Clin Med
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The expected quality of care for epilepsy has increased sharply in the last two decades, informed and directed by published guidance. Meeting these demands has become possible only by providing adequate numbers of consultants and nurses with the relevant expertise, alongside improvements in investigative facilities. The increasing choice of AEDs has been helpful in improving treatment options. Both primary and secondary care have an important role to play in easing diagnosis of new cases and highlighting cases where improvement in control are needed.
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High performance sports medicine involves the medical care of athletes, who are extraordinary individuals and who are exposed to intensive physical and psychological stresses during training and competition. The physician has a broad remit and acts as a 'medical guardian' to optimise health while minimising risks. This review describes this interesting field of medicine, its unique challenges and priorities for the physician in delivering best healthcare.
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First reported in 1898, post-dural puncture headache (PDPH) remains a significant clinical issue. Here, we present a brief case history and a summary of the current evidence for methods to reduce PDPH rates, along with the experience in our department of implementing these methods in clinical practice. The key points to note are that needle design, gauge and orientation, as well as stylet reinsertion, are factors known to affect the incidence of PDPH, and that there is no evidence to support the use of hydration and bed rest to reduce headache following dural puncture.
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Comparative Study
Investigating the frail elderly patient with lower bowel symptoms: what do we do now and can we improve?
To assess the utility of flexible sigmoidoscopy (FS) and minimal preparation CT (MPCT) in investigating lower gastrointestinal (LGI) symptoms in elderly patients who are too frail to undergo colonoscopy or spiral CT. ⋯ LGI investigation in frail elderly patients can be rationalised according to indication. Performing FS and MPCT together is not always necessary.
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Case Reports
Lesson of the month. (1). What lies beneath the surface? Diagnosis. Churg-Strauss syndrome.
This reports describes the development of a rash in a 43-year-old man with asthma, who was admitted to the respiratory clinic with dyspnoea, leucocytosis and a productive cough. His symptoms progressed and he was admitted to the high-dependency unit for respiratory support. ⋯ The key message from this particular case was the importance of early diagnosis of Churg-Strauss syndrome, in which a rash is combined with marked peripheral eosinophilia and signs of respiratory distress. Early intervention will reduce the risks of morbidity and mortality in patients with this rare, life-threatening syndrome.