Irish medical journal
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Irish medical journal · May 2006
Letter Case ReportsThe aetiology of brachial plexus injury: what the paediatrician and obstetrician need to know.
The recognition of brachial plexus injury (BPI) after childbirth suggests to parents a causative rather than temporal relationship. This view is supported by textbooks of paediatrics, which state that: 1. "the mechanism of injury is a forceful separation of the head from the shoulder by lateral bending of the neck with simultaneous shoulder depression, during vaginal delivery"; and 2. "these injuries are due to traction on the brachial plexus during delivery."2 Although an obstetrician will talk to a parent when BPI occurs, the ongoing care of the child is within a mutidisciplinary team, where the paediatrician and obstetrician play leading roles. Parents will ask about aetiology, treatment and prognosis; but is the textbook explanation adequate? We illustrate the potential dilemma for the paediatrician and obstetrician through 2 cases of BPI and outline some data on BPI, which is not congruent with current paediatric texts.
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Irish medical journal · May 2006
Case ReportsThe role of endobronchial electrocautery in the management of malignant airway obstruction.
Bronchoscopy has evolved well beyond a simple look-see examination, with new interventional techniques becoming more commonly employed. So-called interventional bronchoscopy implies the use of bronchoscopy as a therapeutic, in addition to diagnostic, tool. ⋯ There is minimal morbidity associated with this technique. It is anticipated that interventional bronchoscopy will continue to revolutionise management of such conditions in the future, and become a necessary facility in all pulmonary medicine units.
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Irish medical journal · May 2006
Audit of the management of patients admitted with community acquired pneumonia.
Community acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. There is evidence that guidelines do guide and standardise management, but with less measurable effect on outcome. We prospectively audited the management of CAP in patients admitted to a Dublin hospital during the winter of 2003/04. ⋯ Appropriate antibiotic therapy was instituted within 8 hours of presentation in 123 (75.0%) cases. The rate of use of a severity assessment score to stratify patients with CAP based on recognized guidelines is low in our hospital. Despite this, the overall mortality rate of 8.5% is comparable with previous results.