Journal of General Practice

Traumatic diaphragmatic injuries are associated with delayed diagnosis and consequential morbidity and mortality, due to concomitant injuries of proximal organs overshadowing visibility of the diaphragm as well as the difficulty of the various available modalities to diagnose diaphragmatic injury. The presented case involved a penetrating computed tomography-detected diaphragmatic injury, repaired via abdominal laparoscopy/open technique.

Introduction: Graduated compression stockings (GCS) are used for mechanical prophylaxis for VTE. The aim of our study was to compare the incidence of VTE with and without the use of compression stockings after total hip and knee arthroplasty.
Methods: Data was collected retrospectively over 18 month’s duration, and included all consecutive primary total hip and knee replacements. Patients were divided into 2 groups; group І (patients in whom GCS were used) and group ІІ (patients in whom GCS were not used). Data was analyzed by excluding as well as including the patients with previous history of VTE.
Results: 1875 patients underwent total hip and knee replacements, excluding the patients with previous history of VTE. Group І consisted of 982 patients (52.3%) and group ІІ consisted of 893 patients (47.7%). In total, 23 patients (1.22%) had a VTE diagnosed postoperatively (DVT: 8, PE: 15). In group І, 11 patients (1.12%) suffered from VTE (DVT: 4, PE: 7). In group ІІ, 12 patients (1.34%) had VTE (DVT: 4, PE: 8). Including the patients with previous VTE; in total, 2020 patients underwent hip and knee arthroplasty. Group I comprised of 1040 patients with 14 patients (1.34%) diagnosed with VTE (DVT: 5, PE: 9). Group II comprised of 984 patients with15 patients (1.52%) diagnosed with VTE (DVT: 5, PE: 10).
Conclusion: We did not find any obvious benefit of compression stockings in the prevention of VTE after primary total hip and knee arthroplasty in the presence of enoxaparin prophylaxis.

Different etiologic agents or diseases may cause similar types of skin eruption or a specific disease may present with different types of skin eruptions. Because of a wide spectrum of causes of generalized skin eruption, differential diagnosis poses a challenge to physicians. Viral infections more often cause symmetrical rashes widely distributed all over the body which are self-limited and usually last up to one week. Most common causes of maculopapular rashes are viral exanthems and drug reactions in children and in adults, respectively. Measles seems to be controlled in industrial countries with the strict vaccination; it is still endemic/epidemic in developing countries. Measles is re- emerged in some countries where measles was controlled before for the reason of uncontrolled migration, fighting, poverty, infrastructure in health service. In this paper, we aimed to review clinical approach to skin eruption and measles briefly.

Breast cancer metastasis to the conus medullaris is very rare. We report a case of intra-axial conus medullaris metastasis from breast adenocarcinoma in a 39-year-old woman. Two years after the diagnosis of brain metastasis was biopsy-proven, she developed progressive lower limb weakness with urinary incontinence for one month. MRI revealed a contrast-enhancing intramedullary lesion at the conus medullaris. Laminectomy and removal of the tumor were performed for decompression and for preserving function. Postoperative histopathological examinations confirmed the metastatic nature of the lesion. We discuss the possibility of drop metastasis traveling from the brain to the conus medullaris via cerebrospinal fluid (CSF) in the central canal. Since intramedullary spinal cord metastasis can lead to rapid progressive neurological deficits and poor outcome, early diagnosis and decompression could preserve the quality of life. We suggest that CSF cytology could be helpful for the diagnosis of intraspinal metastasis in patients with brain metastasis.

We report a 22 year old male presenting to the emergency department with a symptomatic wide complex tachycardia. We discuss the algorithms to determine the origin of the tachycardia, and we analyzed in detail his 12- lead ECG in sinus rhythm. Most frequent ECG patterns in repaired tetralogy of Fallot are also discussed.

The world is slowly moving to an E-Health environment. Computers are becoming an essential part of how health is delivered, just as they are a part of all other aspects of life. Yet the adoption of computers is patchy. In some jurisdictions it is the hospital sector that is highly computerized, and in others it is primary care. This paper examines the adoption of computers in general practice in Australia, and provides a theoretical explanation for the reasons general practices adopted computers, while hospitals did not. The application of Complex Adaptive Systems not only explains the computerization, but provides lessons for others in promoting computers in the health sector.

Background presenting lung age data to smokers who were invited for a formal spirometry has been shown to increase quit rate at 12 months. Main Objective Here, we evaluate the effect of informing active smokers of their lung age using a portable Vitalograph during routine GP consultations on smoking cessation intentions and quit behavior. Methods Four hundred and two active smokers from 5 General Practices had their smoking behaviors and stages on Prochaska’s wheel of change (WOC) evaluated before consultation. Patients randomized to the control arm received standardized smoking cessation advice during routine consultations. Patients in the intervention arm received, in addition, lung age information derived from a portable Vitalograph. Self-reported quit rates and progression on the WOC were assessed at 4 weeks post-intervention. Results Quit rates at 4 weeks in the control and intervention arms respectively were 12.0% and 22.1% (difference 10.1%, p=0.01, 95% CI 1.5% to 18.7%; number needed to treat 10). Net positive progression on the WOC in the control and intervention arms respectively were 7.3% and 29.1% (difference 21.8%, p=0.02, 95% CI 13.2% to 30.4%; number needed to treat 4.6). Smokers with poorer lung age values were just as likely to quit as those with normal lung ages. Smokers in the intervention group were more likely to request pharmacotherapy to support quitting (p<0.0001). Conclusion When promoting smoking cessation during clinical consultations, providing ‘lung age’ biofeedback to patients using a Vitalograph is a clinically effective intervention to foster quitting and positive intentions towards quitting.