Imaging of pancreatic adenocarcinoma with emphasis on multidetector CT.

Pancreatic adenocarcinoma is the fourth most frequent cause of cancer-related death. The incidence is increasing and the overall survival has altered little in recent years. Moreover, patients usually present late with inoperable disease and curative resection by standard pancreatico-duodenectomy (Whipple's procedure) is associated with significant morbidity.

Compression of the sciatic nerve by wear debris following total hip replacement: a report of three cases.

Pain in the distribution of the sciatic nerve is common in the elderly. In the presence of a long-standing joint replacement, consideration should be given as to whether compression might be due to an extraspinal cause. We present three women, in whom a mass of wear debris from a previous total hip replacement caused compression of the sciatic nerve posterior to the hip.

The experience of uncertainty for individuals with HIV/AIDS and the palliative care paradigm.

This small qualitative study investigated the lived experience of individuals with HIV/AIDS, exploring the uncertainty related to episodes of life-threatening illness followed by recovery, 'revival'. The themes that emerged related to the unpredictability of when death would occur. The participants described the dilemma of living with a chronic illness with a totally unpredictable disease trajectory.

Relevance of thiopurine methyltransferase status in rheumatology patients receiving azathioprine.

Azathioprine (AZA) is widely used in the management of rheumatological diseases. Despite its efficacy, AZA can often cause bone marrow suppression, notably leucopenia, which has been recorded in up to 17% of patients taking AZA for rheumatoid arthritis, though this can be considered clinically significant in about 3% overall. Severe myelosuppression, associated with abnormal AZA metabolism, is linked to the thiopurine methyltransferase (TPMT) genetic polymorphism.

Oncology nurses' perceptions of their role in resuscitation decisions.

A group of nurses working in a unit for oncology and haematology patients took part in a study on how they perceived their role in resuscitation decisions. Although many of the nurses expressed a desire to be involved in helping patients exercise choice in this area, in practice few nurses felt able to raise the subject with patients or to act as their advocate with doctors.

Self-management in diabetes: training implications for professional carers.

A workshop was convened to examine factors determining patient self-management and implications for those providing care. It was attended by 15 doctors and 15 nurses with considerable expertise in education for those with diabetes. Discussion included: the experience of training programmes to date; factors determining effective patient self-management; the implications for training of professionals, skills required, their current availability and proposals for their development.

Local treatments for cutaneous warts.

Background: Viral warts caused by the human papilloma virus represent one of the most common diseases of the skin. Any area of skin can be affected although the hands and feet are by far the commonest sites. A very wide range of local treatments are available.

Sphenoid sinus mucocele: late complication of Sphenoidotomy.

Sphenoid sinus mucocele is an infrequent but well-recognized entity in sinus pathology. The symptoms produced by it are related to the anatomical surroundings of the sphenoid sinus. We describe a case of sphenoid sinus mucocele presenting with ipsilateral oculomotor nerve palsy 10 years after endoscopic sphenoidotomy.

A staff support mechanism: the transformational partnership.

There have been many changes in nursing over the past decade, e.g. the movement of nursing education into higher educational sectors and the generation of many new nursing roles.

Successful treatment of chronic anal fissure with diltiazem gel.

OBJECTIVE: Diltiazem is a calcium channel blocker that has shown potential to heal chronic anal fissures. We have prospectively evaluated the treatment of patients with anal fissure with diltiazem gel (SLA Pharma, UK). PATIENTS AND METHODS: All patients with chronic anal fissure from September 1999 to May 2000 were treated topically with 8 mg 2% diltiazem hydrochloride gel (equivalent to 2 cm of gel supplied by SLA Pharma) three times daily.

Ipswich lacrimal tube: pedicle nasal septal tube for the reconstruction of lacrimal drainage passage.

Canalicular blockage of the lacrimal system still remains a major challenge for oculoplastic surgeons. The conventional treatment of conjunctival dacryocystorhinostomy using the Lester Jones bypass tube is often associated with tube migration and foreign body reaction. The authors report a new technique to reconstruct the lacrimal passage on a single patient with severe canalicular obstruction following repeated failures from previous Lester Jones tube operations.

Orthopaedic Specialist Registrar training and attitudes to spine surgery in the United Kingdom: reasons for poor recruitment and suggestions for improvement.

