bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between Acute Suppurative Otitis Media and Chronic Secretory Otitis Media: Role of Antibiotics
Authors: Mills Robert , Uttley Ann , McIntyre Michelle
Published: January 2017

A total of 204 chronic middle ear effusions from 122 children have been studied. Bacteria were isolated from 30 effusions. The commonest species found were Strep. pneumoniae and H. influenzae. These are also the commonest organisms causing acute otitis media (AOM). A similar pattern of serotypes was also demonstrated. In vitro sensitivity testing showed that most of the organisms isolated were sensitive to most commonly-used antibiotics. The main exception was resistance to penicillin amongst strains of H. influenzae and Staph. aureus. It is suggested that some cases of chronic secretory otitis media (SOM) may arise as a result of incomplete resolution of AOM and that the use of penicillin to treat AOM may be one factor in this process.
Gastric Sarcoidosis
Authors: Gallagher P , Harris M , Turnbull F W A , Turner L
Published: January 2017

Two cases of gastric sarcoidosis are reported. Both patients presented with a history suggestive of peptic ulceration and the diagnosis of sarcoidosis was made mafter operation.
Effect of Family Relationships on Psychogeriatric Patients
Authors: Bergmann K , Manchee V , Woods R T
Published: January 2017

Severe strain has been repeatedly reported in the families of psychogeriatric patients. Nevertheless, many families continue to provide a great deal of support, despite the undoubted burden involved. A retrospective study of short-term outcome in 60 psychogeriatric referrals demonstrated the importance of some aspects of the relationship between the patient and their key supporting relative. In the sample as a whole, and in functional patients, the extent to which a positive communication system existed was significant. In patients with dementia, poor outcome was related to the patient being less dependent and more dominant in their interaction with the relative. The implications of this study for intervention and future research are discussed.
Accessory Cystic Duct — An Operative Hazard
Authors: Senapati Asha , Wolfe John H N
Published: January 2017

Two patients with duplicated cystic ducts are reported. This is a rare and poorly reported anomaly. The hazards of misdiagnosis are discussed.
Computed Tomographic Scanning in Rectal Carcinoma
Authors: Zheng G , Johnson R J , Eddleston B , James R D , Schofield P F
Published: January 2017

Computed tomographic (CT) scanning has been used to assess the extent of local spread in 85 patients with rectal carcinoma. In 37 patients with carcinoma of the rectum who were scanned before surgery, good correlation was found between the extent of local invasion, as assessed by scanning, and that demonstrated at operation by histological assessment. Scanning is not a reliable method for assessing regional lymph node involvement. Forty-eight patients presented with recurrent rectal carcinoma after previous rectal excision (30 patients after abdominoperineal and 18 patients after anterior resection). CT scanning was shown to be a varuable tool in establishing the diagnosis of recurrent tumour. Most of these patients have spread which precludes further curative surgery. CT may identify those patients who have a resectable recurrence, but is especially valuable in planning radiotherapy which may be used for palliation.
Teenage Pregnancy and Motherhood
Authors: Wolkind S N , Kruk S
Published: January 2017

In a random sample of British-born women from a deprived inner London borough who were expecting their first baby, 31% were teenagers at the time they gave birth. The teenage mothers were compared with a group of older women randomly selected from the sample and both groups were followed up for 6 1/2 years after the birth. The teenage mothers were more likely to have had a deprived background and to have experienced material disadvantage. Despite this, they and their children did as well as the older women on a wide variety of measures of physical and mental health. A comparison of the teenagers with another sample of women who did poorly (those who had been brought up in care) suggests that the lack of an adverse result amongst the teenagers was at least in part due to support from the womens' own mothers.
Iron Status in Hypogammaglobulinemia
Authors: Atrah Hasan I
Published: January 2017

Iron, transferrin and ferritin were measured in serum samples from 16 patients with primary hypogammaglobulinemia. Transferrin saturation was low in 12 patients (75%) and serum ferritin was low in 9 patients (56.25%). Both parameters were low, confirming the state of iron deficiency, in 6 patients (37.5%). These figures are highly significant ( P < 0.01) when compared with the prevalence of iron deficiency in the general population. Eight patients were maintained on intravenous immunoglobulin infusions and the rest on intramuscular immunoglobulin injections, their mean serum IgG being 4.4 g/l and 2.6 g/l respectively. There was no difference in the prevalence of iron deficiency between the two groups.
Atropine or Glycopyrrolate with Neostigmine 5 mg: A Comparative Dose-Response Study
Authors: Salem M G , Ahearn R S
Published: January 2017

One hundred and fifteen patients, separated into 4 groups, received neostigmine 5 mg with either atropine 1.2 mg or 1.8 mg, or glycopyrrolate 0.6 mg or 0.9 mg. Those receiving 0.9 mg glycopyrrolate had insignificant changes in heart rate in the immediate postreversal period. It is recommended that when glycopyrrolate is used with 5 mg neostigmine, the optimum dose is 0.9 mg.
Leiomyoma of the Broad Ligament in an Obturator Hernia Presenting as a Lump in the Groin
Authors: Kit H K Ng Lung , Collins R E C
Published: January 2017

