.

Clonidine is a central alpha(2)-agonist antihypertensive used widely for opioid/alcohol withdrawal, attention deficit hyperactivity disorder and chronic pain management. We describe a case of clonidine withdrawal causing life-threatening hypertensive crisis and stress-induced cardiomyopathy. A 47-year-old man with chronic back pain, treated with clonidine for many years via intrathecal pump (550 mcg/24 h), presented following a collapse and complaining of sudden worsening of back pain, severe headache, diaphoresis, nausea and vomiting.

Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies.

Management of cardiovascular instability resulting from calcium channel antagonist (CCB) or beta-adrenergic receptor antagonist (BB) poisoning follows similar principles. Significant myocardial depression, bradycardia and hypotension result in both cases. CCBs can also produce vasodilatory shock.

The Clinical and Service Outcomes of Unilateral and Bilateral ECT Electrode Placements in Australian Aged Psychiatry Services.

Objective: The aim of the study was to determine whether depressed aged inpatients treated with brief pulse unilateral electroconvulsive therapy (ECT) differed from those treated with bilateral (bitemporal or bifrontal) ECT with respect to numbers of treatments, length of hospital admission, changes in scores on depression and cognitive scales, and serious adverse effects.

Methods: An audit of routinely collected data regarding 221 acute ECT courses in 7 public aged psychiatry services in Victoria, Australia.

Results: Patients given unilateral, bifrontal, and bitemporal treatments were similar with respect to personal, clinical, and treatment characteristics.

Off-label and unlicenced medicine administration to paediatric emergency department patients.

Objective: To determine the prevalence and nature of off-label and unlicenced (off-label/unlicenced) medicine administration to paediatric ED patients.

Methods: We undertook a retrospective, observational study in six EDs (July 2011 to June 2012, inclusive). Patients, aged 0-17 years, who were administered a medicine in the ED were included.

Nurses' attitudes towards the reporting of violence in the emergency department.

Background: The incidence of workplace violence against nurses in emergency departments is underreported. Thus, the true nature and frequency of violent incidents remains unknown. It is therefore difficult to address the problem.

An enhanced recovery after surgery program for hip and knee arthroplasty.

Objective: To institute and evaluate the benefits of an enhanced recovery after surgery (ERAS) program across three hospitals in Victoria.

Design, Setting And Participants: We used a before-and-after quality improvement study design consisting of three phases: pre-ERAS program data collection from March to September 2012; ERAS training and implementation during September 2012; and change performance measurement following ERAS implementation from October 2012 to May 2013.

Main Outcome Measures: The primary end point was duration of hospital stay after knee or hip arthroplasty.

Maternal health and pregnancy outcomes comparing migrant women born in humanitarian and nonhumanitarian source countries: a retrospective, observational study.

Background: The relationship between migration and pregnancy outcomes is complex, with little insight into whether women of refugee background have greater risks of adverse pregnancy outcomes than other migrant women. This study aimed to describe maternal health, pregnancy care, and pregnancy outcomes among migrant women from humanitarian and nonhumanitarian source countries.

Methods: Retrospective, observational study of singleton births, at a single maternity service in Australia 2002-2011, to migrant women born in humanitarian source countries (HSCs, n = 2,713) and non-HSCs (n = 10,606).

Paracetamol poisoning in adolescents in an Australian setting: not quite adults.

Objective: To describe and compare the characteristics of paracetamol poisoning in adolescent and adult patients.

Method: Descriptive retrospective case series of adolescent (12-17 years) and adult (>18 years) patients presenting to a metropolitan hospital network ED, diagnosed with paracetamol poisoning from October 2009 to September 2013.

Results: There were 220 adolescent (median age 16 years, 47% treated with acetylcysteine [NAC]) and 647 adult presentations (median age 27 years, 42% treated with NAC) for paracetamol poisoning in the study period.

An unusual ulcer: A case of cutaneous mucormycosis caused by Rhizopus oryzae.

Mucormycoses are high-mortality infections feared by clinicians worldwide. They predominantly affect immunocompromised hosts and are associated with a spectrum of disease. We describe a case of cutaneous mucormycosis caused by Rhizopus oryzae in a patient with multiple risk factors cured with complete surgical excision and a short course of antifungal therapy.

Wide field of view CT and acromioclavicular joint instability: A technical innovation.

