Biomedical subjects
Publications and source records attributed to S Leigh-Smith.
The case is reported of an unusual atlas fracture with no reports of such an injury in the literature. The diagnosis of this injury emphasises the importance of simple clinical decision instruments, and systematic interpretation of investigations.
This review examines the present understanding of tension pneumothorax and produces recommendations for improving the diagnostic and treatment decision process.
A case is presented of unilateral tension pneumothorax associated with flail chest and pulmonary contusions in a spontaneously ventilating patient after a fall. The tension element was not suspected until chest x ray was available, nor was immediate needle thoracocentesis performed. No morbidity resulted as a consequence. This case highlights the difficulty in deciding whether or not tension pneumothorax is the predominant cause of respiratory distress in a patient with multiple chest injuries. It provides further evidence challenging some of the doctrine on how to treat suspected tension pneumothorax.
This article reviews the history, technique, effects, side effects, and detection of blood boosting. It also considers whether or not this particular performance enhancement technique is a thing of the past or a continuing form of abuse among athletes.
A case is presented of unilateral tension pneumothorax in an awake patient who was seen in prehospital care after a significant fall. Because of extrication difficulties it was 40 minutes after the accident when he was first seen and by this stage the tension pneumothorax was well developed. Many features that are taught as "classic" of tension pneumothorax were absent but various other clinical signs were present to aid the diagnosis, and these are reviewed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Aorto caval fistula is one of the less well recognised complications of abdominal aortic aneurysm seen in accident and emergency departments. It presents in a number of different ways the commonest of which is high output congestive cardiac failure with warm peripheries. Initial diagnosis is based on the index of suspicion of the clinician. However, early diagnosis by the emergency physician and early surgery can markedly improve the patients prognosis.
Diarrhoea is the most common illness affecting travellers to developing countries. Our study was designed to compare the efficacy of a single 500 mg dose of ciprofloxacin with placebo for treatment of acute diarrhoea in travellers. British troops who were within their first 8 weeks of deployment in Belize and who presented within 24 h of the onset of diarrhoea, were randomized to receive either ciprofloxacin 500 mg or placebo. Every subject recorded the number and consistency of stools and presence of any other associated symptoms for 72 h or until recovery. Of 88 subjects enrolled, 83 were evaluable, of whom 45 received ciprofloxacin and 38 placebo. Groups did not differ with regard to duration or severity of diarrhoea at randomisation. Mean (SE) duration of diarrhoea, as assessed by time to the last liquid and last unformed stool, was reduced from 50.4 (4.5) h and 53.5 (4.4) h, respectively, in the placebo group to 20.9 (3.4) h and 24.8 (3.8) h in those receiving ciprofloxacin (p < 0.0001). Mean number of liquid stools was reduced from 11.4 (1.2) in the placebo group to 5.0 (0.7) in the ciprofloxacin-treated group (p < 0.0001). The cumulative percentages of subjects with no unformed stool after 24 h, 48 h, and 72 h were, respectively, 64%, 82%, and 93% in the ciprofloxacin group and 11%, 42%, and 79% in the placebo group (p < 0.0001, p < 0.001, and not significant, respectively). A single 500 mg dose of ciprofloxacin was an effective empirical treatment for reducing the duration and severity of diarrhoea in travellers. The regimen should maximise compliance and reduce the cost and duration of therapy.