Obturator hernia is an infrequent entity. About 550 cases have been reported in the English literature1,2 since it was first described by Arnaud de Ronsil in 1724. The commonest structure that herniates into an obturator hernia sac is small intestine3-5. Cases have been reported of bladder, fallopian tube, ovary, omentum, appendix, caecum and uterus3,5-7. No previous report of a benign tumour of the broad ligament herniating into an obturator hernia sac, and presenting as a lump in the femoral triangle, has been traced.
Transsphenoidal Surgery for Cushing's Disease
Authors: Fahlbusch R , Buchfelder M , Müller O A
Published: January 2017

A series of 101 patients with Cushing's disease underwent transsphenoidal surgery. Diagnosis was fundamentally based on dynamic testing, mainly on the dosage-dependent suppression of cortisol after dexamethasone. The effect of surgery was monitored by intraoperative ACTH measurements. In 96 out of 101 patients a microadenoma of the pituitary was identified and removed selectively. In 74% of patients there was a clinical and endocrinological remission of Cushing's disease. Four ‘operative failures’ after selective adenomectomy underwent hypophysectomy in a second operation and each remitted. Thus the overall remission rate was 77%. In general, bilateral adrenalectomy was performed in patients who had failed to remit after selective adenomectomy.

Although there is a considerable mortality and morbidity in patients with Cushing's syndrome, complications attributed to surgery were low. Two patients died postoperatively. In general, an improvement of disturbed pituitary function was noted after selective adenomectomy.
Relationship between Retinopathy and Glycaemic Control in Insulin-Dependent and Non-Insulin-Dependent Diabetes
Authors: Monson J P , Koios G , Toms G C , Kopelman P G , Boucher B J , Evans S J W , Alexander W L
Published: January 2017

The possible relationship between antecedent diabetic control, as determined by serial glycosylated haemoglobin (HbA1) measurements, and diabetic retinopathy was examined in 40 insulin-dependent and 41 non-insulin-dependent diabetics selected consecutively from our clinic population. Multiple logistic regression analysis demonstrated a significant association between mean HbA1 and prevalence of retinopathy in both groups of patients. This association was independent of duration of diabetes which was also significantly associated with retinopathy prevalence. Hypertension and smoking were not obvious risk factors in this group of patients; an apparent association of hypertension and diabetes was entirely accounted for by a positive relationship between the presence of hypertension and duration of diabetes.
Morbidity and Mortality of Radical Cystectomy (1971–78 and 1978–85)
Authors: Hendry W F
Published: January 2017

The mortality after radical cystectomy with urinary diversion has been reduced from 11% in 53 patients operated on during 1971–78, to 2.5% in a similar group of 120 patients operated on during 1978–85. Amongst the latter, mortality varied from 0 amongst 32 non-irradiated patients, to 1 (3%) of 33 after planned preoperative radiotherapy and 2 (3.6%) of 55 after previous radical radiotherapy. The improvement in results appears to be due to a number of factors including routine intensive care in the early postoperative phase, with epidural analgesia, and meticulous attention to haemostasis and the technical details of construction of the ileal conduit.
Trial of (+)-Cyanidanol-3 in Patients with Hepatitis B Chronic Liver Disease
Authors: Keeling P W N , Viola L , Anderson M G , Marigold J H , Macartney J C , Paradinas F J , Murray-Lyon I M , Thompson R P H
Published: January 2017

A double-blind controlled trial of 12 months' treatment with (+)-cyanidanol-3 was carried out in 26 patients with chronic hepatitis B liver disease. Treatment did not improve liver blood tests nor histological appearances of the liver, but there was a trend towards reduction of serum titres of hepatitis B surface antigen.
Kaposi's Sarcoma and HTLV-III: A Study in Nigerian Adult Males
Authors: Otu A A
Published: January 2017

Sera from 37 adult Nigerian men with Kaposi's sarcoma (KS), 30 contemporaneous controls bearing primary cell carcinoma of the liver (PCL), and 150 healthy non-tumour-bearing negative controls were tested for antibody to human T-cell lymphotropic virus type III/lymphadenopathy associated virus (HTLV-III/LAV) by enzyme-linked immunosorbent assays (ELISA). Certain immunocellular functions were also measured: the chemotactic locomotion of peripheral blood monocytes towards casein, delayed-type cutaneous hypersensitivity reaction to tuberculoprotein and opportunistic infection with the fungus Candida albicans. Sera from all these groups were also tested for markers of previous infections with the viruses cytomegalovirus (CMV), Epstein-Barr virus (EBV), hepatitis B (HBV) and hepatitis A (HAV). All serum samples tested were reproducibly and consistently negative for anti-HTLV-III/LAV. Peripheral blood monocytes from both KS and PCL patients showed profound depression of chemotaxis; similarly all tumour patients gave markedly depressed cutaneous reactivity to tuberculoprotein and uniformly exhibited seropositivity to CMV, EBV, HBV and HAV. A great majority showed evidence of infection with Candida albicans. It is concluded that tropical African KS is not associated with HTLV-III/LAV infection.
Parenteral Nutrition via Peripheral Veins: A Feasibility Study
Authors: Wilson A , Goode A W , Kirk C J C , Sugden M
Published: January 2017

