bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of Duodenal Ulcer in the Northern Savannah of Nigeria
Authors: Holcombe C , Okolie H
Published: January 2017

In 4 years, 200 patients were admitted to the University of Maiduguri Teaching Hospital, in the Northern Savannah of Nigeria, with a clinical diagnosis of peptic ulcer; 60 had the diagnosis of duodenal ulcer confirmed on barium meal or at operation, giving an incidence of 6/1000 adult admissions (excluding obstetrics). There were no gastric ulcers.

Forty-four patients had a ‘simple ulcer’, 10 presented with gastric outlet obstruction, five with peritonitis following perforation and one with haematemesis. There were 44 males, and 16 females, with a mean age of 34 years and mean length of history of 44 months.

Contrary to previous published reports improved diagnostic facilities have shown duodenal ulcer to be relatively common in the Northern Savannah of West Africa.
Effects of Skin Contactants on Evolution of Atopic Dermatitis in Children: A Case Control Study
Authors: Macharia W M , Anabwani G M , Owili D M
Published: January 2017

There is little published literature on the effects of skin contactants during early infancy on eventual development of atopic dermatitis (AD). The purpose of this study was to determine whether or not a relationship exists between the use of skin care products in early infancy and the subsequent development of AD.

We studied a group of 54 Kenyan children with AD and 63 age and sex matched controls. Emollients had been used to lubricate the skin during early infancy in a similar proportion of children in both groups (odds ratio = 0.33; 95% CI = 0.14, 0.80). Similarly, no association was found between the use of toilet soaps or laundry detergents in early infancy and development of AD. These findings suggest that baby soaps and vaseline petroleum jelly can safely be used in the skin care of AD susceptible individuals.
Xerophthalmia in Malnourished Sudanese Children
Authors: Hussain M A M , Ahmed S M , El Sheikh E H A
Published: January 2017

Two hundred and thirteen Sudanese children (4–60 months old) with malnutrition were examined for signs of xerophthalmia. Sixty-three (29%) of these children were found to have varying stages of xerophthalmia. These included 35 (56%) patients with conjunctival xerosis, 12 (19%) with Bitot's spots, seven (11%) with corneal xerosis, seven (11%) with corneal ulceration and two (3%) with corneal scar.

Direct questioning of the parents of these children revealed evidence of night blindness in nine (4%) of all patients. All nine patients had signs of xerophthalmia which showed good response to vitamin A therapy.
An Experience in the Control of Plague in Botswana
Authors: Kumaresan J A , Grova J B , Mmatli P K , Maganu E D
Published: January 2017

In October 1989, cases of human plague started to occur in Boteti district of Botswana. One hundred and seventy cases were recorded in total from 15 October 1989 to 6 April 1990. There were 12 deaths, giving a case fatality rate of 7%. All cases were of the bubonic type. A concerted control strategy based on sentinel surveillance, involving public education, flea and rodent control, chemotherapy and chemoprophylaxis controlled the epidemic.
Appropriate Management of Femoral Neck Fractures in Nepal
Authors: Shah R K , Sharma D P
Published: January 2017

The management of femoral neck fractures in the Third World has always been a problem. Its management in Nepal reflects the level of available treatments for other orthopaedic conditions, as well as for medical care in general. The most successful methods of fracture treatment have remained the simple ones, consistent with the available resources. Adherence to this philosophy of management, carried out with attention to the needs of the people, reduces the incidence of iatrogenic complications. Six years of experience in the management of femoral neck fractures by traction, plaster, McMurray's osteotomy, modified Girdlestone's excision arthroplasty and Austin Moore prosthetic replacement have been reviewed, along with the relevant literature. Non-operative management has been found to be the most satisfactory method of treatment when related to the overall medical resources in Nepal.
Relative Sensitivity of Blood and Bone Marrow Cultures in Typhoid Fever
Authors: Akoh J A
Published: January 2017

In a prospective study of typhoid fever in Ahmadu Bello University Hospital, Zaria, the relative diagnostic sensitivities of blood culture and bone marrow culture were studied. The results in 64 patients with proved diagnosis of typhoid fever (either by recovery of S. typhi from stool, blood and/or bone marrow or by a positive Widal agglutination test) are presented. Forty-four per cent and 59% of the patients yielded S. typhi on blood and bone marrow cultures, respectively.

In 31 patients who were investigated by both blood and bone marrow cultures, the yields of S. typhi were 35% and 61% respectively. This difference is statistically significant ( P < 0.05).

