Postgraduate medical journal
-
A fatal case of gastric rupture following the Heimlich manoeuvre is reported. This life-threatening complication has only been reported previously in seven patients with a high mortality rate. All patients should be assessed immediately following this manoeuvre for any potentially life-threatening complications.
-
The use of HMG Co-A reductase inhibitors following acute myocardial infarction in hospital practice.
Treatment with a HMG-CoA reductase inhibitor (statin) following a myocardial infarction has been shown to reduce the incidence of subsequent coronary revascularisation, myocardial infarction and cardiovascular death. The majority (89%) of patients admitted to the coronary care unit of our hospital received a fasting cholesterol check as part of a routine coronary care unit protocol. ⋯ Furthermore, those receiving statins were given smaller doses than those used in clinical trials. One way to ensure patients receive adequate treatment with statins, may be to include it as part of a coronary care unit protocol.
-
We describe a 39-year-old woman presenting with a painless solitary thyroid nodule, initially without signs suggesting thyroiditis. The serum level of thyrotropin was suppressed whereas those of thyroxine and triiodothyronine were normal. Fine needle aspiration cytology showed no signs of inflammation or malignancy. ⋯ At that time, the diagnosis of subacute thyroiditis was made. Upon treatment with steroids the patient's symptoms as well as the thyroid nodule resolved. This case illustrates that subacute thyroiditis de Quervain may present as a solitary, painless nodule with suppressed thyrotropin and should therefore be considered in the differential diagnosis of such lesions.
-
Surveys of senior house officers and registrars were undertaken by postal questionnaire to ascertain views on the need for and content of induction training, career counselling, and performance review. The questionnaire was sent out in May 1990 and repeated in May 1996, after measures had been taken to improve induction training, and assessment and appraisal of trainees. ⋯ There was also a firm view that career counselling could be improved and formal goal setting and performance appraisal interviews would be welcomed. In 1996 there was disappointingly little change in the views expressed by the junior medical staff, though there was a significant increase in confidence in the role of the consultant in career counselling.