Editorial

2004 ◽  
Vol 3 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Case Reports ◽  
Rare Condition ◽  
Final Diagnosis ◽  
Favourable Outcome ◽  
Thyroid Storm ◽  
Acute Medicine ◽  
General Internal ◽  
The Face ◽  
Similar Theme

While the profile of the subspecialty of Acute Medicine continues to rise, so does the burden of work under which we are continually placed. Changes in General Practice out-of-hours cover, reduced junior doctor hours, continued pressure to achieve four hour A&E wait targets along with the arrival of yet another winter will be familiar themes for many readers. There are times when it may seem difficult to stay positive in the face of such adversity. In these moments of despair, I have recently taken to reading our ward admissions list in search of light relief. This list, compiled by non-clinical staff, describes the problems which doctors referring patients to the AMU ascribe to their patients. ‘COPD Exasperation’ appears to be a common problem (not least amongst the junior medical staff), while I hope that the patient admitted with ‘aspirations of pneumonia’ wasn’t too disappointed by his final diagnosis. A patient with Wegener’s granulomatosis was admitted several times with ‘acute f lare-up of vagueness’, an aff liction with which many of us will be familiar. My favourite, however, remains the unfortunate patient described as ‘Bilateral amputee – off legs’; things clearly could not get much worse for this man! If your own search for light relief leads you to browse through the following pages you will find more useful reviews, case reports and the second in our ‘Controversies in acute medicine’ series. This time Guha and Sheron tackle the issue of f luid resuscitation in chronic liver disease, an area which is frequently a source of considerable confusion. I have only ever treated one patient with thyroid storm, sadly without a favourable outcome; Ben Turner’s overview of the management of this rare condition will hopefully equip readers to deal with the consequences, should you ever be faced with such a problem. At the other end of the pulse-rate spectrum, bradyarrhythmias are a more familiar on-take emergency. In part one of a series of reviews on arrhythmias to be published over the next few editions, this subject is tackled in some detail. Diarrhoea and Cardiac Arrest have both been areas traditionally avoided by consultant physicians. In these days of the ‘hands-on’ consultant (preferably gloved!), I would urge colleagues to be prepared for such eventualities by taking note of our final two reviews. I am pleased to report that my continued pleas for submissions has resulted in more than a trickle of case reports, which has enabled us to publish two ‘Cases to remember’ in this edition. More on a similar theme would be most welcome. Mike Jones, originally brought into the editorial board for his renal expertise, wears his hat as Secretary of the SAC in General Internal Medicine to give an insight into Training developments in Acute Medicine in Viewpoint. Submissions for this section would again be welcomed. I hope you enjoy this edition, and that you continue to find the journal helpful in your everyday practice and personal CPD into the New Year.

Editorial

2003 ◽  
Vol 2 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Emergency Services ◽  
Case Reports ◽  
Community Acquired Pneumonia ◽  
Rapid Expansion ◽  
Medical Specialties ◽  
Acute Medicine ◽  
General Internal ◽  
Competency Based ◽  
Exciting Time ◽  
The Uk

