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ABC of diabetes: practical problems.
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Learning medicine. The process of selection.
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Inhaled foreign body causing swelling of the neck.
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Another kind of flying doctor.
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Removal of minute foreign bodies.
The precise localization and surgical removal of the broken tip of an acupuncture needle is reported. The needle was suspected of causing chronic suppuration and sinus formation in the patient's leg. A localizing guide-wire was inserted pre-operatively under fluoroscopic control. Subsequent surgical removal of the foreign body was carried out swiftly and simply with the aid of an image intensifier.
Fish tank granuloma--a frequently misdiagnosed infection of the upper limb.
Five patients attended the accident and emergency (A&E) department with fish tank granuloma caused by an infection with Mycobacterium marinum. All patients had forearm symptoms which were initially misdiagnosed. They were later recognised by the presence of superficial cutaneous lesions in a sporotrichotic distribution. Definitive diagnosis was confirmed by the histological appearances of a biopsy and or culture of the organism. All patients responded to oral minocycline and had uncomplicated recoveries once the diagnosis was established. A&E doctors need to be aware of the possible diagnosis of fish tank granuloma especially when treating forearm infections which have been resistant to antibiotics.
Fucidin in patients on haemodialysis.
Fucidin is useful against ;antibiotic-resistant staphylococci' which are a major problem in causing shunt site infections in patients on chronic intermittent haemodialysis for end-stage renal failure. A new form of intravenous fucidin has been used in vivo in three patients on haemodialysis, and also in experiments in vitro in order to assess its dialysing properties. The experiments in vitro show that some fucidin does cross the dialyser membrane but, in the patients studied, adequate serum levels were maintained throughout a 10-hour haemodialysis. A single intravenous dose of Fucidin is, therefore, adequate for treating ;antibiotic-resistant' staphylococcal infections in patients during haemodialysis.
Severe postural hypotension following home canoe construction from polyester resins.
On two occasions a 36-year-old man developed severe postural hypotension and neurological signs after working with a polyester resin canoe building kit in an unventilated shed. It is likely that his recurrent illness was caused by styrene intoxication. Postural hypotension secondary to styrene exposure has not previously been reported.
'Numismatist's pneumonitis.' A case of acute nitrogen dioxide poisoning.
A case of acute nitrogen dioxide toxicity is described, together with its management and a review of the possible complications.
Abnormal liver function tests following inadvertent inhalation of volatile hydrocarbons.
The use of aerosols containing volatile hydrocarbons in conditions of poor ventilation can result in accidental overexposure which can cause central nervous system effects and hepatic injury. We present a case in which inadvertent usage of an adhesive spray used to make greeting cards resulted in vague neurological symptoms and abnormal liver function tests both of which fully resolved on discontinuation.
MR imaging of the wrist: effect on clinical diagnosis and patient care.
PURPOSE: To evaluate the effect of magnetic resonance (MR) imaging of the wrist on clinicians' diagnoses, diagnostic certainty, and patient care. MATERIALS AND METHODS: A controlled observational study was performed. Referring clinicians completed questionnaires about diagnosis and intended management before and after wrist MR imaging. One hundred eighteen consecutive patients referred for MR imaging of the wrist were recruited from the MR imaging units at a regional teaching hospital and a large district general hospital. The main measures were changes in the clinicians' leading and subsidiary diagnoses after MR imaging, their certainty in these diagnoses, and changes in intended patient care. RESULTS: Questionnaires were incorrectly completed for five patients, questionnaires were not returned for three, appointments were canceled for 10, and two could not tolerate the MR examination. Complete follow-up data were available for 98 patients. The clinical diagnosis changed in 55 of 98 patients; in the remaining 43 patients, diagnostic certainty increased in 23. Clinicians reported that MR imaging had substantially improved their understanding of the disease in 67 of 98 patients. The care plan changed in 45 of 98 patients, with a shift away from surgical treatment. Twenty-eight patients were discharged without further investigation. MR imaging was similarly effective in the regional teaching center and the district general hospital. CONCLUSION: MR imaging of the wrist influences clinicians' diagnoses and management plans.
Aquarium dermatitis: cercarial dermatitis in an aquarist.
