Severe pre-eclampsia and eclampsia: a broad overview with discussion of the nursing care required for the eclamptic patient.

Severe pre-eclampsia and eclampsia are conditions which are rarely seen in A & E departments today. Although the percentage of patients suffering from these conditions is extremely small, the author has been involved in the care and treatment of two patients with this severe complication of pregnancy. A lack of clear guidelines on this subject was the motivation which prompted further study.

Rhabdomyosarcoma masked by orbital trauma.

An orbital embryonal rhabdomyosarcoma is reported. The diagnosis was delayed by several weeks due to a concurrent history of repeated trauma.

Endoscopic laser myotomy in the treatment of pharyngeal diverticula.

The endoscopic approach is a simple and cost-effective option in the treatment of hypopharyngeal diverticula. Whereas almost a third of all endoscopic myotomies performed by UK otolaryngologists are carried out with the stapling technique, CO2 laser diverticulotomy has not been given as much consideration (Koay et al., in press).

Psychiatric dilemmas--surgery and the Mental Health Act (1983).

Clinicians commonly face an ethical conundrum when the patient declines a treatment they believe to be necessary. The decision, whether to give or to withhold treatment, may also have legal repercussions. Two illustrative cases are presented.

Scarred for life?

Acne vulgaris is a common inflammatory dermatosis capable of producing significant psychological and physical scarring. The following work describes the benefit of using a questionnaire as a clinical tool to identify acne patients who have developed psychological sequelae as a result of the disease process. In addition, the benefit of isotretinoin on psychological impact has also been highlighted by this work.

Hyaluronidase (Hyalase): a useful addition in haematoma block?

Objective: To investigate whether hyaluronidase (Hyalase) is a useful and justified addition to haematoma block for pain relief.

Methods: The study was a randomised double blind trial of 33 consecutive patients attending the accident and emergency department for manipulation of distal radius fracture under haematoma block. Control patients received 1% lignocaine; the treatment group received 1% lignocaine plus 1500 IU hyaluronidase.

Hematocolpos. An unusual cause of sciatica in an adolescent girl.

Study Design: A case report.

Objective: To document the occurrence of hematocolpos causing sciatica and leg weakness in an adolescent girl.

Summary Of Background Data: Low back pain resulting from hematocolpos has been reported previously but not associated with symptoms of sciatica or neurologic weakness.

Minocycline induced autoimmune hepatitis and systemic lupus erythematosus-like syndrome.

Monocycline is the most widely prescribed systemic antibiotic for acne largely because it needs to be given only once or twice a day and seems not to induce resistance. Up to April 1994 11 cases of minocycline induced systemic lupus erythematosus and 16 cases of hepatitis had been reported to the Committee on Safety of Medicines. An analysis of these cases together with seven other cases shows the severity of some of these reactions.

Traumatic prepatellar neuralgia.

Fourteen patients with painful knees caused by a direct blow to the front of the knee have been studied. The exact diagnosis was often delayed. Apart from pain, all patients had one common feature which they may not have been aware of, namely, marked tenderness localized towards the middle of the outer border of the patella.

Intramedullary interlocking nailing for humeral fractures: experiences with the Russell-Taylor humeral nail.

The Russell-Taylor intramedullary interlocking nail has been used on 39 patients with fractures that occurred at various levels of the humerus. Thirty patients had acute fractures and nine had pathological fractures. Twenty-five patients with acute fractures were re-examined after their fractures had united and assessed according to Neer's classification of shoulder function.

Leukergy--a new diagnostic test for bone infection.

This new blood test for infection is based on the phenomenon of leukergy in which white cells agglomerate in the peripheral blood of patients with inflammatory diseases. It was used in 26 patients with proven bone or joint infection and was positive in 25. The leukergy test was more accurate than the ESR, white cell count or blood culture.

Quadricepsplasty following femoral shaft fractures.

The results of 12 quadricepsplasties performed on 10 patients with stiff knees following united femoral shaft fractures are reviewed. All fractures were caused by high-velocity road traffic accidents and were associated with a variety of features which led to multiple operations and delayed union. The increased range of flexion achieved in this series is higher than in those reported previously.

Development of atypical amiodarone keratopathy in a corneal graft.

The presence of fine epithelial deposits in a whorled pattern (cornea verticillata) as a consequence of treatment with amiodarone is well documented. We present a case of amiodarone keratopathy in a grafted cornea which is atypical in that the orientation of the pattern is rotated through nearly 90 degrees to that normally observed. This observation runs counter to the hypothesis that cornea verticillata is a manifestation of the line of lid closure.

Microsporidial keratoconjunctivitis in a patient with AIDS.

A male patient is described with acquired immune deficiency syndrome (AIDS) who developed chronic keratoconjunctivitis and chronic sinusitis due to infection with the microsporidian Encephalitozoon cuniculi. Diagnosis was confirmed by electron microscopic examination of conjunctival epithelial cells and nasal polypectomy specimens. Treatment with propamidine isethionate 0.

Plain film reporting in the UK.

A survey has been carried out to investigate the extent of non-reporting and delayed reporting of plain radiographs in UK hospitals. The survey took the form of a confidential postal questionnaire to all consultant radiologists in the UK. Five hundred and sixty-five replies were included in the study, representing 45% of the total consultant workforce.