Irish journal of medical science
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Most patients presenting with acutely perforated duodenal ulcer undergo operation, but conservative treatment may be indicated when an ulcer has spontaneously sealed with minimal/localised peritoneal irritation or when the patient's premorbid performance status is poor. We retrospectively reviewed our experience with operative and conservative management of perforated duodenal ulcers over a 10-year period and analysed outcome according to American Society of Anesthesiologists (ASA) score. ⋯ In patients with a perforated duodenal ulcer and ASA-score I-III, postoperative outcome is uniformly favourable. We recommend these patients have repair with peritoneal lavage performed, routinely followed postoperatively by empirical triple therapy. Given that mortality is equivalent between ASA IV/V patients whether managed operatively or conservatively, we suggest that both management options are equally justifiable.
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A deep soft tissue smooth muscle tumour is a rare entity with few cases described in the literature. ⋯ Smooth muscle tumours in the inguinal area are an exceptionally rare occurrence, but clinicians should always consider less routine causes for a painful inguinal mass.
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Anal intraepithelial neoplasia (AIN) rarely receives as much publicity as its neighbouring orifice, the cervix. As in the cervix, intraepithelial neoplasias are precursors to cancer in the anal canal. AIN and cervical interstitial neoplasia (CIN) undergo dysplasia as a consequence of human papillomavirus (HPV) infection. Since the advent of screening with the Pap smear in CIN, cervical cancer has plummeted to a fifth of its initial incidence. Anal cancer, however, has been rising, with a predilection for human immunodeficiency virus-infected men. HPV causes a squamous epithelial dysplasia and converts healthy tissue into AINs of increasing severity until anal cancer manifests. ⋯ The paper concludes by briefly discussing the implications of a national screening programme against AIN in the future.
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Multicenter Study
Effect of pulsed radiofrequency therapy on the suprascapular nerve in shoulder pain of various aetiology.
Pulsed radiofrequency treatment (PRF) applied to the suprascapular nerve may provide pain relief for patients suffering from shoulder pain as described in three case series. ⋯ Our results suggest that the analgesic effects of PRF last more than 3 months in the majority of patients. The addition of steroid to the PRF treatment appears to have no benefit.
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To evaluate the role of fasting plasma ghrelin levels [ln(ghrelin)] and polymorphisms of ghrelin gene in Chinese obese children. ⋯ Ghrelin is associated with obesity in childhood, especially associated with the glucose homeostasis. Lower ghrelin levels might be a result of obesity, but not a cause of obesity. The Leu72Met polymorphism of ghrelin gene is not associated with obesity and metabolic syndrome in Chinese children.