Serum lithium levels in nursing infants were low and well tolerated. No significant adverse clinical or behavioral effects in the infants were noted. These findings encourage reassessment of recommendations against lithium during breast-feeding and underscore the importance of close clinical monitoring of nursing infants.
Patients who have undergone gastric banding may develop gastroesophageal reflux disease (GERD) with ulceration. This should be treated with band adjustment, proton pump inhibitors, and routine follow-up endoscopies to confirm healing. Surgical revision or reversal should be considered if the process is resistant to band deflation and medical therapy. Persistent dysphagia must be investigated. A patient is presented whose pre-existing GERD was aggravated by adjustable gastric banding and who developed carcinoma of esophagus with liver metastases 8 years after the insertion of her first band.
ObjectiveTo assess the incidence and distribution of recreational equestrian injuries seen in the Kent and Sussex region and review the available literature on this subject.DesignThis is a retrospective case series with historical controls.SettingKent and Sussex region, England.Main outcome measurementInjuries related to horses in the recreational setting.MethodsSubjects were selected from our acute injury database. Notes of all patients presenting with horse riding-related injuries between January and December 2010 were reviewed. Skeletal injuries were confirmed using our Picture Archiving and Communications Systems (PACS) system. Data were tabulated and grouped using Microsoft Excel software. Statistics were calculated using Graph Pad software.ResultsDuring the study period, 155 patients presented with a total of 199 injuries related to horses, accounting for 0.3% of all presentations; 69% were soft tissue injuries. The most commonly affected areas were the extremities (77 patients, 49.7%) followed by injuries to the head (38 patients, 24.5%) and trunk (36 patients, 23.2%). Seventeen patients (11%) were admitted. Patients presenting with head injuries suffered significantly more injuries compared to other groups (1.65 compared to 1.4 injuries, p < 0.0002).ConclusionA larger number of persons were riding for a longer period of the year compared to previous studies in the United Kingdom. There was also a shift in the patterns of injury seen in this population over the last two to three decades.
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