Notes

Paediatric giant cavernomas: statement of about three instances which has a review of your materials.
Basal thumb arthritis is a very common condition encountered by the general practitioner. Treatment must focus on functional expectations and demands of the patient, and individualised treatment plans need to be tailored to the patient. Hand therapy in addition to patient education and use of an orthosis has been shown to be very effective in management of the early stages of basal thumb arthritis. With more advanced disease, surgical modalities provide better symptomatic control.
Low back pain (LBP) is a common presentation in general practice. Clinical workup must exclude sinister underlying diseases. Treatment of central LBP is difficult given the numerous treatment options available.

The aim of this article is to help clinicians assess patients with LBP and formulate evidence-based treatment decisions.

Patient presentations can be stratified according to the presence of red flags andpain type (ie non-spinal, radicular, non‑organic and central). The vast majority ofpatients with acute central back pain experience improvement of their symptoms. Treatment options includeeducation, lifestyle modification, heat, massage, graduated return to early activity, nonsteroidal anti-inflammatory medications and muscle relaxants when appropriate. Chronic LBP treatment can also include paracetamol and physiotherapy. Second-line treatment caninclude psychological therapy, multidisciplinary rehabilitation, targeted injections and antidepressants. Tapentadol is a safe and effective medication frequire controlled analgesia. Surgical treatment has narrow indications in central non-radicular back pain and is considered as a last-line treatment in selected patients.
Lateral epicondylitis, more commonly referred to as 'tennis elbow', is a common condition seen in general practice. Iteffects approximately 4-7 per 1000 individuals. Despite this, the aetiology and pathophysiology remain poorly understood. Often presenting as lateral elbow pain, the differential diagnosis includes entrapment syndromes, cervical radiculopathy, osseous pathology and inflammatory conditions. Though in 90% of cases the condition is self-limiting, persistent symptoms can bedifficult to manage.

In this article, a review of recent English-language journal articles explores current concepts related to lateral epicondylitis and examines the evidence behind the recommendation for the use of non-operative and operative treatment modalities.

Lateral epicondylitis is an enthesopathy associated with the origin of the extensor carpi radialis brevis (ECRB) muscle. Aclinical history and examination is usually sufficient to make a diagnosis. Maudsley's and Cozen's clinical tests have a high sensitivity in diagnosing lateral epicondylitis. The available evidence supports the use of non-operative treatment modalities in managing this condition. When comparing the different operative treatments described, there appears to be no significant advantage ofintervention over the natural history oflateral epicondylitis.
Lateral epicondylitis is an enthesopathy associated with the origin of the extensor carpi radialis brevis (ECRB) muscle. Trametinib A clinical history and examination is usually sufficient to make a diagnosis. Maudsley's and Cozen's clinical tests have a high sensitivity in diagnosing lateral epicondylitis. The available evidence supports the use of non-operative treatment modalities in managing this condition. When comparing the different operative treatments described, there appears to be no significant advantage of intervention over the natural history of lateral epicondylitis.
Bunions are a common complaint, particularly among older female patients. They are characterised by progressive deformity at the metatarsophalangeal joint, resulting in a painful dorsomedial prominence. This may cause difficulties with shoe wear and contribute to falls in the elderly.

The aim of this article is to discuss the aetiology, non-operative and operative management of bunions, as well as indications for referral.

Initial treatment of symptomatic bunions should be non-operative. Accommodative footwear is important. There is evidence supporting the use of nonsteroidal anti-inflammatory drugs, orthotics, splints/braces and toe spacers. However, these may not provide long-term relief, and referral to an orthopaedic surgeon is recommended if the patient has a painful prominence, has exhausted non-operative treatment and is a suitable operative candidate. Cosmesis alone is not an indication for operative management. Smoking is a relative contraindication to surgery, and cessation is recommended. In paediatric or adolescent patients (juvenile bunion), surgery should be delayed until skeletal maturity.
Initial treatment of symptomatic bunions should be non-operative. Accommodative footwear is important. There is evidence supporting the use of nonsteroidal anti-inflammatory drugs, orthotics, splints/braces and toe spacers. However, these may not provide long-term relief, and referral to an orthopaedic surgeon is recommended if the patient has a painful prominence, has exhausted non-operative treatment and is a suitable operative candidate. Cosmesis alone is not an indication for operative management. Smoking is a relative contraindication to surgery, and cessation is recommended. In paediatric or adolescent patients (juvenile bunion), surgery should be delayed until skeletal maturity.
The radius and ulna are the most commonly fractured long bones in the school-aged population, accounting for 40% of all fractures. Management of individual fractures depends on the fracture pattern and age of the child.

The aim of this article is to provide an overview of the management concepts for specific fracture patterns and support general practitioners to confidently manage these fractures and refer to orthopaedic services when required.

