Clinical medicine (London, England)
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Historical Article
Lessons of the month 1: Learning from Harvey; improving blood-taking by pointing the needle in the right direction.
The taking of blood for diagnostic purposes is a frequent cause of difficulty for physicians. In patients with intact visible or palpable large veins, such as those often seen in the antecubital fossa, a needle or cannula entering from any direction will usually be rewarded with any quantity of blood. ⋯ Failure to take blood is very commonly because of failure to appreciate the direction of flow of venous blood up the arm, and the ubiquitous presence of valves in the veins, both aspects of the circulation clearly described by William Harvey nearly 4 centuries ago. This paper encourages more frequent success with phlebotomy by remembering Harvey's work and pointing the needle in the right direction; this is not always towards the heart.
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Decisions on how and when to treat an abdominal aortic aneurysm involve a number of clinicians; interventional radiologists and vascular surgeons assess the technical ability to repair the aneurysm. Patients' fitness and past medical history is assessed to estimate their short- and long-term survival with or without surgery. Most importantly the patients' personal preference for treatment must be identified. Getting a patient to share what matters most to them requires shared decision making.
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Case Reports
Ovarian cyst haemorrhage as a complication of acute myelomonocytic leukaemia induction therapy.
Here we present a case of acute ovarian cyst haemorrhage in a young female during induction therapy for acute myelomonocytic leukaemia (AMML). ⋯ This highlights the importance of recognising coexistent pathology in patients undergoing high intensity chemotherapy.
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QRS electrical alternans is characterised by alternating amplitude of the QRS complexes, and is well-documented in cardiac conditions such as pericardial effusion. We describe a case of QRS alternans in a patient with gastric volvulus.