INTRODUCTIONThe irritable bowel syndrome (IBS) is a gastrointestinal disorder characteried by chronic lower abdominal pain and disordered defaecation associated with bloating ,tenesmus and extra-intestinal symptoms in...INTRODUCTIONThe irritable bowel syndrome (IBS) is a gastrointestinal disorder characteried by chronic lower abdominal pain and disordered defaecation associated with bloating ,tenesmus and extra-intestinal symptoms including and functional upper gastrointestinal symptoms .Currently there is nounifying hypothesis which adepuately explains the pathogenesis of the disorder although a number of physiological and psychological abmormalites have been described.展开更多
Shoulder replacement in cuff tear arthropathy(CTA)is an unsolved challenge.CTA poses a soft tissue deficiency in an arthritic glenohumeral joint which the anatomical total shoulder replacement and hemiarthroplasty can...Shoulder replacement in cuff tear arthropathy(CTA)is an unsolved challenge.CTA poses a soft tissue deficiency in an arthritic glenohumeral joint which the anatomical total shoulder replacement and hemiarthroplasty cannot reliably provide stability,range of movement,function or satisfactory long term outcome.In the past two decades since the introduction of the reverse shoulder replacement,the prosthesis has evolved and has shown promising results.It is a partially constraint joint by virtue of its design features.The reversal of the concavity and convexity of the joint to the proximal humerus and the glenoid,respectively,also shifts and improves its center of rotation onto the osseous surface of the glenoid with less exposure to shear stress.It is a successful pain relieving procedure,offering good outcome in patients with irreparable massive rotator cuff tear with or without osteoarthritis.Consequently,this has led to wider use and expansion of its indication to include more complex elective and trauma cases.Whereas originally used in the more elderly patients,there is increasingly more demand in the younger patients.It is important to have good quality long term data to support these increasing indications.Therefore,we review the literature on the concepts of reverseshoulder replacement and the contemporary evidence.展开更多
Nutritional therapy for active Crohn’s disease (CD) is an underutilised form of treatment in adult patients, though its use is common in the paediatric population. There is evidence that nutritional therapy can effec...Nutritional therapy for active Crohn’s disease (CD) is an underutilised form of treatment in adult patients, though its use is common in the paediatric population. There is evidence that nutritional therapy can effectively induce remission of CD in adult patients. Enteral nutrition therapy is safe and generally well tolerated. Meta-analysis data suggest that corticosteroids are superior to nutritional treatment for induction of remission in active CD. However, the potential side effects of such pharmacotherapy must be taken into consideration. This review examines the evidence for the efficacy of elemental and polymeric diets, and the use of total parenteral nutrition in active CD.展开更多
AIM： To assess the use of topical negative pressure （TNP） in the management of severe peritonitis. METHODS： This is a four-year prospective analysis from January 2005 to December 2008 of 20 patients requiring TNP ...AIM： To assess the use of topical negative pressure （TNP） in the management of severe peritonitis. METHODS： This is a four-year prospective analysis from January 2005 to December 2008 of 20 patients requiring TNP following laparotomy for severe peritonitis. RESULTS： There were 11 males with an average age of （59.3 ± 3.95） years. Nine had a perforated viscus, five had anastomotic leaks, three had iatrogenic bowel injury, and a further three had severe pelvic inflammatory disease. TNP and the VAC Abdominal Dressing System were initially used. These were changed every two to three days. Abdominal closure was achieved in 15/20 patients within 4.53 ± 1.64 d. One patient required relaparotomy due to residual sepsis. Two patients with severe faecal peritonitis due to perforated diverticular disease received primary anastomosis at second look laparotomy, as sepsis and their general condition improved. In the remaining 5/20 cases, the abdomen was lee open due to bowel oedema and or abdominal wall oedema. Dressing was switched to TNP and VAC GranuFoam . Three of the five patients returned a few months later for abdominal wall reconstruction and restoration of intestinal continuity. Two patients developed intestinal fistulae. All 20 patients survived.CONCLUSION： The use of TNP is safe. Further studies are needed to assess its value in managing these difficult cases.展开更多