It could be said that the past 12 months have been an exciting time in the field of acute medicine. In addition to the high profile afforded by the publication of Reforming Emergency Care and the ongoing Emergency Services Collaborative, the significance of the recent acquisition of subspecialty status for Acute Medicine cannot be understated. This, in turn has enabled approval of a new competency-based training curriculum by the JCHMT. Hopefully within the next few months, specialist registrars in General Internal Medicine with Acute Medicine will be appointed to the first few numbered posts in this discipline. Clearly a rapid expansion in posts of this nature will be required in the next few years in order to meet the enormous demand for consultants in Acute Medicine. Recently, in common with other medical specialties, hospitals have experienced difficulties in recruiting suitable applicants for such posts resulting in many vacancies across the UK. One challenge for those of us already working in the field is to maintain enthusiasm for the concept, while we are waiting for the trainees to mature into competent consultants. This edition includes another varied selection of reviews. Community acquired pneumonia may be of particular relevance over the remaining winter months, although hopefully the brief mention of SARS in this paper will now only be of historical significance. Patients with hypercalcaemia, dysphagia and Guillan Barre syndrome may be less frequent attenders, but nonetheless often create management dilemmas with which the admitting physician needs to be familiar. In a departure from our previous format, we have included two case reports this time, both highlighting an important clinical scenario. Power kite flying may not be a familiar activity for many readers, but the outcome described by Merrison and colleagues justifies its inclusion as ‘a case to remember’. Mark Mallett, on the other hand, reminds us that syncope can, on occasions, reflect significant underlying pathology, even in an apparently healthy member of the hospital portering staff. Once again we would like to encourage similar submissions for future editions of the journal. After several years of association with CPD Acute Medicine and its predecessor, it is with great sadness that this edition is Paul Jenkins ’last as sub-editor. We wish him well as he moves on to new challenges in his role as President of the Society for Acute Medicine, and gratefully acknowledge all of his hard work in establishing the journal.

Editorial Volume 1 Issue 1

2002 ◽  
Vol 1 (1) ◽  
Author(s):  
Paul F Jenkins ◽  
Keyword(s):  
Case Reports ◽  
General Medicine ◽  
Work Load ◽  
Original Research ◽  
Acute Medicine ◽  
The Past ◽  
Review Articles ◽  
Medical Emergencies

As you can see, the title of the Journal has changed and this is intended to emphasize its educational direction. It will continue to commission articles covering general medical topics with a particular emphasis on the management of acute medical emergencies, aiming to reflect the challenges that face those physicians responsible for supporting the acute medical intake. The CME component will continue,so helping to facilitate the accumulation of CPD points in General Medicine. As always we welcome submissions for publication and these can take the form of original research in areas of relevance to Acute Medicine or case-reports. We will continue to commission review articles as otherwise it proves impossible to maintain the cycle and the combination of articles we have planned. I am particularly enthused by the combination of topics covered in this Edition and I do hope that you enjoy reading them as much as I have enjoyed my editing duties. Profound thanks as always to those who have so kindly contributed;we do appreciate the extra commitment, especially in these days of inexorably heavier work-load for clinicians. This is my last Journal as Editor and I must extend my gratitude to those who have written articles over the past four years, to the member of the Editorial Board and of course to the Staff at RILA who have self lessly supported the Editor’s task. Unfailingly efficient they have been a complete pleasure to work with and very under tanding of the occasional memory lapse of this particular Editor! Chris Roseveare, Consultant in Acute Medicine in Southampton, takes over and the new editorial board will be announced in the next issue. Chris has some brilliant ideas and will lead this Journal to renewed success I am sure. I wish him the best of luck.

Editorial

2006 ◽  
Vol 5 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Medical Training ◽  
Case Reports ◽  
Junior Doctors ◽  
Acute Medicine ◽  
The Past ◽  
Acute Medical Unit ◽  
Application Service ◽  
Public House ◽  
The Uk