Twenty patients who had undergone uncomplicated surgery of moderate severity were randomly allocated to two groups (both n = 10) who were fed using a peripheral vein for up to six days. Group I received, each day, a nutrient solution providing 10 grams of nitrogen as Perifusin (E Merck Ltd) and 1400 calories as dextrose and Intralipid (Kabivitrum Ltd) with an osmolality of 490 mosmol/kg. Group II received only 15 grams of nitrogen per day as Perifusin with an osmolality of 376 mosmol/kg. The mean (± s.e. mean) nitrogen balance over the study was similar in both groups, in Group I being −1.23 ± 0.89, and in Group II being −1.05 ± 1.08 g ( P > 0.05 Mann-Whitney U test). The nutrient mixture given to Group I resulted in elevated levels of serum 3-hydroxybutyrate and lower levels of serum non-esterified fatty acids. These data suggest that lipolysis and ketogenesis were suppressed. There was no significant difference in serum lactate levels in either group. Venous thrombophlebitis at the infusion site was assessed daily using Maddox's criteria, with a minimal degree of inflammation occurring in either group. This preliminary study suggests that a total parenteral feeding regimen may be designed for peripheral vein infusion. Further studies are indicated.
Building or Extending a Hospital Department: Radiology a Path through the Planning Minefield (7)
Authors: Roebuck E J , Manton D J , Fordham G L
Published: January 2017

This is the seventh of a series of articles on the planning and building of a new radiology department or the extension of an old one. While the series focuses on a radiology department, it will be of interest to anyone who is planning any part of a hospital, particularly in the detailed information about the planning process and the part to be played by hospital staff during the subsequent building and commissioning. (The first article in the series appeared in the January issue, p 40.)
Building or Extending a Hospital Department: Radiology a Path through the Planning Minefield (8)
Authors: Roebuck E J , Manton D J , Fordham G L
Published: January 2017

This is the eighth of a series of articles on the planning and building of a new radiology department or the extension of an old one. While the series focuses on a radiology department, it will be of interest to anyone who is planning any part of a hospital, particularly in the detailed information about the planning process and the part to be played by hospital staff during the subsequent building and commissioning. (The first article in the series appeared in the January issue, p 40.)
Occult Leydig Cell Testicular Tumour Presenting with Gynaecomastia
Authors: O'Donovan J J , Terry T R , Williams G
Published: January 2017

Certain testicular tumours may present with gynaecomastia1–3. Rarely in these cases is the testicular tumour not palpable at the initial clinical examination or at follow-up examinations. To enable early detection of these occult testicular tumours a serum hormonal profile followed by high resolution ultrasound examination of the testes are necessary3–7. We report a case of a Leydig cell tumour in which gynaecomastia antedated the clinical presence of a testicular swelling by 7 months.
Human Rectosigmoid Electromyography: A New Approach and Some Pitfalls
Authors: Wegman E A , Aniss A M , Bolin T D , Davis A E , Gandevia S C
Published: January 2017

A method has been developed to record directly myoelectrical activity from the smooth muscle of the colon of intact subjects using pairs of intramuscular wires. Discrete bursts of myoelectrical activity occurred at 4–20 per min. A small interelectrode distance in this method allows contamination of colonic myoelectrical activity by the electromyogram of skeletal muscle to be excluded. This artefact has not been considered in previous recordings of ‘colonic’ activity.
Plasma and Lipoprotein Lipids and Apolipoproteins AI, AII and B in Patients with Chronic Airflow Limitation
Authors: Bolton C H , Mulloy E , Harvey J , Downs L G , Hartog M
Published: January 2017

Plasma and lipoprotein cholesterol and triglycerides, and plasma apolipoproteins AI, AII and B were compared in patients with chronic airflow limitation, and normal controls matched for body mass index. The controls were non-smokers, and free from respiratory disease.

High-density lipoprotein (HDL) cholesterol concentration was significantly elevated in the patients, due mainly to a raised HDL2 cholesterol level. HDL triglyceride was significantly lower in the patients. All other lipids were not different from normal. Apolipoprotein AI levels were significantly raised in the patients but other apolipoproteins were unchanged.

The changes found may account in part for the fact that patients with chronic airflow limitation have a lower incidence of atherosclerotic heart disease.
Postoperative Nausea is Relieved by Acupressure
Authors: Barsoum G , Perry E P , Fraser I A
Published: January 2017

One hundred and sixty-two general surgical patients were prospectively randomized to one of three treatments for postoperative nausea and vomiting: (1) acupressure using elasticated bands containing a plastic button to apply sustained pressure at the P6 (Neiguan) point above the wrist, (2) control dummy bands without the pressure button and (3) antiemetic injections of prochlorperazine with each opiate given and as required. All patients received papaveretum injections as required for pain, and additional prochlorperazine injections were prescribed if nausea was not controlled in groups 1 and 2. The severity of nausea was assessed using a linear analogue scale and was significantly ( P=0.002) reduced by acupressure on both days 1 and 2, in comparison to both controls and drug treated patients. The incidence of postoperative vomiting, and the need for unplanned antiemetic injections was also reduced by acupressure but this was not statistically significant. Acupressure can work and should be investigated in other clinical situations.
Arthroscopy in Children
Authors: Hope P G
Published: January 2017

