Irish journal of medical science
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Brain natriuretic peptide (BNP) may help general practitioners (GPs) to "rule-out" heart failure (HF) and reduce referral burden on specialist assessment clinics. ⋯ Availability of BNP to GPs would improve referral patterns but with high risk of delayed diagnosis. The data underline the need for a shared-care approach to the new diagnosis of HF.
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Primary bone lymphoma (PBL) is a rare condition and accounts for less than 2% of adult lymphomas and 3% of all primary bone malignancies. Because of the rarity of this disease, there is a lack of prospective randomised clinical trials and hence optimal treatment is uncertain. ⋯ Combined modality therapy, i.e. chemotherapy followed by radiotherapy, is the preferred treatment option unless adverse neurology or an unstable fracture presents first.
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Laparoscopic cholecystectomy has been performed as a day-case procedure for over a decade. This procedure can be associated with a high incidence of pain and post-operative nausea and vomiting (PONV). There is a paucity of information regarding the post-discharge care of these patients. ⋯ The incidence of PONV post-discharge suggests that adding an antiemetic to our take-home analgesic packs may improve patient comfort. The 2-day supply of diclofenac and co-codamol could also be extended as 65% of patients had moderate to severe pain. The information gathered shows the importance of post-discharge follow-up of ambulatory surgery patients.
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Faecal incontinence resulting from obstetric injury is a socially disabling condition with a significant impact on quality of life. Sacral nerve stimulation (SNS) is a relatively new treatment modality, which offers patients a potential for improved continence. ⋯ SNS offers improvement in continence and quality of life in patients with faecal incontinence whose only other option might otherwise be a permanent colostomy.
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A 54-year-old woman was referred to our service with intractable ventricular arrhythmias secondary to a familial long-QT syndrome. Her first presentation was 4 years previously, when she suffered a cardiac arrest, at this time an (Automatic Implantable Cardioverter Defibrillator) AICD device was inserted and she was commenced on sympathetic blockers. She remained symptomatic with ongoing tachyarrhythmias and the subsequent automatic cardioversion or defibrillation was causing significant amount of distress. ⋯ Though open sympathectomy is an established treatment, there are only isolated reports of thoracoscopic sympathetic cardiac denervation in the literature.