European journal of internal medicine
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Eur. J. Intern. Med. · Nov 2008
Is it safe to discharge patients from accident and emergency using a rapid point of care Triple Cardiac Marker test to rule out acute coronary syndrome in low to intermediate risk patients presenting with chest pain?
To determine whether patients presenting with chest pain who are at low to intermediate risk for ACS can safely be discharged from Accident and Emergency using Triple Cardiac Marker [TCM] [CK-MB, myoglobin, troponin I] without increasing risk and cost effective use of coronary care facilities. ⋯ Almost one third of patients who presented with chest pain and low to intermediate probability of ACS were safely discharged from A&E following paired negative TCM. Six month re-admission rate with ACS in this group of patients was only 1% with no death. Therefore paired TCM can be used to safely discharge this group of patients. This marker has the potential to significantly reduce hospital admissions.
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Eur. J. Intern. Med. · Nov 2008
Letter Case ReportsColonic carcinoma unmasked by dual antiplatelet therapy.
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Eur. J. Intern. Med. · Nov 2008
Case ReportsOccult nasal sinus tumours causing oncogenic osteomalacia.
Oncogenic osteomalacia (OOM) is a rare but curable cause of metabolic bone disease. We report 9 patients with OOM, including 2 patients with occult nasal sinus tumours and 1 in whom a progressive increase in the post-operative FGF23 level heralded the development of metastatic pulmonary disease. The median duration of symptoms before definitive surgical treatment was 6 years, and in one patient was more than 10 years. This series demonstrates that careful imaging of the nasal sinuses should be part of the work-up of cases of oncogenic osteomalacia, that serum FGF23 can be helpful in both diagnosis and monitoring treatment outcomes, and emphasizes that serum phosphate should be measured in patients with metabolic bone disease and/or unexplained musculoskeletal symptoms.