The prognosis of patients with end stage cardiac failure is poor. It can be improved by medical treatment, for example by adding vasodilators' or angiotensin converting enzyme inhibitors2 to diuretic treatment. None the less, the survival rate at 12 months in a group treated with enalapril was only 53%.2 At Papworth Hospital the cumulative survival rate for patients treated with "triple" immuno...

Patients should be considered for liver transplantation if they have evidence of fulminant hepatic failure, a life-threatening systemic complication of liver disease, or a liver-based metabolic defect or, more commonly, cirrhosis with complications such as hepatic encephalopathy, ascites, hepatocellular carcinoma, hepatorenal syndrome, or bleeding caused by portal hypertension. While the compli...

I PRoPose to consider this subject especially from the ,point of view of country practice. It is one of those questions which is most prominent at the present time, for the all-sufficient reason that upon it turns in many cases the life or death of the patient. If any one should ask why such cases come now so frequently into question, I have no doubt as to the answer-it is simply this, that in ...

Epilepsy is the fourth most common disorder that affects the nervous system, with only migraine, cerebrovascular incidents and Alzheimer’s disease being more common. Epilepsy affects ~50 million people worldwide.[1] In Africa, epilepsy affects ~10 million people.[2] Global statistics show that about one-third of patients with epilepsy are refractory to anti-epileptic medication.[3] This transla...

Having just completed the writing of a history of the first 50 years of the Nuffield Provincial Hospitals Trust, I was interested in Dr Stephen Frankel's stimulating editorial in your December issue, especially so since it also has some relevance to the recent correspondence in the J7ournal of Public Health Medicine about health service research. My interest is because until the advent of the H...

ERCP was first introduced as a realistic endoscopic procedure in the early 1970s. Since then, the diagnostic and therapeutic clinical applications have changed significantly in parallel with improvements in noninvasive and invasive visualization of the biliary and pancreatic ductal systems. What was once predominantly a combined diagnostic endoscopic and radiographic modality, ERCP has taken on...

A neuropsychological evaluation can help in narrowing the differential diagnosis of cognitive dysfunction, choosing treatments, and evaluating the efficacy of an intervention on an ongoing basis. In patients with documented neurologic disorders, information from neuropsychological assessment can define the patient's functional limitations or residual cognitive strengths. Proper use of neuropsyc...

Corticosteroid therapy is of great value in many types of eye disease. The indications are briefly discussed, together with the choice of agent and mode of administration. The dangers of steroids are now widely recognized, and the complications are discussed, particularly cataract and glaucoma. Reference is also made to optic neuritis and thyroid ophthalmopathy, where the role of steroids is un...

Reconstruction and arthrodesis play a dominant role in the surgical treatment of various disorders of the hindfoot. Subtalar joint (STJ) arthrodesis has accomplished favorable results in the treatment of various disorders such as primary and secondary osteoarthritis, rheumatoid arthritis, neuromuscular disorders, congenital deformity, and adult hindfoot pathology. Likewise, STJ fusion provides ...

I n current obstetric practice episiotomy is generally taken to refer to an incision of the perineum and vagina to facilitate vaginal delivery. While the most precise definition of this incision is perineotomy, episiotomy is the generally employed terminology and thus is used in this article. The evolutionary background and historical perspective of this procedure have been reviewed extensively...