Eight percent of necrotizing soft tissue infections(NSTI) are attributable to group A Streptococci(GAS),and among these,50%develop streptococcal toxic shock syndrome.The reported mortality associated with NSTI reaches...Eight percent of necrotizing soft tissue infections(NSTI) are attributable to group A Streptococci(GAS),and among these,50%develop streptococcal toxic shock syndrome.The reported mortality associated with NSTI reaches 32%.We present cases of two healthy individuals with minor GAS skin infection which developed to a rapidly progressed NSTI and sepsis despite of the antibiotic treatment,aiming to discuss the lessons learned from the course and management of these patients.展开更多
Objective To study the efficacy of single dose of mifepristone and two doses of misoprostol in women undergoing early medical abortion （EMA） up to 9 weeks of gestation. Methods An audit was performed on a retrospect...Objective To study the efficacy of single dose of mifepristone and two doses of misoprostol in women undergoing early medical abortion （EMA） up to 9 weeks of gestation. Methods An audit was performed on a retrospective data analysis of 162 women who underwent an early medical abortion in Southampton U.K. Relevant data on completeness of abortion and other details were analyzed. Results Majority of the women （67%） aged 20-30 years old, 22% were between 30 and 40 years old and 1% were above 40 years old when they came for abortion. About 94.5% women had complete abortion following the use of single dose mifepristone combined with two doses of misoprostol, 4.9% had an incomplete abortion and 0.6% had failure of the procedure. These figures had significantly improved over the results of similar audit in 2005 with single dose of misoprostol to women below 7 weeks of pregnancy. The results in this audit were 82.1% complete abortion, 7.2% incomplete abortion and O. 7% failed procedure. Conclusion Mifepristone in combination with two doses of misoprostol appears to be more effective in all cases of early medical abortion when compared with single dose of misoprostol for termination below 49 d （7 weeks） and two doses of misoprostol between 49 d and 63 d （7-9 weeks） of pregnancy.展开更多
That Easter weekend I was on four night shifts.The firstnight was busy,and I went to sleep early the next day,buttypically I was awake again within an hour and a half:a firealarm had been set off by someone cooking in...That Easter weekend I was on four night shifts.The firstnight was busy,and I went to sleep early the next day,buttypically I was awake again within an hour and a half:a firealarm had been set off by someone cooking in the hospitalaccommodation.'Good start,'I thought.I eventually got back to sleep,but when I woke up thatevening I felt the familiar scratchy throat and slight ache thatgenerally heralds a viral illness.I went to work hoping it展开更多
A 63 year old man comes to you for a routine check of hisblood pressure.During the consultation you notice an entry in hisnotes about difficulty with erections that was never followed up.What issues you should coverIs...A 63 year old man comes to you for a routine check of hisblood pressure.During the consultation you notice an entry in hisnotes about difficulty with erections that was never followed up.What issues you should coverIs this an ongoing problem?-Healthcare professionalsoften fail to initiate discussion of possible erectile dysfunction,whether because of embarrassment,lack of knowledge,orpressure of time.Patients find it even more difficult to raise theissue with their doctors,even though erectile dysfunction展开更多
文摘INTRODUCTIONThe irritable bowel syndrome (IBS) is a gastrointestinal disorder characteried by chronic lower abdominal pain and disordered defaecation associated with bloating ,tenesmus and extra-intestinal symptoms including and functional upper gastrointestinal symptoms .Currently there is nounifying hypothesis which adepuately explains the pathogenesis of the disorder although a number of physiological and psychological abmormalites have been described.
文摘Shoulder replacement in cuff tear arthropathy(CTA)is an unsolved challenge.CTA poses a soft tissue deficiency in an arthritic glenohumeral joint which the anatomical total shoulder replacement and hemiarthroplasty cannot reliably provide stability,range of movement,function or satisfactory long term outcome.In the past two decades since the introduction of the reverse shoulder replacement,the prosthesis has evolved and has shown promising results.It is a partially constraint joint by virtue of its design features.The reversal of the concavity and convexity of the joint to the proximal humerus and the glenoid,respectively,also shifts and improves its center of rotation onto the osseous surface of the glenoid with less exposure to shear stress.It is a successful pain relieving procedure,offering good outcome in patients with irreparable massive rotator cuff tear with or without osteoarthritis.Consequently,this has led to wider use and expansion of its indication to include more complex elective and trauma cases.Whereas originally used in the more elderly patients,there is increasingly more demand in the younger patients.It is important to have good quality long term data to support these increasing indications.Therefore,we review the literature on the concepts of reverseshoulder replacement and the contemporary evidence.
