Surg J R Coll Surg E
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Surg J R Coll Surg E · Apr 2005
Review Case ReportsThe perioperative challenge of nephrogenic diabetes insipidus: a multidisciplinary approach.
Nephrogenic Diabetes Insipidus (NDI) is characterised by the inability of the kidneys to concentrate urine in response to arginine vasopressin (AVP). Such patients typically experience polyuria and polydipsia because of this inability to autoregulate their water balance. This provides a perioperative challenge that could lead to a life-threatening situation. ⋯ Two peak serum sodium values were attained. The first when the patient was retaining sodium due to an inappropriate fluid regimen and the second due to hypovolaemia. The literature is reviewed and principles for NDI perioperative management are proposed.
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Emphysematous cystitis is an uncommon infection of the bladder with the formation of carbon dioxide either within the bladder or within its wall. It is commonly seen in women and those with poorly controlled diabetes mellitus, in association with some form of urinary stasis and obstruction. The clinical features are very varied and the outcome is often unpredictable. ⋯ Occasionally, computed tomography scans are required to help in the diagnosis due to their atypical presentation with acute abdominal pain. Herein, we report three patients with such a condition who were treated with favourable outcomes. Of the three patients, two had to undergo exploratory laparotomy due to their initial presentations with acute abdomens.
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Surg J R Coll Surg E · Oct 2004
Major burn disasters: lessons to be learned from previous incidents and a need for a national plan.
The current concerns regarding possible terrorist actions throughout the world have to be considered to be now even more relevant to the UK. To date, there seem to be no official plans for Scotland other than those "major disaster incident" ones for each major hospital. ⋯ Such an event could swamp the local casualty and Burn Units. A model for possible consideration, based on a Dutch proposal, is put forward as being one that could be usefully applied to Scotland or, indeed, the UK.