International journal of clinical practice
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Int. J. Clin. Pract. · Dec 1999
Case ReportsCystic lymphocytic hypophysitis, visual field defects and hypopituitarism.
A 45-year-old man presented with anterior pituitary failure, requiring thyroxine, hydrocortisone and androgen replacement. An MRI scan revealed a large cystic pituitary mass and thickening of the pituitary stalk. ⋯ Histology revealed lymphocytic hypophysitis, which is rare in men. The presentation with cystic enlargement is unique.
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Int. J. Clin. Pract. · Sep 1999
Clinical Trial Controlled Clinical TrialUpdate on some aspects of the use of epidural analgesia in labour.
The aim of the study was to investigate the effect of epidural analgesia on blood pressure, duration of the second stage and mode of delivery. In a prospective controlled study carried out in a district general hospital, 122 parturients made up the study population; 81 had epidural blocks and 41 had other forms of analgesia during labour. Data were collated using questionnaires within 48 hours of delivery: 58/81 (71.6%) of those who chose epidural were primigravidae compared with 14/41 (34%) in the non-epidural group (p < 0.001). ⋯ Mean duration of the second stage of labour was significantly longer in the epidural group: 108.3 versus 41.6 minutes (p < 0.0001); 28/81 (34.6%) of the epidural group had operative vaginal deliveries compared with 6/41 (14.6%) of the non-epidural group (p = 0.0004). Epidural analgesia provides an effective form of pain relief in labour, which has a particularly strong appeal to primigravidae. It has a hypotensive effect which can be put to beneficial effect in hypertensive disease of pregnancy, but is significantly associated with a lengthened second stage of labour, resulting in an increased operative vaginal delivery rate.
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Int. J. Clin. Pract. · Jul 1999
Randomized Controlled Trial Clinical TrialA randomised, double-blind study of itraconazole versus placebo in the treatment and prevention of oral or oesophageal candidosis in patients with HIV infection.
HIV-infected patients presenting with oral or oesophageal candidosis were randomised to four weeks treatment with itraconazole 200 mg, followed by itraconazole or matching placebo for a prophylaxis phase of 24 weeks. Clinical and mycological evidence of candidosis infection was assessed on a four-weekly basis. Seventy patients were enrolled, of whom 50 completed 28 days of itraconazole therapy; 74% (37 patients) were clinically cured and 40% were also mycologically cured. ⋯ Forty-four patients were enrolled in the prophylactic phase. There were significantly more relapses of candidosis, and time to candidosis was significantly shorter in the placebo group than in the itraconazole treated group (p = 0.0001). Itraconazole 200 mg daily is effective and well tolerated for the treatment and prevention of oral and oesophageal candidosis in HIV-infected patients.
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Dissecting aneurysms generally cause radiating back pain, chest pain, or symptoms caused by aortic insufficiency. Presentation solely with abdominal pain is rare. We report on a patient with dissecting thoracic aortic aneurysm who presented solely with abdominal pain. The possibility of intrathoracic disease must be considered in every patient with abdominal pain, especially if the pain is in the upper part of the abdomen.
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Int. J. Clin. Pract. · Apr 1999
Case ReportsAcute pulmonary oedema complicating adenotonsillectomy for obstructive sleep apnoea.
Acute pulmonary oedema can sometimes complicate adenotonsillectomy carried out for obstructive sleep apnoea. Early recognition and adequate oxygenation are the key to management. We report such a case; the pathophysiology and management of this rare complication of a common procedure are discussed.