Mansfield Community Hospital

Cannabinoid hyperemesis syndrome (CHS) is a condition in which users of marijuana experience symptoms of nausea and vomiting. Due to the nature of the condition, patients may ultimately be admitted to the hospital for complications such as weakness and fluid loss. The usual treatment options for nausea and vomiting include fluids and a combination of metoclopramide, ondansetron, promethazine, or prochlorperazine. We present a case where fosaprepitant was utilized for intractable nausea and vomiting when other treatment modalities failed for CHS.

An optical telescope uses either a mirror or a lens to collect light. The light is then brought to a focus and magnified by an eyepiece. An antenna in some respects can be likened to an optical telescopes lens or mirror, as the antenna collects the radio signals and brings them to a focus at the dipole of the antenna. This signal is then passed along the feed cable to a receiver and amplified.

Objective: To assess the feasibility of conducting a randomised controlled trial of a home-based virtual reality system for rehabilitation of the arm following stroke. Design: Two group feasibility randomised controlled trial of intervention versus usual care. Setting: Patients’ homes. Participants: Patients aged 18 or over, with residual arm dysfunction following stroke and no longer receiving any other intensive rehabilitation. Interventions: Eight weeks’ use of a low cost home-based virtual reality system employing infra-red capture to translate the position of the hand into game play or usual care. Main measures: The primary objective was to collect information on the feasibility of a trial, including recruitment, collection of outcome measures and staff support required. Patients were assessed at three time points using the Wolf Motor Function Test, Nine-Hole Peg Test, Motor Activity Log and Nottingham Extended Activities of Daily Living. Results: Over 15 months only 47 people were referred to the team. Twenty seven were randomised and 18 (67%) of those completed final outcome measures. Sample size calculation based on data from the Wolf Motor Function Test indicated a requirement for 38 per group. There was a significantly greater change from baseline in the intervention group on midpoint Wolf Grip strength and two subscales of the final Motor Activity Log. Training in the use of the equipment took a median of 230 minutes per patient. Conclusions: To achieve the required sample size, a definitive home-based trial would require additional strategies to boost recruitment rates and adequate resources for patient support.

The “Interactive NASA Space Physics Ionosphere Radio Experiments” project, or INSPIRE for short, was created in the early 1990s. An experiment was carried out using an orbiting space shuttle to transmit VLF signals towards the Earth, in order to see if these signals could negotiate the Earth’s atmosphere, and more importantly the ionosphere, to determine if the signal could be detected from the Earth’s surface. NASA distributed a large number of INSPIRE receivers to schools all over the United States. This was done to cover a large area in order to give the experiment the best chance of success, and this was the start of the INSPIRE project.

A total of 4000 consecutive cholecystectomies performed over a period of 25 years has been analysed to determine whether routine peroperative cholangiography (PC) has influenced overall mortality. The patients have been divided into four cohorts of 1000, the first cohort before the introduction of PC, two covering the period of introduction of PC and the final cohort when PC was an established routine. A significant fall in overall mortality has been demonstrated, but when the patients are divided into simple cholecystectomy and the group undergoing additional choledochotomy there is no significant fall in the mortality rate. The mortality rate for the latter group is three or four times greater than that for the cholecystectomy alone group. The main contribution to the lower mortality is the reduced duct exploration rate following the introduction of PC. The stone recovery rate has improved from 34 to 71 per cent. The use of routine PC during cholecystectomy is recommended.

Apomorphine is a dopamine agonist administered subcutaneously for the management of motor symptoms of Parkinson's disease (PD). Patients with Parkinsonian syndrome underwent an apomorphine challenge for therapeutic efficacy, a positive response being a reduction of > 15% score on motor unified PD rating scale. Of the 42 patients, aged 37-81, disease duration 12 months to 20 years, 36 had a positive response. Six non-responders were later diagnosed as non-PD as compared with only two of the 36 responders. Tremor-predominant patients obtained higher motor response. Few patients demonstrated a delayed positive response. Seven (three idiopathic PD (iPD), four non-PD) suffered adverse reactions of nausea, vomiting or ill-sustained symptomatic fall in BP. Majority of the patients who continued with apomorphine therapy were able to reduce levodopa and achieved an improvement in dyskinesia and motor symptoms. Thirteen responding patients were managed by increasing dopamine agonists. Five patients, intolerant of oral dopamine agonists, were able to beneficially tolerate apomorphine. Age and disease duration did not influence tolerability or efficacy. The patients treated with apomorphine were able to significantly reduce the dose of levodopa, and there was a reduction in dyskinesia, hallucinations and fluctuations (all p < 0.05). In some patients, apomorphine prevented admission to institutions. We also describe the use of apomorphine in acutely ill patients unable to ingest oral medication. Apomorphine seems to have a diagnostic element for iPD. Its use leads to a reduction in dyskinesia, improvement in motor symptoms and prevention of institutional care. Apomorphine test also identifies patients likely to benefit with an increase in oral medication. Age and disease duration should not prevent the use of this valuable drug. Apomorphine also has a role in acutely ill PD patients.

International Journal of Clinical PracticeVolume 56, Issue 6 p. 414-415 Editorial Cholinesterase inhibitors in Alzheimer's disease: donepezil or rivastigmine? JC Sharma FRCP, JC Sharma FRCP Mansfield Community Hospital, Mansfield, NottsSearch for more papers by this author JC Sharma FRCP, JC Sharma FRCP Mansfield Community Hospital, Mansfield, NottsSearch for more papers by this author First published: 01 July 2002 https://doi.org/10.1111/j.1742-1241.2002.tb11289.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume56, Issue6July‐August 2002Pages 414-415 RelatedInformation