Gerbode's defect resulting from infective endocarditis.

We present a report of a Gerbode's defect (left ventricular-right atrial communication) resulting from bacterial endocarditis in a 63-year-old man. Also presented is a brief overview of the literature and a possible preoperative echocardiographic diagnostic criterion relating to this unusual condition.     

Pulmonary oedema--prehospital treatment. Caution with morphine dosage.

OBJECTIVE: To inform doctors of potential hazards if opioids are administered in excessive doses to patients with acute pulmonary oedema. CLINICAL FEATURES: Three elderly patients were unresponsive and hypotensive on arrival in the emergency department. All had received morphine parenterally as a component of prehospital treatment for acute pulmonary oedema. INTERVENTIONS AND OUTCOME: All were given naloxone intravenously, regained consciousness and had a rise in blood pressure. CONCLUSION: Parenteral administration of opioids should be used with caution in acute pulmonary oedema. The authors present a protocol for prehospital drug therapy.     

Avulsion fractures of the tibial tuberosity in the adolescent athlete. Risk factors, mechanism of injury, and treatment

Based on a review of the literature and our study of six cases, we investigated avulsion fractures of the tibial tuberosity in the athletic adolescent. A study of the mechanism of this acute injury helps to explain the different types of avulsion fractures of the tibial tuberosity. An understanding of predisposing factors and the biomechanical conditions leading to this injury may help identify those young athletes at the highest risk and may help the surgeon determine the most effective treatment for such a fracture. No complications were experienced by the patients in our study. Displaced fractures underwent open reduction and fixation with screws. This method shortens the period during which athletic activities are restricted.     

Some issues in the assessment of clinical practice: a review of the literature

? This paper focuses on some issues in the assessment of clinical practice of particular interest to the author. ? The assessment of students of nursing in clinical practice is acknowledged as a long-standing and difficult problem. ? There is little consensus as to what is meant by the term competence when applied to clinical nursing practice, making the assessment of clinical practice a mainly subjective process. ? The English National Board (1989) has distinguished the term mentor as meaning counsellor and guide, nevertheless the roles of mentor and assessor are frequently confused. ? It is suggested that nurses are equally accountable for the accurate assessment of student nurses' clinical skills as they are for their own practice. ? The validity and reliability of tools used to assess clinical practice are difficult to establish, making objective assessment complex at best, and impossible at worst. ? The assessment of the reflective process has been suggested as one way out of the dilemma, but the ability to think and to write does not necessarily translate into competent clinical practice.     

Herpes simplex encephalitis in third trimester of pregnancy: successful outcome for mother and child

A woman with herpes simplex encephalitis (HSE) in the third trimester of pregnancy is described. She was treated with acyclovir and recovered completely to deliver a normal child per vaginam at term. She had no evidence of genital or disseminated herpes virus infection. This paper illustrates that (1) the outcome of HSE in pregnancy can be favorable both for the mother and the offspring, (2) early diagnosis and use of acyclovir therapy is essential for successful outcome, and (3) the use of acyclovir in the third trimester of pregnancy was not harmful to the mother or fetus.