Biomedical subjects

P L Milsom

Publications and source records attributed to P L Milsom.

5 recordsLinked to original sources

PubMed1989

Beware the patient with a headache in the accident and emergency department.

We have reviewed the 130 patients presenting to an accident and emergency (A & E) department with a headache, followed up for 2 years. These are infrequent attenders but we have found that there is a high incidence of serious neurological pathology (16%) in this group of patients. We suggest that patients presenting to the A & E department with headache should be thoroughly examined and investigated and in the absence of a definite benign diagnosis should at least be admitted for a period of observation.

Adolescent↗

PubMed1988

The use of computerized echoencephalography after recent head injury presenting to the accident and emergency department.

In a review of the records of 874 head-injured patients who had an echoencephalogram in the Accident and Emergency Department, two patients with apparently 'minor' head injury subsequently developed an extradural haematoma. Both would have been diagnosed earlier if the results of the echoencephalogram had been used to influence their referral to the nearest neurosurgical department before the onset of any neurological deterioration. For those patients who arrive in the Department in coma, failure to detect any midline shift should not delay urgent referral for a CT scan. Such patients may be harbouring either bilateral haematomas or a very large single haematoma causing more than the 14-mm maximum shift recordable by the equipment.

Adolescent↗

PubMed1988

Problems encountered when administering general anaesthetics in accident and emergency departments.

Junior anaesthetists in 75 English hospitals were surveyed for their views on whether administering general anaesthetics in A&E departments provoked more anxiety than in the main theatre, and if so what factors contributed to this. Of these anaesthetists, 71% were more apprehensive working in A&E departments than in main theatre; 91% felt that they were adequately experienced but despite this there was a marked decline in apprehension with increasing experience. Sixty eight per cent of the anaesthetists thought that their assistance was inadequate and only 28% had an Operating Department Assistant (ODA). Forty eight per cent said that the equipment was inadequate in either standard or maintenance and 40% said that some of the patients were unsuitable for day case anaesthesia. The authors recommend that anaesthetists performing general anaesthetics in A&E departments should be adequately experienced using equipment provided and maintained by the anaesthetic department and assisted by adequately trained nurses or ODAs.

Anesthesia, General↗

PubMed1988

Abscesses: an open and shut case!

Thirty-seven years ago, it was suggested that abscesses could be treated with primary closure rather than by conventional incision and drainage, and that subsequent healing was superior. The result of a survey into the practice and teaching of abscess management in accident and emergency departments shows that, despite apparent satisfaction with the technique, it has not gained widespread acceptance. The literature on the subject is reviewed, and from this review it would appear that there cannot be any justification for the traditional method of packing abscess cavities. Areas for further research are identified.

Abscess↗

PubMed1980

Selection by mediastinoscopy and long-term survival in bronchial carcinoma.

In order to reduce the high rate of inoperability in patients with bronchial carcinoma, mediastinoscopy was carried out as a routine preoperative selection in 874 patients during 13 years. Two hundred thirty-six patients (27%) were found to have involved lymph nodes at mediastinoscopy and were not treated surgically. Follow-up data were available on 210 of them: 165 (79%) died within a year, 16 survived for 2 years, and 4 for 5 years. Pulmonary resection was carried out in 638 patients. Five-year survival in the series was 24.5% and 10-year survival (based on 104 eligible patients), 16.3%, including the operative mortality of 5.5%. Mediastinoscopy has not improved long-term survival to any great extent. However, it has raised the rate of resectability to 97.1% and lowered the operative mortality without denying the patient a chance of cure.

Adult↗