Treating refractory epilepsy with tiagabine: clinical experience.

Epilepsy remains difficult to treat with more than 30% of patients being refractory to conventional anticonvulsant therapy. Combination therapy may improve seizure control in some of these patients. Tiagabine is a new anticonvulsant that has a unique mechanism of action as a selective gamma-aminobutyric acid (GABA) re-uptake inhibitor (SGRI).

A study of district nurses' experiences of continuous ambulatory chemotherapy.

As a result of technical developments and policies that promote shorter hospital stays, patients are increasingly receiving high technology treatment in the community. The administration of ambulatory intravenous chemotherapy at home is an example of such treatment. Despite being generalist nurses, district nurses (DNs) are involved in what could be viewed as 'specialist' care - advising and supporting patients while they are receiving treatment.

Interobserver variations in intra-articular evaluation during arthroscopy of the knee.

We carried out a prospective study in order to establish to what extent the intra-articular evaluation undertaken during arthroscopy of the knee differed between surgeons. Two senior specialist registrars and a consultant orthopaedic surgeon with a special interest in knee surgery were involved. A total of 78 knee arthroscopies (78 patients) was studied.

Transepiphyseal fracture of the femoral neck with dislocation of the femoral head and fracture of the posterior column of the acetabulum in a child.

We describe a 15-year-old boy with a posterior dislocation of the hip, fracture of the posterior column of the acetabulum and separation of the femoral capital epiphysis. To our knowledge no previous case in a child has been reported. Such high-energy injuries are extremely rare, and a poor outcome is expected.

HOPE for patients with Type 2 diabetes: an application of the findings of the MICRO-HOPE substudy in a British hospital diabetes clinic.

Aims: The MICRO-HOPE substudy demonstrated that when ramipril treatment was added to people with Type 2 diabetes and additional cardiovascular risk factors cardiovascular events were reduced by 25% in 4.5 years. We wished to determine the proportion of people with Type 2 diabetes and additional cardiovascular risk factors registered with a hospital diabetes service.

Lymphoscintigraphy and sentinel lymph node biopsy for melanoma.

The role of the sentinel node in the management of malignant melanoma is currently being investigated in specialist centres the world over. The methods employed in identifying the sentinel node(s) depend on the locally available human and technical resources. We describe a three-part technique commonly used by most established centres i.

The relationships between cardiovascular risk factors and socio-economic status in people with diabetes.

The hypothesis that the prevalence of cardiovascular risk factors in people with diabetes is inversely related to socio-economic status was tested. Demographic and biochemical data were collected on 1246 patients, aged 20-69 years, attending a hospital diabetes clinic. This is estimated to represent between 71% and 78% of all people of this age with a diagnosis of diabetes in the health authority.

Necrobiosis lipoidica diabeticorum: association with background retinopathy, smoking, and proteinuria. A case controlled study.

In order to evaluate patients with necrobiosis lipoidica diabeticorum and to compare them with age, sex, and duration of diabetes matched controls, 15 patients with necrobiosis were each matched with 5 control subjects with diabetes mellitus. Complications of diabetes, glycaemic control, and proteinuria were measured. Patients with necrobiosis (mean age 40, range 18-74 years) had a mean duration of diabetes of 14 (range 3-36) years; 8 patients were male, and 7 were female.

Adenomatoid odontogenic tumour. Report of an unusual lesion in the posterior maxilla.

The adenomatoid odontogenic tumour most commonly presents as a 1.5-3 cm radiolucency in the anterior maxilla, and often associated with an unerupted tooth. It is very unusual for these tumours to occur behind the premolar region and the few reports of much bigger lesions have been in black African patients.

The effects of differing pharmaceutical preparations of indomethacin on night pain and morning stiffness in patients with rheumatoid arthritis.

A study was carried out in 18 patients with rheumatoid arthritis to compare the effects of two different preparations of indomethacin with placebo on night pain, sleep and duration of morning stiffness. Patients were treated for 1 night each, in random order, with identical capsules containing 75 mg indomethacin, either as 'Indomod' (all sustained-release form) or 'Indocid' R (25 mg normal, 50 mg sustained-release form), or placebo as a substitute for their usual night-time medication. The results of visual analogue scale scores and a standard sleep assessment questionnaire score indicated the same order of effectiveness for each of the three parameters, with 'Indomod' best, 'Indocid' R intermediate and placebo worst, but only the difference in sleep was statistically significant.