Author Archives: Ramon.KGS

What To Do In An Emergency

To a person with a reasonable knowledge of the simple basics of first aid, there is usually a clear-cut course to follow. There is no need to panic. This helps nobody, least of all the victim. Here in this section you will find the basic needs that may help in coping with the general run-of-the-mill accidents that commonly occur. It is not a complete manual, but it should serve as a guide in emergencies. However, this does not replace first aid training.

Read it through and get to know the requirements of how to act in an emergency. Who knows, but the next time it is needed you may be able to save someone very close to you – one of your children, relatives or friends. First aid knowledge will never go amiss, even if you use it only a few times in your lifetime. If it saves one life or more, then it will have been all worthwhile. It is possible to take courses in first aid in most countries.

To start this section, a few of the essential ingredients of first aid care will be outlined. It is not an exhaustive list, but covers the more important and more pressing needs.

Remain Calm

It is essential that the person offering first aid remain calm throughout the entire procedure. In major accidents, fear will no doubt strike the heart of any amateur not regularly geared for the unpleasant sights that may occur. Seeing humans in pain and distress is never easy, and a sense of empathy is inevitable. However, do not be overcome with anxiety, for this will reduce your efficiency. It is preferable for the adrenaline produced by your system to convert you into a more efficient unit. When you are calm, you can think clearly, act with precision, with dignity and authority.

Others will tend to listen to you, and are more likely to be helpful. Most important, your patient will appreciate kind, authoritative words, filled with good cheer, confidence and hope. Do not tell stories about the last person you saw with similar injuries who died two days later. Right now the patient wants good cheer, hope, confidence, life, more than anything else. Use this to its full effect, no matter how you might feel, and how poor the outlook appears. It is a major factor, and is repeated often in the following headings of guidance.

Breathing and Heartbeat When attending a person who has sustained an injury, or some type of medical emergency, there are several steps to follow. These may be summarised as follows:

1. First, make sure that both you and your patient are in a safe position. This is especially true of roadside accidents, where passing traffic may cause further serious injury to you both. Or with electrical emergencies, make certain that the power has been turned off, so that further danger cannot occur.

2. It is essential to check the patient’s level of consciousness.

3. Next, check that the airways are open and clear. When this has been done,

4. Check for breathing, and

5. Check the pulse in the neck (the carotid artery pulse). This may be felt by the fingers just below the jawbone on the side of the throat.

If the patient is not breathing automatically, it is necessary to take steps to force air into the lung system. This is called expired air resuscitation, or EAR for short. It used to be called mouth-to mouth breathing or resuscitation.

If the heart is not beating, indicated by an absence of the carotid pulse in the neck, it is essential that this be started again. This is carried out by external cardiac compression (ECC for short. formerly known as external cardiac massage). More likely both procedures will be carried out together, and this collectively is called cardiopulmonary resuscitation, or CPR for short. In summary, EAR + ECC = CPR.

It is essential to get the blood flowing again as urgently as possible, for it is well-established that irreversible brain damage may occur after three minutes, although this is a variable time. Sec the section on Resuscitation and learn by heart the methods to be used. The methods have various names, but names are unimportant; the basic steps are what matter. Any first aider must be aware of the system and be able to put it into immediate action at any moment. It is frequently life-sustaining.

These measures must be continued until normal heart and breathing action resume, or the patient is handed over to professional personnel geared with other methods of sustaining life.

Stop Bleeding

Once the heart and lung action have been re-established, the next most pressing emergency action is to check any abnormal bleeding. Blood loss is crucial, and it must be stopped as a matter of urgency The more forceful the loss (and the greater the volume being lost), the more urgent the measure.

If this does not happen, fluids are lost from the body, and very quickly the patient may submerge into various states of shock. This may lead to unconsciousness, and death may quickly result.

Blood loss, irrespective of where it is coming from, must be checked. External loss can usually be stopped or greatly reduced by direct pressure using some form of clean padding. It doesn’t matter what this is during an emergency. Be as sterile in your actions as possible, but stemming the flow comes before sterility with haemorrhaging.

