Infratemporal and temporal fossa abscess complicating dental extraction.

Abscess formation in the infratemporal and temporal fossae is rare. Their presentation to accident and emergency departments is unusual and consequently may cause problems with diagnosis. Once diagnosed, treatment should be aggressive with intravenous antibiotics and surgical drainage.

Pneumococcal pericarditis presenting as an out of hospital cardiopulmonary arrest.

Serious complications of pneumococcal pneumonia have become uncommon with effective antibiotic treatment. Purulent pericarditis is a rare though well described complication of untreated pneumococcal sepsis. A case of untreated pneumococcal pneumonia complicated by purulent pericarditis is described. This presented as an out of hospital asystolic cardiopulmonary arrest.

Neuralgic amyotrophy presenting to an accident and emergency department.

Two patients with neuralgic amyotrophy (Parsonage-Turner syndrome) are described. Problems arising from the shoulder girdle commonly present to accident and emergency (A&E) departments. Neuralgic amyotrophy is an infrequent neuromuscular disorder which predominantly affects the shoulder girdle. Characterised by severe pain followed by muscle weakness, atrophy, and variable sensory deficits, the diagnosis is based on history and physical findings and is confirmed by electromyography. The prognosis is excellent and treatment is supportive using analgesia and physiotherapy.

What information do general practitioners want about accident and emergency patients?

OBJECTIVES: To establish what information general practitioners (GPs) want about their patients who attend accident and emergency (A&E) departments and the GPs' preferences for the type of communication and method of delivery. METHODS: Analysis of questionnaire sent to all 350 GPs in the catchment area of one A&E department. RESULTS: 219 completed questionnaires (63%) were returned. GPs requested information about most new attendances at A&E, but only 50% of GPs wanted details of every new A&E patient. Most GPs preferred a small computer generated letter or sticky label which included details of investigation results, diagnosis, treatment, and follow up arrangements. 47% of GPs requested delivery of letters by the pathology specimen service, but 25% preferred hand delivery by the patient or a relative. Individual GPs often had widely different preferences, especially about the type of communication and method of delivery. Most GPs would value a monthly list of all their patients who have attended A&E. CONCLUSIONS: GPs need prompt and appropriate information about their patients who attend A&E. A computerised records system should be arranged so that relevant information can be produced easily and quickly in a format suitable for filing in GP records. Good communications with GPs would improve the continuity of care for A&E patients.

Changing patterns in accident and emergency attenders.

OBJECTIVE: To investigate demographic changes in attenders at an accident and emergency (A&E) department. METHODS: Patients attending Leeds General Infirmary A&E department in 1990 were compared with those attending in 1993 and 1994. Internal quality control suggested that 99% of patients were correctly registered for details of method of arrival, age, and departure (admission/discharge). RESULTS: By 1994 there had been a 6.9% increase in total numbers, including a disproportionate rise in elderly patient attendances. The overall number of patients admitted increased, as did the proportion of those attending the A&E department. There was a 28% increase in number of patients arriving by ambulance between 1990 and 1993, and this rose to 32% in 1994. CONCLUSIONS: The increasing number of new patients, especially elderly people, has implications for future planning of A&E departments. The expected demographic rise in the elderly population means that A&E departments must expect to receive more elderly patients. Our figures, if generally applicable, suggest that this is already occurring. Staffing requirements and the physical space necessary to care for these extra patients needs to take these figures into account. These factors are of relevance to both purchasers and providers.

Preparing students for health promotion: the challenge for Australian nursing in the 90s.

Health promotion is increasingly recognized as a role to be taken up by all health workers, and nurses, in particular, have been recognized for their potential contribution in this area. Nurse educators around Australia are currently grappling with how best to reorient nurses towards health promotion, and how to prepare nursing students for a health promotion role. In this discussion paper, one university's preparation of their undergraduate students will be examined, as a means of stimulating further debate about how health promotion can be effectively incorporated into undergraduate nursing education. The Health Education and Promotion unit at University of New England, Armidale is offered in the third year of the Bachelor of Nursing. It incorporates traditional teaching strategies and a specific health promotion practicum. The practicum is vital in developing students' health promotion skills and helping them to integrate their theoretical learning into practice. It is argued that education in health promotion is vital if nurses are to prepare themselves for the challenge of promoting the health of their communities.

Cortical bone cyst following a greenstick radial fracture.

There are only a few reports of well defined cystic lesions of the peripheral skeleton following fracture. In children, these lesions are mostly small cortical defects affecting the distal radial metaphysis after a greenstick or torus fracture. A cyst is reported complicating a greenstick fracture, together with a brief review of published reports confirming that these are asymptomatic lesions which can be managed conservatively without further investigation.

