British medical bulletin
-
British medical bulletin · Jan 2006
ReviewIdiopathic intracranial hypertension and visual function.
Idiopathic intracranial hypertension is a relatively common condition (incidence up to 19/100 000/year in the high-risk group of obese women in reproductive age range) causing headaches with papilloedema. Detailed investigations are required to exclude other causes of raised intracranial pressure. The condition may be self-limiting or enter a chronic phase with significant morbidity because of headache and visual loss. ⋯ Management of hypertension is initially medical, utilizing a combination of managed weight reduction and diuretic therapy. Cerebrospinal fluid (CSF) diversion surgery may be required to stabilize vision. Options include neurosurgical shunting by lumbar-peritoneal of ventriculo-peritoneal routes or by optic nerve sheath fenestration or both. High category evidence from randomized trials to guide management decisions is lacking. This article sets out to guide current best practice.
-
Leprosy is a granulomatous disease affecting the skin and nerves caused by Mycobacterium leprae. It continues to be a significant public health problem. Multidrug therapy (MDT) cures the infection, but immunological reactions may occur and neuropathy may lead to disability and deformity. It is important that the manifestations of the condition are recognized as early as possible so that early nerve damage can be identified and treated rapidly.
-
British medical bulletin · Jan 2006
ReviewPreventing incapacity in people with musculoskeletal disorders.
Musculoskeletal disorders are among the most common causes of sickness absence, long-term incapacity for work and ill-health retirement. The number of Incapacity Benefit (IB) recipients in the United Kingdom has trebled since 1979, despite improvement in objective measures of health. Most of the trend is in non-specific conditions (largely subjective complaints, often with little objective pathology or impairment). ⋯ Rehabilitation should be directed to overcome biopsychosocial obstacles to recovery and return to work. These principles are fundamental to better clinical and occupational management and minimizing incapacity. Sickness absence and incapacity from non-specific musculoskeletal conditions could be reduced by 33-50%, but that depends on getting all stakeholders onside and a fundamental shift in thinking about these conditions-in health care, in the workplace and in society.
-
All cases of falciparum malaria are potentially severe and life threatening, especially when managed inappropriately. A major reason for progression from mild through complicated to severe disease is missed or delayed diagnosis. ⋯ The most recent advance in antimalarial chemotherapy has been the use of artemisinin derivatives especially intravenous artesunate, which may well revolutionize the management of severe disease. Outside antimalarial therapy, mechanical ventilation and renal replacement have also played an important role in reducing mortality of this life-threatening condition.
-
British medical bulletin · Jan 2005
ReviewThe diagnosis and management of chronic heart failure in the older patient.
Chronic heart failure is a common problem in old age. Dyspnoea and fatigue are the most common symptoms and should alert the clinician to the likely diagnosis. When there is a clinical suspicion of heart failure, further assessment is required to confirm the aetiology. ⋯ Additional treatments include spironolactone, angiotensin antagonists and digoxin. Patient factors and tolerability may limit the number of treatment options. Treatment regimes are most effective when delivered using a multidisciplinary approach.