In order to improve the provision of spinal surgery in the United Kingdom, the number of Specialist Spinal Surgeons and Surgeons with an Interest in Spinal Surgery needs to increase by 25% from the existing 175 surgeons. A survey of Specialist Orthopaedic Registrars was performed, which quantifies the predicted shortfall in the number intending to practise spinal surgery. The attitudes towards and perceptions of this field were obtained to identify factors that could be discouraging an interest in spine surgery.

Childhood obesity: a challenge for the anaesthetist?

The definition of childhood obesity has not been standardized in the past, making studies difficult to compare. In spite of this, the increase in the incidence of childhood obesity is evident and has now reached epidemic proportions. Obese children experience few of the medical complications seen in obese adults.

Nasal polyposis in children with cystic fibrosis: a long-term follow-up study.

The incidence of nasal polyposis among children 5 to 18 years of age with cystic fibrosis (CF) was investigated with a systematic examination of all children on the local CF register. Out of 23 children with CF, 13 had endoscopic evidence of nasal polyposis. Four children had grade 2 polyposis, and 9 children had grade 3 polyposis.

The rising cost of health care: can demand be reduced through more effective health promotion?

The cost of health care continues to rise in the face of an apparently insatiable demand. Unless the actual need for health care can be reduced to manageable levels, the financial burden will probably become economically unacceptable. Although some illnesses are unavoidable, others that are largely due to unhealthy lifestyles are preventable.

Delayed hypersensitivity reaction to topical aminoglycosides in patients undergoing middle ear surgery.

Repeated exposure to a topical aminoglycoside in patients with ear discharge can induce a delayed hypersensitivity reaction eventually. A postal survey conducted by the authors showed that 75% of UK otolaryngologists routinely prescribe topical aminoglycosides to their patients following ear surgery. This is a prospective study on the result of skin patch testing on 119 patients with chronic otitis media and 30 patients with otosclerosis who were scheduled for otosurgery.

Treatment of chronic painful diabetic neuropathy with isosorbide dinitrate spray: a double-blind placebo-controlled cross-over study.

Objective: Considerable evidence implicates impaired nitric oxide (NO) generation in the pathogenesis of diabetic neuropathic pain. We therefore conducted a pilot study to examine the effects of isosorbide dinitrate (ISDN), a NO donor with local vasodilating properties, in spray form in the management of chronic neuropathic pain.

Research Design And Methods: The study was of double-blind, randomized, placebo-controlled, and two-period cross-over design.

Local treatments for cutaneous warts: systematic review.

Objective: To assess the evidence for the efficacy of local treatments for cutaneous warts.

Methods: Systematic review of randomised controlled trials.

Main Outcomes Measures: Total clearance of warts and adverse effects such as irritation, pain, and blistering.

Treatment of a heel blister caused by pressure and friction.

The treatment of heel blisters caused by pressure, friction, and shear is a complex subject. Issues such as whether to aspirate the blister, how to protect it from further pressure, friction, and shear, and which dressing to choose, need to be considered. As nurses are increasingly aware of the emphasis that has been placed on the importance of ensuring that clinical practice is based on evidence, this article attempts to shed some light on these areas of debate.

A study of the intra-operative effect of the Argon and KTP laser in stapes surgery.

The intraoperative effect of the Argon and KTP laser was studied on 20 patients who had primary stapes surgery under local anaesthetic; 10 had Argon and 10 had KTP laser stapedotomy. Symptoms of inner ear disturbance such as dizziness and tinnitus were systematically recorded during the laser procedure. Both dizziness and tinnitus were relatively uncommon when the laser was used on the promontory.

Long-term survival of Stanmore total hip replacements inserted with radiolucent bone cement.

Radio-opacifiers in bone cements are an accepted part of every-day practice. They have, however, been shown to be a potential cause of an increase in third body wear and to excite bone resorption in in vitro and in vivo studies. We reviewed the results of 228 consecutive Stanmore total hip replacements performed between 1981 and 1985 in 211 patients.

Occupational stress in consultants in accident and emergency medicine: a national survey of levels of stress at work.

Objective: To assess levels of occupational stress in UK accident and emergency (A&E) consultants.

Method: Postal survey of complete enumeration of UK consultants.

Main Outcome Measures: GHQ-12 and SCL-D, and respondents' reported perceptions of stressors.