Clin Med
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Breathlessness is a common symptom in respiratory, cardiovascular and malignant disease. It reduces exercise tolerance and mobility, and is an important determinant of quality of life. The multifactorial nature of the symptom often presents difficulties in understanding why individual patients are breathless, and how breathlessness should best be palliated, especially in advanced disease. ⋯ Mismatch between efferent neural respiratory drive and afferent feedback, reflecting the degree of neuromechanical dissociation, is also important. This paper describes mechanisms by which ventilatory load, capacity and drive may be affected by disease, and how these can be measured physiologically. The schema presented also provides a framework for understanding the mechanisms by which interventions that relieve breathlessness may have their effect.
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Rheumatoid hands are a common clinical finding and subject for post graduate exams. The following explores some of its more unusual cases.
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John Hughlings Jackson (1835-1911) first clearly described apraxia in 1861, though he did not provide the specific name. Apraxias are subtle motor disorders in which there is an interruption of the organisation of movement mainly located in the left hemisphere. ⋯ This notion was later expanded and clarified by Geschwind's 'disconnection syndromes'. This article summarises the history of this important and common pattern of motor dysfunction.
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This recent conference provided an all-round review of the current issues to be considered in palliative care. A list of the top 10 points that one hospital physician found most useful is presented.