Treatment of atrial fibrillation in a district general hospital.

Objective: To assess current strategies used to investigate and manage acute atrial fibrillation in hospital.

Design: Prospective survey of all acute admissions over 6 months.

Setting: District general hospital serving a population of 230,000 in north east Glasgow.

Papuloerythroderma and cutaneous T cell lymphoma.

An 83-year-old man had the typical cutaneous features of papuloerythroderma of Ofuji. There were reduced numbers of lymphocytes and platelets in his peripheral blood but the eosinophil count was normal. Skin biopsy showed a nondiagnostic infiltrate of T lymphocytes in the dermis.

Preparation of a temporal bone exhibit.

Temporal bone dissection forms an important aspect in the training of an otolaryngologist. The more dissection one does the more confident one is in the operating room. The aim of this paper is to advise in the preparation of temporal bones for the purpose of display, exhibition or competition.

Effects of Preservatives on Viability of Cryptosporidium parvum Oocysts.

Potassium dichromate and formalin reduced the viability of Cryptosporidium parvum oocysts as assessed by inclusion or exclusion of 4',6-diamidino-2-phenylindole (DAPI) and propidium iodide (PI) and excystation. Some formalin-treated oocysts containing dead sporozoites excluded PI; that this fluorogenic assay relies not solely upon exclusion of PI but also upon highlighting of sporozoite nuclei by DAPI is reiterated.

Assessment by general practitioners of suitability of thrombolysis in patients with suspected acute myocardial infarction.

Objective: To assess the clinical ability of general practitioners to decide to give thrombolytic therapy to patients with suspected myocardial infarction and to assess the contribution of the electrocardiograph (ECG) to this decision-making process.

Setting: 7 practices on the North side of Glasgow and the coronary care unit of Stobhill General Hospital.

Subjects: 137 patients presenting with chest pain who required direct admission to the coronary care unit.

Induction of folds or sutures on the walls of Cryptosporidium parvum oocysts and their importance as a diagnostic feature.

The proportion of oocysts of Cryptosporidium parvum showing a fold on oocyst walls when incubated with either fluorescent monoclonal antibody or a surface-reactive fluorescent dye was increased by incubating suspensions of oocysts with dimethyl sulfoxide, sucrose, or Hanks' balanced salt solution. Further incubation of sucrose-incubated oocysts with water showed this to be a reversible phenomenon. Oocysts demonstrating this fold after incubation in dimethyl sulfoxide were of the same viability as control oocysts and followed the same excystation dynamics.

An audit of emergency echocardiography in a district general hospital.

Eighty patients (43 M, 37 F), aged 23-89 years who were referred for emergency echocardiography over a 12-month period were prospectively studied in order to determine the reasons for emergency echocardiography and the influence of its results on patient management. The most frequent emergency request was to clarify whether the basis for cardiomegaly in a haemodynamically unstable patient was pericardial effusion or left ventricular dilatation. Other reasons for requests were for assessment for source of systemic emboli, acute complications of myocardial infarction, endocarditis, valve dysfunction and cardiac trauma.

Management of paroxysmal atrial fibrillation.

Paroxysmal atrial fibrillation is a common, poorly understood and difficult-to-treat arrhythmia. Although it tends to be treated in a similar fashion to chronic atrial fibrillation, its pathophysiology is different, and drugs commonly used for chronic atrial fibrillation may have only limited value in treating paroxysmal atrial fibrillation. A broad range of presenting clinical symptoms may be associated with this arrhythmia, and even in the asymptomatic patient, there may be a risk of serious thromboembolic events.

Skin pigmentation due to minocycline treatment of facial dermatoses.

Fifty-four patients taking minocycline for acne or rosacea were assessed for adverse effects. Their mean duration of treatment was 17 months, and their average cumulative dose was 47 g. No symptoms attributable to the therapy were reported.

Ulceration in necrobiosis lipoidica--a case report and study.

A case of aggressive ulceration of necrobiosis lipoidica was successfully treated with oral prednisolone. A retrospective study of 23 cases of necrobiosis lipoidica revealed a 13% incidence of ulceration. The pathogenesis, clinical features and treatment of ulceration in necrobiosis lipoidica are discussed.

Contact allergy to aluminium in 2 brothers.

