Abstract:
:This review examines the appropriate timing of intervention in acute pancreatitis. In gallstone pancreatitis, it is now clear that cholecystectomy during the primary admission carries no greater risk of complications than delayed cholecystectomy and enables earlier recovery to normal activity. This course of action pre-empts a second, possibly fatal attack of acute pancreatitis. Cholecystectomy should be done after the acute phase has settled, before discharge from hospital. Patients with gallstones should now be offered endoscopic sphincterotomy within 48 hours of admission. This approach is safe, and reduces the risk of complications. When complications develop, early necrosectomy is only indicated if conservative measures fail. Delayed (> 10 days) necrosectomy is appropriate if there is evidence of sepsis, or clinical failure to improve. Pancreatic pseudocysts can often be managed expectantly; a high proportion will resolve spontaneously. After a delay of 12 weeks, persistent cysts require evaluation by endoscopic pancreatography, which gives crucial information in the choice between percutaneous or surgical drainage of the pseudocyst. A patient with pancreatitis is usually treated under the care of a surgeon, who has traditionally taken the decision on the timing of any intervention, and has performed such intervention at open operation. Recently, the development of alternative techniques has enabled the surgeon to call on the skills of his colleagues in endoscopy and interventional radiology. However, the availability of these alternatives to surgery should not affect the timing of intervention unless it can be clearly shown that such a change in timing combined with the minimally invasive technique can improve the outcome for the patient. Intervention may be required to deal with gallstones in the gallbladder or in the bile duct, to deal with, or ideally prevent, the deleterious systemic effects of pancreatic and peripancreatic necrosis, or to drain a peripancreatic abscess. Peripancreatic fluid collections and pancreatic pseudocysts may also require either internal or external drainage to relieve symptoms or prevent complications.
journal_name
Postgrad Med Jjournal_title
Postgraduate medical journalauthors
Johnson CDdoi
10.1136/pgmj.69.813.509subject
Has Abstractpub_date
1993-07-01 00:00:00pages
509-15issue
813eissn
0032-5473issn
1469-0756journal_volume
69pub_type
杂志文章,评审abstract::Candida albicans peritonitis developed in a 48-year-old man with a perforated gastric ulcer who subsequently was treated with intravenous amphotericin B. The drug penetrated well into the inflamed peritoneal cavity and eradicated the organism from the peritoneal fluid. Nevertheless, at post-mortem, Candida organisms w...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.54.631.340
更新日期:1978-05-01 00:00:00
abstract::The clinical features, treatment and survival of 36 patients with microscopic polyarteritis diagnosed between 1957-1988 have been reviewed. All had a focal segmental necrotizing glomerulonephritis on renal biopsy with evidence of a small vessel vasculitis. Most had a prodromal illness of less than 1 month. Severity of...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.65.766.515
更新日期:1989-08-01 00:00:00
abstract::In 114 patients (52 males and 62 females) with long-standing pernicious anaemia, hypoferritinaemia was found in 27 (23.7%) and hypochromic microcytic anaemia in 19 (16.6%). Our findings indicate that iron deficiency is a common yet neglected complication of long-standing pernicious anaemia and warrants greater diagnos...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.64.748.110
更新日期:1988-02-01 00:00:00
abstract::There is an increasing awareness on the part both of the media and the profession of the need to co-operate in providing information and education on medical matters. This co-operation should be strongly encouraged. Where children are concerned the opportunities for education are great. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.54.629.225
更新日期:1978-03-01 00:00:00
abstract::Mild and self-limiting fever following bleomycin use is common, and a fatal hyperpyrexial response occurs rarely. In previously reported cases, such hyperpyrexia occurred either after the initial administration of the drug or during subsequent therapy following an initial pyrexial response. We describe a fatal hyperpy...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.65.764.417
更新日期:1989-06-01 00:00:00
abstract::Aneurysmal subarachnoid haemorrhage is associated with a uniquely severe headache of acute onset. Classical cases are readily identified as such, although this is not always the case. Four cases who were admitted to a district general hospital within a 3-month period are presented, because they demonstrate a variety o...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.74.878.743
更新日期:1998-12-01 00:00:00