In this study bone marrow culture proved to be the most sensitive diagnostic test for typhoid fever. A simple technique of bone marrow aspiration is described and its use is recommended for large general teaching hospitals.
Illegal Induced Abortion: A Study of 74 Cases in Ile-Ife, Nigeria
Authors: Okonofua F E , Onwudiegwu U , Odunsi O A
Published: January 2017

Seventy-four women with complications of induced abortion were studied prospectively at the Obafemi Awolowo University, Nigeria. Twenty of the women were interviewed privately to elicit confidential information and also to determine their attitudes to contraception and to the Nigerian national abortion law. The results showed that abortion is prevalent in all classes of women and in married as well as unmarried women. There were 13 maternal deaths, accounting for 35% of the maternal mortality in the hospital during the period. Sepsis was the most common cause of death, and most of the abortions complicated by sepsis had been performed by medical practitioners. Interviews with the women revealed that most of them had knowledge of contraception but were unwilling to use it because of wrong information. Most women did not know that abortion is illegal in Nigeria, but felt that it should be. Measures that could be of value in reducing abortion-associated maternal mortality in Nigeria include training and retraining of physicians in the management of abortion and of abortion complications, family planning education of all fertile women, provision of confidential family planning services and liberalization of the abortion law.
Bacteriology of Snakebite Abscess
Authors: Kerrigan Kevin R
Published: January 2017

Thirty-eight cases of abscess secondary to pit viper envenomation are reviewed. The incidence of abscess formation was 9%. Results of aerobic cultures revealed growth of enteric, coliform organisms in 22 of 25 isolates obtained from previously unopened abscesses. Clinical evidence for co-existent anaerobic infection is presented. No cases of tetanus were encountered.

Clinical and laboratory findings of patients in the study are correlated with a review of bacteriologic investigations of the oral flora of venomous snakes. Use of antibiotics effective against aerobic coliforms and histotoxic anaerobic organisms for prophylaxis and/or treatment of infectious complications of pit viper envenomation are recommended.
Treatment of Scabies in Rural East Africa—A Comparative Study of Two Regimens
Authors: Henderson Catriona A , Nykia M
Published: January 2017

Scabies is endemic in Africa where living conditions make synchronous treatment of every member of the large extended family impossible. An open study was designed to investigate the optimum treatment of school children in rural Tanzania. In one school where 34 children (7%) were infested, treatment with benzyl benzoate was distributed to the affected child and those sleeping in close proximity. In another school where 29 pupils (6.4%) were affected, the above treatment was given along with soap and some scabicidal ointment (6% sulphur) to be used on residually affected areas. Again, the treatment was given to those sleeping in proximity. One month later 46% were clear at the first school and a significantly higher proportion (69%) at the second. I conclude that inefficient application of scabicidal treatment and lack of washing contribute to scabies treatment failures. Synchronous treatment of small groups within the extended family can be effective.
Endoscopic Retrograde Cholangiopancreatography and Endoscopic Sphincterotomy: Experience in the Sudan
Authors: Fedail Sulieman S , Gaber A Alia , Sulieman Ikhals
Published: January 2017

Over a 5 year period 626 endoscopic retrograde cholangiopancreatography (ERCP) examinations were attempted in Khartoum, Sudan. The relevant duct was successfully cannulated and visualized in 94% of cases of biliary tract disease and in 73% of cases of pancreatic disease. This was due to the large number of cases with advanced pancreatic cancer.

The commonest abnormal finding was stones in the biliary tree in 214 cases (35% of all cases). Cholangiocarcinoma was seen in 18 cases, pancreatic cancer in 64 cases, chronic pancreatitis in 48 cases and periampullary carcinoma in 20 cases. ERCP was considered normal in 100 cases. Endoscopic sphincterotomy (EST) was performed in 48 cases; 44 had common duct stones.

ERCP and EST are feasible and useful procedures in a developing country. However they are expensive and should be carried out in referral centres.
Body Temperatures of Home Delivered Newborns in North India
Authors: Kumar Rajesh , Aggarwal Arun K
Published: January 2017

In this prospective study, the axillary temperature of newborns delivered at home were recorded by a field worker once within a period of 24 h after the birth in 10 villages of Haryana, India, during 1992–1993. Room air temperature was measured at the same time. Family members were interviewed to record newborn care practices. Of the 189 babies, 11.1% were found to be hypothermic (temperature <35.6°C) and 22.8% were hyperthermic (temperature >37.3°C). During winter months 19.1% were hypothermic as compared to only 3.1% in summer whereas 8.5% were hyperthermic in winter compared to 36.8% in summer. Room air temperature of <24°C was recorded in 41%. A strong correlation was observed between room air temperature and neonatal temperature.