Orthopaedic advice and/or referral are recommended for unstable fracture types (greenstick and complete fractures), particularly in older children where remodelling potential is minimal. Early referral for growth plate injuries and suspected Monteggia and Galeazzi injuries is warranted to minimise long term complications.
Orthopaedic advice and/or referral are recommended for unstable fracture types (greenstick and complete fractures), particularly in older children where remodelling potential is minimal. Early referral for growth plate injuries and suspected Monteggia and Galeazzi injuries is warranted to minimise long term complications.
In the field of melanoma, clinical trials evaluating the impact of sentinel node biopsy, completion lymph node dissection and adjuvant medical therapies on patient outcomes have provided evidence that has changed practice significantly over the past five years.

The aim of this article is to discuss key evidence that hasinformed new Cancer Council Australia melanoma management guidelines.

General practitioners play a critical role in melanoma diagnosis and follow-up. Complete excisional biopsy to achieve accurate tumour microstaging is essential for obtaining reliable prognostic information, planning further management and accessing adjuvant medical therapies. The management of patients with Stage III disease has changed dramatically over the past few years. Less surgery is now recommended, and patients may be offered potentially life-prolonging systemic therapies. Multidisciplinary discussion of management is recommended. Rapid advances in therapeutic options for patients with advanced melanoma have plaanagement. Accordingly, the Australian national melanoma management guidelines have recently been updated. These evidence-based guidelines are now readily available on Cancer Council Australia's electronic Wiki platform, which facilitates regular further updating.
General practitioners (GPs) have some ofthe highest rates of mortality from COVID-19 among healthcare workers. SARS-CoV-2 has unique properties thatplace GPs at particular risk.

The aim of this article is to discuss the nose-related features of SARS-CoV-2 that place GPs at risk, and to make recommendations pertinent to the safety and protection of primary healthcare physicians.

The highest viral load of SARS-CoV-2 is in the nose and nasopharynx. It is often highest early in the illness, before the development of symptoms. Further, SARS-CoV-2 replicates and continues to shed in the nasopharynx long after the virus is no longer detectable in the lower respiratory tract. This places any physician performing examinations on, or procedures involving, the upper respiratory tract at risk for contracting COVID-19. New-onset hyposmia and dysgeusia are indicators for COVID-19 and should be included in screening protocols.
The highest viral load of SARS-CoV-2 is in the nose and nasopharynx. It is often highest early in the illness, before the development of symptoms. Further, SARS-CoV-2 replicates and continues to shed in the nasopharynx long after the virus is no longer detectable in the lower respiratory tract. This places any physician performing examinations on, or procedures involving, the upper respiratory tract at risk for contracting COVID-19. New-onset hyposmia and dysgeusia are indicators for COVID-19 and should be included in screening protocols.
General practitioners provide essential primary care topaediatric patients. The aim of this study was to explore associations between prevocational paediatric experiences of general practice registrars and their confidence in providing paediatric care in the general practice setting.

This was a cross-sectional observational study. Paediatric experiences and level of confidence ratings were collected using an online survey emailed to 530 Victorian general practice registrars in 2017; the response rate was 41% (217/530). Analysis used descriptive statistics, cross tabulation and Fishers' exact test.

The most common paediatric training was undertaken in a general hospital emergency department (180/197, 91%). The majority of registrars reported that they felt confident or very confident in managing acute presentations (92% for upper respiratory tract infection, 80% for asthma, 81% forimmunisation), but fewer were confident in managing mental health, behavioural or developmental presentations (all <36%).

Registrars felt more confident managing acute presentations. However, the predominantly hospital-based prevocational paediatric training offers limited exposure to - and, thus, confidence in - managing behavioural, mental health and developmental issues. Training opportunities to address this identified gap should be explored.
Registrars felt more confident managing acute presentations. However, the predominantly hospital-based prevocational paediatric training offers limited exposure to - and, thus, confidence in - managing behavioural, mental health and developmental issues. Training opportunities to address this identified gap should be explored.The aim of this case report was to evaluate the feasibility, efficacy, and safety of nerve-sparing laparoscopic sacrocolpopexy (SCP) performed with a minimally invasive approach by using 2.9-mm Senhance ® surgical robotic system (Senhance ® , TRANSENTERIX Inc., USA). A 60-year-old Caucasian woman with symptomatic pelvic organ prolapse-Q (POP-Q) Aa 2, Ba 3, C +4, Bp2, Ap 2, TVL10 underwent subtotal hysterectomy with bilateral salpingo-oophorectomy, with nerve-sparing SCP performed using the Senhance surgical robotic system.. The urogynaecological assessment on the day of discharge and at the 3 month follow-up showed surgical anatomic success ( less then 2 POP-Q stage). The patient was fully satisfied with the cosmetic result. This is the first case of SCP performed with this innovative system. SCP using "Senhance ®" is a feasible and effective approach with good results in terms of operative time, cosmesis, postoperative pain and length of hospitalisation.
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