International journal of clinical practice
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Int. J. Clin. Pract. · Jul 2000
ReviewCodeine analgesia is due to codeine-6-glucuronide, not morphine.
Eighty per cent of codeine is conjugated with glucuronic acid to codeine-6-glucuronide. Only 5% of the dose is O-demethylated to morphine, which in turn is immediately glucuronidated at the 3- and 6-position and excreted renally. ⋯ Poor metabolisers of codeine, those who lack the CYP450 2D6 isoenzyme for the O-demethylation to morphine, experience analgesia from codeine-6-glucuronide. Analgesia of codeine does not depend on the formation of morphine and the metaboliser phenotype.
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The use of various drug delivery systems to achieve high levels of the desired antibiotic(s) at the site of infection has become commonplace in orthopaedic and trauma units the world over. One of these techniques uses the implantation of antibiotic-impregnated beads at operation sites. ⋯ We have also shown that such beads elute the antibiotic (ceftriaxone) effectively in vitro, achieving similar or better activity when measured by zones of inhibition against various bacteria species compared with standard antibiotic discs. This technique offers a cost-effective method of treating chronic bone infections in resource-poor settings.
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Int. J. Clin. Pract. · Jun 2000
Multicenter Study Comparative StudyA comparison of patients admitted to two medium secure units, one for those of normal intelligence and one for those with learning disability.
Differences between patients being treated in two different medium secure units, one for those of normal intelligence and one for those with learning disability, were investigated. Sociodemographic, psychiatric, medical and medicolegal data were recorded for all inpatients in both secure units. ⋯ Their index offence was more likely to be homicide, attempted murder, manslaughter or grievous bodily harm, while that of the patients with learning disability was more likely to be a sexual offence. A need for separate medium secure unit facilities for those of normal intelligence and those with learning disability is supported by differing psychiatric and behavioural requirements.
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First branchial groove anomalies are very rare. We report a case of a first branchial groove anomaly presented as an infected cyst in an 11-month-old child. ⋯ Surgical management must include identification and protection of the facial nerve. Embryology and facial nerve disposition in relation to the anomaly are reviewed.