At the time of birth, 13.2% of the delivery rooms in summer and 73.6% in winter were reported to have heat source: 58.2% babies were reported to be wiped soon after birth; 97.3% were wrapped in cloth; the head was covered in 59.1% cases in winter and 10.5% in summer; 97.3% babies were kept with mother in same bed but not in skin-to-skin contact; and 65% were bathed within 24 h after delivery. Neonatal hypothermia is a common problem in developing countries. It is important that information, education and communication strategy about appropriate technologies for prevention and management of neonatal hypothermia is provided at domiciliary level. A significant proportion of babies are likely to suffer from hyperthermia in warm countries, specially in summer. Therefore, guidelines for thermal control in home births should be tailored to the specific environmental situation.
Antimicrobial Sensitivity Pattern of Salmonella: Comparison of Isolates from HIV-Infected and Hiv-Uninfected Patients
Authors: Wolday Dawit , Erge Worku
Published: January 2017

A retrospective analysis of all cases of Salmonella infections occurring between 1991 and 1995 was undertaken in order to evaluate the antimicrobial sensitivity pattern of the isolates from both human immunodeficiency virus (HIV) infected and uninfected Ethiopian patients. During the 5-year study period, we identified 147 cases of Salmonella infections. Only in 49 cases was the HIV serostatus known; 22 (44.9%) of the infections were in HIV seronegative patients while 27 (55.9%) were in HIV seropositive patients. The strains were isolated from blood (71.4%), urine (18.4%) and stool (8.2%). Salmonella infection was found to be more frequent (55.15% versus 44.9%) among HIV positive than HIV-negative patients. Moreover, Salmonella isolates recovered from HIV-seropositive patients were significantly resistant to many of the antibiotics tested when compared to the isolates from HIV-seronegative patients. The only chloramphenicol resistant Salmonella typhi occurred in a patient who was seropositive for HIV. According to these results, Ethiopian patients infected with HIV may be at increased risk of acquiring infections, especially non-typhoidal salmonellas, that are multi-drug resistant (MDR) strains than HIV-uninfected subjects. The emergence of MDR Salmonella infection among HIV-positive patients requires reassessment of chemotherapeutic approaches in this patient population, and warrants continued laboratory surveillance.
Family Expenditure on Sickness Episodes of Pre-School Children in Urban Slums of Lucknow, North India
Authors: Awasthi Shally , Pande Vinod Kumar
Published: January 2017

This study investigated family expenditure on the sickness episodes of pre-school children in 32 urban slums of Lucknow, North India. Between July 1995 and January 1996, 396 children between the ages of 1.5 to 3.5 years were contacted. The main objective was to discover the direct medical cost of illness incurred by their families in the preceding months.

Point prevalence of major morbidities, in the preceding month, were as follows: 17.2% respiratory and 6.3% diarrhoeal. A health care provider saw 31.4% [95% confidence interval (CI): 26.9–36.01] children. In >95% of the cases, the health care provider was a self-employed, non-governmental dispenser (NGD). More than half of NGDs did not have a recognized medical degree. The mean family expenditure on sickness in 1 month was RS 12.27 [standard deviation (SD): RS 23.81], approximately 1% of their income (1 US$ = RS 32). Respiratory illness was the primary cause of financial burden to the community. The isolated symptom of fever was the most expensive to treat, with diarrhoea and dysentery costs being similar. Immunizing a child saved money.

We conclude that since the NGDs are the predominant health care providers in the urban slums, and since neither the nature of medicines dispensed by them nor their additional costs can be ascertained, steps must be taken to monitor their dispensing practices and to educate them about rational drug therapy.
Births, Deaths and Medical Emergencies in the District: A Rapid Participatory Appraisal in Nepal
Authors: MacRorie R A
Published: January 2017

Two qualitative rapid appraisal techniques were used in a community-based study to investigate health beliefs, attitudes and practices in a rural district in Nepal. Pregnancy and childbirth remain non-medical activities managed at home. Deaths may be avoided by better access to hospital emergency services. Health awareness of some problems, e.g. oral rehydration in diarrhoeal disease, is high; but of others, e.g. association of haemoptysis with tuberculosis, is poor. These methods require few resources, are efficient in time and manpower required, and generate useful relevant information on a target population. They are recommended for district health development programmes elsewhere.
Growth Monitoring: Family Participation: Effective Community Development
Authors: Meegan Mike , Morley David C
Published: January 2017

Growth monitoring was introduced into most developing countries in the 1970s with the aim of combating under nutrition in infancy and childhood. Ten years later analysis showed weight charts were not completed satisfactorily and not used in decision making. Although growth monitoring is now seldom mentioned in nutrition studies, the authors of this study are convinced of its value.

