Unable to weight-bear: a common presentation in emergency department that always needs thorough assessment: a case report.

Femoral neck fracture in young individuals with an unusual mechanism of injury is uncommon. We report a case of grade 3 fracture in young adults without significant trauma. This case reinforces the need for a thorough assessment of the hip joint even after an apparently trivial mechanism of injury.

Effects of halothane, sevoflurane and desflurane on the force-frequency relation in the dog heart in vivo.

Purpose: Frequency potentiation is the increase in force of contraction induced by an increased heart rate (HR). This positive staircase phenomenon has been attributed to changes in Ca2+ entry and loading of intracellular Ca2+ stores. Volatile anesthetics interfere with Ca2+ homeostasis of cardiomyocytes.

Intravenous immunoglobulin for the treatment of severe, refractory, and recurrent Clostridium difficile diarrhea.

Purpose: Clostridium difficile diarrhea is common in elderly patients and leads to prolonged hospitalization. Patients with severe or recurrent Clostridium difficile diarrhea have poor antitoxin antibody responses. Intravenous immunoglobulin has been advocated in these patients.

Adenocarcinoma as a complication of small bowel Crohn's disease.

Carcinoma is a recognized but rare complication of small bowel Crohn's disease. This case series emphasizes the importance of considering this diagnosis in patients with small bowel Crohn's disease. We report three cases in which patients were treated for presumed exacerbations of Crohn's, but were subsequently found to have underlying small bowel adenocarcinoma.

Herniography (peritoneography) for diagnosis of Spigelian hernia.

Background: Spigelian hernia is a rare clinical condition. It is difficult to diagnose in absence of obvious clinical signs. Ultrasound scan, cross-sectional imaging and contrast studies like herniography have been widely used for detecting occult abdominal wall hernias in symptomatic patients.

Fusobacterium necrophorum infection associated with portal vein thrombosis.

This report describes a patient without obvious upper respiratory tract or gastrointestinal infection who developed portal vein thrombosis secondary to Fusobacterium necrophorum septicaemia. The patient responded well to systemic antibiotic therapy. The implications of F.

Gastrointestinal autonomic nerve tumours--report of a case and review of literature.

Background: Gastrointestinal autonomic nerve tumours are uncommon stromal tumours of the intestinal tract. They can involve any part of the gastrointestinal system, but are very rarely seen in the rectum.

Case Presentation: We report a unique case of rectal schwannoma with associated synchronous adenocarcinoma of the splenic flexure and adenoma of the descending colon.

A systematic review of psychological therapies for nonulcer dyspepsia.

Objectives: We conducted a systematic review to determine the effectiveness of psychological interventions including psychodrama, cognitive behavioral therapy, relaxation therapy, guided imagery, or hypnosis in the improvement of dyspepsia symptoms in patients with nonulcer dyspepsia (NUD).

Design: Trials were identified through electronic searches of the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL, and PsycLIT, using appropriate subject headings and text words and searching bibliographies of retrieved articles. All randomized controlled trials (RCTs) or quasi-randomized studies were eligible.

Urgent cancer referral guidelines: a retrospective cohort study of referrals for upper gastrointestinal adenocarcinoma.

Dyspepsia in primary care is common and guidelines indicate that patients with alarm symptoms, as defined by the urgent cancer referral guidelines, should be investigated by gastroscopy. The specificity and sensitivity of alarm symptoms is poor and only a small percentage of patients will turn out to have malignant disease. This primary care study shows that employing current guidelines will identify only 72% of patients at their initial visit to a general practitioner, but this figure could be increased to 86% if the guidelines included patients with weight loss or anaemia in the absence of dyspepsia.

Psychological interventions for non-ulcer dyspepsia.

Background: Studies have also shown that NUD patients have higher scores of anxiety, depression, neurotism, chronic tension, hostility, hypochondriasis, and tendency to be more pessimistic when compared with the community controls. However, the role of psychological interventions in NUD remains uncertain.

Objectives: This review aims to determine the effectiveness of psychological interventions including psychotherapy, psychodrama, cognitive behavioral therapy, relaxation therapy and hypnosis in the improvement of either individual or global dyspepsia symptom scores and quality of life scores patients with NUD.

A study to investigate high readmission rates for COPD.

When an NHS trust found it had high readmission rates among patients with chronic obstructive pulmonary disease, nurses from the acute respiratory assessment service decided to find out why. An audit found that, in fact, a very small number of patients were the cause of the problem. They suggest that improved care at home after discharge could help resolve the issue.

Multi-agency training for quality: reflections and recommendations.

Clinical governance within the National Health Service (NHS) and best value across local authorities in England have emphasised the need for decisions and actions being demonstrably evidence based. In an attempt to progress these related initiatives and facilitate a closer working relationship between NHS Trusts and local government departments, a multi-agency and interprofessional training event on evidence-based practice (EBP) was organised across three boroughs within Tyne and Wear. While there are advantages to different agencies learning and working in partnership to develop quality systems for health improvement, the reality of introducing EBP concepts and creating an evaluative culture within and across public sector organisations represents a major challenge.

Auto-immune haemolytic anaemia--a high-risk disorder for thromboembolism?

An audit of the effect of anticoagulant prophylaxis in acute exacerbations of severe autoimmune haemolysis was undertaken. All cases of this disorder presenting to one institution over a 16 year period were reviewed. There were 28 patients who had a total of thirty six exacerbations of haemolysis.

Twin reversed arterial perfusion (TRAP) syndrome.

Twin reversed arterial perfusion (TRAP) syndrome is an extremely rare manifestation of feto-fetal transfusion syndrome. This condition is seen in monozygotic twin pregnancies, where the affected twin is perfused retrogradely by the healthy twin. The affected twin presents with bizarre malformations such as acardia and acephalus.

Managing cytotoxic extravasation.

The administration of cytotoxic drugs is an area in which evidence-based practice has never been more important, yet information on extravasation is sparse and largely anecdotal. To help staff, an effective and user-friendly approach to the management of cytotoxic extravasation was developed and is described in this article. It details the problems that can arise during the administration of cytotoxic drugs and focuses on the risk of extravasation, which requires urgent management.

Home chemotherapy: NHS and independent sector collaboration.

Current government health policy calls for increased collaboration between acute and primary care, and between the NHS and the independent sector. This article describes an initiative in which an NHS trust contracted an independent company to provide home chemotherapy for patients with cancer of the colon. Home-based therapy enables patients to choose the service that suits them most, and can reduce the stress associated with their disease and treatment.

Improvements in the provision of hospital diabetes services in an English region 1988-98.

Aims: To investigate the changes in provision of hospital-based services for patients with diabetes in an English region over a 10-year period.

Methods: Questionnaires were completed by lead clinicians in hospitals in the Northern region of England in 1988 and repeated in 1998. Information was sought on diabetes service provision including the staff and their working practices.