A 33-year-old man presented with very itchy red papules on the back of his hands and forearms. These papules appeared about 90 min after he had cleaned his aquarium in which he kept native fish and watersnails. He had obtained the watersnails some weeks before from a nearby pond. Examination of water from the aquarium revealed cercariae. The clinical diagnosis of cercarial dermatitis was corroborated. Cercarial dermatitis has repeatedly been seen in swimmers but not in aquarists keeping fish in a home aquarium.
Depressed patients have higher body temperature: 5-HT transporter long promoter region effects.
BACKGROUND: Depression has been associated with a decrease in intracellular serotonin (5-HT) reuptake through its transporter, SERT. The 5-HT transporter long promoter region (5-HTTLPR) deletion in the SERT gene has also been associated with a decrease in 5-HT reuptake. Conversely, increases in extracellular 5-HT have been associated with increased temperature. It has not been established, however, whether body temperature in depressed patients is different from controls. Here, we hypothesized that temperature would be increased in depressed patients as well as in those with the 5-HTTLPR deletion. METHODS: A strict oral temperature protocol employed single, cross-sectional, naturalistic time-of-day temperature measures in 125 subjects (46 normal controls, 79 outpatients with major depression). Controls and depressed patients were free of psychotropic medication and classified by the Structured Clinical Interview for Psychiatric Diagnoses. Eighty-one of the subjects (68 depressed, 13 normal) were additionally genotyped for 5-HTTLPR polymorphisms. RESULTS: Depressed patients had a significantly higher uncorrected body temperature (mean +/- SD 98.38 +/- 0.61 degrees F) than controls (mean +/- SD 98.13 +/- 0.59 degrees F; F = 4.8, p = 0.03). An age (F = 14.09, p < 0.001) and time-of-day (11.4, p = 0.001) correction revealed a more robust (F = 14.02, p < 0.001) difference between depressed patients (mean +/- SD 98.44 +/- 0.55 degrees F) and controls (mean +/- SD 98.02 +/- 0.56 degrees F). When normalized for age and circadian differences between subjects, random, outpatient oral temperatures had a sensitivity of 63% and a specificity of 76% in identifying the depressed subjects from the controls. Independent of depression, subjects with the 5-HTTLPR deletion (short SERT allele) were warmer (mean +/- SD 98.33 +/- 0.65 degrees F) than those lacking the short allele on either chromosome (mean +/- SD 97.91 +/- 0.69 degrees F; F = 7.0, p = 0.01). However, the genotype did not explain the temperature differences between controls and depressed patients. CONCLUSION: This is the first demonstration of an increased daytime body temperature in cases with major depression. Subjects with a corrected temperature above 98.3 degrees F were 2.6-fold more likely to be depressed. The results may strengthen the hypothesis of an inflammatory component of depression. In addition, the findings suggest a potential link between genetic differences in 5-HT transport and body temperature.
Is it possible to predict one-year survival in centenarians? A neural network study.
BACKGROUND: Human life expectancy is constantly increasing: the challenge for modern geriatric medicine is to identify the means to reach successfully extreme longevity. OBJECTIVE: To determine which are the survival determinants in centenarians using a neural network. METHODS: Sample of 110 centenarians living in Rome, mean age 101.6 years (SD=1.8) with a sex ratio males:females of 1:3. We administered an extensive health interview (lasting 1-2 h) to each subject. The questionnaire, carried out according to the Geriatric Multidimensional Assessment, is made up of 100 items including a comprehensive health and psychosocial assessment aimed at various topics of general health and well-being and some scales used in geriatric practice. We applied several three-layered feed-forward neural networks by mixing in different ways the most important of the 100 items. RESULTS: The most predicting powered net is the one constructed with 23 variables regarding comorbidity, cardiovascular risk factors, cognitive status, mood, functional status and social interactions, which therefore are strictly related to survival in centenarians. CONCLUSION: Survival in longevity is a complex biological phenomenon, which is an ideal field for using the neural network as a statistic method. The net shows us that the maintenance of social relationships even in presence of disability is of major importance for survival in the oldest old.
Behavioural activities in demented geriatric patients. Study based on evaluations made by nursing staff members and on patients' scores on a simple psychometric test.
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On pigmented macules and butterfly collection.
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