Arthroscopy was performed on the knees of 67 children aged 2–16 years with an overall clinical diagnostic accuracy of 45%. The most common clinical diagnoses were meniscal tear and patello-femoral pain and the accuracy of these diagnoses was 33% and 59% respectively. Diagnostic accuracy seemed unrelated to age. Arthroscopy led to definitive treatment which relieved symptoms in 21 (31%) of cases, revealed a diagnosis only in 43 (64%), and was non-contributory in 3 (4.5%). The procedure did not significantly help patients with patello-femoral pain.
On-Line Noise Estimation for Adaptive SPC Loop Control
Authors: Twigg P.M. , Thomson M.
Published: January 2017

This paper describes a method of measuring the variance of a noisy process on-line, enabling the application of adaptive Statistical Process Control (SPC) to supervise a continuous process loop. A fundamental requirement of SPC techniques is that the data are independent. Process control loops typically generate autocorrelated data, and this tends to create an increase in the false alarm rate when attempting to apply SPC techniques. The method presented here produces an uncorrected sequence from potentially correlated data, overcoming this problem. The SPC supervisory unit acts externally to the control loop preventing any lags in feedback. When these SPC charts are used in a supervisory role with a conventional PID controller, application of individual PID terms achieves a much quieter control with little reduction in performance and without the need for prior off-line noise tests. The results of tests in simulation and on a steam-water heat exchanger are presented.
Adaptive Neural Network Controller Design for Flexible Joint Robots using Singular Perturbation Technique
Authors: Ge Shuzhi S. , Postlethwaite Ian
Published: January 2017

In this paper, an adaptive neural network controller is presented for flexible joint robots using Singular Perturbation techniques by modelling the elastic forces as the fast variables and link variables as slow variables. The neural network controller is to control the slow dynamics in order to eliminate the tedious preliminary computation of the regressor matrix. Unlike many neural network (NN) controllers in the literature, inverse dynamical model evaluation is not required and no time-consuming training process is necessary except for initialising the NNs based on approximate function values at the initial posture at time t = 0. It can be shown that the controller can control the system successfully by intensive computer simulation tests.
Pre-Scheduled PID Control of a Solar Thermal Power Plant
Authors: Meaburn A. , Hughes F. M.
Published: January 2017

Efficient operation of a distributed solar collector field requires effective regulation of the outlet temperature. Control schemes utilising PI-based controllers, whether adaptive or fixed parameter, have been shown to be unsuitable for this application with a stable well-damped response only obtained at the expense of an unacceptably low speed of response. The reason for this is that collector fields possess low-frequency resonance dynamics which tend to restrict the bandwidth of such controllers. This paper examines the suitability and capability of PID controllers in this application area.

Using experimental frequency response data, the Ziegler-Nichols tuning method for PID design is demonstrated to yield an unstable closed-loop system. However, by adopting a strategy which specifically aims to counter the adverse phase characteristics of the plant at resonance, good effective closed-loop control can be achieved. This is implemented as a pre-scheduled control scheme on the Acurex collector field at the Plataforma Solar de Almeria and tested in conjunction with a feedforward control scheme.
Modelling the Conical-Entrance Orifice Plate Flow Sensor
Authors: Ho Y. S. , Abdullah F.
Published: January 2017

This paper presents a numerical model for the conical entrance orifice plate flow sensor, which is essentially used as a low Reynolds number flow measuring device. The model was developed using a low Reynolds number k-ɛ model of turbulence – the Lam and Bremhorst model. Numerical results were obtained for diameter ratios of 0.1, 0.2 and 0.3, and for pipe Reynolds numbers of between 80 and 60000. The computed discharge coefficients are compared with available experimental data and with the value stated in BS 1042. Results show that the model developed can predict the discharge coefficient to within ±3% for the range of diameter ratios and Reynolds numbers investigated.
Health Care in Jails: An Evaluation of the American Medical Association's Pilot Projects
Authors: B. Jaye Anno , Hornung Carlton A.
Published: January 2017

In 1975 the American Medical Association was awarded a grant by the Law Enforcement Assistance Administration to conduct pilot projects to improve the quality of health care in jails. The medical societies of six states were selected as subgrantees and projects were initiated in thirty jails. The evaluation of these projects involved both process and impact components. The principle criterion for the process evaluation was the success of jails in meeting the standard of health care for jails that were established by the AMA as part of the project. The principle criterion employed in the impact assessment was the extent of improvement in the early detection of inmates' health problems. The project was determined to be successful in both the process and the impact evaluation, although notable improvements in jail health care are still to be made.
Evaluating a Voluntary Second Surgical Opinion Program
Authors: Joffe Jerome
Published: January 2017

Numerous problem areas were encountered in the evaluation of a voluntary second surgical opinion program. Some problems could be handled only on a conceptual level, while others require for their solution the integration of existing with new data sets. (1) Reliance on program participants to provide medical data was sensitivity tested and found to have minimal impact. (2) Program impact on hospital bed reduction was considered in the context of the total market and political environment in the region, and the anticipated duration of the program. A reasonable judgment was that almost the entire fixed component in the per diem cost of anticipated patient days foregone could be written off as part of the cost savings of the program. (3) As hospital reporting systems identify only average per diem costs, a methodology was developed to separate surgical from nonsurgical case costs. (4) Quality of care evaluation will incorporate a substratum of cases for which there exists a control group within the program user population. Outcome measures obtainable through survey interviews were identified.
What is happened may not be what appears to be happening: a corpus study of ‘passive’ unaccusatives in L2 English
Authors: Oshita Hiroyuki
Published: January 2017

