Biomedical subjects
Publications and source records attributed to J Cox.
We report a case of fulminant supraglottitis with dramatic external cervical swelling due to associated cellulitis. Blood cultures were positive for Neisseria meningitidis. The patient recovered completely after emergency fiberoptic intubation and appropriate antibiotic therapy. We summarize five other cases of meningococcal supraglottitis, all reported since 1995, and discuss possible pathophysiologic mechanisms.
Quality medication administration is not simply a matter of adhering to the 'five rights'. The nurses' role in medication management is influenced by a multitude of factors not always within their control. Yet nurses maintain a duty of care to uphold safe and appropriate nursing interventions in pursuit of quality drug use. Whilst legislation and nursing standards offer principles and parameters for such interventions they can not provide directives. Hence, it remains each nurse's responsibility to understand the factors that influence medication management, to attain best practice on the patient's behalf.
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Abnormalities (reduction in/absence of) in diurnal bp rhythm are much more commonly seen in patients with chronic uremia than in patients with primary hypertension or in normal subjects. Target-organ damage is greater in these patients. However, the extent to which these diurnal bp rhythm changes are consistent or variable is untested. We retrospectively examined 223 ambulatory blood pressure monitoring (ABPM) traces in 92 patients with chronic uremia who had undergone ABPM at least twice (mean 2.3 ABPM traces/patient) over the period 1991-1997. ABPM technique and analysis were constant over this period. We found that for patients with chronic declining renal function but not yet on dialysis therapy, 67% retained the same diurnal rhythm from one ABPM recording to the next; if the known tendency for declining renal function to accompanied by a greater prevalence of "non-dipping" is taken into account, 82% of all patients had a "predictable" diurnal pattern. 79% of transplant patients, 87% of haemodialysis patients and 100% of CAPD patients retained the diurnal rhythmicity from one ABPM session to the next. Non-dipping was much more frequent than dipping (67% vs 33%). We conclude that abnormalities of diurnal BP rhythm are reasonably consistent in patients with renal hypertension, especially as renal function declines and patients enter the renal replacement therapy programme.
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The authors report a case of intracranial aspergillosis secondary to immunosuppression. Signal intensity changes in the lesion on brain MR are compared with gross and histopathologic findings at autopsy. A peripheral ring of low signal intensity relates to a dense population of Aspergillus hyphal elements and small areas of hemorrhage. CT findings are included for comparison.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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The importance of early recognition and treatment of patients who are at risk of developing malnutrition is becoming increasingly recognised. Percutaneous endoscopic gastrostomy has become increasingly popular as a method of feeding, since its description in 1980, because of its ease of insertion and low morbidity and mortality. Its success, however, depends upon the use of a multidisciplinary approach.