Postgraduate medical journal
-
In the UK an aging population is resulting in more people being diagnosed with cancer, and an increasing number of treatment options means that many patients live significantly longer with their disease. It is anticipated therefore that an increasing number of patients will present to primary and secondary care with acute complications of cancer, or the treatment thereof. ⋯ This article reviews the diagnosis and management of four common oncological emergencies: febrile neutropenia, metastatic spinal cord compression, superior vena cava obstruction, and malignancy associated hypercalcaemia. It is vital to recognise these conditions, as failure to implement immediate and appropriate treatment may result in significant morbidity or death.
-
Acute infectious thyroiditis is a rare condition of the thyroid gland, most often arising in children with congenital conditions connecting the thyroid directly to the oropharynx, such as a piriform fistula or thyroglossal duct. We report a case of acute thyroiditis due to septic emboli derived from infective endocarditis.
-
Early neurological deterioration (END) in acute ischaemic stroke is a common event. The underlying mechanisms are heterogeneous. The clinical predictors of END include severity of the initial stroke, large vessel occlusion, diabetes mellitus, hypotension, and atrial fibrillation. ⋯ Advances in brain and vascular imaging have provided insight into the underlying mechanisms, enabling clinicians to use preventative and therapeutic interventions specifically targeted at them, though several questions still remain unanswered. END has potentially serious consequences on the short term (morbidity and death) and long term (recovery from stroke) outcomes for the patient. Therefore, attempts to prevent and treat END should be made promptly and aggressively.
-
A newly acquired neuromuscular cause of weakness has been found in 25-85% of critically ill patients. Three distinct entities have been identified: (1) critical illness polyneuropathy (CIP); (2) acute myopathy of intensive care (itself with three subtypes); and (3) a syndrome with features of both 1 and 2 (called critical illness myopathy and/or neuropathy or CRIMYNE). CIP is primarily a distal axonopathy involving both sensory and motor nerves. ⋯ Avoidance of systemic inflammatory response syndrome (SIRS) is the most effective way to reduce the likelihood of developing CIP or CIM. Outcome is variable and depends largely on the underlying illness. Detailed history, careful physical examination, review of medication chart and analysis of initial investigations provides invaluable clues towards the diagnosis.
-
Interest in the development of medical educators working in the postgraduate sector is running high. Driven by three interlinked trends--the professionalization of medical education, increasing accountability, and the pursuit of educational excellence--there is a growing need for high quality and sustained faculty development programmes across the network of education providers. ⋯ The key issue for the future will be how to engage the service in the business of education. Widespread cultural change is required and this will require effective and sympathetic leadership from postgraduate training institutions, hospitals and health authorities.