Irish journal of medical science
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Case Reports
Fractured closed suction catheter: an unusual cause of endobronchial obstruction in a ventilated patient.
A 32-year-old HIV-positive man required ventilation for seizures secondary to viral encephalitis. He had a prolonged care unit stay and had percutaneous tracheostomy performed on day 14 of his admission. He subsequently developed persistent right basal infiltrates and atelectasis on chest radiographs that were slow to respond to antibiotic treatment. Fiberoptic bronchoscopy revealed the cause of his infiltrates to be a 14-cm tip section of closed suction catheter tubing that had presumably fractured during suctioning and became lodged in his trachea and right main bronchus. ⋯ This case describes a rare cause of endobronchial obstruction in a ventilated patient. Medical staff requires education about the importance of ensuring that suction catheters and other airway adjuncts are intact following use to prevent possible airway foreign bodies.
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Biography Historical Article
Douglas Argyll Robertson (1837-1909) and his pupil.
Douglas Argyll Robertson's (1837-1909) experimental work with physostigmine in 1863 sharpened his knowledge of the innervation of the internal muscles of the eye. So he was ideally prepared in 1869 to analyse the conundrum when he saw patients with spinal cord disease who had lost the response to light even though accommodation to near objects was normal. By translating his knowledge of basic science to a clinical problem he drew attention to this phenomenon, known subsequently as the Argyll Robertson pupil that came to be considered pathognomonic of tabes dorsalis, general paresis and neurovascular syphilis.
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This study evaluated outcomes for the first 100 bariatric surgical procedures in a single, publicly funded Irish centre. ⋯ This series audits the introduction of a publicly funded bariatric service in Ireland and reports a high percentage of procedures completed laparoscopically with an acceptable morbidity and mortality.
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Comparative Study
An audit of hip fracture services in the Mater Hospital Dublin 2001 compared with 2006.
Evidence-based practice supports the provision of integrated geriatric multidisciplinary care for older people with hip fractures. ⋯ Following introduction of an orthogeriatric service, improvements in mortality and discharge destination occurred. This may have been influenced by higher proportions of disability among the 2001 cohort.
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A 76-year-old previously well farmer presented having caught his left index finger in a gate. He gave no history of prior tetanus vaccination. ⋯ Eleven days later he represented unable to open his mouth. On examination he was noted to have trismus, generalised muscle spasms, diaphoresis and emotional lability and he was diagnosed with generalised tetanus.