Irish journal of medical science
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Paget's disease of the bone (PDB) is a localized disorder of bone remodeling. Nitrogen-containing bisphosphonates (N-BPs) are the treatment of choice. ⋯ Newly diagnosed patients with PDB should be treated for 6 months with oral N-BPs prior to administration of intravenous ZA. Repeat ZA infusions are necessary only if the serum total ALP levels rise above normal, or if symptoms or complications attributable to PDB persist.
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Review Case Reports
Male lupus: a diagnosis often delayed--a case series and review of the literature.
Systemic lupus erythematosus (SLE) is an auto-immune disease that is characterised by autoantibody production. Male lupus is rare, apart from at either end of the age spectrum. ⋯ Our patients presented in middle age and tended to develop haematological abnormalities, renal involvement and neurological manifestations which preceded the onset of their skin and joint complaints. Our patients accrued damage rapidly and overall did badly. They tended to respond sub-optimally to standard treatments. These cases highlight the need an increased awareness that male SLE patients present with a wide variety of symptoms, and that they accrue damage quickly. There is a need for timely diagnosis and appropriate initiation of treatment. This may help avoid preventable organ damage and increase the survival of men with SLE.
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Calf swelling is a common clinical presentation with a wide and varied differential diagnosis. The Morel-Lavallee is a rare cause of subcutaneous swelling, caused by post-traumatic shearing of the hypodermis from the underlying fascia. The potential space so created fills with blood, lymph and necrotic fat giving specific findings on MR evaluation. ⋯ The Morel-Lavallee lesion is a rare but important cause of calf swelling. MRI is the mainstay of diagnosis and treatment includes both surgical and minimally invasive modalities.
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The aim of this study was to determine what made people want to change their choice of general practitioners (GP). Furthermore, the study aimed to correlate the perceived quality of patient-GP communication with the motives inducing individuals to change their doctors. ⋯ These findings suggest several actions to improve the doctor-patient relationship, including training for physicians to develop their communication skills; involving public health operators in helping to understand the rights and obligations of patients and doctors; and a reorganization of the GP's workload.
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The purpose of this study is to determine the association between fetal nasal bone length (NBL) and gestational age (GA), biparietal diameter (BPD) and head circumference (HC) in women undergoing prenatal assessments and Down syndrome screening. ⋯ Using multiple parameters (GA, BPD and HC) to estimate NBL is more accurate than using than using GA or BPD or HC alone, as indicated by the higher predictive value.