Other Injuries

After these first essentials have been attended to, it is then possible to reassess the patient and attend to other injuries. These may include such features as broken bones (fractures), dislocations, soft tissue injuries such as lacerations, sprains and contusions (bruises). It may affect burns, foreign missiles and any number of items.

If the patient is unconscious, it may be impossible to decide what has happened. In any case, the patient is then best placed in a stable side position (see instructions and pictures), and medical help obtained.

Medical Help

Many accidents need urgent help from doctors and ambulance officers. Do what you can on the spot, and then summon assistance. Ideally, if living in the city or in areas where ambulance services are available, call them urgently, or have an assistant do this.

You will need to state clearly your address. and often the nearest cross-street, for this can help quicker access. State how many are injured and need help, and briefly the nature of the accident. Great details are unnecessary. Simply state: “There has been a motor-car accident and three persons are badly injured and two are unconscious.” That is adequate. Usually the ambulance depot gives you a reference number that is worth remembering in case there is some subsequent delay, or something goes wrong. If this is not available, get the help of a doctor.

If this is not forthcoming, then getting the patient to the emergency ward of a large hospital is the next best thing. The sooner this can be carried out the better. This is particularly difficult with serious accident cases, and unconscious victims or persons with a probable spinal or other serious fractures. However, in an emergency when there is no help available, you can only do your best.

First Aid Kit

Often many minor accidents can be helped a great deal if you happen to own a simple first aid kit. It is wise to have it ready for all occasions, and use it as need be. But after use, make certain you replenish the items used so that once more it will he readily available.

It is worth while having a photocopy of the methods of resuscitation and the stable side position glued to the inside of this kit, and also glued to the inside of your home medicine cabinet. Also, have the emergency phone numbers of likely persons you may need to contact similarly listed in these two places. It can make it so much easier when an emergency arises. How often have you seen people trying to fumble through the small print of the telephone book in an emergency. desperately trying to locate a much-needed number? Often they will miss it many times over because their nervous system is trying just too hard, and they are too overwrought to know what they are seeking. This even applies to such vital services as the ambulance, doctor, police and fire brigade. if these are clearly written in an obvious place, then you will have less worry, and you will be able to act in a more calm, positive and beneficial manner.

Summon Help

Often accidents require the assistance of many persons. Often you will need a neighbour or friends. Often there will be plenty of people around. But even though the crowd rapidly gathers when an accident occurs (especially spectacular events such as fires and road smashes), often there is hardly a soul who will willingly come forward to offer help. Far better to be able to call a friend or neighbour to lend a hand, and ideally someone who also has a little knowledge of first aid.

As a Last Resort

If, as a last resort, even though you are unfamiliar with first aid, and do not know too much about general principles, at least try to remain calm and do your best. Fortunately, commonsense often comes to the rescue, and will suggest to you what to do next. Be guided by your inner directives, and frequently this will help – at least until somebody with some more direction and knowledge turns up. Good wishes and success in your first aiding.

Ideas on How to Set Up Contract for Home Improvement

It is likely that you will want to have some professional help for many home improvement projects. The experts can help you solve design problems, make sure you satisfy the requirements of the building regulations and stop you falling foul of your local government planning committee. They can also organize and manage large scale projects in a way that no home owner with a frill-rime jog could hope to do. Which experts you call in and what you get them to do for you depends on the project concerned.

You are most likely to call on the services of an architect or a building surveyor if you are building a home extension, converting a loft (attic) or carrying out major internal alterations to your house. Apart from that, many jobs around the home, such as replacing tiles on the roof, can be done safely and thoroughly by the home owner. If major repairs or renovation work is needed however, it is always worth obtaining a quote train a contractor before starting the project yourself.

While waiting for government approval, get renders(bids) for the work from contractors, prepare contracts, devise work schedules and supervise work on site. Architects and surveyors will usually charge a percentage of the project cost as their fee.

If you are planning a loft (attic) conversion, a conservatory, replacement windows, or a kitchen or bathroom refit, you can call in firms who specialize in each of these areas. Since each may offer a complete package, from computer aided design to completion, they may be very tempting to employ. However, this area is very much one of ‘buyer beware’. If you decide to use this route, try to find a firm that either comes with a personal recommendation or is prepared to put you in touch with several satisfied customers. Read the contract offered by the firm in detail, querying any unclear terms and, above all, do not part with any money in advance.

