Recurrent parotitis.

(1) Recurrent parotitis is probably caused by a congenital abnormality of the salivary gland ducts with recurrent attacks of ascending infection, perhaps aided by dehydration. The parotid gland is predominantly affected probably because of its lower rate of secretion compared with the submandibular gland. (2) The condition mainly affects children between the ages of 3 and 6, with males being more commonly affected.

Apathetic thyrotoxicosis.

A previously fit 37-year-old woman was admitted with acute left ventricular failure, atrial fibrillation and a left-sided thromboembolic stroke. Her ventricular rate progressively increased despite full digitalisation. She had a cardiac arrest and was successfully resuscitated.

Results of middle ear ventilation with 'Mangat' T-tubes.

Tympanostomy tube placement has been shown to be an effective treatment for recurrent acute otitis media and chronic otitis media with effusion. The Senior author, (K.S.

Transtympanic myringoplasty in children.

Our experience with myringoplasty by the transtympanic "push through' technique in paediatric patients is described. We have used this method in 40 children utilizing autologous temporalis fascia as the graft material. The procedures were all performed as day cases under general anaesthesia.

Pneumopericardium: an unusual manifestation of blunt tracheal trauma.

A case of pneumopericardium in a child following blunt injury to his trachea is described. Such a case has not been previously described in the literature. A probable anatomical explanation for this rare event is offered.

Non-recurrent laryngeal nerve: identification during thyroid surgery.

The non-recurrent course of the inferior laryngeal nerve is a rare anomaly. The incidence varies from 0.3 to 4% on the right side.

Fixation of intracapsular femoral neck fractures with a one-hole plate dynamic hip screw.

The results of internal fixation of 55 subcapital fractures of the femoral neck with a one-hole plate dynamic hip screw are presented. Two fractures could not be satisfactorily fixed and the procedures were converted to hemi-arthroplasties, but the remainder united within 6 months. The rate of avascular necrosis after union was 3 per cent in undisplaced and 31 per cent in displaced fractures.

Lipoma of the parotid gland presenting with facial palsy.

Facial palsy in the presence of ipsilateral parotid tumour is considered to be pathognomonic of malignancy. However, benign neoplasms and inflammatory lesions of the parotid gland have been reported to present with facial palsy. A case of lipoma of the parotid gland associated with partial facial paralysis is reported.

Topical active H1-antihistamines and their effect on nasal airway resistance.

The introduction of a topically active H1-antihistamine nasal spray Azelastine, has given an extra dimension in the management of allergic rhinitis. The drug acts rapidly and avoids the systemic adverse effects of antihistimines. An objective prospective study was performed to detect the effect of Azelastine nasal spray on nasal airway resistance.

Nurses in private nursing homes: a study of their knowledge and attitudes to pain management in palliative care.

Nurses working in private nursing homes may not have the same degree of access to support and education in palliative care as nurses in NHS 'care of the elderly' wards. A study was conducted comparing two groups of nurses working in these two environments in one health district. Twenty-four nurses underwent semistructured interviews focusing on pain management.

Antiphospholipid syndrome in pregnancy: a diagnostic dilemma.

Objective: To present a case of severe pre-eclampsia in which diagnosis of the antiphospholipid syndrome was made after delivery, and to discuss pointers to the diagnosis.

Clinical Features: A 32-year-old woman in her second pregnancy presented at 32 weeks' gestation with severe pre-eclampsia. Her persisting severe postpartum illness was investigated.

Transporting patients with overwhelming pain.

The use of ketamine anaesthesia is described for the transport from home to hospital of patients in severe pain secondary to malignant disease. The technique is simple and highly effective and introduces a new role for anaesthetists and pain relief specialists.

Setting standards--antibiotic policies.

It is important to choose appropriate topics for audit in order to produce satisfactory results and maintain interest and enthusiasm. A trail of incomplete audit cycles is unhelpful and demoralizing. The audit should be carefully designed and a vital stage is choosing appropriate standards upon which to measure current performance.

Development of a MUMPS-based anticoagulant management system.

A computerised anticoagulant management system written in Digital Standard MUMPS, and incorporated into an ACT Medisys Computer Integrated Laboratory Management System (CILMS), has been developed. The system will automatically adjust and prescribe warfarin dosage for selected patients and set clinic appointments based upon defined criteria. Other significant features include printed patient dosage cards, cumulative worksheets for clinicians, clinic and transport lists, statistical searches, rapid enquiry facilities and operator alerts.

Overdose of opioid from patient-controlled analgesia pumps.

Two incidence have occurred in our hospital when a patient-controlled analgesia pump has accidentally delivered the whole contents of the syringe of diamorphine (60 mg) over a period of approximately 1 h. Electrical corruption of the pumps' program has been identified as the probable cause. All pumps of this type have been modified to prevent such occurrences.

Diabetic retinopathy screening service.

The planning, establishment, financing and general organization of a Diabetic Screening Service within a District Health Authority can be a daunting task if not handled correctly. This paper outlines such a service, established in 1987, at a District General Hospital serving a population of 202,000 permanent residents. It highlights the necessity for such a service and its diagnostic value to the local diabetic population.

High Dose, Short Duration Combination Chemotherapy (MEGA III) for Patients with High Grade Poor Prognosis Non-Hodgkin's Lymphoma-A Phase I/II Study.

16 patients with histologically high grade poor prognosis non-Hodgkin's lymphoma were treated with high-dose, short duration combination chemotherapy (MEGA III). 14 patients had de novo disease and 2 patients primary refractory lymphoma. The 2 patients with primary refractory disease both died, 1 of disease progression and 1 of toxicity of the regimen.

Management of posterior epistaxis with the use of the fibreoptic nasolaryngoscope.

Posterior epistaxis is usually treated by repeated nasal packing and in failed situations by ligation of feeding arteries with considerable morbidity and mortality. The most logical approach should be location of the bleeding site and arrest of haemorrhage by local treatment. The exact location of the bleeding area can be identified in actively bleeding noses with the fibreoptic naso-laryngoscope and the bleeding arrested by chemical, or thermal cautery and in failed situations by using small nasal packs confined to the bleeding site.

The implications of Project 2000 for nursing libraries.

Drawing on their experience as a demonstration district for Project 2000 the authors discuss the implications of the changes to nurse education for nursing libraries and the services which they provide. A survey of library usage patterns under the 'new' curriculum is also described.

Introducing patient-controlled analgesia for postoperative pain control into a district general hospital.

Patient-controlled analgesia was introduced in a district general hospital in order to improve postoperative pain control. Techniques of management were developed with effectiveness, safety and practicality as the main objectives. An analysis of the first 1000 patients to use the system is presented.