Brit J Hosp Med
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Multiple sclerosis is a common disease of the CNS. The first of these articles (Hassan-Smith and Douglas, 2011) examined its epidemiology and diagnosis. ⋯ However, equally important is the management of problems related to chronic multiple sclerosis and knowledge of which symptomatic treatments may be helpful. Finally, the prognosis is discussed; vital when counselling newly diagnosed patients.
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Sevoflurane is used for inhalational induction of anaesthesia because of its pleasant odour and quick onset. However, its use for maintenance of anaesthesia in children has been questioned because of the risk of emergence delirium. Emergence delirium is defined by Sikich and Lerman (2004) as a disturbance in awareness of, and attention to, the environment with disorientation and perceptual alterations including hypersensitivity to stimuli and hyperactive motor behaviour in the immediate post-anaesthesia period. Its incidence is between 10 and 80% following general anaesthesia, and it has the potential to cause injury to the child or care provider, may cause intravenous lines or drains to become dislodged, often requires additional nursing support and delays recovery time (Vlajkovic and Sindjelic, 2007).
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This article discusses an elderly woman presenting with haematemesis and chest pain who underwent urgent oesophago-gastroduodenoscopy. This revealed a large dissecting intramural oesophageal haematoma, initially mistaken for a varix. ⋯ Misdiagnosis of the chest pain as cardiac ischaemia may have an adverse outcome if antiplatelet or anticoagulation therapy is commenced. Follow up endoscopy a week later showed complete resolution of the lesion leaving a linear mucosal defect.