International journal of clinical practice
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Int. J. Clin. Pract. · Jul 2002
Review Case ReportsFractured lateral epicondyle with associated elbow dislocation.
We describe a case series involving a very unusual injury in children, i.e. a Milch 1 fracture of the lateral condyle with an associated dislocation of the elbow. This fracture configuration is normally stable as the intact capitellotrochlear groove serves as a lateral buttress for the coronoid-olecranon ridge of the ulna. ⋯ These injuries usually present as a clinical dislocation and if the elbow is manipulated before radiographic imaging, the fracture line can be difficult to see on the post-reduction films. We recommend that all patients with a dislocated elbow should have elbow stability assessed under general anaesthesia, because a missed lateral condylar injury can lead to abnormalities in carrying angle, epiphyseolysis or an unstable elbow.
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Int. J. Clin. Pract. · Jul 2001
ReviewSmoking cessation: a consensus statement with special reference to primary care.
Nicotine addiction is a serious medical condition that needs to be treated like any other chronic disease. Primary care must play a key role in smoking cessation and offering help should be a routine part of primary care practice. As the most frequent opportunity for intervention lies within primary care, GPs should ensure that they raise the issue of stopping smoking at least annually with their smoking patients. ⋯ Secondary care staff should also make every effort to help people to stop smoking and should communicate effectively with primary care--opportunities during hospitalisation are frequently missed. Specialist smoking cessation clinics have an essential role in providing more intensive specialist treatment and the expertise to partner and support the primary care effort. Smoking cessation is one of the most cost-effective healthcare interventions that can be made.
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Int. J. Clin. Pract. · May 2001
ReviewAetiology and treatment of hyperhomocysteinaemia causing ischaemic stroke.
Recent studies have shown that hyperhomocysteinaemia is a common, independent and easily modifiable risk factor for atherosclerotic and thromboembolic diseases such as cerebrovascular disease, coronary artery disease and venous thrombosis. The vascular risk rises continuously across the spectrum of elevated plasma homocysteine concentrations. ⋯ It seems logical to assume that a reduction in homocysteine concentration will reduce the risk of ischaemic stroke, but there are as yet no published data to prove this. This review will discuss the aetiology and possible treatment of hyperhomocysteinaemia causing ischaemic stroke.
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Int. J. Clin. Pract. · Oct 2000
ReviewSkeletal muscle relaxants: pharmacodynamics and pharmacokinetics in different patient groups.
Muscle relaxants can be safely administered during anaesthesia, providing the basic pharmacodynamic and pharmacokinetic characteristics of the compounds together with the physiological status of the patient are known. In this review the pharmacodynamics and pharmacokinetics of the neuromuscular blocking agents are discussed and related to the physical health or disease state of groups of patients.
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Pulse oximetry monitoring is a relatively recent technique that has been embraced enthusiastically by medical, nursing and paramedical personnel in many clinical situations. Few people, however, have any idea of how it provides the reading of arterial blood saturation. This review performs several functions: it discusses the haemoglobin molecular structure and explains its relation to spectrophotometry, describes the history and principles of pulse oximetry and the nature of the equipment used, and reviews its common uses. It also explores the principles and proposed uses of its lesser known corollary, photoplethysmography.