Postgraduate medical journal
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Case Reports
Diabetic ketoacidosis associated with outpatient treatment using continuous subcutaneous insulin infusion.
The occurrence of ketoacidosis in out-patient diabetics treated with continuous subcutaneous insulin infusion (CSII) has received little attention. We report two such cases of ketosis, each precipitated by infection and occurring in patients previously well controlled on CSII. This report illustrates that the risk of ketoacidosis is ever present in insulin-treated patients, whether the insulin is infused by pump or injected intermittently.
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We report a case of primary malignant melanoma of the gallbladder with review of the literature and comment on the frequency of secondary deposits of melanoma within the small bowel.
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Case Reports Comparative Study
Terminal care: evaluation of effects on surviving family of care before and after bereavement.
To evaluate the effects on the family of a comprehensive programme of terminal cancer care, 20 close relatives of patients who had died in a Palliative Care Unit (PCU) were compared with a matched group of 20 relatives of patients who had died of cancer in other wards of the same teaching hospital. Interviewed by telephone 1 year and 2 weeks after bereavement, relatives of PCU patients report significantly fewer psychological symptoms and less lasting grief and anger than relatives of patients who had died elsewhere. Factors thought to have contributed to good outcomes were successful relief of pain, awareness by relatives of the coming death of the patient and support given to relatives after bereavement. Two case examples illustrate these findings.
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Randomized Controlled Trial Clinical Trial
The respiratory effects of meptazinol.
The respiratory effects of the new analgesic, meptazinol, were compared with a placebo and with equianalgesic doses of morphine and pentazocine and with diazepam in a double-blind crossover trial in seven healthy volunteers. No significant change in the ventilatory response to rebreathing carbon dioxide was observed after meptazinol or placebo but morphine, pentazocine and diazepam depressed the slope of the ventilatory response (-30.0%, -31.6% and -50.0% respectively, P less than 0.02). End-tidal carbon dioxide tension (PE',CO2) breathing air increased significantly following all three analgesic drugs but not after diazepam. ⋯ The increase following pentazocine (0.80 kPa) was significantly greater than that after both morphine and meptazinol (P less than 0.02). In a preliminary study of pain relief following cholecystectomy there was no significant difference in the analgesic effect of meptazinol compared to morphine, both drugs being given by continuous infusion. More of the patients given morphine had apnoeic periods, although the difference between the groups was not significant.