Use the bulla for pneumostasis.

Prolonged air leak following bullectomy is a common problem and increases the morbidity of the procedure and hence the hospital stay for patients. Different surgical methods have been used to decrease the duration of the air leak. One of the common methods is the use of sealant material, synthetic or biological, over which either a stapler or suture closure is made.

Communicating with the ventilated patient--a literature review.

This review will directly examine the role of the intensive care nurse as a communicator in the provision of holistic nursing care to the ventilated patient Frequent occurrences of breakdown in the process of communication are identified In many cases nurse communication with the patient is only on a task-orientated basis A lack of effective communication may be attributable to psychological problems related to 'ITU syndrome' The critical care nurse is at the forefront in the delivery of a first class National Health Service and a breakdown in communication between the nurse and their patient can be perceived as poor nursing care.

Dead? Or just cold: profoundly hypothermic patient with no signs of life.

A 37 year old man was found in his garden cold with no signs of life. Pupils were fixed and dilated. Electrocardiography showed asystole initially.

Peritoneal glucose exposure and changes in membrane solute transport with time on peritoneal dialysis.

Peritoneal solute transport increases with time on treatment in a proportion of peritoneal dialysis (PD) patients, contributing to ultrafiltration failure. Continuous exposure of the peritoneum to hypertonic glucose solutions results in morphologic damage that may have a causative role in changes in peritoneal function. The purpose of this analysis was to establish whether increased exposure to glucose preceded changes in solute transport in a selected group of long-term PD patients.

Abnormal markers of endothelial cell activation and oxidative stress in children, adolescents and young adults with type 1 diabetes with no clinical vascular disease.

Background: Endothelial cell dysfunction is an early feature of vascular disease and oxidative stress may be involved in its pathogenesis.

Methods: Fifty-one children, adolescents and young people with Type 1 diabetes with no clinical diabetic angiopathy, mean age+/-SD of 16+/-4 years, diabetes duration of 8+/-5 years, and HbA(1c) of 8.5+/-1.

Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation.

Two hundred and ten obstetric anaesthetists completed a questionnaire assessing how they would perform a rapid sequence induction of anaesthesia for a Caesarean section and their continued management during a failed tracheal intubation. The survey revealed considerable variation in the timing and application of cricoid pressure, the choice and dose of drugs used and the timing of their administration. The management of a difficult intubation also varied.

Standardisation of radiographic views of the fractured tibia.

Serial radiographs are difficult to compare when the position of the shin is not accurately controlled in rotation. We have designed a device which can be used easily by the radiographer to produce accurately standardised radiographs of the tibia.

Comparison of the low dose short synacthen test (1 microg), the conventional dose short synacthen test (250 microg), and the insulin tolerance test for assessment of the hypothalamo-pituitary-adrenal axis in patients with pituitary disease.

There is still uncertainty about what is the most appropriate test for assessment of the integrity of the hypothalamo-pituitary-adrenal (HPA) axis. Many advocate the insulin tolerance test (ITT), but this is unpleasant and resource intensive, and may occasionally give misleading results. The conventional [250 microg tetracosactrin, ACTH-(1-24)] short synacthen test (SST) has been used as a simple alternative to the ITT, but it has produced some falsely reassuring results with potentially serious consequences.

An audit of the management of thyroid cancer in a district general hospital.

Objective: Thyroid cancer is the commonest endocrine malignancy yet it appeared to present infrequently to the endocrinologists at this large District General Hospital. The management of well-differentiated thyroid cancer remains controversial with a wide variation in clinical practice. The aim of this survey was to determine the characteristics of the patients diagnosed with thyroid cancer and whether any deficiencies existed in the management of subjects diagnosed with thyroid cancer over a five-year period using standards of care based upon long-term outcome data and recently published USA guidelines.

Dependency scoring in a critical care area: a direct nursing assessment method.

The evaluation of dependency in a critical care area can be a difficult process. Often, dependency scoring systems involve time-consuming data completion and collection. The innovative method of dependency scoring described here uses bedside nurses' own assessment of patient needs to provide an accurate and usable scoring system based upon nursing process documentation.

Does an increase in the sensitivity of serum thyrotropin assays reduce diagnostic costs for thyroid disease in the community?

Many authorities now advocate that the first-line assessment of thyroid function should be measurement of thyrotropin (TSH). The latest serum TSH assays (third generation) are more sensitive than the second generation but the reagents are more costly. We have examined whether overall assay reagent costs would be higher or lower with a third-generation assay, in a laboratory that serves a population of almost 500,000.

CT of pulmonary thromboembolism.

Conventional incremental CT has for many years been useful in the fortuitous diagnosis of pulmonary thromboembolic disease, allowing for visualization of both the central occluding thrombus and the pleuroparenchymal sequelae. Unfortunately, the slow data acquisition times precluded the inclusion of conventional CT in diagnostic algorithms for the diagnosis of this disease. The development and increasing availability of fast scanning techniques, namely helical (spiral) CT and electron-beam CT, now provide a noninvasive means of consistently and accurately demonstrating acute and chronic pulmonary arterial thrombus to the segmental level.

Inhalation induction with sevoflurane: a double-blind comparison with propofol.

We conducted a randomized, double-blind comparison of 8% sevoflurane and propofol as induction agents for day-case cystoscopy in 102 patients. All patients received an i.v.

The role of sevoflurane in outpatient anesthesia.

Sevoflurane appears to have several properties that make it an attractive alternative to the currently available anesthetics for outpatient anesthesia. The relative low solubility of sevoflurane, as well as an impressive lack of airway irritation, makes it a very useful anesthetic for inhalation induction of anesthesia. This feature is likely to make sevoflurane a population choice for pediatric outpatient anesthesia.

Fetal and maternal lipoprotein metabolism in human pregnancy.

1. Lipid, apolipoprotein concentration and composition were determined in maternal venous and umbilical arterial and venous blood at delivery by elective Caesarean section in 13 full-term pregnancies and in 25 healthy non-pregnant females. The indications of Caesarean section were a previous Caesarean section or breech presentation.