Human relationships: an exploration of loneliness and touch.

The aim of this article is to provide a cursory review of some of the literature relating to loneliness, existentialism and touch. With reference to the critical incident analysis (see Box 1), a reflection on the learning that has been achieved both intrapersonally and interpersonally will also be provided. A consideration of how exactly this experience of structured reflection may be used to enhance and develop practice will also be explored.

Will I? Won't I? Why do men who have sex with men present for post-exposure prophylaxis for sexual exposures?

Background: Failures of post-exposure prophylaxis following sexual exposure (PEPSE) to prevent seroconversion have been reported and are often associated with ongoing risk exposure. Understanding why men who have sex with men (MSM) access PEPSE on some occasions and not others may lead to more effective health promotion and disease prevention strategies

Methods: A qualitative study design using semi-structured interviews of 15 MSM within 6 months of them initiating PEPSE treatment at an HIV outpatient service in Brighton, UK.

Results: PEPSE seeking was motivated by a number of factors: an episode that related to a particular sexual partner and their behaviour; the characteristics of the venue where the risk occurred; the respondent's state of mind and influences of alcohol and recreational drug use; and their perceived beliefs on the effectiveness of PEPSE.

The surgical management of patients who deliberately self-harm.

Introduction: Deliberate self-harm is a common problem that often requires orthopaedic treatment. Patients with injuries due to deliberate self-harm are often referred to our unit. This study assessed the type of treatment required and the cost of treatment.

Acute hepatitis C: changing epidemiology and association with HIV infection.

Over the past 6 to 7 years an increasing incidence of acute hepatitis C virus (AHCV) has been fuelled by two different changing epidemics: (1) a new resurgence of AHCV amongst intravenous drug users (IVDU); and (2) presumed sexually transmitted AHCV amongst predominantly HIV-positive men who have sex with men (MSM). Increasing incidence amongst IVDUs is likely to be a consequence of changing injecting behaviour, possibly related to changes in perception of HIV as well as HCV risk and consequences. Increasing incidence amongst MSM is likely to be a consequence of changing sexual practices, for example number of sexual partners and type of sexual behaviour, as well as increasing availability of recreational drugs associated with sexual risk-taking, and wider availability of casual sexual partners via the internet or sex-on-premises venues.

Endovascular repair of a recurrent aortocaval fistula and anastamotic false aneurysm.

Aortocaval fistula (ACF) and false aneurysm are a recognized complication of open abdominal aortic aneurysm (AAA) repair. Untreated they are often fatal. However, open surgical repair of this complication is associated with a high operative mortality and a significant complication rate.

"Hot potato voice" in peritonsillitis: a misnomer.

The "hot potato voice" is widely recognized as a symptom of peritonsillar cellulitis or abscess; yet there have been no studies assessing the resonance characteristics of the vocal tract in peritonsillitis. Analysis was undertaken of formant frequencies in the articulation of the vowels /i:/. /a:/ and /u:/ in six subjects with peritonsillitis and compared with articulation once the peritonsillitis had settled.

How is risk defined in high-risk surgical patient management?

The definition of risk in surgical patients is a complex and controversial area. Generally risk is poorly understood and depends on past individual and professional perception, and societal norms. In medical use the situation is further complicated by practical considerations of the ease with which risk can be measured; and this seems to have driven much risk assessment work, with a focus on objective measurements of cardiac function.

The porcine forelimb as a model for human flexor tendon surgery.

Technical skills have been shown to transfer very well from bench models to practical use. The central two rays of 30 forelimbs of pigs were dissected and anatomical observations were made. The rays contained deep and superficial flexor tendons enclosed in a fibro-osseous tunnel and these were present in all 60 specimens.

Patient maintained sedation for colonoscopy using a target controlled infusion of propofol.

In this study, we evaluated safety and recovery using a patient maintained, target controlled infusion of propofol for sedation in 20 patients undergoing colonoscopy. Using a handset with a two-minute lockout interval, patients could make 0.2 micro g.

Insulinoma: how reliable is the biochemical evidence?

Background And Methods: We report a case of insulinoma in which the diagnosis was very challenging as some of the biochemical data were consistently equivocal. In order to assess the relative reliability of the analytical tests, retrospective biochemical data on 45 other cases of histologically confirmed insulinoma were evaluated, enabling the most secure diagnostic process to be identified.

Results: The data showed that insulin concentrations alone, although measurable, were equivocal in 17% of cases.

Peyronie's disease-the Plymouth experience of extracorporeal shockwave treatment.

Objective: To describe our experience of the use of extracorporeal shockwave treatment (EST) for Peyronie's disease. Patients and methods The study included 28 patients (mean age 57 years, range 34-72) with stable Peyronie's disease who were treated with 3.9 (3-5) sessions of EST to the Peyronie's plaque.

