Clinical medicine (London, England)
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This review provides a contemporary overview of HF management and highlights the key studies which have informed recent European HF guidelines.
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Hypercalcaemia of malignancy (HCM) is a common metabolic complication of advanced malignancies with a prevalence varying from 2-30%, depending on cancer type and disease stage. HCM is associated with impaired quality of life, increased risk of hospitalisation and limited survival. Evidence-based guidelines for management of HCM have been lacking to date, despite its prevalence and detrimental impact. ⋯ A systematic review and meta-analysis was commissioned to support the guideline development process. Key suggestions include the use of denosumab in preference to intravenous bisphosphonates as first-line treatment for HCM and the use of denosumab in cases of recurrent or refractory HCM in patients previously treated with intravenous bisphosphonates. The guideline also identifies priority areas for future research.
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Observational Study
Duration of consultant experience and patient outcome following acute medical unit admission: an observational cohort study.
The effect of the duration of consultant experience on clinical outcomes in the acute medical unit (AMU) model remains unknown. ⋯ Increasing consultant physician experience associates with early safe discharge after AMU admission. These data suggest that the support and retention of experienced clinicians is vital if escalating pressures on unscheduled medical care are to be addressed.
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A 28-year-old man was brought to the emergency department with quadriparesis of acute onset after a bout of binge drinking. Evaluation revealed a mid-cervical myelopathy and magnetic resonance imaging (MRI) showed an acute compressive cervical myelopathy. ⋯ After resolution of rhabdomyolysis and acute kidney injury, he underwent cervical spine fixation. He was found to have acute dropped head syndrome with secondary compressive myelopathy.
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Refractory hypoglycaemia in a patient with a solitary fibrous tumour (SFT) is very rare and was first reported in 1930 independently by Doege and Potter, leading to it being named 'Doege-Potter syndrome'. Here, we report the unusual case of a 77-year-old woman with a giant solitary fibrous pleural tumour who presented with complicating pulmonary hypertension and associated heart failure with hypoglycaemia, and subsequently underwent curative resection of the pleural mass with clinical improvement.