Second Language (L2) researchers have been studying ‘passive’ unaccusative errors such as What was happened?, but have not yet reached a consensus about the ultimate cause of this unique interlanguage structure. This article critically reviews five major accounts proposed in the literature, namely:

• transfer of a compound tense/aspect structure in the learner's first language (L1);

• overgeneralization of adjectival passive formation in English;

• nontarget lexical causativization;

• identification of the passive morphosyntax with the lack of a logical subject; and

• nontarget overt marking of syntactic NP movement.

By analysing each account in terms of its ramifications in light of the data already available in the literature and additional data from a large corpus of nonnative English, I demonstrate that the most plausible account of the ‘passive’ unaccusative structure is to regard it as an overt marker of NP movement, an overgeneralization of the passive morphosyntax of the target English.
Missing inflection in second language French: accidental infinitives and other verbal deficits
Authors: Herschensohn Julia
Published: January 2017

This article re-examines the morphology/functional category debate in the light of empirical data drawn from the author’s longitudinal study of two intermediate learners of French as a second language (L2). It argues that inflectional deficits -which appear both as nonfinite verbs and as other morphological errors in the interlanguage data -support neither a codependence of syntax and morphology (Eubank, 1993/94) nor a gradual structure-building of L2 functional categories (Vainikka and Young-Scholten, 1998a, 1998b). The French data rather indicate that deficiencies in morphological mapping, not defective syntax (functional categories), are the cause of L2 failed inflection (Schwartz and Sprouse, 1996; Lardière, 1998). The data also support the claim that L2 morpholexical characteristics - the most prone to cross-linguistic variation - are more difficult to master than syntactic differences (Herschensohn, 2000). The first section reviews the theoretical issues, discussing the morphology/functional category link in L1 and then in L2 acquisition. The second section presents relevant data on infinitival forms and other errors from the author’s study. The third section discusses the data, arguing that the infinitival forms of intermediate grammars are not ‘root infinitives’ such as those seen in early stages of L1 acquisition, but rather examples of defective inflection.
Sentence matching: a re-examination
Authors: Gass Susan M.
Published: January 2017

This article examines sentence matching, a methodology frequently used in the second language (L2) literature to determine notions of grammaticality of nonnative speakers (NNS). Native speakers (NS) of French and L2 learners of French performed a sentence-matching task focusing on three areas of French grammar: adverb placement, subject-verb agreement and clitic-pronoun placement. In sentence-matching tasks participants respond to two sentences on a computer screen indicating whether the two sentences are identical or not. In general, grammatical sentences are responded to faster than ungrammatical sentences and have been used in the L2 literature as a way of determining grammatical knowledge. The results from the NSs of French show that when there is a high degree of difficulty in interpretation of ungrammatical sentences, sentence matching is a useful tool for determining grammaticality. For NNSs there is little evidence that sentence matching predicts grammaticality. A traditional acceptability judgement task was administered to NNSs. Sentence-matching did not correlate with NNS’s individual notions of grammaticality. Issues of proficiency level and the nature of ungrammatical sentences are important determinants when considering the validity of sentence-matching as a research tool.
A Novel Endoluminal Technique for Varicose Vein Management: The VNUS Closure
Authors: Fassiadis N. , Kianifard B. , Holdstock J. M. , Whiteley M. S.
Published: January 2017

In an attempt to reduce the morbidity of high tie and strip of the long saphenous vein various extraluminal and intraluminal electrosurgical devices have been employed in the past using monopolar energy to ablate varicose veins. As result of this full-thickness skin burns and saphenous nerve injuries were observed by surgeons using these techniques. This report describes the VNUS Closure, a novel endovascular computer-feedback-controlled application of bipolar electrothermal energy which ensures transmural heating of the vein wall while minimising thermal spread to neighbouring tissues.
Influence of Preoperative Duplex Ultrasonography on the Operative Procedure for Primary Varicose Vein Surgery
Authors: Rautio T. , Perälä J. , Wiik H. , Haukipuro K. , Juvonen T.
Published: January 2017

Objective:

To evaluate the impact of duplex ultrasonography on the treatment plan of patients with uncomplicated primary varicose veins.

Methods:

Forty-nine consecutive patients (62 legs) with primary uncomplicated varicose veins were examined clinically and with hand-held Doppler (HHD) and duplex ultrasonography in an outpatient clinic on the same day. The plans for subsequent treatment were recorded separately after the two ultrasound examinations.

Results:

The accuracy of the HHD examination was 0.71 in the saphenofemoral junction (SFJ) and long saphenous vein (LSV trunk). In fifty-six limbs (90%) duplex scanning did not affect the surgical treatment of the patients.

