QJM : monthly journal of the Association of Physicians
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Post-traumatic lower limb amputees have an increased morbidity and mortality from cardiovascular disease. Risk factors for this amplified morbidity and the involved pathophysiologic mechanisms have not been comprehensively studied. ⋯ Coronary risk in lower limb amputees may be substantially greater than predicted by available algorithms, given that neither hemodynamic nor psychological factors concern the current prediction models. It seems reasonable to take early prophylactic measures in lower limb amputees by discouraging smoking, excessive alcohol consumption and adherence to a low fat diet. Studies are needed to evaluate the optimal intensity of physical exercise effects on reflected pulse waves and their possible long-term consequences. Guidelines for optimal blood pressure, blood glucose and lipid control in amputees need to be convened.
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Case Reports
Management of upper gastrointestinal haemorrhage complicating dual anti-platelet therapy.
Upper gastrointestinal haemorrhage is a serious complication of aspirin and clopidogrel (dual) anti-platelet therapy with a high morbidity and mortality. Using an illustrative case this article examines the prognostic significance of gastrointestinal haemorrhage and the risk of stopping anti-platelet therapy. The management of this clinical challenge is reviewed, in the absence of a clinical guideline, with particular reference to the judicious tailoring of anti-platelet therapy, the role of therapeutic endoscopy and the utility of blood transfusion.