RESUMEN
Lillias Hamilton trained as a doctor in London, qualified in 1890 and practiced in Calcutta and later in Afghanistan where she was the personal physician to the Amir and the only Western doctor. After six years abroad, she returned to England but owing partly to establishment prejudice was unsuccessful in setting up a London practice and eventually became the Principal of a Women's Agricultural College. Her career illustrates the aspects of medical practice abroad in the 1890s, as well as the difficulties encountered by women doctors in England even after the route to qualification in the UK had been opened.
Asunto(s)
Médicos Mujeres , Médicos , Afganistán , Inglaterra , Femenino , Humanos , IndiaRESUMEN
Fraser Rose was a general practitioner in Preston, Lancashire, England and a medical politician. He was one of two doctors who in 1951 took the initial steps and subsequently played a major role in the founding of the College of General Practitioners, later to become the Royal College of General Practitioners. This paper examines his life, his career in general practice and medical politics, and his unique contribution to the 'Steering Committee' that set up the College.
Asunto(s)
Médicos Generales/historia , Sociedades Médicas/historia , Inglaterra , Historia del Siglo XX , PolíticaRESUMEN
Orolingual angioedema (OLA) is a known complication of intravenous alteplase used to treat ischaemic stroke. The incidence may be as high as 5.1%. ACE inhibitors are thought to increase the risk of developing this potentially life-threatening complication. This case report demonstrates how we may improve in the identification of risk factors in the history; the counselling of patients appropriately; in seeking alternative therapies such as mechanical thrombectomy; and in the monitoring of patients for signs of OLA once alteplase has been given.
Asunto(s)
Angioedema/inducido químicamente , Fibrinolíticos/efectos adversos , Enfermedades de la Boca/inducido químicamente , Accidente Cerebrovascular/tratamiento farmacológico , Activador de Tejido Plasminógeno/efectos adversos , Anciano , Femenino , Humanos , Factores de RiesgoRESUMEN
PURPOSE: To review the records of 50 children who underwent open joint washout for septic arthritis with (n=25) or without (n=25) preoperative antibiotics. METHODS: Records of 50 children who underwent open joint washout for presumed septic arthritis with (n=25) or without (n=25) preoperative antibiotics were reviewed. 17 boys and 8 girls aged 3 weeks to 16 years (median, 1.5 years) who were prescribed preoperative antibiotics before joint washout were compared with 12 boys and 13 girls aged one month to 14 years (median, 2 years) who were not. Following arthrotomy and washout, all patients were commenced on high-dose intravenous antibiotics. Patients were followed up for 6 to 18 months until asymptomatic. RESULTS: Patients who were referred from places other than our emergency department were twice as likely to have been prescribed preoperative antibiotics (p=0.0032). Patients prescribed preoperative antibiotics had a longer median (range) time from symptom onset to joint washout (8 [2-23] vs. 4 [1-29] days, p=0.05) and a higher mean erythrocyte sedimentation rate (93.1 vs. 54.3 mm/h, p=0.023) at presentation. Nonetheless, the 2 groups were comparable for weight bearing status, fever, and positive culture, as well as the mean (range) duration of antibiotic treatment (4.9 [4-7] vs. 4.7 [1-8] weeks, p=0.586). CONCLUSION: Preoperative antibiotics should be avoided in the management of septic arthritis in children. Their prescription delays diagnosis and definitive surgery, and leads to additional washouts and complications. A high index of suspicion and expedite referral to a specialist paediatric orthopaedic unit is needed if septic arthritis is suspected.