Calling in professional help with your home improvements raises a few questions, since you are effectively handing over the work to a third party. You need to keep control over the job to ensure you get the results you want. If you need contractors to carry out the work for you, decide first of all whether you want a main contractor to run the entire project and bring in his or her own specialist subcontractors, rooters, plasterers, plumbers, electricians and so on, for individual parts of the job.

The alternative is to employ those sub-contractors yourself for the parts of the job that are beyond your abilities. As always, the best way of finding contractors and subcontractors is by personal recommendation. If you are employing an architect on your project, he or she may be able to recommend firms in your area.

Other ways of finding contractors include local newspaper advertisements, telephone directories and trade associations, which will send lists of their members working in your area. One last method involves looking round your area for houses where projects similar to yours are being carried out. Knock at the door and ask the owner how the work is going; people cannot resist discussing things if they are going well.

What a home improvement project will cost is of prime importance to every householder. If you are doing the job yourself, make contact with all the relevant local trade suppliers builders and other specialist merchants, plus second hand outlets such as salvage yards, and explain to them what you are doing and what your requirements are. Some projects will be easier to price than others, but suppliers will generally be eager to help you estimate costs if there is an order in it for them.

Don’t forget about hire (rental) shops for the equipment not included in your do-it-yourself toolkit. It is also worth hiring (or even better, buying) heavy duty versions of your existing power tools, which are likely to be burnt out by the sort of use they will get on a major improvement project. If you are employing an architect, he or she will be responsible for obtaining costs for the job. If you are putting the entire job in the hands of builders, they will be responsible for pricing the job and for buying all the materials.

Never employ any contractors on a home-improvement project without a contract, however simple. This will give both parties a clear description of what the job involves and who is responsible for what. Above all, it will give each party the protection of the law if the other breaks its terms. A simple job probably needs no more than a letter of agreement. This should include a description of the work to be done, the price, the agreed starting and finishing dates and details of how payments will be made. On more complex jobs, a contractor’s derailed quotation plus your signature will constitute a valid contract. A builder will save you the trouble of hiring specialist equipment unlikely to be found in many a home owner’s toolkit.

Preparing Garden Soil

The key to any successful gardening is good soil preparation. Inadequate attention to preparation at the outset is difficult to remedy once the plant has put down its roots and become established.

First of all, it is extremely important to clear the soil of perennial weeds. If only one piece of many of these remains, it will soon re-grow and, if the roots become entwined in those of the climber, could become impossible to eradicate. Once the planting area is completely cleared, however, it is not such a difficult task to remove weed seedlings and keep the bed and the plants clear from then on.

Digging is important, too, as it breaks up the soil, allowing moisture and air to enter, both being vital to the well-being of the plant. The process also allows the gardener to keep an eye out for any soil pests. Dig the soil some time before you intend to plant thebe; digging in autumn and planting in early spring, after checking for any emerging weeds, is ideal.

As you dig the soil, incorporate well-rotted organic material. Not only does it provide food for the plants but it also helps to improve the structure of the soil. The fibrous material helps to breakdown the soil to a crumbly consistency, which allows free drainage of excess water and, at the same time, acts as a reservoir to hold sufficient water for the plants without water-logging them.

The final breaking down of the soil with a rake is more for aesthetic appeal than usefulness; the planting area will look more attractive if it has a smooth finish than if it is left rough.

If possible, prepare an area of at least1-1.2 m/3-4 ft in diameter, so that the roots can spread out into good soil as they grow.

Soil conditioners

Most gardens have patches where, for whatever reason, there is less moisture than elsewhere. If you improve the soil and select plants that are able to thrive in dry conditions, however, this need not be a problem.

Chipped or composted bark has little nutritional value, but makes a good mulch when spread on the surface, by reducing water evaporation and discouraging weeds. It will break down in time. Farmyard manure is rich in nutrients but often contains weed seed; it is a good conditioner. Garden compost (soil mix) is also very good as a conditioner and has good nutrient value. Leaf mould, made from composted leaves, also has good nutritional value and is an excellent conditioner and mulch. Peat is not very suitable as it breaks down too quickly and has little nutritional value.

