Persistence with NOAC drugs in patients with AF appears to be superior to warfarin. If continued long-term, this alone will be of clinical importance in the prevention of stroke and death.
Eight cases of herniation through the foramen of Morgagni are described. They fell into two distinct groups presenting either as neonatal respiratory distress or as an incidental findings in older children. Diagnosis is essentially radiological, stressing the importance of a lateral film. Surgical repair is advocated. the abdominal approach being perferred. Pneumopericardium is a rare but severe complication.
This case summarises the rehabilitation and return to play management of a 17-yearold elite male soccer player who required surgical stabilisation of an Osteochondritis Dissecans (OCD) lesion of the trochlea groove. Trochlea groove lesions represent <1% of OCD cases, resulting in limited evidence to inform practice. The case was initially identified as antalgic running gait, and at this point the player revealed progressively worsening knee pain (over preceding 2 months) which presented as patellofemoral pain with a small knee effusion and quadriceps atrophy present on assessment. No improvement in symptoms after two weeks of unloading (no running) and traditional patellofemoral treatment prompted magnetic resonance imaging and computed tomography scans to inform surgical intervention. We present a summary of the fourstage rehabilitation process defined by objective assessments, resulting in a successful return-to-play 24 weeks post-surgery. This case advocates consideration of OCD in the assessment of persistent knee pain in young athletes.
Aims-To determine the cost and sensitivity of sputum cytology in routine use and to determine when sputum cytology is most appropriate. Methods-A retrospective study, based on all sputum cytology requests received in five histopathology/cytopathology laboratories in Yorkshire from 1 January to 31 December 1993. Cytology findings were correlated with histological diagnosis or clinical outcome, and related to the speciality of the referring clinician. Results-Laboratory practice and performance was similar in all five centres. The average laboratory cost of sputum cytology was £26.93. The mean absolute sensitivity was 36% and the specificity was 99.6%. The majority of specimens was submitted by general physicians or geriatricians. The largest proportion of positive specimens were submitted by chest physicians. Conclusions-Often sputum cytology is used inappropriately as a screening investigation on, or soon after, admission. In addition, it is used inappropriately before bronchoscopy. Sputum cytology should be limited to individuals in whom a histological diagnosis is desired, but in whom bronchoscopy is inappropriate or unsuccessful. (i Clin Pathol 1997;50:566-568) Keywords: sputum cytology; sensitivity; cost; specificity; laboratory practice Sputum cytology is a common diagnostic test, forming much of the non-gynaecological cytology workload in many laboratories. Before the development of fibreoptic bronchoscopy, sputum cytology was the only alternative to thoracotomy for tissue diagnosis of many pulmonary neoplasms. It is regarded by clinicians as a simple, cheap, and non-invasive investigation.However, sputum cytology is relatively costly in terms of laboratory time, both during specimen preparation and screening; also, it has a low sensitivity. While there are individuals in whom it is the most appropriate means of investigation, there is an increasing recognition by cytopathologists and chest physicians that in many instances it is not a cost-effective investigation. This study examines the cost of sputum cytology and the laboratory practices of a selection of hospitals in Yorkshire. It also examines the sensitivity and specificity of sputum cytology requests from clinicians in different specialities to delineate better the appropriate role of sputum cytology. MethodsFive centres participated in the study, ranging from a relatively small district general hospital (350 beds) to a large general hospital with a significant teaching commitment (800 beds), and including one specialist cardiothoracic hospital. The participating pathologists were all consultants with a minimum of four years consultancy experience. All have a sizeable cytology workload, and one has a special interest in cardiothoracic pathology. All sputum cytology requests received from 1 January to 31 December 1993 were analysed with respect to age, sex, clinical details, requesting clinician, and cytology findings. Subsequent investigative procedures and final diagnosis were obtained either from the hospital's clinical information syst...
Summary 34 children with myelomeningocele were operated by a technique of “closed” external sphincterotomy (without opening the urethra). Bladder expression was made easier in 25 out of 30 patients available for follow up. The effects of operation on the volume of residual urine, reflux and dilatation of the upper renal tract were not consistent. It is not easy to predict which cases are likely to respond to this operation sufficiently well to justify its general use for bladder outlet obstruction at external sphincter level in spina bifida.
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