International journal of clinical practice
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A case of acute pulmonary oedema after smoke inhalation from a chip pan fire is presented. The role of bronchial and pulmonary circulation in the development of pulmonary oedema after smoke inhalation is discussed. We stress the importance not only of observation after smoke inhalation, as the manifestation of pulmonary oedema may be delayed, but also of a baseline chest X-ray before admission for comparison.
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Int. J. Clin. Pract. · Jan 2000
ReviewTreatment of status epilepticus with midazolam in the critical care setting.
Status epilepticus (SE) is a potentially life-threatening condition that requires prompt and aggressive treatment. Prolonged status seizures are associated with significant physiological sequelae and neurological deficits. Although systemic events such as hyperthermia and anoxia contribute to neuronal damage, SE in and of itself can induce cell death. ⋯ Midazolam by continuous i.v. infusion and by the i.m. route has been successfully used in the treatment of SE. Although some respiratory and haemodynamic side-effects have been associated with midazolam, no clinically significant side-effects were observed with its use for the indication of SE. It is suggested that midazolam is a safe and rapidly effective treatment option in the management of SE in the critical care setting.
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Diaphragmatic rupture following trauma is often an associated and missed injury. The diagnosis is difficult, so is usually made intraoperatively. Twenty-one patients with traumatic rupture of the diaphragm (TRD) who presented between 1995 and 1998 were retrospectively analysed: 12 had penetrating injuries and nine had blunt injuries. ⋯ We conclude that correct preoperative diagnosis of TRD needs a high index of suspicion. It can be diagnosed intraoperatively by explorative laparotomy. Most ruptures can be repaired by the abdominal approach.
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Circumcision is a simple operation often performed under general anaesthesia. In this study, we assessed the suitability of local anaesthesia in 38 adult patients, 79.4% of whom suffered little or no discomfort. Infiltration of local anaesthesia caused moderate pain in 10 patients (29.4%) and severe pain in only one. The circumcision itself caused moderate pain in three patients and severe pain in another three (8.8%); 85% of patients expressed complete satisfaction.
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Int. J. Clin. Pract. · Dec 1999
The original sin of madness--or how psychiatrists can stigmatize their patients.
A stigma is a mark of infamy or disgrace. People who are stigmatized are subject to abuse and social exclusion. Negative attitudes towards people with mental illness are attributed to stigma. ⋯ Firstly, it is the person who is regarded as disgraceful, not the illness or diagnosis, and secondly, the diagnosis of mental illness is itself evaluative. Mental illness is by definition bad, so to be diagnosed as mentally ill is to be defined as bad (or somehow wrong). The stigmatization of the mentally ill will not stop until this negative evaluation is removed from diagnosis.