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Constipation management is in need of improvement. This improvement is more likely to be achieved with a thorough initial assessment and ongoing daily monitoring with evaluation. A practical, user-friendly documentation system that facilitates this has been developed at Marie Curie Hospice, Solihull. It is currently being used with great success in a hospice inpatient setting and is transferable to hospitals. With some modification it could be used by district nurses and general practitioners in the community. It is an important step towards improving the management of constipation.

Hepatic infarction was observed post mortem in a 27-year-old man who died of aortic dissection. Blood had been sampled at admission and 12 and 19 hours later. Values for aspartate aminotransferase and alanine aminotransferase in serum were markedly above normal, whereas those for alkaline phosphatase and gamma-glutamyltransferase were only marginally increased. A threefold-increased creatine kinase was ascribable solely to isoenzyme CK-3, suggesting muscle breakdown. Moreover, total lactate dehydrogenase activity was increased threefold, accounted for by a ninefold increase in LD-5 isoenzyme. Those enzyme activities in serum that evidently are associated with acute hepatocellular necrosis increase quickly in hepatic infarction, and CK isoenzyme assay is a useful adjunct if LD-5 increases are significant.

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