Internal medicine journal
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Conventional teaching on the mechanisms and treatment of spontaneous pneumothorax is either obviously wrong or based on a misunderstanding of the natural history of the condition. Spontaneous pneumothorax is a generally benign, self-limiting condition where conservative management should be considered. If intervention is needed, medical thoracoscopy might be the procedure of choice.
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Internal medicine journal · Mar 2010
Comparative StudyPilot study of high-sensitivity troponin T testing to facilitate safe early disposition decisions in patients presenting to the emergency department with chest pain.
Many patients present to emergency departments with chest pain, but little is known about this population and the safest, most efficient testing strategies. We assessed clinical risk stratification of all patients with chest pain and, on a subset, utility of high-sensitivity troponin at 4 and 6 h after pain onset in aiding disposition decisions. ⋯ These preliminary data suggest that high-sensitivity troponin 6 h after chest pain onset may be diagnostically useful. Marked differences in outpatient testing attendance suggest bookings should be made before discharge.
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Internal medicine journal · Mar 2010
ReviewUn-promoted issues in inflammatory bowel disease: opportunities to optimize care.
Inflammatory bowel diseases (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory disorders of the gut, which lead to significant morbidity and impaired quality of life (QoL) in sufferers, without generally affecting mortality. Despite CD and UC being chronic, life-long illnesses, most medical management is directed at acute flares of disease. ⋯ This leads to less attention on relatively 'low-technology' issues including: (i) the psychosocial burden of chronic disease, QoL and specific psychological comorbidities; (ii) comorbidity with functional gastrointestinal disorders (FGIDs); (iii) maintenance therapy, monitoring and compliance; (iv) smoking (with regard to CD); (v) sexuality, fertility, family planning and pregnancy; and (vi) iron deficiency and anaemia. We propose these to be the 'Un-promoted Issues' in IBD and review the importance and treatment of each of these in the current management of IBD.