Postgraduate medical journal
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Bacille Calmette-Guérin (BCG) lymphadenitis is the most common complication of BCG vaccination. Two forms of BCG lymphadenitis can be recognised in its natural course-simple or non-suppurative lymphadenitis, which usually regresses spontaneously over a period of few weeks, and suppurative BCG lymphadenitis distinguished by the development of fluctuations in the swelling, with erythema and oedema of overlying skin. ⋯ Suppurative BCG lymphadenitis may be treated by needle aspiration to hasten resolution and prevent spontaneous perforation and sinus formation. Surgical excision is rarely needed and is meant for cases of failed needle aspiration or for draining BCG nodes.
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Foot health is an important issue in older people. Inappropriate shoes increase the risk of callous and ulcer formation, as well as increasing the risk of falls. There are no data defining the size of this problem. ⋯ Most older people on a rehabilitation ward wore ill fitting shoes. An association was found between ill fitting shoes and self reported pain, and between ill fitting shoes and ulcer formation. A straightforward assessment of footwear in older people could improve comfort and avoid preventable foot disorders.
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Significant numbers of presentations to the emergency department were found to relate to low voltage electrical injury, for which there was no widely accepted management protocol. It was decided to examine the outcome of patients after low voltage electrical injury with particular reference to electrocardiogram (ECG) changes and to evaluate a protocol for managing these injuries in order to optimise the management of patients after electrical injury. A prospective observational study was done over three years of 212 consecutive presentations to the emergency department of Mount Isa Base Hospital with a four year follow up after implementation of the revised protocol. ⋯ Asymptomatic patients with a normal ECG on presentation do not need ECG monitoring after low voltage electrical injury. Patients with significant symptoms or ECG changes should be admitted for monitoring and observation. In view of the high proportion of workplace related injuries occupational health measures such as "triple gloving" should be mandatory for high risk groups.
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An 80 year old man, who relied on a home based meals-on-wheels service was admitted to hospital with non-specific symptoms, but had clinical and biochemical evidence of scurvy. Subsequently, all new admissions (n=37) to the department over a three week period were assessed for evidence of undernutrition. ⋯ The commonest symptom associated with vitamin C deficiency was anorexia, but overall, there was a paucity of clinical signs associated with vitamin C deficiency. The possible associations of vitamin C deficiency in the elderly are discussed.