http://pmj.bmj.com Postgraduate Medical Journal RSS feed -- recent Reviews articles Postgraduate Medical Journal 0032-5473 http://pmj.bmj.com/site/homepage/PMJ_95x60.gif http://pmj.bmj.com http://pmj.bmj.com/cgi/content/short/89/1052/340?rss=1 Meningococcal sepsis and purpura fulminans is a rare but highly lethal disease process that requires a multidisciplinary team of experts to optimise morbidity and mortality outcomes due to the breadth of complications of the disease. The surgical perspective involves the critical care management which utilises all currently available measured outcomes of critical care management as well as experimental therapies. Limb loss is common, and is reflective of the high incidence of compartment syndrome compounded by the significant soft tissue loss secondary to purpura and limb ischaemia, presumptively due to digital microemboli. A multidisciplinary approach involving current standards in critical care and early surgical evaluation are important in improving patient outcomes and limb salvage.

]]> 2013-05-17T01:04:30-07:00 info:doi/10.1136/postgradmedj-2012-130989 hwp:master-id:postgradmedj;postgradmedj-2012-130989 The Fellowship of Postgraduate Medicine 2013-06-01 Reviews 89 1052 340 345 http://pmj.bmj.com/cgi/content/short/89/1052/346?rss=1 Atrial fibrillation, the commonest cardiac arrhythmia, predisposes to thrombus formation and consequently increases risk of ischaemic stroke. Recent years have seen approval of a number of novel oral anticoagulants. Nevertheless, warfarin and aspirin remain the mainstays of therapy. It is widely appreciated that both these agents increase the likelihood of bleeding: there is a popular conception that this risk is greater with warfarin. In fact, well-managed warfarin therapy (INR 2-3) has little effect on bleeding risk and is twice as effective as aspirin at preventing stroke. Patients with atrial fibrillation and a further risk factor for stroke (CHA2DS2-VASc >0) should therefore either receive warfarin or a novel oral agent. The remainder who are at the very lowest risk of stroke are better not prescribed antithrombotic therapy. For stroke prevention in atrial fibrillation; aspirin is rarely the right choice.

]]> 2013-05-17T01:04:30-07:00 info:doi/10.1136/postgradmedj-2012-131386 hwp:master-id:postgradmedj;postgradmedj-2012-131386 The Fellowship of Postgraduate Medicine 2013-06-01 Reviews 89 1052 346 351