Volume 4, Issue 1, Pages 1 – 44 (2005)

Acute Abdominal Pain for the General Physician – who, when and how to refer to the on-call surgeon

Viewpoint, Volume 4, Issue 1, Pages 1 - 44 (2005)

Abstract

Patients with abdominal pain are most frequently referred to the on-call surgical team, but there are occasions when physicians may be required to assess, investigate or treat such patients. This article aims to equip non-surgeons with the skills to undertake an appropriate initial assessment and consider the most appropriate selection, timing and mode of referral to the surgical team.

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Picture Quiz: An unusual cause of headache – Answers

Regular features, Volume 4, Issue 1, Pages 1 - 44 (2005)

The MRI images (see page 27) show lobulated meningeal thickening along the medial aspect of the right middle cranial fossa extending into sylvian fissure, suprasellar cistern, interpenduncular cistern and roof of 4th ventricle which enhanced on postcontrast images. These appearances are diagnostic of metastatic leptomeningeal carcinomatosis.

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The Evolving Role of the Acute Assessment Unit – from inpatient to outpatient care

How to Do It, Volume 4, Issue 1, Pages 1 - 44 (2005)

Abstract

Acute Assessment Units (AAUs) have been developed to meet the demand for emergency care. Traditionally, AAUs have been an admission route to secondary care but the role is now evolving to assessment. AAUs are complex and have many interactions both in hospitals and the community. The effective functioning of an AAU requires excellent clinical leadership, appropriate facilities, timely access to diagnostics and input from the multi-disciplinary team. Increasingly, AAUs will have to develop services which are not dependent on using hospital beds. A variety of emergency medical presentations can, with the appropriate resources, be delivered in an out-patient setting.

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Sudden Hemiplegia in a young patient

A Case to Remember, Book Review, Volume 4, Issue 1, Pages 1 - 44 (2005)

Abstract

Stroke is more common in older patients; when it occurs in younger persons the causes may be slightly different. If adequately investigated, a cause can be ascertained in significant proportion of younger patients with stroke. Dissection of the internal carotid artery is an important cause of stroke in this age group and probably accounts for about 20% of cases. An association with elevated plasma homocysteine has been previously reported. We report a case of spontaneous internal carotid artery dissection associated with raised plasma homocysteine in a twenty-two year old, previously healthy man.

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Picture Quiz: An unusual cause of headache

Regular features, Volume 4, Issue 1, Pages 1 - 44 (2005)

A sixty-six year old lady was admitted after describing two ‘vacant’ episodes with collapse. She had also complained of chronic fronto-occipital headache and more than 10kg weight loss over the preceding three month period. She denied any gastrointestinal, respiratory or cardiac symptoms. She was a non-smoker and did not drink alcohol regularly. She had a past history of hypertension and hypothyroidism for which she was taking ramipril and thyroxine. On examination she appeared cachexic, but no other abnormality was detected.

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Acute Urinary Tract Infections

Clinical Reviews, Volume 4, Issue 1, Pages 1 - 44 (2005)

Abstract

Urinary tract infections remain a significant cause of morbidity throughout the globe. Proper understanding of the disease is extremely important for appropriate management. Recent studies have helped to define the population groups at risk for these infections, as well as the most cost-effective management strategies. This article will discuss aspects of initial diagnosis and subsequent management of different high risk groups.

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Non Invasive ventilation for acute respiratory failure

Clinical Reviews, Volume 4, Issue 1, Pages 1 - 44 (2005)

Abstract

Non-invasive ventilation has become an increasingly utilised tool for the treatment of acute respiratory failure. Potential benefits include a decreased incidence of intubation, duration of hospital stay and mortality. Non invasive ventilation is also being used more and more outside the intensive care environment. Successful use of non invasive ventilation involves knowledge of its indications, contraindications and limitations, and appropriate patient selection. This article reviews these issues as well as the practical application of non invasive ventilation in the acute setting.

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Pyrexia of unknown origin

Clinical Reviews, Volume 4, Issue 1, Pages 1 - 44 (2005)

Abstract

Classical pyrexia of unknown origin (PUO), defined as fever of >38 oC on several occasions for greater than three weeks despite investigation in hospital (>3 days) or out of hospital (>2 visits), is an uncommon but challenging problem. The incidence and aetiology vary according to the geographic region, the age structure of the population, and the immune status of the patient; alternative definitions of PUO exist for immune compromised individuals. Preliminary investigations should be determined by detailed history and repeated examination. Biopsy of abnormal tissues should be performed early. If uncertainty persists, abdominal computerised tomography (CT), radiolabeled white cell scans, and the Duke endocarditis criteria carry the highest diagnostic yield. Blind bone marrow biopsy is probably only useful in immunocompromised patients.

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Cardiac Arrhythmias – Part II:Broad Complex Tachycardia . . .

Clinical Reviews, Volume 4, Issue 1, Pages 1 - 44 (2005)

Abstract

The acute management of the patient presenting with a broad complex tachycardia is a daunting clinical challenge. A broad complex tachycardia may be ventricular or supraventricular in origin and the ability to interpret correctly the 12-lead electrocardiogram is of critical importance in this differentiation. Broad complex tachycardia should be assumed to be ventricular in origin unless there is compelling clinical and electrocardiographic evidence to the contrary. This article focuses on the immediate diagnosis and management of broad complex tachycardia. In view of the broadening indications for implantation of cardioverterdefibrillator devices (ICD) in the management of ventricular arrhythmias, an approach to the ICD patient presenting to the accident and emergency department with recurrent device discharges is discussed.

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