Tending The Soil

1. Using a chemical spray is the only way to be sure of completely eradicating perennial weeds. Use a non-persistent herbicide, which breaks down when it comes into contact with the soil. It is vital always to follow the instructions on the pack exactly, not only for the obvious safety reasons but also to ensure you use the correct dose to kill all the weeds in the area first time.

2. If the turf to be removed does not include perennial weeds, or the soil is friable enough for the weed’s roots to be removed by hand, it is safer to remove the turf by slicing it off with a spade. Stack the turf in a heap, grass-side down, and use them as compost (soil mix)when they have broken down.

3. Dig over the soil ‘and, as you dig, remove any weed roots and large stones. Double dig, if the subsoil needs to be broken up. Add as much well-rotted organic material as you can to the soil before it is planted, in order to improve its condition.

4. Add the compost (Soil mix) or manure to the soil as you dig, or spread it over the top after all weed roots have been removed, and fork it in.

5. If you dig in the autumn, leave the soil for the winter weather to break down; at any other time, break the soil down by hand into a reasonably fine tilth. Use a rake or hoe to break down the larger lumps of soil, until the bed has an even appearance

Paralytic Ileus

What is Paralytic Ileus?
This is a type of bowel obstruction, but instead of being caused by some mechanical means, it is simply due to intestinal immobility. Normally peristaltic waves of contraction constantly move along the length of the bowel, pushing the fluid contents forwards at all times.
However, under certain circumstances, most commonly following surgical operations on the abdomen, a portion of the bowel suddenly ceases to pass on the waves of contraction. This probably occurs to a small extent after most abdominal operations, but it invariably reverts to normal function after a short time, with no adverse aftermath.
Accidents and a variety of other less commonly encountered causes may also produce the complication.
Paralytic Ileus Symptoms
There is usually a history of recent operation, accident or precipitating cause. Vomiting usually occurs, and constipation is the rule. Peristalsis is usually markedly diminished or absent. This is evidenced by complete silence when the abdomen is checked with a stethoscope. Abdominal distension is present, and soreness may or may not occur. X-rays show distension of the bowel with gas throughout (different from an obstruction where only the part above the obstruction shows distension).
Paralytic Ileus Treatment
Most patients are already in hospital, recuperating from a surgical operation. Treatment involves supplying adequate fluids, restricting the oral intake of food, decompressing the bowel (it may be necessary to intubate the patient, by passing a tube into the bowel) and dealing with any suspected underlying disorder. Most cases respond well to these measures, and the paralysed intestine soon resumes normal function.

Spina Bifida


Spina Bfida is claimed to occur about once in every 1,000 births. It may even be less. Spina Bifida is a developmental abnormality, the spinal canal failing to completely close over. Various types are possible, but those occurring in the lower part of the back are more common.

Spina Bifida Symptoms

There may be a lump along the course of the spinal column, for example at the lower end. Symptoms may be mild or nonexistent, especially in the form referred to as spina bifida occulta. There may be a weakness of the lower limbs, and later, paralysis may set in; there may be a lack of control over the valves of the bladder and bowels. The parent may be first made aware of it when the child has difficulty in normal toilet training

Spina Bifida Treatment

Many mild cases may live a reasonably normal life. I treated a patient for many years, and he lived until his mid-50s before he died of sudden renal complications. He held down a normal, responsible job, and coped remarkably well. He married, and one lad was born who was perfectly normal.

Often if the disorder is picked up early, say at birth, when obvious cases may be quite apparent, surgery is attempted. A great deal is possible at the time, but unfortunately these children, although saved from death at the time, may endure a very difficult time afterwards and pose a major problem for those undertaking their care from that time on.

All patients will be cared for in accordance with their symptoms and their own level of attainment. Some may require intensive hospital care for a long period of time; other milder ones, such as my patient, may live for many years and engage in useful work.

