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Fine-needle aspiration biopsy (FNAB) of the thyroid is generally a well-tolerated procedure associated with weak levels of pain. However, pain may be very intense in some patients. The cause for the pain in these patients has not been identified. The hypothesis of this study is that there is a likely relationship between pain level and nodule depth during FNAB. Included in the study were 98 patients with euthyroid nodular goiter who underwent FNAB. When ultrasound guided thyroid fine-needle aspiration biopsy was performed findings such as the distance of the nodule to the skin, the size of the nodule, visual analogue scale (VAS) score values were recorded. The distance of nodule to skin and nodule size was measured, respectively, as 10.7 ± 2.8 mm and 21.7 ± 8.6 mm. Mean VAS score was 36 ± 16. FNAB-related pain was correlated with the nodule depth (r = 0.43, p < 0.001). In the logistic regression analysis, we also found that high VAS score class was effected by only nodule depth (B = −1.619; OR 1.287; CI 1.057–1.565, p < 0.05). Our results show that pain increased significantly during FNAB in patients who had more deeply situated nodules. Local anesthetic methods may be recommended for these patients.

Venous thromboembolism (VTE) is a common complication of hospital admission. The incidence of hospital-acquired deep vein thrombosis is approximately 10–40 % amongst medical and general surgical patients without prophylaxis. Pulmonary embolism accounts for 5–10 % of deaths in hospitalised patients, making hospital-acquired VTE the most common preventable cause of in-hospital death. Studies suggest that prophylactic measures are widely under- and inappropriately used. We hypothesised that the introduction of a medication chart with a dedicated VTE prophylaxis section would improve compliance with local guidelines. Trial medication charts were piloted over a 4-week period in one surgical and two medical wards. Data on compliance with hospital guidelines were collected before and after introduction using a detailed chart review. The difference in prescribing compliance was assessed with the Chi-squared test. 70 patients were assessed before and 38 after the introduction of the new charts. Initially, only 58.6 % (n = 41) of patients’ prescriptions were in compliance with local guidelines. In 28.6 % (n = 20) of patients, VTE prophylaxis was needed and not prescribed. 7.1 % (n = 5) of patients were prescribed an inappropriately low dose of low molecular weight heparin (LMWH) prophylaxis. 2.9 % (n = 2) of patients were prescribed inappropriately high dose of LMWH prophylaxis. After introduction of the new medication chart, compliance with guidelines rose to 71 % (n = 27, p = 0.09). Compliance with VTE guidelines is inadequate. Medication charts with specific sections on VTE assessment and prophylaxis may increase compliance with guidelines.

(1) Those geometrical factors which determine the effect upon a bone of successive movements at a joint are considered. (2) The following terms are defined:—Cardinal movements, circumductions, conjunct and adjunct rotations, diadochal movements, loxodromic movements. (3) These terms are necessary for a discussion of the practical mechanics of the joints. (4) They are illustrated by experiments upon the shoulder joint.

Chronic mesenteric angina is a rare condition with high morbidity and mortality, which occurs due to stenosis or occlusion in the mesenteric vessels commonly due to atherosclerosis. Typically, patients present with worsening postprandial abdominal pain, chronic weight loss and fear of food. The condition can be treated by surgical bypass, but also by percutaneous transluminal angioplasty and stenting of the affected mesenteric arteries. To assess the mid-term outcomes in patients treated by endovascular stenting for chronic mesenteric ischaemia (CMI). Six patients were treated for symptomatic CMI. In total, six severely stenosed vessels were stented including the superior mesenteric artery (n = 5) and coeliac artery (n = 1). A retrospective review of these patients was performed with end points including symptom recurrence, major morbidity and mortality. The mean follow-up was 16.5 months (range 5–28 months). Initial clinical success was observed in all six patients. Four patients were clinically asymptomatic, but died within 18 months after the procedure from other conditions. One patient suffered from recurrence of symptoms. Only one patient died as a consequence of mesenteric artery re-stenosis. Stenting of mesenteric vessels has shown excellent early and mid-term clinical success in selected patients. Though no direct comparison with open revascularization surgery was performed in this case series, technical and mid-term clinical success is promising.