Tibiae from normal broiler chickens were compared with those from broilers displaying twisted leg in an attempt to develop a pattern recognition for the disorder. Qualitative differences were determined using conventional radiography, and quantitative differences were determined using sequential morphometry. Sequential radiography revealed that twisted leg developed from a slight deviation or torsion of the distal tibiae. Progressive bowing of the tibiae and compensatory thickening of the cortex on the weight-bearing side were characteristic radiographic features of twisted leg and were most likely a functional adaptation to the disorder. Sequential morphometry suggests that the development of twisted leg in broilers may be related to a structural abnormality in the distal tibiae, namely shallow distal condyle grooves. Shallow distal condyle grooves may predispose the distal tibiae to a slight displacement of the gastrocnemius tendon and hence uneven strain on the distal condyles. Other changes in tibial morphology (diameter at midshaft, condylar width, cortical thickness) appeared to be functional adaptations to the deformation rather than the primary cause.
Early CT scans show promise in the diagnosis of scaphoid and other fractures of the wrist and carpals. Further study is warranted to validate early CT in clinical scaphoid fracture as an alternative to other early advanced imaging, or plaster immobilization and 2 week review.
Objective:
To examine patients who presented to a hospital emergency department with evidence of warfarin toxicity, and to review the available published literature to determine what guidelines are available for management of this problem.
Method:
A retrospective analysis of all adult patients who presented to The Geelong Hospital Emergency Department between 1 January 1996 and 30 June 1998 with international normalized ratio > 6 due to warfarin toxicity.
Results:
A total of 84 patients with international normalized ratio > 6 were included in the study. The average age was 68.3 years. Fifty‐three per cent were women. The international normalized ratio was between 6 and 10 in 33 patients (39%), and greater than 10 in 51 patients (61%). Major bleeding occurred in 16.7% of patients, minor bleeding in 17.8%. Sixty‐five per cent had no bleeding. Seven patients died, four of those with bleeding. Patients with an international normalized ratio > 10 were more likely to receive fresh frozen plasma (77.6%vs 28.6%; P < 0.001) and in greater amounts (3.0 units vs 0.8 units; P < 0.001) than those with an international normalized ratio of 6–10. There were also more episodes of major bleeding, although not significant. Patients with major bleeding were older (mean 75.4 years vs 67.5 years; P = 0.04), more likely to be admitted (P = 0.046), were more often given fresh frozen plasma (P = 0.003) and in greater amounts (3.28 units vs 2.0 units; P = 0.02).
Conclusion:
Warfarin toxicity is a common problem, and variation in management is not surprising considering the lack of consensus in the literature on this topic. Current recommendations are summarized and a simple flowchart for management of this problem is provided.
The order of poisons information sources most utilised was: consultation with a colleague, in-house protocols and electronic resources. There was a significant difference in satisfaction with electronic poisons information resources and a movement away from existing sources when choice was provided. Interest in increased use of mobile solutions was identified.
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