Brit J Hosp Med
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Epidural analgesia is the gold standard for labour analgesia. Dural puncture epidural analgesia is a modification of the conventional technique, where the dura is intentionally perforated with a spinal needle but no intrathecal medication is given. This article reviews the evidence for and against the clinical use of dural puncture epidural.
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Cognitive complaints are very common in people diagnosed with epilepsy. These difficulties are often another manifestation of the same pathology responsible for seizures. ⋯ There is surprisingly little overlap between memory complaints and performance on formal memory tests in this population. This article examines the multifactorial and heterogeneous nature of cognitive difficulties in epilepsy and makes the case for the provision of basic psychoeducation as the foundation for all interventions aimed at ameliorating these difficulties in this patient population.
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Skin cancer is the most common malignancy in the world, and the majority of cases affect the skin of the head and neck. The face is a particularly emotive area for patients who often present with a lesion that is causing them concern. This article reviews the identification, diagnosis and principles of management of non-melanoma skin cancer of the head and neck. ⋯ The vast majority of non-melanoma skin cancer are basal cell carcinoma, followed by squamous cell carcinoma. These and the other types of non-melanoma skin cancer are described and illustrated. Current methods of clinical identification, diagnosis and evaluation of skin cancers are clarified, and contemporary treatment paradigms are presented.
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Osteochondritis dissecans is a condition characterised by acquired pathological subchondral bone lesions and its incidence is unknown. It has a multifactorial aetiology, with a combination of genetic and acquired risk factors. It commonly presents in adolescents and young adults. ⋯ The joints primarily affected are the knee, ankle and elbow joint. Early identification is key to treatment and to prevent future osteoarthritis of the joint. This article gives an overview of the presentation, assessment and management of the juvenile form of osteochondritis dissecans.
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Fluids are usually administered perioperatively to maintain euvolaemia and adequate oxygen delivery, but administration of too little or too much fluid can cause problems. This article summarises the current evidence on the type of fluid and volume best administered in the perioperative period.