They say time flies when you’re having fun – and the 5 years since Paul Jenkins convinced me to take over as editor of this journal have certainly flown by. This period has seen a dramatic expansion in the numbers of physicians specialising in Acute Medicine, the confirmation of subspeciality status and development of a training curriculum. Addressing over 300 delegates at the recent Society for Acute Medicine meeting at the Royal College of Physicians, President Mike Jones reminded us that only seven years earlier the Society’s entire membership had sat around a small table in a public house just a few hundred yards from that spot. At that time many were predicting that recruitment to the speciality would be a major challenge. ‘Why would anyone choose to specialise in acute medicine?’ was a question, sometimes whispered in the corridors of St Andrew’s Place. And yet many have made this choice, and many more continue to do so. The Society for Acute Medicine now has upwards of 400 members, a figure which has doubled in the past 12 months. Even more encouraging was the large number of trainees who visited the Acute Medicine stand at the recent BMJ careers fair. Many junior doctors clearly view Acute Medicine as a positive career choice, not the ‘last resort’ which some predicted it may become. However, challenges remain. By the time this edition hits the press the Medical Training Application Service (MTAS) will be swinging into action to produce the first applicants for ‘post MMC’ training positions across the UK. For those of us who are involved in the shortlisting and interview process, the enormity of the task is rapidly becoming apparent. In Wessex, the Deanery has suggested that Acute Medicine shortlisting may take as much as a week, with a further week set aside for interviews of the hopeful candidates. Then comes ‘round two’, later in the year, when potentially we do it all over again. Suddenly the prospect of annual leave in the months of March or April looks like a forlorn hope. But before I break this news to my wife and family, I should spare a thought for those readers who find themselves on the opposite side of the process. To be part of the first cohort of trainees to be involved in this must be a daunting prospect. Many of those enthusiastic potential recruits to the speciality are clearly struggling to know where to turn to for advice on the process, confused by often contradictory messages and unanswered questions. Hopefully all will become clearer as the deadlines approach. A smaller ‘Reviews’ section in this edition reflects a dramatic increase in the number of articles submitted for consideration of publication in this journal over the past 6 months. As a result we have accommodated more case reports than normal, along with two papers in our new section for research and audit. I would encourage similar submissions in the future; case reports need not be rare or esoteric, provided they contain a clear teaching message clinicians involved in the acute ‘take’. Completed audits will be considered if they demonstrate clear evidence of how to improve practice in an acute medical unit. Owing to some software problems, Rila has temporarily suspended their submissions website which, until recently, had been the mechanism for submission of articles to this journal. Until these problems are resolved, I would be grateful if any articles could be e-mailed directly to me at the address shown on this page, so that I can arrange for peer review. Finally, a reminder that this edition concludes the cycle of reviews which started in 2002 and has now covered the majority of conditions presenting as emergencies on the acute medical ‘take’. The new cycle, starting in 2007 with volume 6 issue 1 will follow a modified pattern, with different authors hopefully providing a fresh perspective in their updated reviews. My thanks go to all of the authors who have produced material over the past 5 years as well as to the editorial board for their ongoing hard work in commissioning articles for the past and future cycles.

scholarly journals Unusual Bladder Metastasis from a Primary Gastric Carcinoma: Two Case Reports and Review of Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mohamed Ali Nouioui ◽  
Ahmed Saadi ◽  
Marouene Chakroun ◽  
Amine Oueslati ◽  
Meriem Ksentini ◽  
...  
Keyword(s):  
Case Reports ◽  
Bladder Neoplasms ◽  
Rare Condition ◽  
Final Diagnosis ◽  
Secondary Tumor ◽  
Distant Organ ◽  
Bladder Metastasis ◽  
Primary Bladder ◽  
Primary Gastric Carcinoma ◽  
Shed Light

Primary bladder cancer is a frequent malignancy in the urology field, whereas secondary bladder neoplasms from a distant organ are extremely rare. This paper aims to report two rare cases of a secondary tumor of the urinary bladder from a primary gastric tumor and to perform a literature review of similar reported cases in order to better characterize its clinicopathological features and diagnosis in effort to shed light on this rare condition. The final diagnosis of secondary adenocarcinoma was made histologically after transurethral biopsy or resection of the bladder lesion. In one case, the bladder metastasis was a synchronous metastasis, and in the second case, it occurred under chemotherapy five months after initial diagnosis with gastric adenocarcinoma. Secondary adenocarcinoma of the bladder is extremely rare but should be considered when evaluating a bladder lesion in a patient treated for gastric cancer or presenting with gastric symptoms.

scholarly journals EP.FRI.277 A Young Lady with Lower Abdominal Pain. Eosinophillic Enteritis; an uncommon cause for a common symptom