A 21-year-old female with a traumatic shoulder injury is investigated and managed for symptoms relating to this injury. Pathology at the acromioclavicular joint is detected clinically; however, clinical examination and multiple imaging modalities do not reach a unified diagnosis on the grading of this acromioclavicular joint injury. When management appropriate to that suggested injury grading fail to help the patient's symptoms, further investigation methods were utilised.

Diabetic nephropathy - complications and treatment.

Diabetic nephropathy is a significant cause of chronic kidney disease and end-stage renal failure globally. Much research has been conducted in both basic science and clinical therapeutics, which has enhanced understanding of the pathophysiology of diabetic nephropathy and expanded the potential therapies available. This review will examine the current concepts of diabetic nephropathy management in the context of some of the basic science and pathophysiology aspects relevant to the approaches taken in novel, investigative treatment strategies.

A retrospective descriptive study of the characteristics of deliberate self-poisoning patients with single or repeat presentations to an Australian emergency medicine network in a one year period.

Background: A proportion of deliberate self-poisoning (DSP) patients present repeatedly to the emergency department (ED). Understanding the characteristics of frequent DSP patients and their presentation is a first step to implementing interventions that are designed to prevent repeated self-poisoning.

Methods: All DSP presentations to three networked Australian ED's were retrospectively identified from the ED electronic medical record and hospital scanned medical records for 2011.

Cadaveric scapholunate reconstruction using the ligament augmentation and reconstruction system.

Background Untreated scapholunate ligament disruption may lead to progressive wrist arthritis. Current techniques used to treat the disruption may not prevent arthritis because of attenuation of a reconstructive ligament substitute or failure to re-establish normal wrist kinematics. Questions/Purposes This study evaluates a combined synthetic-autologous technique for the treatment of scapholunate dissociation.

One versus two venous anastomoses in microsurgical free flaps: a meta-analysis.

Background:  Various reports suggest the augmentation of venous drainage through performing two venous anastomoses as a means of reducing the rate of thrombosis in free flap surgery. However, some suggest dual venous drainage may actually reduce venous blood flow velocity causing a potential risk for thrombosis.

Methods:   On the basis of the Preferred Reporting Items for Systematics Reviews and Meta-analysis statement, a systematic search was conducted using PubMed and Medline databases.

Lymph node status as a prognostic indicator after preoperative neoadjuvant chemoradiotherapy of rectal cancer.

Aim: The primary aim of this study was to examine lymph node status after neoadjuvant chemoradiotherapy (CRT) using a novel scoring system describing the pathological lymph node regression grade. The proposed scoring system was based on the percentage of fibrosis and the presence of residual tumour amount. The secondary aim of the study was to assess the oncological impact of this scoring system.

Vascular anomalies of the hand and wrist.

Vascular malformations of the hand and wrist are uncommon. They develop from aberrations in angiogenic signaling during vascular development. Unlike hemangiomas, which are characterized by biphasic growth and slow spontaneous involution, vascular malformations continue to grow proportionally with the child.

Carpal fractures.

Carpal fractures are exceedingly rare clinical entities and are often associated with concomitant injuries. In this review, we focus on fractures of the carpus, excluding the scaphoid, and provide an update on the current consensus as to mechanism, diagnosis, management, outcomes, and complications after such injuries.

Osteotomy for sigmoid notch obliquity and ulnar positive variance.

Background Several causes of ulnar wrist pain have been described. One uncommon cause is ulnar carpal abutment associated with a notable distally facing sigmoid notch (reverse obliquity). Such an abnormality cannot be treated with ulnar shortening alone because it will result in incongruity of the distal radioulnar joint (DRUJ).

Comparisons of preoperative three-dimensional planning and surgical reconstruction in primary cementless total hip arthroplasty.

Reconstruction of important parameters such as femoral offset and torsion is inaccurate, when templating is based on plain x-rays. We evaluate intraoperative reproducibility of pre-operative CT-based 3D-templating in a consecutive series of 50 patients undergoing primary cementless THA through an anterior approach. Pre-operative planning was compared to a postoperative CT scan by image fusion.

Distal renal tubular acidosis associated with Sjogren syndrome.

Renal tubular acidosis is a common cause of normal anion gap metabolic acidosis but these disorders can be easily missed or misdiagnosed. We highlight the approach to assessing renal tubular acidosis by discussing a case study with a temporal data set collected over more than 5 weeks. We highlight the principles and the necessary information required for a diagnosis of classic distal renal tubular acidosis.