The Medical journal of Australia
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Acute meningitis and encephalitis are medical emergencies that require prompt assessment (usually by cerebral imaging and lumbar puncture) and treatment; specialist consultation is recommended. In acute meningitis, early administration of antibiotics can be life-saving (usually high-dose penicillin and/or a third-generation cephalosporin); antibiotics may be needed before referral to hospital. ⋯ Adjunctive dexamethasone therapy may be of benefit in children with Haemophilus influenzae meningitis; there is no controlled evidence of its benefit in adults, but it could be considered in those with raised intracranial pressure. In possible encephalitis, empirical therapy with intravenous aciclovir should be given to cover herpes simplex virus (HSV) until the cause is established; HSV encephalitis may be fatal and leaves up to 50% of survivors with long-term sequelae.
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To summarise recent evidence from case reports (published January 1995-September 2001) of adverse events after cervical spine manipulation. ⋯ Serious adverse events after cervical spine manipulation continue to be reported. As the incidence of these events is unknown, large and rigorous prospective studies of cervical spine manipulation are needed to accurately define the risks.
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Case Reports
Extracorporeal membrane oxygenation in fulminant myocarditis complicating systemic lupus erythematosus.
A 24-year-old woman with systemic lupus erythematosus developed cardiac failure and cardiogenic shock that failed to respond to both high-dose inotrope therapy and the insertion of an intra-aortic balloon pump. Circulatory support with extracorporeal membrane oxygenation facilitated cardiac recovery, either spontaneously or assisted by steroid therapy.
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To determine the prevalence of colorectal neoplasia detected by rescreening people with average risk five years after initial screening by flexible sigmoidoscopy. ⋯ Average-risk people who have been screened for colorectal neoplasms, with none found, have a low prevalence of neoplastic lesions five years later. Longer rescreening intervals need to be considered.