The British journal of clinical practice
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Drugs affecting the leukotriene pathway are emerging as a new class of asthma treatment--the first for more than 20 years. Development of these leukotriene antagonists should lead to greater understanding of the underlying processes in asthma and may result in a safe, oral, anti-asthmatic drug to benefit particular groups of asthmatic patients.
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Flecainide acetate is a potent class 1C antiarrhythmic agent, overdosage with which is rare. An overdose is reported in a patient on long-term therapy, resulting in life-threatening arrhythmias and prolonged electrocardiographic abnormalities.
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To assess the current training and practice of central venous cannulation and temporary transvenous pacemaker insertion, a telephone survey of senior house officers (n = 60) and registrars (n = 20) was carried out in 80 acute hospitals in England and Wales. A median of one central line and two pacings were performed under supervision before the respondents were left unsupervised. ⋯ Training in central vein cannulation and temporary pacing needs to be more structured. This could be done by the use of videos or mannequins, and should include the use of routes other than the subclavian.
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A patient is reported with spontaneous pneumothorax in whom a Horner's syndrome occurred as a complication of drainage tube thoracostomy. Ascending sympathetic fibres lie in close contact with the parietal pleura at the apex of the hemithorax and may be damaged by an inappropriately positioned thoracostomy tube. It is suggested that drainage tubes found to be sited medially at the apex of the hemithorax should be immediately repositioned to avoid this complication.
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While playing a game of cricket, a 42-year-old man was struck on the chest by the ball. The blunt trauma precipitated a myocardial infarct in the absence of other risk factors or evidence of pre-existing coronary artery disease. Probable pathophysiological mechanisms and potential problems of immediate treatment are discussed.