ABSTRACT
In a retrospective, case-note based, audit of the initial management of spontaneous pneumothoraces in a large teaching hospital, 38 events were identified in 37 patients admitted over 12 months to the end of September 1991. The initial management was intercostal tube drainage in 21 (55%), decided upon by middle grade staff, with a cost in terms of the duration of hospitalisation (median 7 (range 2-18) days), chest radiography (6 (3-10) films) and potential for complications including infections (3 wound, 2 chest). Aspiration was performed in only three cases, the remainder were managed by observation. We suggest that undue reliance is placed upon intercostal tube drainage to treat spontaneous pneumothoraces with aspiration alone performed too infrequently. Moreover, other deficiencies in management including the practise of drain clamping and incomplete follow-up were identified.
Subject(s)
Medical Audit , Pneumothorax/therapy , Adolescent , Adult , Aged , Drainage/methods , Emergency Service, Hospital/statistics & numerical data , Female , Hospitals, Teaching/statistics & numerical data , Humans , Length of Stay , Male , Middle Aged , Retrospective Studies , Suction/methods , United KingdomSubject(s)
Contact Tracing , Tuberculosis, Pulmonary/epidemiology , Child , Follow-Up Studies , Humans , Infant , Time FactorsABSTRACT
Few doctors routinely examine the epitrochlear glands as part of their physical examination of a patient. No palpable epitrochlear nodes were detected in 140 healthy subjects, but palpable epitrochlear nodes were present in 27% of 184 patients with diseases in which lymphadenopathy occurs. Whilst epitrochlear nodes are commonly enlarged in specific acute, subacute, and chronic infections, they are not enlarged in the mild, transient, non-specific febrile illnesses with cervical lymphadenopathy of children and young adults. Enlarged epitrochlear glands provide a useful discriminatory sign in the diagnosis of glandular fever. Enlargement of these nodes is common in most of the lymphoproliferative disorders except Hodgkin's disease. In rheumatoid arthritis their palpability indicates activity of hand joints. The examination of epitrochlear nodes should form part of the routine physical assessment of any ill patient.
Subject(s)
Arm , Lymph Nodes , Palpation , Adolescent , Adult , Aged , Aged, 80 and over , Arthritis, Rheumatoid/diagnosis , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Lymphatic Diseases/diagnosis , Lymphoproliferative Disorders/diagnosis , Male , Middle Aged , Sarcoidosis/diagnosisABSTRACT
The ability of 550 consecutive patients attending a tuberculosis clinic to grade their own Heaf skin test reaction, using an illustrated card designed for such self-reporting, was assessed. Individuals were asked to grade their own Heaf skin reaction and at the same attendance the reaction was formally graded by a respiratory health visitor. There was overall excellent agreement with only 58 (10.5%) disparate gradings. We conclude that self-reporting of Heaf skin tests using an illustrated card is simple, usually accurate and may preclude an otherwise unnecessary early reattendance. This study also validates an often used system of self-reporting.
Subject(s)
Self Care/methods , Tuberculin Test , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Hypersensitivity, Delayed/pathology , Male , Middle Aged , Scotland , Skin/pathologyABSTRACT
Eight hundred and sixty Heaf test positive contacts of cases of tuberculosis in Lothian were offered screening with chest radiographs for the recommended period of two years. In spite of the use of standard methods of encouragement to attend, only 309 (35.9%) completed the two year period of follow-up. Seven cases of tuberculosis (representing a crude rate of eight cases per 1000 contacts) were detected radiologically, all within 3 months of entering the screening programme. In view of the poor compliance with the extended period of follow-up and the detection of all cases early in the screening process, we recommend that, at least in Lothian, radiological follow-up of Heaf positive tuberculosis contacts need only be applied for a period of 6 months.
Subject(s)
Population Surveillance , Radiography, Thoracic , Tuberculosis, Pulmonary/prevention & control , Adolescent , Child , Child, Preschool , Female , Humans , Male , Time Factors , Tuberculosis, Pulmonary/diagnostic imagingABSTRACT
Five splenectomized patients suffered six episodes of bacterial meningitis with positive cerebrospinal fluid cultures. They were admitted to the Nottingham hospitals between 1974 and 1985. The infecting organism in all cases was Streptococcus pneumoniae. Only one patient, who survived, had had pneumococcal vaccine; two patients died in spite of intensive therapy. There is now good evidence for giving prophylactic penicillin to asplenic patients but the efficacy of the pneumococcal vaccine remains uncertain.
Subject(s)
Meningitis, Pneumococcal/etiology , Splenectomy/adverse effects , Adolescent , Adult , Animals , Chick Embryo , Child , Female , Humans , Male , Middle AgedABSTRACT
In four cases of biopsy proven amyloidosis there was evidence of impaired splenic function. All had absent or grossly reduced splenic uptake on colloid isotope scans and three had haematological changes consistent with hyposplenism. Poor splenic function with a normal sized or enlarged spleen may be a clue to underlying amyloid.
Subject(s)
Amyloidosis/physiopathology , Spleen/physiopathology , Aged , Aged, 80 and over , Amyloidosis/diagnostic imaging , Female , Humans , Male , Middle Aged , Radionuclide Imaging , Spleen/diagnostic imagingABSTRACT
Five patients with autoimmune chronic active hepatitis were diagnosed for the first time over the age of 70 years. They tolerated diagnostic and follow-up liver biopsies well and made gratifying responses to conventional immunosuppressive therapy when indicated. Autoimmune chronic active hepatitis certainly occurs in the elderly and management should be similar to younger patients. We see no reason to withhold immunosuppressive agents.
