Postgraduate medical journal
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Case Reports
Exercise-induced urticaria and angio-oedema with relief from cromoglycate insufflation.
The pathogenesis of physical urticarias is unknown and the treatment is often difficult and unsatisfactory. A patient with severe exercise-induced angio-oedema and urticaria is reported who responded dramatically to cromoglycate by insufflation and not when treated with orally active cromoglycate.
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Two cases of Guillain-Barré syndrome occurring in association with chronic pulmonary tuberculosis are reported. A cell-mediated, delayed hypersensitivity reaction to, or invasion of the nerve roots by tubercle bacilli would seem to be the likely explanation of the neuropathy.
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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.