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A 78-Year-Old Man Presents to the Emergency Department With Leg Pain and Swelling CME

The goal of this activity is to provide an update on the use of NOACs in the treatment of VTE, especially in those patients with compromised renal function.  
medscape.org
over 4 years ago
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Management of lumbar spinal stenosis

Lumbar spinal stenosis (LSS) affects more than 200 000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.  
feeds.bmj.com
over 4 years ago
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Management of lumbar spinal stenosis

Lumbar spinal stenosis (LSS) affects more than 200 000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.  
feeds.bmj.com
over 4 years ago
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Emergency Medicine Literature of Note: CTCA in the ED, Getting Less Sexy By The Day

Hello, there, Thanks for fishing this. I can't comment on the paper but what I read in the abstract is intersting. A somewhat physician influenced outcome (patients identified with significant coronary artery disease requiring revascularisation within 30 days. The the best fullproof endpoint , ikely the "least worse" for the patient number in the study. A test, CTCA, that does not improve this outcome. But that seems to stop dotors from further investigating patients: "The CCTA group ... less outpatient testing after the index ED visit (10 [4%] vs. 26 [10%], p < 0.01).".I'm still to understand how one can explain that adding CTCA , within a 6hours stay in the ED may lead to this finding: "The CCTA group had lower direct medical costs (€337 vs. €511, p < 0.01)".Oh and by the way, what do our West of the pond colleagues think of the efficiency of a system , in the Netherlands where the cost of 6 hours in the ED with troponins, nurses, docs, documentation, and a high tech imaging study results in MEDICAL COSTS OF €337 vs. €511 without the CTCA. (I hope I didnt miss something). This last paragraph is in tongue in cheek - leg-pulling mode of course.  
emlitofnote.com
over 4 years ago
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271

Compartment syndrome - Musculoskeletal Medicine for Medical Students - OrthopaedicsOne

Description Compartment syndrome is a limb-threatening condition caused by swelling within the myofacial compartments of the limb. It most commonly occurs in the leg or forearm secondary to trauma and leads to decreased tissue perfusion below basal tissue  
orthopaedicsone.com
over 4 years ago
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Controlling blood glucose in treating diabetic foot ulcers (sores) | Cochrane

Background: People with diabetes can develop foot ulcers (sores) for a number of reasons. This includes nerve damage and reduced blood flow to the feet and legs. Having high blood glucose may affect the ability of foot ulcers to heal and therefore intensively controlling blood glucose may be beneficial.  
cochrane.org
over 4 years ago
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155

What is the largest bone in the human body?

The largest and longest bone in the human body is the femur, and it is located in the upper leg. The femur connects to the knee at one end and fits into the hip socket at the...  
ask.com
over 4 years ago
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Hypopigmentation of newborn skin

A full term baby girl was initially seen on the neonatal unit with respiratory distress, thought to be transient tachypnoea of the newborn. While on the unit she was noted to have a hypopigmented, whorl-like pattern extending over her right arm, leg, torso, and back. Examination was otherwise normal, with good tone, active movements, and a good suck.  
feeds.bmj.com
over 4 years ago
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Boston Sci's ELUVIA Drug Eluting Stent Cleared in Europe |

Boston Scientific got hold of a CE mark to introduce the ELUVIA drug eluting vascular stent in Europe. Designed for delivery into the leg arteries above th  
medgadget.com
over 4 years ago
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Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II | Cochrane

Complex regional pain syndrome (CRPS) is a painful and disabling condition. Most commonly it affects a person's arm and hand or leg and foot and may occur after a traumatic injury. There are two types of CRPS: CRPS I in which there is no nerve injury, and CRPS II in which there is a nerve injury. Guidelines recommend physiotherapy, which could include different kinds of exercise therapy or electrotherapy for instance, along with other medical treatments for treating the pain and disability associated with CRPS. However, we do not know how well these treatments work.  
cochrane.org
over 4 years ago
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Regional or general anaesthesia for hip fracture surgery in adults | Cochrane

Background: The majority of people with hip fracture are elderly and are treated surgically, which requires anaesthesia. The fracture usually results from a simple fall. These patients often have many other medical problems associated with ageing, which places them at high risk of mortality after anaesthesia. The most common types of anaesthesia are 'general' and 'regional anaesthesia'. General anaesthesia involves a loss of consciousness (induced sleep). Regional anaesthesia involves an injection of a solution containing local anaesthetic inside the spine (neuraxial block) or around the nerves outside the spine (peripheral nerve block) to prevent pain in the leg with the hip fracture. We reviewed the evidence about the effect of regional anaesthesia on patients undergoing surgery for hip fracture.  
cochrane.org
over 4 years ago
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107

