Postgraduate medical journal
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As a response to the UK Health Department's "two week cancer wait" initiative a one stop dyspepsia clinic based on a nurse endoscopist was introduced, and the first 100 cases attending this clinic have been audited. After referral on a purpose designed form, patients were assessed by a gastroenterologist and then investigated at the same visit--where possible and appropriate--by endoscopy or ultrasound scan. All endoscopies were performed by a trained nurse specialist. ⋯ The waiting time for an appointment rose progressively during the first six months of the clinic. The system was popular with patients as most of them (70%) were dealt with at a single hospital attendance. Basing the endoscopy practice on a trained nurse specialist not only facilitated the creation of the service by maximising the use of scarce resources, but also improved communication and overall management of patients.
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A case of isolated splenic metastasis from carcinoma of the breast in a 54 year old woman, two years after treatment for breast carcinoma, is presented. There was no involvement of other organs like liver, bone, lungs, etc. The patient underwent splenectomy and recovered without any complications. This case is being reported because of the rarity of the lesion.
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To examine the current attitudes towards the prevention of venous thromboembolism among a cohort of surgeons. ⋯ This study confirms that Welsh surgeons conform to standard methods, but also highlights some uncertainties that are present in current surgical practice. Those who responded all routinely used prophylaxis, the timing of which was variable. The main risk factors identified when considering prophylaxis were previous history of deep vein thrombosis/pulmonary embolism, hypercoagulability, and the presence of malignancy. Suggestions for future practice are made.
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Review Case Reports
Adult Still's disease and respiratory failure in a 74 year old woman.
A case of adult onset Still's disease in an elderly woman, that was associated with severe respiratory failure and multiorgan dysfunction, is reported. Histopathology was confirmed on open lung biopsy.
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Chronic subdural haematoma is predominantly a disease of the elderly. It usually follows a minor trauma. ⋯ Neurological state at the time of diagnosis is the most important prognostic factor. Morbidity and mortality is higher in the elderly but outcome is good in patients who undergo neurosurgical intervention.