Posterior nutcracker phenomenon.

Case A 26-year-old woman was referred to us because of her hypertensionand microscopic haematuria. Her past medical and family historieswere unremarkable and the physical examination was not contributory.The urinary analysis revealed numerous red blood cells withoutdysmorphic changes. The laboratory tests revealed haemoglobin13.6 g/dl, haematocrit 39%, white blood cell count 4300/mm³,blood urea nitrogen 16     

Massive haemorrhage in pregnancy

The first 150 words of the full text of this article appear below. Key points Massive haemorrhage remains a significant causeof maternal mortality and morbidity. Clear and timely communicationbetween surgical, anaesthetic and haematology services is vitalto ensure optimal maternal and fetal outcome. Signs of hypovolaemiaoccur relatively late because of physiological changes in pregnancy. Theextent of intravascular volume deficit is not reflected by visualestimates of vaginal bleeding. The decision to perform a hysterectomyshould be made when other methods of haemostasis have failedand not delayed until control of maternal haemostasis and cardiovascularstability has been lost.   Massive haemorrhage is a major cause of maternal mortality.Life-threatening haemorrhage may occur as frequently as 6.7per 1000 deliveries.¹ This equates to 1400 cases yr ^–1in the UK or 33.5 yr ^–1 in an obstetric unit with 5000deliveries annually. Pregnancy-related conditions and complicationsaccount for 0.8% of intensive care admissions; 35% of thesearise from massive haemorrhage.^{1 2} Management of massive . . . [Full Text of this Article]

Atrial fibrillation

The first 150 words of the full text of this article appear below. Key points

• Atrial fibrillation (AF) is the commonest cardiacarrhythmia; its incidence increases with age.
• Diabetes mellitus,hypertension and ventricular hypertrophy are commonly associatedwith non-valvular atrial fibrillation.
• Primary aims of managementof AF are conversion to sinus rhythm, maintenance of sinus rhythmand prevention of thromboembolic complications.
• In elderlypatients who are asymptomatic, adequate rate control of AF appearsto offer the same benefits as rhythm control.
• Chronic AF carriesa high risk of ischaemic stroke from thromboembolism; all patientsat risk must receive adequate anticoagulation.
• Anticoagulationshould be continued in patients with risk factors despite successfulconversion to sinus rhythm.

  Atrial fibrillation (AF) is the commonest cardiac arrhythmia.The incidence increases with age and affects 5% of UK populationabove the age of 65 yr and 10% above 75 yr.^{1 2} In the UnitedStates, AF accounts for more than 35% of all admissions forcardiac arrhythmias.³ Men are . . . [Full Text of this Article]

Anaesthesia and adrenocortical disease

The first 150 words of the full text of this article appear below. Key points Adrenocortical disease results in disturbances ofbody water volume and electrolyte concentrations; intra-cellularelectrolyte defects may be severe. Preoperative assessmentis of crucial importance in identifying the endocrine diseaseprocess and the severity of its effects. Preoperative preparationinvolves correction of volume deficit and electrolyte disturbances,and replacement of deficient hormones. Cardiovascular disturbanceand instability are particularly common and invasive cardiovascularmonitoring should be considered. Postoperative mineralocorticoidand glucocorticoid supplementation should be considered in Addison'sdisease and in steroid-induced hypoadrenalism.  

Carbon dioxide transport

The first 150 words of the full text of this article appear below. Key points Carbon dioxide is transported in the blood in threeways: (i) dissolved in solution; (ii) buffered with water ascarbonic acid; (iii) bound to proteins, particularly haemoglobin. Ata haemoglobin concentration of 15 g dl^–1, mixed venous

Bedside stereomicroscopy of renal biopsies may lead to a rapid diagnosis of Fabry's disease.

Case A 43-year-old female Fabry patient presented with asymptomaticslight albuminuria (0.043 g/l), normal glomerular filtrationrate (120 ml/min/1.73 m²) and normal echocardiography. In youngerage she had complained of typical burning pains in her extremities.A renal biopsy was done in     

Alcohol and anaesthesia

The first 150 words of the full text of this article appear below. Key points

Consumption of alcohol is widespread in British societyand a common co-factor in emergency hospital admissions.

Morbidityassociated with chronic alcohol abuse appears to be increasingand affecting younger patients.

Anaesthetists must considerthe acute and chronic effects of alcohol at all stages of thepatient pathway.

Alcohol withdrawal is a potentially life-threateningcomplication that must be diagnosed and actively managed.

Anaesthetistsare as susceptible to alcohol-related disease as others in thesame socio-economic group.

  Two-thirds of adults in England drink alcohol on a weekly basis,and 30% drink more than the recommended daily level.¹ Amongchildren, 46% of 15 yr olds and 3% of 11 yr olds admit to drinkingperiodically.² Alcohol misuse is estimated to cost the NHS £3 billionper year. Alcohol-related disease was the primary or secondarydiagnosis for over 180 000 NHS hospital admissions in 2004/2005.³This includes a doubling in the number . . . [Full Text of this Article]