ABSTRACT
Haemorrhage into the iliopsoas muscle causing femoral neuropathy is an infrequent complication of haemophilia or anticoagulant therapy. The association of an iliopsoas haematoma with enoxaparin therapy is very rare. We describe a case of femoral neuropathy secondary to psoas haematoma in a patient who was on enoxaparin therapy for suspected non-Q wave myocardial infarction. There is no clear consensus for the treatment of these haematomas, with both surgical and conservative options advocated. In this case, our patient recovered fully following conservative management.
Subject(s)
Anticoagulants/adverse effects , Enoxaparin/adverse effects , Femoral Neuropathy/chemically induced , Hematoma/chemically induced , Muscular Diseases/chemically induced , Psoas Muscles , Adult , Femoral Neuropathy/therapy , Hematoma/therapy , Humans , Male , Muscular Diseases/therapy , Tomography, X-Ray Computed/methodsABSTRACT
Malignancy may produce ureteric obstruction. This obstruction may be relieved by inserting a nephrostomy tube. All 31 cases of malignant ureteric obstruction from a single institution were retrospectively analysed. The commonest indications for nephrostomy tube insertion were renal failure (87%) and flank pain with hydronephrosis (13%). The mean serum creatinine levels pre and post insertion were 481 and 170 micromol/l, representing significant improvement (p<0.01). The complication rate was 13%, relating to tube blockage or dislodgement. Survival of patients was significantly worse if their malignancy was not resectable or suitable for chemotherapy (p=0.01). However, incurable patients still survived for a mean of 232 days, and although 46% of this time was spent as an inpatient, it did not differ significantly from the inpatient rate of curable patients (31%, p=0.1). Nephrostomy tube insertion should be considered for all palliative cases of malignant ureteric obstruction.
Subject(s)
Nephrostomy, Percutaneous/methods , Ureteral Obstruction/therapy , Aged , Aged, 80 and over , Creatinine/blood , Female , Humans , Male , Middle Aged , Palliative Care , Retrospective Studies , Survival Analysis , Treatment Outcome , Ureteral Neoplasms/complications , Ureteral Obstruction/complicationsABSTRACT
Reducing the prevalence of smoking in pregnancy is a priority target for health care. We administered a semi-structured questionnaire to mothers in an inner city general practice who were given brief anti-smoking advice during routine antenatal care. Of a cohort of 113 mothers, 52(46%) reported smoking at the start of pregnancy. Six(12%) of these 52 smokers reported no change in smoking habit during pregnancy; 24(46%) cut down; 12(23%) stopped; 10(19%) increased their cigarette consumption. Of the 52 smokers, 41(79%) believed smoking was harmful to an unborn baby, yet 30(73%) of these women continued smoking. Almost all recalled having been given anti-smoking advice by the GP and/or hospital. There is an urgent need to identify more effective methods of reducing smoking in pregnancy.