Postgraduate Medical Journal articles from December 2002

Postgraduate Medical Journal archives from December 2002

"Cases" and voices: the changing agenda for doctors and their patients: Change in health care delivery has major implications for doctor-patient communication. (Editorial).
December 1, 2002... The variety and speed of change in the delivery of health care has considerable implications for what has traditionally been called the "doctor-patient relationship". The possibility of improving the communication between patients and doctors...

Culyer, research governance, and all that: Observations on life as an NHS R&D director. (Personal View).(Anthony Culyer, professor, commissioned by UK government to report)(National Health Service, research and development)
December 1, 2002... In the early 1990s, an expert group chaired by Professor Anthony Culyer, was commissioned by the government to report on the state of research and development (R&D) within the National Health Service (NHS) in the UK, and to make recommendations...

The most famous doctor in the last 50 years? (Filler).
December 1, 2002... Few readers will guess the identity of the most famous doctor of the last 50 years. A clue. He was an alternative medicine enthusiast with Marxism-Leninism as his medicine and he had a lot of sugar at his disposal to help this medicine go...

A rational approach to uninvestigated dyspepsia in primary care: review of the literature. (Review).
December 1, 2002... In this paper the rationale and limitations of the four most important approach strategies to dyspepsia in primary care (empiric treatment, prompt endoscopy, "test-and-scope", and "test-and-treat") are analysed. It is concluded that in the...

Critical review of unstable angina and non-ST elevation myocardial infarction. (Review).
December 1, 2002... Within the coronary vasculature the progression of a stable atherosclerotic plaque into a vulnerable and ultimately unstable lesion leads to a cascade of events culminating in the clinical presentation of unstable angina or acute myocardial...

Monitoring hormone replacement therapy by biochemical markers of bone metabolism in menopausal women. (Review).
December 1, 2002... Biochemical markers of bone metabolism are divided into two groups: formation and resorption markers. Bone turnover is a dynamic process, which increases in postmenopausal period. Hormone replacement therapy (HRT) can diminish this increased...

Shaken baby syndrome. (Review).
December 1, 2002... Shaken baby syndrome is the most common cause of death or serious neurological injury resulting from child abuse. It is specific to infancy, when children have unique anatomic features. Subdural and retinal haemorrhages are markers of shaking...

Management of motor neurone disease. (Best Practice).
December 1, 2002... Motor neurone disease is a progressive neurodegenerative disorder leading to severe disability and death. It is clinically characterised by mixed upper and lower motor neurone involvement affecting bulbar, limb, and respiratory musculature....

An algorithm for the investigation and management of patients with suspected deep venous thrombosis at a district general hospital. (Original Article).
December 1, 2002... The aim was to show that clinical assessment and serial Dopplers could be used to exclude deep venous thrombosis (DVT), and also that clinical assessment in combination with D-dimers could be used to exclude DVT. This was a prospective trial....

Dorsalis pedis arterial pulse: palpation using a bony landmark. (Original Article).
December 1, 2002... Introduction: The unreliability of the pulse examination of the foot has primarily been due to variability of technique between examiners. Whereas the groove between the medial malleolus and the Achilles tendon more readily defines the location...

Guidelines, compliance, and effectiveness: a 12 months' audit in an acute district general healthcare trust on the two week rule for suspected colorectal cancer. (Audit).
December 1, 2002... Objectives: The Department of Health had recently introduced guidelines so that all suspected colorectal cancer patients could be seen by a specialist within two weeks of referral by their general practitioners. The usefulness and practicality...

Presentation of a PTHrP-secreting pancreatic neuroendocrine tumour, with hypercalcaemic crisis, pre-eclampsia, and renal failure. (Case Report).(parathyroid-hormone-related protein)
December 1, 2002... Severe hypercalcaemia during pregnancy is rare and most cases are secondary to hyperparathyroidism. This is the first report of a parathyroid hormone related protein (PTHrP) secreting neuroendocrine tumour of the pancreas manifesting with...

Rectus sheath haematoma: a new set of diagnostic features. (Case Reports).
December 1, 2002... Rectus muscle haematoma is a well documented clinical entity, but its diagnosis remains elusive. A hoematoma within the rectus sheath produces a painful, tender swelling that can mimic an intraperitoneal mass with features of an acute abdomen....

New World leishmaniasis from Spain. (Case Report).
December 1, 2002... A 69 year old man living in Spain contracted mucocutaneous leishmaniasis involving the nose. The infecting organism was Leishmania infantum, which only rarely causes the New World form of the disease. The source of infection was probably a...

Renal involvement in an Anderson-Fabry heterozygote. (Images in Medicine).
December 1, 2002... A 34 year old Algerian woman with no history of consanguinity was referred to the nephrology service in 1998 with oedema, protcinuria (3.5 g/24 hours), and hypoalbuminaemia (28 g/l). These abnormalities were identified immediately before...

A rare cause of backache in an adult male. (Self Assessment Questions).
December 1, 2002... A 45 year old man complained of pain in the lower back for one year. He presented with constipation and hesitation in passing urine for one month. The pain had been increasing in severity over the past three months. The patient had to take...

A drowsy breathless man. (Self Assessment Questions).
December 1, 2002... A 70 year old man was found collapsed and acutely breathless in his toilet and was rushed to the local accident and emergency department. On arrival he was found to be dyspnoeic and unconscious with a Glasgow coma scale of 3. He had a...

Letters.
December 1, 2002... Use of adrenaline by junior doctors The survey reported by Gompels and colleagues showing the incorrect use of adrenaline in anaphylaxis by over 50% of junior doctors reveals sobering but perhaps not startling statistics. (1) Their study...