Clostridium novyi infection: a fatal association with injecting drug users.

Injecting drug users frequently use accident and emergency (A&E) departments to access emergency care for local and systemic infections. Clostridium novyi type A is a bacterium that has recently been associated with a number of fatalities among drug injecting addicts. The clinical course is described of a patient who attended an A&E department with septicaemia who was found at postmortem examination to have been infected with Clostridium novyi type A.

Deliberate removal of incisor teeth to allow access for laryngoscopy.

This paper describes a clinical situation where it was impossible to obtain a biopsy of a lesion at the anterior commissure in a patient with progressive hoarseness of voice using standard microlaryngoscopy techniques. Due to anatomical difficulties and a histological suggestion of laryngeal papillomatosis the incisor teeth were deliberately removed to allow an adequate view of the larynx and to facilitate further access.

A prospective series of out-patient endoscopic retrograde cholangiopancreatography.

Objective: Out-patient endoscopic retrograde cholangiopancreatography (ERCP) is widely practised but the safety of this approach has only been addressed in a limited number of prospective series mainly from specialist North American centres. Our objective was to determine prospectively the safety and admission rates of out-patient ERCPs.

Study Design And Participants: Patients were selected for out-patient ERCP if in relatively good health, without major risk factors for complications following ERCP and with adequate social support.

Brain attack!--How good is the early management of subarachnoid haemorrhage in accident and emergency departments? South Thames A&E Specialty Sub Committee Audit Group.

Objectives: The aim of this study was to assess the characteristics and audit the management of patients for whom a diagnosis of subarachnoid haemorrhage was made and who were admitted to a neurosurgical centre from an accident and emergency (A&E) department. The objective was to use the results to make recommendations for improving care in this group of patients.

Methods: Four neurosurgical centres in the South Thames Region provided lists of patients admitted with a diagnosis of subarachnoid haemorrhage during 1997.

Evaluation of fine-needle aspiration cytology for renal masses.

Objective: To evaluate the accuracy and use of fine-needle aspiration (FNA) cytology for the diagnosis of renal masses because with the improved quality and increasing use of ultrasonography and computed tomography (CT), asymptomatic renal masses, particularly small (< 5 cm) tumours, are being discovered more frequently.

Patients And Methods: Between 1995 and 1997, 49 patients (mean age 67.5 years, range 42-88, 34 men and 14 women) underwent FNA of a solid or complex cystic mass under radiological guidance.

A & E nursing and the Internet.

The Internet is a relatively new addition to the world of information technology which can be incorporated for use in Accident & Emergency (A & E) nursing, It can provide an information resource and a communications tool for helping A & E nurses in their work. This paper explains the Internet for novices. It discusses the requirements for accessing it and how it can be used by A & E nurses.

Interstitial radiofrequency therapy of the prostate in the management of acute urinary retention.

Objective: To evaluate in a prospective study the efficacy of interstitial radiofrequency therapy (IRFT) of the prostate in relieving acute urinary retention in patients with benign prostatic hyperplasia.

Patients And Methods: Twenty-seven patients presenting in acute urinary retention who failed at least one trial of voiding one week after presentation were treated with IRFT of the prostate. During the 6-month follow-up, the International Prostate Symptom Score (IPSS), urinary flow rate, post-void residual volume (PVR) and serum creatinine were determined and changes in erectile and ejaculatory functions recorded.

Pyridostigmine, an Acetylcholinesterase Inhibitor, Stimulates Growth Hormone Release, but has no Effect on Basal Thyrotrophin or Adrenocorticotrophin Levels, or the Thyrotrophin Response to Thyrotrophin-Releasing Hormone.

Abstract Pyridostigmine, an acetylcholinesterase inhibitor, stimulates growth hormone (GH) release and is thought to act by inhibiting hypothalamic somatostatin release. There are few data concerning the effect of pyridostigmine on other pituitary hormones apart from GH. We have studied the effect of pyridostigmine on basal GH, thyrotrophin (TSH), prolactin, adrenocorticotrophin and cortisol release, and thyrotrophin-releasing hormone (TRH)-stimulated TSH and prolactin release, in two studies involving nine healthy male subjects.

When is a nurse not a nurse?

Having been a staff nurse for nearly four years, currently working in a busy A&E department and with a variety of experience and courses under my belt, I thought that I had all the answers to those searching questions that patients like to ask. Even when slightly unsure, I could still have vague answers in the knowledge that my authorita'tive uniform would hide any uncertainty. But then, quite unexpectedly, I too became 'one of them'; I became a patient.