abstract::A 22 year old woman was admitted with amitriptyline overdose. Twenty six hours later she developed acute myocardial infarction. Cardiotoxic effects of tricyclic antidepressants are discussed and the importance of considering myocardial infarction as a complication of tricyclic antidepressant overdose is emphasized. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.64.758.968
更新日期:1988-12-01 00:00:00
abstract::A previously healthy 17 year old boy had Staphylococcus aureus endocarditis presenting as acute scrotal pain. There was no trauma or evidence of scrotal or epididymal infection. The pain subsided after therapy for endocarditis was started. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.63.741.585
更新日期:1987-07-01 00:00:00
abstract:BACKGROUND:The survival of whites who have been treated for pernicious anaemia (PA) is unaffected, apart from incurring a greater risk of gastric cancers. The long term outcome of PA in Chinese is unknown. METHODS:A hospital based prospective longitudinal study of Chinese PA patients was conducted. Patients with known...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.2007.067421
更新日期:2008-12-01 00:00:00
abstract::Healthcare workers have a high risk of occupational exposure, more so in developing countries, with high incidence of blood borne diseases and prevalence of unsafe practices. Among the various blood borne diseases, the most common and important ones are HIV infection, hepatitis B, and hepatitis C. Most of the occupati...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pmj.79.932.324
更新日期:2003-06-01 00:00:00
abstract::Two young patients with sickle cell trait (AS haemaglobinopathy) and ischaemic stroke are reported. The stroke involved the internal carotid artery territory in one and the brainstem in the other. A review of the literature is presented to suggest that the association of sickle cell trait and cerebral infarction is mo...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.66.782.1078
更新日期:1990-12-01 00:00:00
abstract:PURPOSE OF STUDY:The aim of the study is to describe the prevalence of illicit drug use in England and Wales using data from the UK Survey of Non-Medical Use of Prescription Drugs (NMURx) programme and to compare against the well-established Crime Survey England and Wales (CSEW). The rationale is that recreational and ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2018-135798
更新日期:2018-11-01 00:00:00
abstract::A severe case of the cast syndrome is described following Harrington rod distraction and application of a body cast. The case was unusual as it presented late with no warning symptoms and progressed rapidly to death. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.59.694.539
更新日期:1983-08-01 00:00:00
abstract::Rhabdomyolysis is a rare but potentially fatal complication of hyperosmolar states. We report a case of severe hyperosmolar non-ketotic diabetic coma causing rhabdomyolysis in a young man. Despite very high levels of creatine kinase there was no detectable myoglobinuria. Creatine kinase estimation should be a standard...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.70.819.44
更新日期:1994-01-01 00:00:00
abstract::The incidence, predisposing factors, management and outcome of toxic megacolon (TM) has been reviewed in 65 cases of severe ulcerative colitis (UC) and compared in 2 successive 6-year periods before and after January, 1973. Nineteen episodes of TM occurred in 18 patients. Despite a conscious aim towards earlier surger...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.57.666.223
更新日期:1981-04-01 00:00:00
abstract::Forty patients with seasonal rhinitis and a proven sensitivity to pollens were studied for 2 weeks during the pollen season of 1982. The study was carried out according to a double-blind, double-dummy design. All patients received 100 micrograms beclomethasone dipropionate (BDP) into each nostril twice daily (400 micr...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/pgmj.60.704.404
更新日期:1984-06-01 00:00:00
abstract::In 93 patients with hypertension uncontrolled by bendrofluazide 5 mg plus atenolol 100 mg daily, the effects of adding nifedipine (up to 60 mg/day, n = 31), prazosin (up to 20 mg/day, n = 31), or hydralazine (up to 200 mg/day, n = 31) were compared in a 6 month open random parallel group study. The three drugs did not...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/pgmj.63.736.99
更新日期:1987-02-01 00:00:00
abstract:BACKGROUND:The British Thoracic Society (BTS) guidelines have not been examined collectively for their impact on chronic obstructive pulmonary disease (COPD). Whether intensive outpatient follow up of COPD patients after acute admission, using these guidelines, improved quality of life compared to the "usual practice" ...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/pgmj.2003.012831
更新日期:2004-03-01 00:00:00
