The British journal of clinical practice最新文献

We report a case of bile duct hamartoma which developed in a patient who had been on long-term danazol treatment. Such patients should be under close follow-up, preferably with periodic ultrasound examination of the liver. If the patient develops a liver mass, because of non-specific clinical features and imaging appearances, biopsy may be the only way to achieve a definitive diagnosis.

Thrombosis of the cerebral dural sinuses and veins has been described since the early 19th century. Clinically the process is characterised by diverse symptomatology and physical findings and in spite of advances in diagnostic radiological techniques it remains an under-recognised condition. It has been most commonly associated with sepsis, trauma, pregnancy, the puerperium and many other hypercoagulable states. We describe an apparently unique case of sagittal sinus thrombosis occurring during an ectopic pregnancy. This was subsequently complicated by intracranial hypertension in spite of clinical improvement and magnetic resonance imaging (MRI) evidence suggesting a return of venous patency. The clinical presentation, radiological features and management is discussed.

We report on a large asymptomatic placental chorioangioma, identified as an area of reduced echogenicity on ultrasound at 36 weeks' gestation. Despite the large size, it was not associated with the usual maternal or fetal complications expected with a chorioangioma of that size, possibly because of thrombosis and tumour degeneration.

Superior mesenteric vein occlusion is a rare condition which has protean clinical manifestations. It frequently occurs secondary to an underlying coagulation defect. We present the case of a young female who presented uniquely with a massive colonic vascular malformation and who had various predisposing factors, the most serious being a protein C deficiency.

Arterial blood gases and pH are routinely being measured in clinical practice, both to provide diagnosis and to guide therapy in critically ill patients. Oximetry is clinically useful in establishing the presence of hypoxaemia in patients with respiratory diseases. Oximetry is also a simple and reliable method for monitoring patients undergoing anaesthesia, sleep studies and cardiopulmonary exercise testing. The search continues for new innovative techniques for continuous transcutaneous and intra-arterial blood gas monitoring. This is essential in the management of critically ill patients because blood analysers provide only intermittent monitoring of arterial blood gases.

A 73-year-old lady, who underwent coronary artery bypass grafting eight months previously, presented with rigors and chest pain. The upper sternum was tender, swollen and erythematous, suggesting a retrosternal abscess. Radiological investigation supported the clinical diagnosis. Local infections following median sternotomy are uncommon, most being early and superficial. Late infections are very uncommon, and should suggest alternative pathology. Following open surgical drainage, histology showed the mass to be a poorly differentiated adenocarcinoma. The primary tumour was never found.

We conducted a comparative study of 150 patients referred for endoscopy to an NHS hospital and 150 patients referred to an open access scheme in the private sector for fundholding GPs. The concept of consultoscopy, whereby a consultant gastroenterologist gives an opinion at the same visit as the endoscopy is performed, is introduced. Results showed a similar number of normal studies (about 40%) were performed in each group, although the number of examinations showing serious pathology was significantly higher in the fundholding group (p < 0.01). Patients seen in the fundholding scheme had less sedation, required fewer outpatient appointments, and the GPs were given more advice on further management than those seen in the non-fundholding group. We conclude that open access endoscopy in the private sector is a workable option and may result in work being transferred from NHS hospitals to the private sector unless NHS hospitals review their working practices. The concept of consultoscopy is a useful development on traditional open access systems.

A 64-year-old female presented with episodes of small bowel obstruction. Ultrasound and barium meal showed a polypoidal lesion in the proximal segment of small bowel. The patient underwent emergency surgery because of signs of impending acute intestinal obstruction. Pathology showed characteristics features of an inflammatory fibroid polyp (IFP) which is an important though rare benign cause of small bowel obstruction. We document clinical and pathological aspects of this case.

Fifty-two children, aged less than 5 years, with chronic lung disease or congenital heart disease were entered into a two-centre open study to determine the immunogenicity and tolerability of Influvac, a trivalent influenza sub-unit vaccine. Seroresponses were determined following two intramuscular vaccinations with 0.25 ml of Influvac, four weeks apart. Any local or systemic reaction was sought. Seroresponses were age and antigen specific, with children older than 9 months showing better seroresponses to all three antigens. Both A/Taiwan and B/Panama strains met all efficacy criteria. A/Shangdong met two of the three criteria: seroconversion and mean geometric titre increase. Local (23%) and systemic (48%) reactions following either of the two vaccinations were minor in nature and resolved within a few days. The vaccine induced a strong antibody response against all three haemagglutinin antigens and was well tolerated. The incidence of local and systemic reactions was comparable with those reported in healthy adults.