Conclusions:

Most operations on primary varicose veins can be performed on the basis of clinical and HHD examinations by an experienced surgeon. Duplex ultrasonography can be used selectively in the patients with suspected saphenopopliteal junction (SPJ) reflux or equivocal HHD findings.
Tourniquets Cannot Identify Superficial Venous Reflux Nor Predict the Haemodynamic Outcome of Saphenous Vein Surgery
Authors: Scriven J. M. , Bianchi V. , Hartshorne T. , London N. J. M.
Published: January 2017

Objective:

To evaluate the ability of tourniquets or manual venous compression to predict the haemodynamic outcome of saphenous vein surgery.

Design:

Prospective, observational study using colour duplex scanning and photoplethysmography (PPG) in patients undergoing saphenous vein surgery.

Patients and methods:

Twenty-six patients (26 limbs) undergoing saphenous vein surgery underwent colour duplex and PPG assessment before and after the application of tourniquets or manual venous compression. The effect of compression on the superficial and deep veins was assessed by colour duplex scanning. The haemodynamic effect of compression was measured using PPG 90% refill times (PPGRT90) and the results compared with the postoperative PPGRT90.

Results:

Pneumatic tourniquets occluded 27% of saphenous veins. Manual compression significantly lengthened PPGRT90 compared with pneumatic tourniquets but neither method could usefully predict the postoperative PPGRT90.

Conclusion:

Neither pneumatic tourniquets nor manual venous compression predict postoperative venous refill times. We advise caution in the interpretation of tourniquet testing.
Short Saphenous Vein Surgery, Pre-Operative Doppler Ultrasound Marking Compared with on-Table Venography and Operative Findings
Authors: Gilliland E.L. , Gerber C.J. , Lewis J.D.
Published: January 2017

Unidirectional Doppler ultrasound is a simple and inexpensive adjunct to the clinical examination of varicose veins; its accuracy in determining the level of the saphenopopliteal junction has not previously been assessed. A total of 30 limbs with saphenopopliteal reflux were examined with a portable Doppler on the day of surgery and the upper limit of reflux marked. This was compared with the findings of on-table venography and surgery. Venography provided accurate anatomical information in only 84% of cases, in the failures the Doppler mark proved useful by eliminating the need for multiple incisions. Doppler estimation of the saphenopopliteal junction was correct in only 40% of cases but in nine cases out of 10 it was within 2 cm; a distance that will allow appropriate surgery through a single incision. In experienced hands the use of unidirectional doppler may eliminate the need for pre-operative venography in selected cases.
Augmentation of Upper Limb Venography with Digital Subtraction
Authors: Hughes D.G. , Dixon P.M. , Fletcher E.W.L.
Published: January 2017

Digital subtraction venography is a safe, cheap and accurate method of imaging the veins of the upper limbs.
A Pressure-Based Technique for the Detection of Acute and Chronic Venous Obstruction
Authors: Raju Seshadri
Published: January 2017

A simple pressure-based technique for the detection of venous obstruction is described. The severity of obstruction can be graded utilizing the technique outlined. The method has a high degree of sensitivity and specificity and is easily employed as a routine procedure in the vascular laboratory. The technique provides invaluable haemodynamic information in venous obstruction in a variety of clinical settings as illustrated.
Effect of Paroven on Skin Oxygenation in Patients with Varicose Veins
Authors: Burnand K.G. , Powell S. , Bishop C. , Stacey M. , Pulvertaft T.
Published: January 2017

A double blind placebo-controlled clinical trial was undertaken to investigate the effect of 500 mg bd of Paroven taken for four weeks on the tissue oxygenation, ankle oedema and calf pump function of 48 patients with chronic venous disease.

There was no evidence that Paroven reduced ankle swelling or improved calf pump function, but it did cause a significant improvement in transcutaneous oxygen levels measured in the calf skin of the ulcer hearing area ( p = 0.026) which was confirmed when the oxygen levels of the active and placebo treated groups were compared at the end of four weeks treatment ( p = 0.02). This improvement in tissue oxygenation may be the result of alterations in the capillary exchange produced by the drug and may account for the symptomatic benefit associated with its use.
Axillo-Jugular Bypass for Axillary Vein Thrombosis
Authors: Schraibman I.G.
Published: January 2017

Reconstructive surgery of major veins has lagged far behind that of corresponding arteries and its place has still to be defined despite a recent upsurge in interest Most attention has been focused on lower limb veins but occlusion of the axillary–subclavian trunk can be attended by disabling symptoms and is the subject of this report. A case is presented in which thrombosis followed mastectomy for carcinoma and the methods which can be used to bypass the obstruction are reviewed.
A Comparison of Photoplethysmography, Doppler Ultrasound and Duplex Scanning in the Assessment of Venous Insufficiency
Authors: McMullin G.M. , Scott H.J. , Smith P.D. Coleridge , Scurr J.H.
Published: January 2017

Effective surgical treatment for venous insufficiency depends on an accurate assessment of the veins. Phlebography, giving an anatomical view, is now being replaced by non-invasive methods of examination which give both anatomical and physiological information. This study compared the diagnoses obtained from three methods of non-invasive assessment: photoplethysmography, continuous wave Doppler ultrasound and duplex scanning. One hundred and twentyfour limbs were evaluated by each of the three methods. There was concordance about the diagnosis between all three methods in 42.2%. Duplex and Doppler agreed in 62%; duplex and PPG in 60.5%; Doppler and PPG in 54.8%. Confirmation of the results using invasive methods showed duplex to be the most accurate method for detecting deep vein reflux. We would question the efficacy of tourniquets in controlling reflux, leading to misinterpretation of the PPG results and Doppler ultrasound results.
Suitability for Day-Care Varicose Vein Surgery
Authors: Clinton Oliver , Negus David
Published: January 2017

