Postgraduate medical journal
-
The incidence, predisposing factors, management and outcome of toxic megacolon (TM) has been reviewed in 65 cases of severe ulcerative colitis (UC) and compared in 2 successive 6-year periods before and after January, 1973. Nineteen episodes of TM occurred in 18 patients. Despite a conscious aim towards earlier surgery in recent years this was not achieved, and despite more intensive medical therapy the incidence of TM was unchanged. ⋯ The chief cause of death was colonic perforation. Mortality was associated with increased age, longer pre-operative hospital stay and lower levels of serum albumin. These findings reemphasize the need for earlier surgery if TM is to be prevented, but such a policy must result in some unnecessary emergency colectomies.
-
One hundred and forty-six patients with trigeminal neuralgia were studied. Of 49 patients ultimately maintained pain-free by non-medical means, 26 underwent peripheral neurectomy. ⋯ Seven patients required repeat neurectomies. Peripheral neurectomy is a useful and simple method of pain control in trigeminal neuralgia.
-
A case of obstruction of the colon by a solitary, large gall-stone is described. This rare event usually occurs in elderly females in whom there is frequently an underlying pathological condition at the site of obstruction in the colon. ⋯ Diagnosis may be assisted by plain abdominal X-ray and contrast radiography. Immediate operative treatment should be tailored to the patient's general condition and the nature of the pathological changes.
-
A patient with hypocalcaemia and hypomagnesaemia secondary to small bowel resection and malabsorption was treated with synthetic vitamin D analogue, 1-alpha hydroxy vitamin D3. A prompt rise in serum calcium concentration and some days later a smaller and transient rise in serum magnesium concentration was observed. These changes in extracellular fluid composition presumably resulted from enhanced calcium and magnesium absorption associated with vitamin D activity.