Mimetic - Featured Scenario

Acute swelling of the right leg. Sinister or not?  
clinicalsenseapp.com
over 4 years ago
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Amputee 'wasted' cash on prosthetic leg - BBC News

An amputee says he paid nearly £10,000 on a prosthetic limb because he was not told he could have been entitled to a similar one on the NHS.  
bbc.co.uk
over 4 years ago
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EM Cases: Hand Emergencies - emdocs

Dr. Andrew Arcand & Dr. Laura Tate discuss the key clinical pearls and pitfalls in the recognition and management of many apparently benign hand emergencies that have serious morbidity, including high pressure injection injury, flexor tenosynovitis, gamekeeper’s thumb (or skier’s thumb), fight bites, hook of the hammate fractures and many more important hand emergencies. Dr. Tate & Arcand answer such questions as: which lacerations require prophylactic antibiotics? Which hand lacerations do not require sutures? How is rotational deformity best tested for metacarpal fractures? What are the pearls of tendon repair? How do you test for instability when you suspect a Gamekeeper’s thumb? How is compartment syndrome of the hand different to compartment syndrome in the leg? What are Kanavel’s signs of tenosynovitis? How should felons be managed in the ED? What are the most common errors that plastic surgeons see ED docs make?  
emdocs.net
about 4 years ago
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Sciatica ? why ? Animation

Sciatica causes pain that radiates out from the lower back, down the buttocks and into one or both of the legs, right down to the calf. This animation explai...  
youtube.com
about 4 years ago
E86fd00c5e5caabe396fd6f5aba98ec83415af4125741499322368966
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X-Ray depicting Extensive Fractures In Lower Limb Bones

X-Ray of lowelimbs of a 25 year old female who was run over by a truck in legs after an accident. The Patient is currently on Ilizarov supports and is currently steady state without any vital recovery after 8-10 months of extensive limb saving efforts.  
Parantap J. Trivedi
about 4 years ago
12ca5cca308a36a67138a7d80bf438ccd71d0e0f3159822881651433
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What is Spinal Stenosis?

Spinal stenosis is a condition in which the spinal canal narrows and pinches the nerves, resulting in back and leg pain. Spinal stenosis often occurs in older adults, although younger people who are born with a small spinal canal may also develop symptoms.  
youtube.com
about 4 years ago
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A 65 year old man with macroscopic haematuria and acute kidney injury

A 65 year old man who presented to his general practitioner with a three day history of bright red, painless, macroscopic haematuria was found to have a raised serum creatinine of 461 μmol/L (reference range 60-105) (estimated glomerular filtration rate 11 mL/min/1.73 m2). His baseline serum creatinine had been stable (~120 μmol/L) for five years until one month earlier, when he had an episode of acute kidney injury while in hospital for cellulitis of the right leg. After discharge the cellulitis had resolved but his serum creatinine had remained raised at 252 μmol/L. He denied any recent respiratory infections, weight loss, night sweats, lethargy, or haematuria.  
feeds.bmj.com
about 4 years ago
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A 65 year old man with macroscopic haematuria and acute kidney injury

A 65 year old man who presented to his general practitioner with a three day history of bright red, painless, macroscopic haematuria was found to have a raised serum creatinine of 461 μmol/L (reference range 60-105) (estimated glomerular filtration rate 11 mL/min/1.73 m2). His baseline serum creatinine had been stable (~120 μmol/L) for five years until one month earlier, when he had an episode of acute kidney injury while in hospital for cellulitis of the right leg. After discharge the cellulitis had resolved but his serum creatinine had remained raised at 252 μmol/L. He denied any recent respiratory infections, weight loss, night sweats, lethargy, or haematuria.  
feeds.bmj.com
about 4 years ago
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A 65 year old man with macroscopic haematuria and acute kidney injury

A 65 year old man who presented to his general practitioner with a three day history of bright red, painless, macroscopic haematuria was found to have a raised serum creatinine of 461 μmol/L (reference range 60-105) (estimated glomerular filtration rate 11 mL/min/1.73 m2). His baseline serum creatinine had been stable (~120 μmol/L) for five years until one month earlier, when he had an episode of acute kidney injury while in hospital for cellulitis of the right leg. After discharge the cellulitis had resolved but his serum creatinine had remained raised at 252 μmol/L. He denied any recent respiratory infections, weight loss, night sweats, lethargy, or haematuria.  
feeds.bmj.com
about 4 years ago