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rebecca Lefroy ◽  
V Kalatzis ◽  
Alastair Brookes
Keyword(s):  
Abdominal Pain ◽  
Human Subjects ◽  
Case Reports ◽  
Lower Abdominal Pain ◽  
Rare Condition ◽  
Favourable Outcome ◽  
Young Lady ◽  
Common Symptom ◽  
Clinical Notes ◽  
Surgical Setting

Abstract Aims Abdominal pain presents frequently to the acute general surgical take with a huge variation in nature and, most importantly, in cause. The large number of common diagnoses are frequently discussed however, we present the case of a young lady with the uncommon diagnosis of eosinophilic enteritis as a primary presentation of lower abdominal pain. Here we present her case and review the current literature surrounding this condition and the group of conditions causing eosinophilia in the gastrointestinal tract. Methods A search of PubMed was performed, looking for research published within the last 50 years, regarding human subjects and published in English. This identified 16 review papers and 18 case reports. From these, current recommendations regarding investigation, diagnosis, management and follow up was assessed. We reviewed our case using clinical notes, clinic letters and investigations to evaluate our management of this case.  Results Our case represents an unusual case where not only did our patient suffer eosinophilic enteritis (the least reported of these group of conditions) but they also underwent surgery to reach diagnosis. Our review of the literature revealed that although our lady presented in an unusual fashion, this may well have prevented months of investigation.  Conclusions Eosinophilic enteritis is a rare condition, unusually seen or managed by surgeons. An awareness of this diagnosis and group of conditions is useful in the acute surgical setting as another differential for a common presentation. In our presented case, multidisciplinary management resulted in a swift diagnosis and favourable outcome for this patient.

scholarly journals A Case Report of Aggressive Angiomyxoma in Pregnancy: Do Hormones Play a Role?

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Theofano Orfanelli ◽  
Chi-Son Kim ◽  
Sally F. Vitez ◽  
James Van Gurp ◽  
Neeti Misra
Keyword(s):  
Case Report ◽  
Case Reports ◽  
Rare Condition ◽  
Final Diagnosis ◽  
Reproductive Age ◽  
Aggressive Angiomyxoma ◽  
The Right ◽  
Labium Majus ◽  
Growing Mass ◽  
In Pregnancy

Aggressive angiomyxoma is a rare, locally invasive tumor that generally affects the perineum and pelvis of reproductive age females. Aggressive angiomyxoma is often misdiagnosed, resulting in the delay of the treatment. Case reports show increased growth of the tumor during pregnancy, thus suggesting a hormonal dependency. We report this rare condition in a 29-year-old primigravid female with a growing mass on the right labium majus at 20 weeks’ gestation. The patient also developed a smaller mass on the left labium majus at 37 weeks’ gestation. The patient underwent a primary cesarean section with resection of the right labial mass, with a final diagnosis of aggressive angiomyxoma. The lesion on her left labium majus resolved spontaneously postpartum. This case report supports a hormonal involvement in this tumor.

Editorial Volume 16 Issue 4

2017 ◽  
Vol 16 (4) ◽  
pp. 155-155
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Internal Medicine ◽  
Case Reports ◽  
Editorial Team ◽  
Research Committee ◽  
Acute Medicine ◽  
The Future ◽  
New Vision ◽  
The Uk