A total of 149 patients on the waiting list for inpatient varicose vein surgery were assessed for suitability for day-care surgery. In all 99 patients (66%) were considered unsuitable for medical or social reasons.
For How Long Do We Have to Advise Elastic Support after Varicose Vein Surgery? A Prospective Randomized Study
Authors: Rodrigus I. , Bleyn J.
Published: January 2017

A prospective randomized study was performed to compare different periods of bandaging after varicose vein surgery. No difference was found from wearing an elastic support for 1, 3 or 6 weeks after surgery.
Diagnosis and Surgical Aspects of Congenital Venous Angiodysplasia in the Extremities
Authors: Paes E. , Vollmar J.
Published: January 2017

Objective:

An evaluation of the treatment of patients with venous angiodysplasia and severe chronic insufficiency.

Design:

The clinical series of patients with venous angiodysplasia of Klippel-Trenaunay (K-T) and Servelle-Martorell (S-M) type.

Setting:

Primary care teaching hospital.

Patients:

Eighty-three patients with angiodysplasia type K-T characterized by the triad of local giantism, varicose veins and naevus flammeus. Malformations of the deep venous system were present in 96%. The predominant vascular lesion in patients with the S-M syndrome ( n=34) was a haemangiomatosis, involving both the skeleton and soft tissues, causing growth retardation in the affected extremity. A malformation of the deep venous system could be seen in all patients.

Main outcome measures:

Healing of skin ulcers and varicose bleeding of the lower extremities.

Interventions:

Conservative treatments included external compression bandages or stockings. In 14 patients, surgical extirpation of superficial veins was used.

Results:

All the ulcers were treated successfully, and no haemorrhage reoccurred. Haemodynamic studies showed an improvement of the venous reflux disease in 86% of patients.

Conclusion:

Venous angiodysplasia of the lower extremity is nearly always associated with malformation of the deep venous system. Surgery is indicated for the elimination of a pathological short circuit flow in atypical drainage veins of the affected leg, especially when skin lesions are present. For any type of surgery, a careful preoperative angiographic and haemodynamic evaluation is mandatory.
Videophlebography with Foot Venous Pressure Measurements: Description of a Technique for Diagnosing Venous Dysfunction
Authors: Björgell O. , Ekberg O. , Åkesson H. , Olsson R.
Published: January 2017

Objective:

To introduce phlebography with simultaneous video recording of the fluoroscopy (VIP, videophlebography), to improve phlebography performed in patients with venous dysfunction. Ambulatory foot venous pressure (AVP) was measured in the same session.

Design:

Descriptive study of an improved phlebographic technique.

Setting:

University Hospital MAS, Malmö, Sweden.

Study group:

Forty-one consecutive patients (50 legs) referred to phlebographic investigation. In the last 27 legs the AVP was also measured.

Intervention:

Phlebography with video recording and measurement of AVP.

Results:

In 49 out of 50 (98%) of the VIPs, information allowing a detailed description of venous function was obtained. Normal closing of venous valves, seen on the ascending VIP, combined with a normal venous pressure made it possible to exclude deep vein incompetence and avoid descending phlebography. In 16 out of 27 legs (59%) this combined approach showed that descending phlebography was unnecessary.

Conclusion:

VIP provides an adequate image of the venous anatomy, important in preoperative evaluation. The combination of this technique with AVP may clarify the pathophysiological abnormalities resulting from the venous dysfunction.
Venous Insufficiency of the Lower Limbs and Working Conditions
Authors: Sobaszek A. , Frimat P. , Tiberguent A. , Domont A. , Chevalier H. , Catilina P.
Published: January 2017

Objectives:

To determine the prevalence of venous insufficiency (VI) in a population of women working in the health and social sectors. In a second stage, we assessed the relative contributions of the different occupational and personal risk factors for venous disease.

Design:

Descriptive, randomized, multicentre, cross-sectional study during January to September 1995.

Study group:

One thousand eight hundred and twenty-three women working in four health sectors: operating rooms, hospital laundries, day-nurseries and offices.

Methods:

The study was based on a physical examination and a medical questionnaire (personal and family history of VI, symptoms, use of medical care). Working conditions, temperature and humidity recordings were studied for each activity. A typological analysis and a discriminant analysis were carried out to determine the contribution of personal and occupational factors to the course of VI.

Findings:

VI is highly prevalent: 76% of subjects and up to 84% in the surgical room and laundry population. Functional symptoms and the presence of varicosities (small varicose veins of the ankle and medial plantar arch) and large varicose veins are more frequent, with the highest prevalence among operating room staff (respectively, 68% and 41%). Seniority is the first and main factor to explain the severity of the disease, independently of age. The number of pregnancies is also an important factor for the severity of VI, while a family history is not. Occupational factors such as high temperature and load-carrying have a significant direct influence.