It is possible to diagnose some of these cases antenatally now? Yes, with the so-called AFP (short for alpha-feto-protein) assessments, cases may be diagnosed before birth. This chemical is produced by the open nerve canal, and may be present in the amniotic fluid of the uterus, or increased amounts may be present in the mother’s blood.

In women who have sustained one case, there appears to be an increased risk of further babies with the same disability, and these women may be screened. It is an indication for a legal termination if the mother so desires it but this of course is an emotive and individual topic.

Wall Decorating Ideas

The first involves finishing off apart-riled wall with a band of narrow tiles in a colour or design that complements or contrasts with the main riled area, to form a decorative border. These tiles are available in lengths that match standard rile widths, and are usually 50-75 minimum 2-3 in wide. They are cur and fixed just like any other tile.

The second method is to incorporate a group of patterned tiles as a feature panel within a larger area of plain riling. The group may simply be contrasting patterned tiles, or may be a multi-tile motif a group of four, six or more tiles that fit together to form one large design when they are fixed in position. Tile manufacturers offer a range of mass-produced designs you can choose from, or a motif panel can he commissioned from a specialist tile supplier. Plan the motif’s position on the wall carefully, and build it in the usual way as tiling progresses.

I. Use a tiling gauge to mark the position of the first row of tiles on the wall surface. Put up a support batten (furring strip) if necessary then spread some tile adhesive on the wall, and place any plain tiles that will be below the decorative panel. Start placing the first tiles that will form the decorative panel. Here the tiles are being laid at an angle of 45°, so half-tiles are placed first.

2 .Continuous adding whole and half-tiles to build up the pattern, checking is you work that the edges of the panel are uniformly horizontal and vertical.

3. Here the panel is being surrounded by slim border tiles. Add whole border riles to the top of the panel first, working from the centre line outwards.

4. At the corners of the panel, fit an over-long horizontal border tile and hold another vertically over it so you can mark a 45° cutting line on each tile.

5. Make the 45° cuts on the end of each corner tile, then bed the horizontal tile in place. Check that the CUE end is precisely aligned with the panel comer. Repeat the process at the other end of the horizontal section of the border. The pieces should be the same length, as the border is centred.

6. Fit the border riles up each side of the decorative panel, then mark the position of the mitre cut on the final tiles, cut them and fit them in place.

Preparing Surface for Covering

Once the previous wall and ceiling decorations have been removed the next task is to restore any defects in the surfaces to be covered, and then to prepare them so that they present the perfect substrate for successful paperhanging.

The first step is to put down some heavy-dory plastic sheeting on the floor to catch splashes, and then to wash down the hare wall and ceiling surfaces thoroughly with strong household detergent or sugar soap (all-purpose cleaner), working from the bottom upon walls, and then to rinse them off with clean water, working this time from top to bottom on walls. Turn off the electricity supply first in case water gets into light switches and socket outlets (receptacles). Leave the surfaces to dry out thoroughly.

Next, repair defects such as cracks, holes and other surface damage which may have been concealed by the previous decorations, or even caused by their removal.

Finally, treat the wall and ceiling surfaces with a coat of size or diluted wallpaper paste, and leave this to dry before starting paperhanging. Size seals porous plaster, providing a surface with absorption, and also makes it easier to slide the pasted lengths of wall covering into position on the wall.

Wash wall surfaces with sugar soap (all-purpose cleaner) or detergent, working from the bottom up , then rinse them with clean water, working from the top down

Wash ceilings with a floor mop or squeegee, after disconnecting and removing light fitting.. Again, rinse off with clean water.

Fill cracks, holes other detects in the wall and ceiling surfaces as appropriate, leave the filler to harden and then sand the repair down flush.

Apply a coat of size or diluted wallpaper paste to wall and ceiling surfaces that are to be papered, and leave them to dry before starting paperhanging.

CROSS-LINING

If the wall surface is in poor condition, has been previously decorated with gloss paint or is being decorated with a thin fabric wall covering, it is best to hang lining(liner) paper first. This is usually hung horizontally rather than vertically, with butt joints between lengths and with ends and edges trimmed just shun of adjacent ceiling and wall surfaces. Use the same type of paste for the lining paper as for the subsequent wall covering.