A 10-year-old boy reacted to aluminium Finn Chambers during routine patch testing. Further patch tests with aqueous aluminium chloride confirmed contact allergy to aluminium. The boy's 8-year-old brother also reacted to aluminium Finn Chambers.

Unilateral pulmonary artery agenesis: a rare cause of haemoptysis and pleuritic chest pain.

Haemoptysis and pleuritic chest pain are common presentations of cardiopulmonary disease. While a number of common disorders may explain these symptoms, occasionally unusual causes may emerge which should be considered in the differential diagnosis especially if pulmonary embolism is unlikely; so that inappropriate anticoagulation or thrombolytic therapy is avoided. We present a case of unilateral pulmonary artery agenesis, who presented with pleuritic chest pain and haemoptysis, and was initially treated as a case of pulmonary thromboembolism.

Occurrence of Giardia sp. cysts and Cryptosporidium sp. oocysts in faeces from public parks in the west of Scotland.

One hundred faecal specimens, randomly collected from various locations within seven public parks in the west of Scotland, were examined for the presence of Giardia sp. cysts and Cryptosporidium sp. oocysts.

The incidence and mechanism of hypotension following thrombolytic therapy for acute myocardial infarction with streptokinase-containing agents--lack of relationship to pretreatment streptokinase resistance.

The incidence, amplitude, mechanism and relationship to prior exposure to streptococcal antigen of blood pressure changes to streptokinase-containing thrombolytic agents were investigated in 125 patients treated with either 1.5 x 10(6) IU streptokinase over 60 min or 30 U anistreplase over 5 min, within 6 h of onset of acute myocardial infarction. Twenty-one of 52 patients with anterior and 34 of 73 with inferior myocardial infarction had a hypotensive response.

Familial idiopathic oedema in prepubertal children: a new syndrome.

Idiopathic oedema has not been previously described in prepubertal children. Between 1977 and 1991, eighteen children (15 girls, three boys) from 13 unrelated kindreds presented with the clinical features of idiopathic oedema commencing between the neonatal period and 12 years. These comprised a triad of swelling, affective disturbance and functional autonomic symptoms.

A case of acute respiratory failure due to tracheal compression by a thyroid cyst.

A patient is described who presented with sudden collapse due to acute respiratory failure caused by tracheal compression from a thyroid cyst. He made a complete recovery and the cyst was electively excised two weeks later.

Naso-labial flap in the reconstruction of floor of the mouth defects.

Defects caused by tumour excision in the floor of the mouth can be closed by different methods. We present thirteen cases treated in our department over the last seven years in whom naso-labial flaps were used. Twelve patients had squamous cell carcinoma of the floor of the mouth and one had fibro-sarcoma of the right lower mandible.

Intuition as a function of the expert nurse: a critique of Benner's novice to expert model.

Benner's model of skill acquisition is currently receiving considerable interest from nurse educationalists, and promises to form the basis for some curricula offered by colleagues of nurse education. This paper debates the 'novice to expert' model and seeks to explain exactly what an 'expert' is. The Benner model proposes that one component of expertise is working from an intuitive base.

Occurrence of oocysts of Cryptosporidium sp. in Larus spp. gulls.

Between November 1990 and February 1991 101 gull faecal samples, collected in central Scotland, and 50 cloacal lavages, from gulls captured at two refuse tips near Durham, England were examined for the presence of Cryptosporidium sp. oocysts. Five of 101 (c 5%) of faecal samples and 11 of 50 (22%) of cloacal lavages contained oocysts, of which 64% and 83%, respectively were considered viable when examined with propidium iodide and 4'-6-diamidino-2-phenylindole.

In vitro excystation of Cryptosporidium parvum.

Protocols for in vitro excystation of oocysts of Cryptosporidium parvum, including different chemical pre-incubation steps, were compared to examine some of the biochemical triggers involved in excystation and to define an in vitro excystation protocol of a reproducibly high efficiency. Pre-incubation steps which increased the permeability of the oocysts were found to enhance excystation dynamics and pre-treatment of oocysts with saliva was found to decrease the permeability and reduce excystation. Although excystation was maximal after incubation for 4 h, sporozoites tended to lyse over this period, and maximum sporozoite recovery occurred after 30 min.