Conclusion:

We observed a strong relationship between occupational factors and severity of VI. Occupational factors and personal factors could be quantified on the basis of scores identified in the discriminant analysis.
Venous Aneurysm Occurring after Revisional Hip Surgery: A Case Report
Authors: Jalaluddin M. , Parnell E. J. , Corbett C. R. R.
Published: January 2017

Objective:

To report a rare case of venous aneurysm.

Design:

Case report.

Setting:

Departments of General Surgery and Orthopaedic Surgery, The Princess Royal Hospital, Haywards Heath, a district general hospital.

Patient, intervention and results:

A 63-year-old woman underwent revision of a right total hip replacement in 1994, using a cemented prosthesis. She continued to have pain in the region of the hip and a pulsatile swelling was noted in the right iliac fossa. A pseudoaneurysm of the external iliac artery was suspected but investigations showed a venous aneurysm of the external iliac vein. Thus far, this aneurysm has been observed without complication. In 1996 the prosthesis was revised because of loosening of the femoral component and the pain resolved.

Conclusion:

Vascular injury is a rare complication of total hip replacement and thermal arterial injury can occur. Iliac venous aneurysms are recognized but are extremely rare so we conclude that this lesion was caused by thermal injury.
Clinical Impressions on Treatment of Obsessional States with Intravenous Clomipramine (Anafranil)
Authors: Walter C J S
Published: January 2017

On the basis of clinical, albeit limited, experience, the treatment of obsessional states with intravenous clomipramine holds a great deal of hope. Patients find this method of treatment acceptable. It should be administered on an in-patient basis or in the day hospital and form the focal point of a treatment regimen. Clomipramine infusion appears to be effective in reducing both anxiety and depression and these aspects of its action must be submitted to further study in elucidating its possible attenuating effect on obsessional symptoms. Side-effects, though frequent, are not such that treatment need be abandoned nor are they qualitatively different from those of other tricyclic compounds.
Analgesic Efficacy and Acceptability of Fenoprofen Combined with Paracetamol and Compared with Dihydrocodeine Tartrate in General Practice
Authors: Murphy J E , Donald J F , Molla A Layes
Published: January 2017

A single-blind between-patient study in general practice was made to examine the acceptability and analgesic efficacy of a combination of fenoprofen (200 mg) and paracetamol (500 mg) given 3 to 4 times daily for a period of 4 to 14 days in the treatment of acute and chronic pain. The combination was compared with dihydrocodeine tartrate (30 mg) in two groups of 75 patients suffering from a wide variety of presenting conditions, including osteoarthritis, spondylitis, lumbago,' sciatica, non-articular rheumatism and trauma. Clinical and patient assessment indicated that the combination was an effective analgesic combination, significantly better in success rate than dihydrocodeine tartrate and with a much lower incidence of side-effects (13% of patients receiving fenoprofen and paracetamol reported side-effects compared to 37% for the dihydrocodeine group). The combination demonstrated particular success in the treatment of non-articular rheumatism.
A Double-Blind Study of Cimetidine in Patients with Duodenal or Gastric Ulcer in Greece
Authors: Manousos O N , Zografos A , Nicolaou A , Scandalis N , Kalogerakou-Ioannidi E
Published: January 2017

The results of a double-blind study comparing oral cimetidine with placebo in the short-term treatment of endoscopically proven gastric and duodenal ulceration are presented. Cimetidine was used at a dosage of one gram per day and treatment continued over a period of 4 weeks. Greek patients' tolerance of the drug has been recorded. The outcome of treatment was significantly better for the group of patients who received cimetidine treatment.
Double-Blind Comparison of Butorphanol Tartrate and Meperidine Hydrochloride in Balanced Anaesthesia
Authors: Stehling Linda C , Zauder Howard L
Published: January 2017

Butorphanol tartrate, a synthetic morphinan which has analgesic agonist and antagonist properties, was compared with meperidine for balanced anaesthesia. The two agents were found to be comparable in efficacy, maintenance of cardiovascular stability, and incidence of side-effects. Butorphanol has the advantage of being non-narcotic and having a lower propensity for addiction. Because of its antagonist properties, there appears to be a limit to its depressant effects on respiration.
A Double-Blind Study of Dothiepin Hydrochloride (Prothiaden) and Amitriptyline in Out-Patients with Masked Depression
Authors: Dahl L E , Dencker S J , Lundin L
Published: January 2017

A group of forty patients who presented to their general practitioner with depression or somatic complaints, which were considered to be due to depression, were included in a double-blind trial of dothiepin and amitriptyline. Patient improvement as judged by the Hamilton Rating Scale (HRS) and the Comprehensive Psychopathological Rating Scale (CPRS) indicated that both groups significantly improved over the 6 week period. Only in one comparison, CPRS after 1 week, was there any statistical difference between the groups and in this case dothiepin produced a better response than amitriptyline (p < 0.05).

Statistical analysis of side-effects indicated that the frequency and severity of certain individual side-effects, hypotension, tiredness/sleepiness and dry mouth were significantly less with dothiepin than with amitriptyline at Week 1 (p < 0.05). The overall incidence and severity of side-effects was also less with dothiepin at all assessments during the trial.