MEASURING AND CUTTING TO LENGTH

1. For quick and easy calculations, mark the length of the pasting table at 30 cm/12 in intervals using a pencil and metal straight edge.

2. Measure the length of wall covering needed for the drop, including trim allowances., and mark this on the paper. Cur the first piece to length.

PASTING WALL COVERINGS

1. Face the light to make it easy to spot any unpasted areas – they look dull, nor shiny. Apply a generous hand of pastedown the centre of the length.

2. Align one edge of the wall covering with the edge of the pasting table, then brush the paste out towards that edge from the centre band.

3. Draw the length across to the other edge of the table, and apply paste out to that edge Rio. Check that there are no dry or thinly pasted areas.

4. Continue pasting until the end of the table is reached. Then lift the pasted end of the wall covering and fold it over on itself, pasted side to pasted side.

5. Slide the paper along the table so the folded section hangs down. Paste the rest of the length and fold the opposite end over on itself.

Urticaria


What is Urticaria?

Hives are localized skin reaction indicating that fluid is collecting (edema). They usually appear suddenly and arc whitish-pink in colour. They may he small or large, and single hives may coalesce with neighboring ones to form a large area of inflamed surface. (This is called “giant hives” or angioneurotic edema.)

The itch is often marked and there is a persistent desire to scratch. But this brings little satisfying relief and often produces further infection later. Sometimes itch is minimal.

The lesions vary in the time they persist. This may be from a few hours to days or even weeks.

Urticaria Causes

Generally hives are a manifestation of an allergy. A product called histamine is liberated by the cells, and this produces the swelling, irritation and itch. The factors producing this sensitivity are many.

The possible ones include:

Sensitising drugs. Practically any medication is capable of producing an allergic reaction in a susceptible person. For example pain-reducing preparations (aspirin etc), antibiotics (particularly penicillin, but others as well), sulpha drugs, antihistamines and many others. Sensitizing foods. Many foodstuffs may produce allergic skin eruptions. Some of the common offenders include wheat products, milk, eggs, pork, fish, shellfish and crustaceans, tomatoes, strawberries and chocolates.

Physical factors. Extremes of heat and cold are fairly common in producing urticarial reactions. (For example, after a hot shower, or a swim in a very cold surf or pool, eruptions can suddenly appear.) Other general factors. Chronic infections, foci of infection (such as bad teeth or tonsils), anaemias, and a similar list of “poor health” conditions have also been incriminated. They may play a part in certain people.

Urticaria Treatment

The occurrence of hives is fairly easy to diagnose, and many people have experienced them on many occasions before. Most cases are simple, and home remedies often bring prompt relief.

Local applications

Cool (or sometimes ice-cold) packs often bring soothing relief from the itch, heat and discomfort. Apply often (but discontinue if there is any worsening). Simple lotions and creams containing an antipruritic (anti-itch) product often give relief if the irritation and itch is excessive (for example, calamine liniment containing benzocaine 3 per cent and camphor 1 per cent). Many commercial products are available for this purpose (eg Dermocaine).

Antihistamine creams do not afford much relief (as would he expected). Antihistamines. In simple cases, an antihistamine tablet will often bring quick relief. The non-sedating brands arc best, for this will not cause drowsiness and will enable a good result without the risk of becoming drowsy while driving or working. Terfenadine (“Teldane”) tablets and astemizole (“Hismanal”) tablets do not induce sleepiness and are worthwhile.

However, if sleepiness is not a problem, any of the older antihistamines are suitable. Many brand names are now available over the counter.

Mild laxative

This often assists to eliminate the cause from the system, particularly if the hives appear suddenly and tend to persist. “Coloxyl” or “Colox: with Senna,” or paraffin and its various commercial products are all effective Natural products include psyllium fibre (“Metamucil” powder in water) or taking processed bran with your morning  breakfast cereal. “Durolax” an “Granacol” are also effective. Drinking plenty of fluids (especially water) is quick way of eliminating toxins from the system, or diluting them in the gut.

Diet.

Many people are aware of the foods that produce symptoms. During outbreak it is wise to eliminate the foods  listed above that could cause trouble. Stick to simple foods for a few days.

Medication.

