Fatal Venlafaxine poisoning: Case Report.

Venlafaxine is a selective serotonin and noradrenaline re-uptake inhibitor (SNRI), used in the treatment of depressive illness and anxiety disorder. Overdose may result in cardiac and neurotoxicity, but there are very few case reports of fatal isolated Venlafaxine overdose.1 The following case highlights the potentially serious consequences of overdose of this drug.

Epidural haematoma after a combined spinal-epidural anaesthetic in a patient treated with clopidogrel and dalteparin.

We report a case of a spinal-epidural haematoma occurring in a patient after a combined spinal-epidural anaesthetic. She had been taking clopidogrel and had received perioperative dalteparin for thromboprophylaxis. Despite adhering to standard guidelines concerning administration of low molecular weight heparin perioperatively and stopping the clopidogrel 7 days before the anaesthetic, the patient developed an epidural haematoma.

The management of hiccups in terminally ill patients.

There is a reasonable amount of literature on the subject of hiccups. However, the evidence shows that existing practice relies heavily on anecdotal case reports and clinical experience. Hiccups affect talking, eating and sleeping, and can lead to weight loss, exhaustion, anxiety and depression, all factors affecting quality of life.

Non-small-bowel lesions detected by capsule endoscopy in patients with obscure GI bleeding.

Background: Approximately two thirds of patients undergoing capsule endoscopy for obscure GI bleeding will have an abnormality found in the small intestine. This report describes 9 patients (4 men, 5 women) of 140 with obscure bleeding in whom a source of their blood loss was found in the stomach or the colon at capsule endoscopy.

Methods: A review was made of a prospective database of 140 consecutive patients undergoing capsule endoscopy for obscure GI bleeding at a single center.

Specifying colours for colour vision testing using computer graphics.

Aims: This paper describes a novel test of colour vision using a standard personal computer, which is simple and reliable to perform.

Methods: Twenty healthy individuals with normal colour vision and 10 healthy individuals with a red/green colour defect were tested binocularly at 13 selected points in the CIE (Commission International d'Eclairage, 1931) chromaticity triangle, representing the gamut of a computer monitor, where the x, y coordinates of the primary colour phosphors were known.

Results: The mean results from individuals with normal colour vision were compared to those with defective colour vision.

Is the constant score reliable in assessing patients with frozen shoulder? 60 shoulders scored 3 years after manipulation under anaesthesia.

We assessed the function of 60 primary frozen shoulders at a mean of 33 months after manipulation under general anaesthesia. Each patient was scored according to the system described by Constant and Murley (1987). We also evaluated a modified method of strength assessment with the sling over the mid-humerus (modified Constant score), and analyzed the abbreviated Constant score, which excludes the strength measurement (Patel et al.

Delayed presentation of septic arthritis of a lumbar facet joint after diagnostic facet joint injection.

We report the case of a 46-year-old, otherwise healthy, man with chronic lower back pain and no evidence of nerve root compression who underwent diagnostic facet joint injections to assist in establishing where his pain sources were located and to try to help his spinal rehabilitation program. He presented with a facet joint infection 2 months after injection, in a manner that was indistinguishable from an acute intervertebral disc herniation. The diagnosis was confirmed on magnetic resonance imaging, and he was successfully treated with surgical debridement and antibiotics.

Adenocarcinoma of the ethmoid sinuses: a case of two primary tumours.

The authors present a case report of a retired furniture worker who initially presented with a mucin-secreting adenocarcinoma of the right ethmoid sinus. He underwent surgical resection, leaving the nasal septum intact, and topical treatment with 5-fluorouracil. He remained disease free.

Possible functional regression of insulinoma with prolonged octreotide.

A 75 year old woman was treated for over three years with the somatostatin analogue, octreotide for an insulinoma. She had presented in a hypoglycaemic coma. C-peptide and insulin concentrations were both raised and an area of increased vascularity within the pancreas was shown by angiography.

Manipulation under anaesthesia for frozen shoulder.

Following manipulation of frozen shoulders under general anaesthesia, we reviewed 74 shoulders at an average of 3 weeks and again at an average of 33 months following the manipulation. We used an adjusted Constant score by excluding the abduction strength measurement. The maximum score was therefore 75 points.

ROMEO: a rapid rule out strategy for low risk chest pain. Does it work in a UK emergency department?

Aims: To examine the feasibility of using the ROMEO (rule out myocardial events on "obs" ward) pathway for low risk patients with chest pain in a UK emergency department.

Methods: A prospective study was undertaken to determine outcomes for the first 100 patients entering the pathway (from May to Oct 1999). Serum troponin levels, serial ECG recordings, exercise test result, total length of stay, and final diagnoses were reviewed.

Ovarian response in three consecutive in vitro fertilization cycles.

Objective: This study was designed to assess the ovarian response in the same patient in consecutive IVF cycles.

Design: Retrospective study.

Setting: Assisted reproductive unit at a university hospital.

Issues of consent in renal transplantation.

Background: Renal transplantation is a semi-elective procedure. The specific risks of surgery are well-known. Obtaining informed consent is a complex process made more complicated in transplantation by the long-term nature of some of the risks involved.

Internal fixation of lateral clavicle fractures with Vicryl tape.

Six consecutive Neer type II fractures of the lateral end of the clavicle were treated by indirect open reduction and internal fixation using Vicryl tape. All fractures healed within 6-8 weeks after the operation. The pre-injury level of function was restored in all cases.

Re-transfusion of autologous blood from wound drains: the means for reducing transfusion requirements in total knee arthroplasty.

The requirements for homologous blood transfusion in patients undergoing total knee replacements under tourniquet, before and after the introduction of autologous transfusion of blood collected from wound drains, are compared. In a control population of 93 patients undergoing total knee replacement, 67 required homologous transfusions of two units or more. In 160 patients who were re-transfused with blood from wound drains, only 30 required additional homologous transfusions.

The design of a corporate identity for a department of medical illustration: a case study.

This paper outlines the author's attempt to design and introduce a corporate identity into the Department of Medical Illustration at the South Buckinghamshire NHS Trust. It is intended to furnish the reader with an insight into the process of designing a corporate identity and to relate one department's experience. This may be useful for those who wish to develop a corporate identity of their own or contribute, as a department, towards an identity for their own Trust or other institution.

Can we reduce the caesarean section rate?

Caesarean section rates continue to be an issue of great concern to many midwives, obstetricians, women, and society as a whole. With an increase in women requesting caesarean sections, the responsibility for the caesarean section rate needs to be re-defined. There is a need to improve the routine information collection on all aspects of childbirth.

Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed.

Aims: Patients without spleens are at increased risk of overwhelming infection. Recently, greater efforts, including the publication of national guidelines, have been made to improve the management of asplenic individuals. In theory, risks of serious sepsis can be reduced by good advice, immunisation, and antibiotic prophylaxis.