文摘Nutritional therapy for active Crohn’s disease (CD) is an underutilised form of treatment in adult patients, though its use is common in the paediatric population. There is evidence that nutritional therapy can effectively induce remission of CD in adult patients. Enteral nutrition therapy is safe and generally well tolerated. Meta-analysis data suggest that corticosteroids are superior to nutritional treatment for induction of remission in active CD. However, the potential side effects of such pharmacotherapy must be taken into consideration. This review examines the evidence for the efficacy of elemental and polymeric diets, and the use of total parenteral nutrition in active CD.
文摘AIM： To assess the use of topical negative pressure （TNP） in the management of severe peritonitis. METHODS： This is a four-year prospective analysis from January 2005 to December 2008 of 20 patients requiring TNP following laparotomy for severe peritonitis. RESULTS： There were 11 males with an average age of （59.3 ± 3.95） years. Nine had a perforated viscus, five had anastomotic leaks, three had iatrogenic bowel injury, and a further three had severe pelvic inflammatory disease. TNP and the VAC Abdominal Dressing System were initially used. These were changed every two to three days. Abdominal closure was achieved in 15/20 patients within 4.53 ± 1.64 d. One patient required relaparotomy due to residual sepsis. Two patients with severe faecal peritonitis due to perforated diverticular disease received primary anastomosis at second look laparotomy, as sepsis and their general condition improved. In the remaining 5/20 cases, the abdomen was lee open due to bowel oedema and or abdominal wall oedema. Dressing was switched to TNP and VAC GranuFoam . Three of the five patients returned a few months later for abdominal wall reconstruction and restoration of intestinal continuity. Two patients developed intestinal fistulae. All 20 patients survived.CONCLUSION： The use of TNP is safe. Further studies are needed to assess its value in managing these difficult cases.
文摘Eight percent of necrotizing soft tissue infections(NSTI) are attributable to group A Streptococci(GAS),and among these,50%develop streptococcal toxic shock syndrome.The reported mortality associated with NSTI reaches 32%.We present cases of two healthy individuals with minor GAS skin infection which developed to a rapidly progressed NSTI and sepsis despite of the antibiotic treatment,aiming to discuss the lessons learned from the course and management of these patients.
文摘Objective To study the efficacy of single dose of mifepristone and two doses of misoprostol in women undergoing early medical abortion （EMA） up to 9 weeks of gestation. Methods An audit was performed on a retrospective data analysis of 162 women who underwent an early medical abortion in Southampton U.K. Relevant data on completeness of abortion and other details were analyzed. Results Majority of the women （67%） aged 20-30 years old, 22% were between 30 and 40 years old and 1% were above 40 years old when they came for abortion. About 94.5% women had complete abortion following the use of single dose mifepristone combined with two doses of misoprostol, 4.9% had an incomplete abortion and 0.6% had failure of the procedure. These figures had significantly improved over the results of similar audit in 2005 with single dose of misoprostol to women below 7 weeks of pregnancy. The results in this audit were 82.1% complete abortion, 7.2% incomplete abortion and O. 7% failed procedure. Conclusion Mifepristone in combination with two doses of misoprostol appears to be more effective in all cases of early medical abortion when compared with single dose of misoprostol for termination below 49 d （7 weeks） and two doses of misoprostol between 49 d and 63 d （7-9 weeks） of pregnancy.
文摘That Easter weekend I was on four night shifts.The firstnight was busy,and I went to sleep early the next day,buttypically I was awake again within an hour and a half:a firealarm had been set off by someone cooking in the hospitalaccommodation.'Good start,'I thought.I eventually got back to sleep,but when I woke up thatevening I felt the familiar scratchy throat and slight ache thatgenerally heralds a viral illness.I went to work hoping it
文摘A 63 year old man comes to you for a routine check of hisblood pressure.During the consultation you notice an entry in hisnotes about difficulty with erections that was never followed up.What issues you should coverIs this an ongoing problem?-Healthcare professionalsoften fail to initiate discussion of possible erectile dysfunction,whether because of embarrassment,lack of knowledge,orpressure of time.Patients find it even more difficult to raise theissue with their doctors,even though erectile dysfunction