My time has come. After 15 years and over 50 editions it is time for me to hang up my metaphorical red biro, and hand over the role of Editor. It has been an interesting job, and I am extremely grateful to everyone who has contributed and supported the journal over this period. When I took on the position in 2002, this journal was very different to how it is today. Some readers may recall its original incarnation as the CPD journal of Internal Medicine, part of a series of publications produced at that time by Rila. Initially this was comprised predominantly of commissioned review articles, running over a 5 year cycle which was designed to cover the common conditions managed by ‘general’ physicians. As time progressed, the number of unsolicited submissions grew steadily – initially (and continually) dominated by case reports, but with a slowly increasing number of research-based articles as the readership expanded. The quality of these submissions improved further when we finally attained indexing in PubMed, which also attracted more international submissions. I am delighted that the current edition features research papers from the Netherlands and Singapore, both of which have a growing community of Acute Physicians. I remain hopeful that the number of acute medicine-related research submissions from the UK will rise as the speciality grows. The number of high quality abstracts presented at the Society for Acute Medicine (SAM) meetings is indicative of the amount of work that is going on, but it is disappointing that so few of these turn into publications in peerreviewed journals. Acute Physicians are busy people with constant and year-round operational pressures, which may mean that writing up research is continually pushed down the list of priorities. Perhaps also the fact that the number of consultant posts across the continues to exceed the number of Acute Internal Medicine trainees removes some of the ‘pressure to publish’ which is felt by trainees in other hospital specialities. My hopes for the future of this journal have been boosted by the appointment of Tim Cooksley as my replacement ‘Editor in Chief’, who will take over from the Spring 2018 edition onwards. Tim has been a hard working member of the editorial team over recent years, and prior to this was a regular contributor to the journal. He has a strong research background and is a leading member of the SAMBA academy and SAM research committee. I would also like to thank the other members of the editorial board without whose support and contributions this job would have been completely untenable. I understand that Tim plans to keep many of these colleagues in post, as well as bringing in some ‘new blood’ to create a fresh new vision for the future. I wish them all well, and will look forward to reading (as opposed to writing) these editorials. Thanks, finally, to all of the loyal readers who have stuck with the journal over the past 2 decades. I hope that we have managed to keep you entertained and educated on those occasional moments of respite during the acute medical on-call. I wish you all well for the future.

Editorial Volume 1 Issue 2

2002 ◽  
Vol 1 (2) ◽  
Keyword(s):  
Case Reports ◽  
Editorial Team ◽  
Original Research ◽  
Self Assessment ◽  
Acute Medicine ◽  
Questions And Answers ◽  
Medical Emergencies ◽  
Near Future

When I was invited to take over as Editor of this journal, I had little idea of the amount of work which went into its production. I am indebted to Paul Jenkins for staying on in the role of sub-editor, and for helping me up a very steep learning curve over the past few months. I am certain that regular readers will wish to join me in thanking Paul and his editorial team for all their hard work during the last three years. The new editorial board has been expanded to include physicians with a broad range of specialty interests. We will be making use of their expertise and their contacts within their fields to commission reviews on a range of topics relevant to Physicians involved in the Acute Medical take. The intention is to cover all of the common (and some less common) conditions presenting as medical emergencies over a four yearly cycle. Ultimately this will mean that regular subscribers will have access to a comprehensive ‘textbook’ of acute medicine, with ongoing regular updates. The cycle schedule has already been determined, and a provisional plan is listed on page 71. The second section of the journal will include some new features. Some of these will be commissioned, but we would also like to encourage submissions from the readership. Case reports of a ‘General Medical’ nature, pieces of original research and audits relevant to Acute Medicine would be most welcome for this section. ‘Viewpoint’ is intended as a soapbox for anyone with a strong opinion which they would like to air in around 1000 words. This edition contains reviews of the management of suspected pulmonary embolism, diabetic ketoacidosis, anaphylaxis and cellulitis, all relatively common presentations on an Acute Medical take. In addition, we have a detailed review of the management of severe asthma, written from an intensivist’s perspective. This should provide an insight into the management of this complex group of patients, for those of you who are unfamiliar with what goes on beyond the ITU doors. Our ‘How to do it’ feature for this edition is an ophthalmologists’ view of fundoscopy, and some key abnormalities of the optic disc. Self assessment questions and answers are included at the back of this edition. Unfortunately, external CPD credits cannot currently be accrued by completion of these, although we hope to remedy this in the near future. I am sure this will not detract from the enjoyment of reading the journal, which I hope you find as educational an experience as I have had in editing it.