abstract::The in vitro activity of cefaclor was compared with that of cephalexin and cephradine. This new antibiotic was the most active of the oral agents against Haemophilus influenzae (especially non-beta-lactamase producing strains). It was also significantly more active against N. gonorrhoeae and the Enterobacteriaceae. Th...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:
更新日期:1979-01-01 00:00:00
abstract:INTRODUCTION:Approximately 366 million people worldwide live with diabetes and this figure is expected to rise. Among the correct diagnosis, there will be errors in the diagnosis, classification and coding, resulting in adverse health and financial implications. AIM:To determine the prevalence and characteristics of d...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,多中心研究
doi:10.1136/postgradmedj-2013-132068
更新日期:2014-01-01 00:00:00
abstract::The prognosis of patients with metastatic adrenal cortical carcinoma is poor, and their disabling symptoms are usually unresponsive to conventional therapy. A patient with Cushing's syndrome secondary to a secretory adrenal cortical carcinoma was treated with octreotide, endocrine therapy and chemotherapy having faile...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.71.834.229
更新日期:1995-04-01 00:00:00
abstract::Recent studies of stress mechanisms in hypertension have focussed on the cardiovascular and neuroendocrine reactions to challenging or threatening psychosocial stimuli. Fixed hypertension may develop in some animal models following chronic exposure to psychosocial conflict. Acute experiments in humans show that marked...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.62.729.697
更新日期:1986-07-01 00:00:00
abstract:BACKGROUND:Transient ischaemic attacks (TIAs) carry a significant early risk of stroke. New national guidelines state patients should be seen within 7 days of the incident, with higher-risk patients being seen within 24 h. Meeting these targets across the NHS poses a significant challenge. A novel approach to TIA asses...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.2009.083162
更新日期:2009-12-01 00:00:00
abstract::Children in India constitute a very high risk group from mortality and morbidity due to lack of specialised healthcare. Remote care of paediatric patients by offsite specialists using telemedicine technology is a highly potential solution for coping up with the shortage of specialists in Indian subcontinent. We at a t...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.2009.082735
更新日期:2010-12-01 00:00:00
abstract::The gastric acid response and the buffer capacity of the stomach were measured in 30 control subjects and 22 duodenal ulcer patients in response to a masticatory (solid) and a non-masticatory (homogenized) meal having the same chemical composition. The peak acid output values were equal after a masticatory and after a...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.60.702.272
更新日期:1984-04-01 00:00:00
abstract::Erythromelalgia is an unusual condition characterized by attacks of burning pain in the hands and feet with local congestion and increased skin temperature. We report a case of erythromelalgia, with transient hypertension and elevated urinary catecholamines successfully treated by hypnotherapy. Such an association has...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.68.795.44
更新日期:1992-01-01 00:00:00
abstract::Various tumours, in particular lymphomas, have been reported in association with azathioprine treatment, both after renal transplantation and in other conditions. A case is reported here of acute myeloid leukaemia associated with azathioprine therapy for rheumatoid arthritis, and this is now the third case reported in...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.53.617.173
更新日期:1977-03-01 00:00:00
abstract:PURPOSE OF THE STUDY:The aim of this study was to investigate the association of fluid overload, measured by bioelectrical impedance vector analysis (BIVA) and also by accumulated fluid balance, with 30-day mortality rates in patients admitted to the emergency department (ED). DESIGN:We conducted a prospective observa...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2018-135695
更新日期:2018-07-01 00:00:00
abstract::Heart failure is a major problem worldwide; it is the leading cause of hospitalisation and is posing a huge financial burden. Advances in healthcare have contributed to increased life expectancy, with a resultant increase in the number of patients with chronic heart failure. For many patients who are still severely sy...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/postgradmedj-2015-133718
更新日期:2016-05-01 00:00:00
abstract::Focused assessment with sonography in trauma (FAST) is a limited ultrasound scan performed in the emergency department to assess patients admitted with blunt abdominal trauma (BAT). It is normally undertaken by emergency physicians in order to identify the presence of free fluid, which may represent haemoperitoneum. T...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.2008.076711
更新日期:2010-05-01 00:00:00