Life support courses for all.

Many courses teaching advanced life support skills are now available in this country. These 'provider' courses include those dealing with cardiac, trauma and paediatric resuscitation. The numbers of applicants for all these courses far exceed the places available. There is further demand for places from those who currently hold advanced life support provider certificates and who require re-evaluation to maintain their certification. For many, particularly non-medical staff, obtaining funding or study leave to attend such a course may also be a problem. All these factors lead to delays in providing the training in advanced life support skills that is clearly needed. We here report on the development and success of local 1-day resuscitation courses as a means of introducing all staff who may be expected to cope with an emergency situation to the current principles of resuscitation. We do not suggest that such abbreviated courses are in any way a substitute for the full advanced life support course, but that they can provide tuition that may otherwise be unavailable.

A review of the management of a major incident involving predominantly paediatric casualties.

On 27 September 1993 a double-decker bus full of secondary school children was involved in a collision with a lorry. A total of 58 people were injured, including two fatalities. All except two of the casualties were children. Forty-two casualties, including all of the seriously injured, were taken to the Accident & Emergency Department at York District Hospital. Fifteen casualties were admitted, the majority with closed head injuries. Most of the injuries were of a minor nature, predominantly soft-tissue damage and superficial lacerations. This paper reviews these injuries and the implementation of the hospital major accident (MAJAX) plan. It identifies specific problems encountered with this incident. It also describes the measures taken retrospectively to upgrade the MAJAX plan. It highlights the difficulties encountered by medical staff called to the incident who were unfamiliar with managing injuries and describes retrospective attempts to improve the awareness of trauma management skills.

Morphologic correlates of glomerular oxidant injury induced by the myeloperoxidase-hydrogen peroxide-halide system of the neutrophil.

Neutrophilic polymorphonuclear leukocytes can mediate glomerulonephritis by releasing reactive oxygen species such as H2O2. We have previously demonstrated that H2O2-mediated glomerular injury can be potentiated by reaction with polymorphonuclear leukocyte myeloperoxidase (MPO). When MPO was perfused into renal arteries of rats, it bound to the glomerular capillary wall due to its cationic charge. Subsequent perfusion with nontoxic concentrations of H2O2 and halides resulted in acute glomerular injury, halogenation of the glomerular basement membrane, and proteinuria. The studies reported here document the morphologic changes that accompany MPO-mediated glomerular injury. Acutely, there is severe injury to the endothelium with cell swelling and lysis. Within 10 minutes, a marked platelet influx occurs. Platelets frequently occlude capillary lumens and bind to areas of denuded glomerular basement membrane where platelet degranulation results. By 4 days, the platelet infiltration has ceased, and a reparative phase develops characterized by marked proliferation of resident endothelial cells and possibly mesangial cells. By 21 days postperfusion, the glomerular lesion had largely resolved. In contrast, control rats perfused with MPO alone, H2O2 alone, or buffered saline alone demonstrate minimal glomerular injury at all times studied. MPO-mediated glomerular disease results in endothelial and mesangial cell injury, activation of platelets, and a subsequent proliferative response. These morphologic changes resemble those seen in several forms of inflammatory and proliferative glomerulonephritis in man.

Urinary alkalinization and smoking cessation.

Previous studies have shown that large doses of a urinary alkalinizing agent reduced cigarette consumption spontaneously among smokers. After establishing a safe daily dose of an alkalinizing agent, sodium bicarbonate, its effect upon smoking cessation rates among 72 enrollees in a smoking cessation program was studied. In the first study, we determined that sodium bicarbonate (3900 mg per day) significantly increased urinary pH (from 6.0 to 6.7) and lowered titratable acidity. Ascorbic acid (1500 mg per day) had no effect of pH or acidity. In a second study, a group given sodium bicarbonate surpassed a placebo control group (who were given 1500 mg per day ascorbic acid) in total daily cigarette reduction after 5 weeks and in week-to-week smoking reduction. The groups did not, however, differ in the number who achieved total abstinence.

Immediate carbon monoxide estimates and self-reported smoking.

Because carbon monoxide (CO) is an easily understood danger of cigarette smoking, new breath CO analyzers may be useful in cessation programs. Self-reported cigarette consumption and breath CO correlated .70 using a 90-sec. CO-determination method. Smokers averaging 17 daily cigarettes had average breath CO of 24 parts per million (ppm), falling to 7.71 ppm for smokers claiming at least 24-hr. abstinence. Corresponding carboxyhemoglobin (COHb) estimates were 4.34% (slightly above World Health Organization 4% safety limit) and 1.39%. Smoking clinics can use CO-monitoring devices for feedback or surveillance, although feedback would provide the most benefits for participants.