Editorial

2010 ◽  
Vol 9 (1) ◽  
pp. 2-2
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Case Reports ◽  
Correct Diagnosis ◽  
Favourable Outcome ◽  
Original Research ◽  
Free Text ◽  
High Stakes ◽  
Acute Medicine ◽  
Acute Medical Unit ◽  
Area Of Interest

The nature of Acute Medicine requires physicians to make ‘high stakes’ decisions on a regular basis. The constant pressure to create space within a busy Acute Medical Unit needs to be weighed up against the dangers of missing serious pathology due to a premature discharge. A visit to the Coroner’s court or the fear of litigation may make us more cautious, but even the most cautious physician will ‘get it wrong’ on occasions. Case reports submitted to this journal frequently highlight these dangers; rare or serious pathology masquerading as a common or benign illness, followed by an unexpected deterioration, is a regular theme. Early Warning Scores have helped to improve safety for those patients who remain in hospital – Katherine Rowe’s article on p8 discusses the value of Critical Care Outreach in supporting this process. However neither of these innovations is of use for those patients discharged home. The ability to provide early AMU-based follow-up clinics is an important element in reducing risk for this group. The case report on p24 from the team at Hutt Valley Hospital in New Zealand illustrates the value of early reassessment following discharge. In this case the diagnosis of lead poisoning was not considered as a cause for the patient’s myalgia at the time of admission – an understandable ‘miss’, given the apparent chest x-ray abnormality. However, early outpatient CT with follow-up enabled revisitation of the history and the correct diagnosis was made – with a favourable outcome. As finances become stretched over the coming months there will be pressure to reduce hospital follow-up visits. However any drive from Primary Care Trusts to reduce AMU follow-up clinics as a cost-saving measure needs to be resisted if we are to optimise the safety and efficiency of our service. On a different note, I am grateful to those of you who completed the on-line journal survey which was circulated to Society for Acute Medicine members earlier this year. I will aim to include a summary of the results in the next edition. The free-text sections have generated a number of interesting ideas, which we will try to incorporate into future editions on the journal. Many respondents indicated that they would like to see inclusion of more original research; however we remain dependent on submissions we receive, which explains the predominance of case reports in this, and previous, editions. The content of the journal can only be as good as the material we receive, so please keep the submissions coming, particularly AMU-based research projects and completed audits. I am also keen to expand the pool of expert referees for future articles. If any readers would like to contribute to this process, I would be grateful if you could contact me directly at the email address shown on this page, indicating your particular area of interest or expertise.

scholarly journals Delayed diagnosis of postcardiac injury syndrome

2019 ◽  
Vol 12 (2) ◽  
pp. bcr-2018-228877 ◽  
Author(s):  
Mitsushige Nishimura ◽  
Naho Goda ◽  
Keiko Hatazawa ◽  
Kazuhiko Sakaguchi
Keyword(s):  
Differential Diagnosis ◽  
Pleural Effusion ◽  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Case Reports ◽  
Delayed Diagnosis ◽  
Rare Condition ◽  
Final Diagnosis ◽  
Delay In Diagnosis ◽  
Autoimmune Mechanism

Postcardiac injury syndrome (PCIS) is a rare condition that is considered to have a trauma-induced autoimmune mechanism triggered by damage to pericardial and/or pleural tissues. We report a case of PCIS accompanied by systemic oedema after thymectomy. A 73-year-old woman was referred to our hospital for dyspnoea and oedema, 9 months after thymectomy. Evaluation revealed the presence of pericardial effusion, pleural effusion and systemic oedema. Differential diagnosis included constrictive pericarditis (secondary to tuberculosis), serositis caused by collagen disease and malignancy. Detailed investigations led to the diagnosis of PCIS, which was successfully treated with prednisolone. This report focuses on the diagnostic approach to PCIS. Since it took time to make a final diagnosis in our patient, we analysed several past case reports and series to determine the cause of the delay in diagnosis.

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