Brit J Hosp Med
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Selective internal radiation therapy is a type of brachytherapy used to provide targeted radiotherapy, most commonly to treat primary or metastatic disease within the liver. This review outlines current clinical practice, dosimetric considerations, the pre-treatment workup and safety considerations before treatment. It also examines the clinical evidence for its use in patients with both primary and metastatic disease within the liver.
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Gallstone disease is the most common gastrointestinal disease in developed countries and is present in up to 15% of the population. Owing to the increased risk factors for gallstones in pregnancy, it is the second most common non-obstetric emergency, affecting up to 12% of pregnant women with a risk of recurrence. Up to 3% of pregnant women in America require a cholecystectomy in the first year after delivery. ⋯ Endoscopic retrograde cholangiopancreatography and cholecystectomy can be performed safely in the second trimester when benefits outweigh the risks. However, if the patient is able to be managed conservatively, then a cholecystectomy should be performed in the postnatal period to avoid further recurrences and complications. Despite this, there is currently no national UK guidance on how to manage gallstones and related diseases during pregnancy.
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Heel pain and a history of a 'pop' or feeling 'something go' are the buzz phrases classically associated with Achilles tendon rupture. However, the diagnosis is often missed in clinical practice because of the assumption that this is a sporting injury suffered only by the young or middle-aged. In a sedentary older patient, the injury may be dismissed as an ankle sprain. ⋯ The diagnosis of Achilles tendon rupture is clinical, based on history and examination. Radiological imaging (ultrasound scan) is useful to plan orthopaedic management and exclude concomitant deep vein thrombosis. In most cases, non-operative management with the ankle held plantar flexed in a boot is the current best practice.
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Patients with a fractured neck of femur require effective analgesia to improve positioning before the administration of spinal anaesthetic. This article discusses the evidence to show whether fascia iliaca compartment block or intravenous opioid analgesia is preferable in this situation.