Postgraduate medical journal
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The frequency with which clinicians can expect to face allegations of clinical negligence and court proceedings related to those allegations is likely to increase in coming years. The processes of investigation and defence have been modified by the introduction of the Civil Procedure Rules in 1999. This review outlines these developments and emphasises the need for speedy and comprehensive responses by doctors involved in such procedures.
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Review Case Reports
Brachial plexus injury as an unusual complication of coronary artery bypass graft surgery.
Brachial plexus injury is an unusual and under-recognised complication of coronary artery bypass grafting especially when internal mammary artery harvesting takes place. It is believed to be due to sternal retraction resulting in compression of the brachial plexus. Although the majority of cases are transient, there are cases where the injury is permanent and may have severe implications as illustrated in the accompanying case history.
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A 12 year old boy presented with 11 episodes of weakness, ataxia, nausea, slurred speech, dehydration, and sometimes severe lethargy bordering on coma. A year previously the boy had small intestinal resections leaving 20 cm of small bowel remaining. ⋯ The diagnosis is dependent on the presentations and the plasma D-lactate level. Development of the syndrome seems to be the effect of the accumulation of D-lactic acid.