Clinical medicine (London, England)
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In this brief obituary, we celebrate the life and achievements of Professor Roger Williams, who set up the UK's first liver transplant programme and championed excellence in hepatology for six decades.
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Paroxysmal atrial fibrillation (PAF) is a frequent cause of recurrent stroke but can be difficult to detect because of its episodic and often asymptomatic nature. We sought to improve rate of PAF detection through a quality improvement project (QIP) to deliver early prolonged inpatient cardiac monitoring on the stroke unit (SU). ⋯ Although this study had a number of limitations, it did demonstrate that early and prolonged non-invasive IP cardiac monitoring could be delivered 'in-house' on the SU and improve AF detection rates.
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Case Reports
Lessons of the month: Pyroglutamic acidosis: long-term paracetamol and a high anion gap.
An 84-year-old woman presented in extremis with confusion and Kussmaul respiration. She had a history of urosepsis, renal impairment and osteoarthrosis. The venous blood gas showed a marked metabolic acidosis with a high anion gap. ⋯ Paracetamol was stopped and fluids administered; she recovered over 7 days and was sent home. The biochemical diagnosis was confirmed by a central laboratory after discharge. This case emphasises the importance of the anion gap in diagnosis, and one important danger of chronic paracetamol administration.
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Recently, the UK's national Targeted Lung Health Checks programme produced recommendations for the management of incidental findings identified during the scans performed as part of the lung cancer screening programme. We identified significant discrepancies between the recommendations for adrenal incidentaloma management and those currently implemented into UK practice (2016 European Society of Endocrinology guidelines). ⋯ We also address the potential cost implications of adopting a more vigilant approach as advised by the European Society of Endocrinology. Urgent multidisciplinary and unified guidelines should be established in the interest of clinical- and cost-effectiveness.