International journal of clinical practice
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Int. J. Clin. Pract. · Jul 2002
Review Case ReportsFractured lateral epicondyle with associated elbow dislocation.
We describe a case series involving a very unusual injury in children, i.e. a Milch 1 fracture of the lateral condyle with an associated dislocation of the elbow. This fracture configuration is normally stable as the intact capitellotrochlear groove serves as a lateral buttress for the coronoid-olecranon ridge of the ulna. ⋯ These injuries usually present as a clinical dislocation and if the elbow is manipulated before radiographic imaging, the fracture line can be difficult to see on the post-reduction films. We recommend that all patients with a dislocated elbow should have elbow stability assessed under general anaesthesia, because a missed lateral condylar injury can lead to abnormalities in carrying angle, epiphyseolysis or an unstable elbow.
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Int. J. Clin. Pract. · Apr 2002
Management of chronic osteomyelitis in a developing country using ceftriaxone-PMMA beads: an initial study.
Chronic osteomyelitis is a debilitating disease that is fairly common in developing countries. Various operative techniques have been adopted in the management of this disease but there have been few reports of their use in Africa. In this report, we present our experience of the use of a modified two-staged Belfast operation in patients with chronic osteomyelitis in Ibadan, Nigeria. ⋯ There was recurrence of infection in three patients (8.6%) who had a suction drain inserted at the first stage and in six patients (17.1%) who had no suction drain at the first stage. The locally produced ceftriaxone-PMMA beads were found to be as efficient as the commercially available gentamicin beads in eluting antibiotics locally, thereby eliminating the residual infection in the bone cavities after the first stage. Another important outcome was a fourfold saving in cost in choosing to use ceftriaxone-PMMA beads rather than gentamicin beads.
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Int. J. Clin. Pract. · Mar 2002
Randomized Controlled Trial Multicenter Study Clinical TrialMultidose flurbiprofen 8.75 mg lozenges in the treatment of sore throat: a randomised, double-blind, placebo-controlled study in UK general practice centres.
The flurbiprofen 8.75 mg lozenge is a novel formulation that combines a demulcent effect with the analgesic activity of a non-steroidal anti-inflammatory drug. Previous controlled clinical studies have demonstrated the single- and multi-dose efficacy of these lozenges over placebo. ⋯ Additionally, significant benefit over placebo was demonstrated where concomitant antibiotic use was introduced, indicating that flurbiprofen 8.75 mg lozenges can be co-administered when antibiotic therapy is appropriate. No significant safety issues were identified.
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Int. J. Clin. Pract. · Mar 2002
Randomized Controlled Trial Comparative Study Clinical TrialComparison of non-invasive ventilation and standard medical therapy in acute hypercapnic respiratory failure: a randomised controlled study at a tertiary health centre in SE Turkey.
This study was designed in a tertiary health centre in south-eastern Turkey to compare the effectiveness of non-invasive ventilation (NIV) plus standard medical therapy (ST) to ST alone, in acute hypercapnic respiratory failure (AHRF) due to chronic obstructive pulmonary disease (COPD) exacerbation. Thirty-four consecutive patients were randomly assigned to receive either NIV plus ST or ST alone. NIV was applied with a simple non-invasive ventilator through a full face mask in the general ward. ⋯ PaO2 (p<0.05) showed significant improvement only in the first hour of ST. The intubation rate and duration of hospitalisation in the NIV group were significantly shorter than those in the ST group (p<0.05). We conclude that NIV provides adjunctive therapeutic benefits compared with ST alone, and should be the choice of first step treatment in the AHRF due to COPD exacerbation in the appropriate setting and in selected patients.
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Int. J. Clin. Pract. · Jan 2002
Comparative StudyReferral patterns to a district general hospital gastroenterology outpatient clinic: implications for the 'two-week target'.
We defined the pattern and appropriateness of GPs' new-patient referrals to a large district general hospital gastroenterology department, and assessed the implications for workload in the context of the recently introduced 'two-week target'. Prospective data were collected on all new referrals over a two-month period and 426 new appointments were included, from which data were available on 390. ⋯ Nineteen per cent of all GP referrals were classified as urgent and 6% of these had a malignancy. Fifty per cent of patients with malignancy were not perceived as meriting an urgent referral by the GP Gastroenterology outpatient facilities are already overstretched and the implementation of the two-week target will add considerable strain to the current resources, with little gain in identifying malignancy.