Do not take any medication unless under doctor’s orders. Even if on medication, and relief is not  forth coming, it is wise to have this reevaluated by your physician. You may allergic to some of the items taken.

Further Treatment.

Simple hives often respond quickly and effectively to simple routines. If they persist, or if they become more marked, if they tend to blister or the irritation becomes annoying, further medical advice may be required. Sometimes acute widespread complications take place. Two major complications requiring immediate medical attention a – commencement of hoarseness sudden- or a harsh noise coming from the box, especially if associated with respiratory difficulty and “Anaphylactic. shock,” in which there is uneasiness a feeling of faintness, headache throbbing in the ears. This requires prompt treatment by a doctor.

Adrenaline by injection by the physician may be required and steroid therapy may also be necessary in certain cases. Further investigation is needed if the response persists.

Stamping Equipment

Materials

When you are stamping, you will discover that different paints and stamps will produce very different results. Here are some of the best materials to experiment with.

Dutch metal leaf and gold size: metal leaf is a cheap, easy-to-use alternative to real gold leaf. Use a sponge stamp to apply gold size in a repeating pattern. When the size is tacky, carefully apply the gold leaf.

Inks: water-based inks are too runny to use on their own but can be added to wallpaper paste or varnish to make a mixture thick enough to adhere to the stamp. Use them for paper or card, but not for walls. If you are using rubberstamps, inkpads suitable for them are commercially available in a wide range of colours.

Interior filler (spackle): add filler, in its dry powdered state to emulsion (latex) paint to give it body without diluting the colour.

Paint: water-based paints such as emulsion and artist’s acrylics dry quickly to a permanent finish. Use emulsion paint straight from the can or dilute it with wallpaper paste or varnish. For wall treatments, emulsion paint can be thinned with a little water and sponged or brushed over the wall as a colourwash.

Precut stamps: rubber stamps are widely available in thousands of designs, usually mounted on wooden blocks. Finely detailed motifs are best suited to small-scale projects, while bolder shapes are more effective when used for walls and furniture. Make your own from foam or sponge.

Sponge or foam: different types of sponge are characterized by their density and are easy to make yourself. High-density sponge is best for detailed shapes and will give a smooth, sharp print. Medium-density sponge or low-density sponge will absorb more paint and give a more textured result and is better for larger projects.

Varnish: use water-based, acrylic varnish (sold as quick-drying) for stamping projects. The varnish can be mixed with emulsion paint or ink to thicken the texture and create a range of different sheens.

Wallpaper paste: wallpaper paste allows you to thin emulsion paint without making it too runny to adhere to the stamp. Mix up the paste with the required amount of water first, and then add the emulsion.

Volvulus

When this occurs. part of the bowel twists on itself. The result is that the blood supply is suddenly cut off. This gains access to the bowel via the mesentery, a sheet of thin tissue that provides the bowel with its nutritional requirements. When this occurs, a closed-loop type of obstruction takes place. The immediate risk is that if complete, the bowel, devoid of its blood supply, may quickly die and become gangrenous and perforate. Peritonitis may quickly follow. Often the volvulus is not complete, and cases occur where it tends to come and go.

Sometimes symptoms come on rapidly, or they may be much slower. Symptoms simulate a bowel obstruction.

Volvulus Treatment

Acute cases must be surgically treated as an emergency. For chronic forms, more probable with older adults, decompression by a rectal tube may be possible. However, this again is in the province of the doctor, and any symptoms that indicate abdominal problems must receive prompt, expert medical attention. Delay may prove fatal.

One of the major changes in surgical care in recent years is the day-care centres. Here, the patient is admitted for one day (or part of a day) only. Many one-time major surgical operations have contracted to fairly “minor” procedures that can be completed in a short time.

With quick-acting general anaesthetics (or the use of local anaesthesia), a large amount of investigation and treatment can be quickly and expertly carried out. Theatres are often attached to the centres, with certain theatres being geared for a small, specific range of operations (eg endoscopic or colonoscopic surgery, eye surgery, various gynaecological or abdominal laparoscopic techniques). This not only reduces overall costs, but enables more patients to be treated in a shorter time. It appears to be the way of the future.