Irish journal of medical science
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Pneumobilia is the presence of gas within the biliary tree. It is an important diagnostic sign in spontaneous biliary enteric fistulae, classically in gallstone ileus. There are a number of other causes including surgically created biliary enteric fistula, instrumentation of the bile duct at endoscopic retrograde cholangiopancreatography, emphysematous cholecystitis and pyogenic cholangitis. Pneumobilia has also been reported following blunt abdominal trauma. The significance of isolated pneumobilia following abdominal trauma has not been conclusively established. ⋯ Pneumobilia following blunt abdominal trauma is not an absolute indication for laparotomy.
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Lack of financial resources was internationally ranked as the greatest limitation to the application of human physiological simulation in clinical teaching. The Beaumont Simulation Centre in the Republic of Ireland is solely funded by once-off grant payments. Attracting a range of health care specialties through course diversity can offset costs. ⋯ This study demonstrates successful post-graduate course development in a simulation centre with narrow budgetary restrictions. In addition, it is the first to examine Irish anaesthetists', nurses' and dentists' attitudes towards full-scale simulation as an assessment tool.
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Pneumocystis carinii pneumonia (PCP) is a rare form of pneumonia associated with immune-suppression. It is common in patients with AIDS and with a CD4 count of less than 200 cells/mm(3). We report a case of PCP secondary to immune-suppression in a 41-year-old man with psoriatic arthritis being treated with the immune-modulatory agent etanercept. ⋯ This report highlights a recognised but previously unreported complication of etanercept.