Postgraduate medical journal
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Cough is one of the commonest symptoms of lung disease and is a frequent problem encountered in general practice as well as in hospital practice. A wide range of disease processes may present with cough and definitive treatment depends on making an accurate diagnosis of the cause. A diagnostic work-up for patients with persistent dry cough is presented. ⋯ An increased sensitivity of the cough reflex can be observed in patients with persistent dry cough. Symptomatic relief must be considered when the cough interferes with the patient's health and sleep but the most effective antitussive opiates cause sedation and may be addictive. Treatment of persistent dry cough remains a challenge in some patients and there is still scope for improvement in its diagnosis and effective therapy.
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Nitric oxide has been determined to be a potential mediator of the haemodynamic changes associated with sepsis. The haemodynamic eects of nitric oxide can be partially antagonised by methylene blue, through inhibition of the enzyme, guanylate cyclase. The case report presented here demonstrates a beneficial haemodynamic eect of continuous infusion of methylene blue during sepsis. These findings could be extrapolated to other patients or prompt additional research.
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Recovery of lung function following the acute respiratory distress syndrome (ARDS) is thought to be related to the severity of the initial insult. We report a case demonstrating virtually complete functional recovery following severe ARDS. The significance of this and the need for comprehensive follow-up of such patients is discussed.
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We describe the case of a 34-year-old man who presented intermittent faecal incontinence as a manifestation of cataplexy. The patient's sleep history was positive for the full narcoleptic tetrad (sleep attacks, cataplexy, sleep paralysis and hypnagogic hallucinations) while extensive neuropsychiatric work up was negative for any neurologic or psychiatric illness. Repeat polysomnograms (including a polysomnogram with a full seizure montage) were positive for pathologic sleepiness, but there was no evidence of a seizure disorder. The course of the patient's symptomatology and the favourable response of his symptoms to stimulants and imipramine support the theory that his intermittent loss of sphincter control is part of his narcolepsy-cataplexy.
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Carbon monoxide (CO) poisoning is a common medical emergency and a frequent cause of deliberate or accidental death. It can cause acute and chronic central nervous system damage which may be minimised by prompt treatment with 100% oxygen or hyperbaric oxygen therapy. ⋯ Guidance on the correct diagnosis of this condition is provided in the light of a number of studies screening emergency room populations. Guidelines for treatment with hyperbaric oxygen therapy are also reviewed.