Postgraduate medical journal
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Review Case Reports
Clinical presentation and operative repair of hernia of Morgagni.
A 77 year old woman who presented with an incarcerated hernia of Morgagni was successfully treated without complications. A Medline search (1996 to date) along with cross referencing was done to quantify the number of acute presentations in adults compared to children. Different investigating modalities--for example, lateral chest and abdominal radiography, contrast studies or, in difficult cases, computed tomography or magnetic resonance imaging--can be used to diagnose hernia of Morgagni. ⋯ Fourteen percent of children (seven out of 47) presented acutely compared with 12% of adults (12 out of 93). Repair at laparotomy was the method of choice but if uncertain, laparoscopy would be a useful diagnostic tool before attempted repair. Laparoscopic repair was favoured in adults especially in non-acute cases.
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In 2001, the Department of Health produced the Improving Working Lives (IWL) for Doctors document. This is the first national survey which asks hospital doctors what changes are needed to improve their working lives. ⋯ Hospital doctors in the UK need more support to improve their working lives. The principle needs are better secretarial and managerial support for consultants; education, training, and mentoring for junior doctors and staff and associate specialist grades; and improved opportunities to develop new skills for those in surgical specialties. Support with childcare is an important issue for female specialist registrars. The Department of Health, NHS trusts, deaneries, and Royal Colleges need to endorse policies that promote a training and working environment that will improve working lives for all hospital doctors, ensuring that appropriate and continuing support is available from the time doctors enter the new foundation programmes and proposed run-through grades, to their time spent as consultants in today's NHS.
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Multicenter Study
National review of urology outpatient practice in the UK.
To audit the current UK outpatient workload and compare this to the national standards as set out by the British Association of Urological Surgeons (BAUS) in A Quality Urological Service for Patients in the New Millennium published in October 2000. ⋯ A minority of consultants are able to adhere to the outpatient workload guidelines as set out by BAUS council in 2000. In addition, there appears to be significant variations within and between training regions. Development of this project into a regional audit tool may allow intraregional guideline formation governing hospital outpatient workload.
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The case of a young woman with flare-up of Crohn's disease, who had an acute myocardial infarction due to the spontaneous dissection of the left anterior descending coronary artery, is reported. The literature on this rare condition is reviewed and a mechanism postulated for spontaneous coronary artery dissection in inflammatory bowel disease.
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Randomized Controlled Trial Comparative Study Clinical Trial
Rofecoxib versus ibuprofen for acute treatment of migraine: a randomised placebo controlled trial.
Rofecoxib is a potent cyclo-oxygenase-2 inhibitor with a long duration of action. Its role in migraine has not been systematically evaluated. ⋯ Both ibuprofen and rofecoxib were superior to placebo in aborting an acute migraine attack, and there was no significant difference in their efficacy in an acute migraine attack.