American family physician
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American family physician · Jun 1997
ReviewAcute ankle injuries: clinical decision rules for radiographse.
The need to perform "routine" radiographs after every case of ankle trauma has been repeatedly questioned, since less than 15 percent of ankle injuries are found to involve a significant fracture. Several authors have proposed guidelines to define clinical characteristics that may help physicians identify patients with a higher probability of having a fracture on the radiograph. The Ottawa ankle rules are the latest guidelines developed for the management of ankle injuries. These highly sensitive decision rules may allow a significant reduction in the number of ankle radiographic series ordered and may decrease patients' waiting times and costs without an increased rate of missed fractures or patient dissatisfaction.
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Patients with autoimmune bullous diseases are occasionally encountered in primary care practice, usually in middle-aged and older patients. The differential diagnosis includes nonimmune causes, such as contact dermatitis, infections and bullous reactions to drugs or insect bites. ⋯ Because the clinical presentations of blistering disorders are often similar, special immunofluorescence tests are used to confirm the specific diagnosis. Since diagnosis and management of an autoimmune bullous disease may involve systems other than the skin, coordination by the primary care physician is crucial.