With new technology using the direct recording scales (DRS), illiterate or semi-literate mothers are able to complete the growth curve on the weight chart and acquire understanding about the process and its significance for their infant. This study investigates the understanding of the growth curve by the rest of the family.

The mother, their daughters and significantly, the grandmothers were shown to have comprehended the meaning of the growth curve. In families where mothers weighed their infant using the DRS, a smaller proportion were found to be suffering from periods of growth failure compared with families where the infant was weighed by community health workers with a dial scale.

There are obvious gains if technologies are moved from the clinic into the family and the community. The weighing and charting of children by DRS may be a further step in the fight to overcome undernutrition in developing countries.
Drastic Performance Improvement of Hand-Operated Sterilizers
Authors: Huys Jan
Published: January 2017

In a great number of low-income countries, hand-operated sterilizers are commonly used for the sterilization of medical supplies, including porous loads and hollow instruments. Due to the socio-economic situation in these countries the introduction of fully automatic sterilizers is not (yet) feasible. During a course on sterilization technology for hospital technicians at the Polytechnic in Mombasa, Kenya, some performance tests have been done with locally used sterilizers with standard test loads and loads as are common in the hospitals that were visited. The results for porous loads were alarming due to poor air-removal. Immediately, a number of modifications in the processes were made and tested, based on a method of steam pulsing. This resulted in a significant improvement of performance and can be introduced at a very low cost.
The Global Health Licensing Program: A New Model for Humanitarian Licensing at the University Level
Authors: Roose-Snyder Beirne , Doyle Megan K.
Published: January 2017

Disparities in health outcomes and access to the essential medicines that affect health outcomes are two of the most pressing issues facing the world today. The lack of adequate health care in developing countries is rooted in a number of systemic problems, including insufficient health infrastructure, lack of medical personnel, government corruption and incompetence, and the high price of pharmaceuticals. These problems are not mutually exclusive. Instead, they are mutually reinforcing, particularly in least developed and developing countries.

The high cost of drugs and vaccines is undoubtedly one of the driving forces in disparate health outcomes, and partial solutions to poor health in the developing world rightly focus on lowering the cost of health products, while preserving the financial incentive for innovation. The high cost of many medicines is largely due to the international patent system, codified by the Trade Related Intellectual Property Rights (TRIPS) Agreement, which grants a monopoly to the innovator and allows it to completely control pricing for a period of years. The result is an access gap, whereby patients in low- and middle-income countries (LMI) cannot afford expensive patented drugs, while patients in wealthy countries can afford and do have access to such treatments.
Human Rights in Health Equity: Cervical Cancer and HPV Vaccines
Authors: Erdman Joanna N.
Published: January 2017

This article seeks to demonstrate that health equity, as an empirical and normative concept, is reflected in the human rights to health and equality under international law. The obligations on government that flow from health equity as a human right are then examined. These include the obligation to act in pursuit of health equity as a policy objective, and the obligation to enact measures to ensure health equity as a policy outcome. These obligations are considered in relation to a promising remedial measure for social disparities in cervical cancer: HPV vaccines.
Compounding Problems and Compounding Confusion: Federal Regulation of Compounded Drug Products and the FDAMA Circuit Split
Authors: Boodoo Jesse M.
Published: January 2017

Drug compounding is the long-standing pharmacy practice of mixing, combining, or altering ingredients to create drugs tailored to individual patient needs. Compounding is as old as the practice of pharmacy and close to the heart of the modern profession. Indeed, the mortar and pestle – an iconic emblem of compounding – have long been the prevailing symbol of pharmacy. Prior to the emergence of commercially available drug products, the practice of compounding was the practice of pharmacy – to create medicines, early pharmacists inevitably needed to extract and compound natural vegetable, animal, and mineral substances. In one impressive example of successful early compounding, God commanded Moses to “compoundeth” a holy anointing oil of myrrh, cinnamon, cassia, olive oil, and sweet calamus. Not generally one to shrink from a challenge, Moses followed God’s recipe and used his compounded oil to anoint the vessels of the Tabernacle and High Priest.
Is a Flat-Line a Good Thing? On the Privatization of Israel's Healthcare System
Authors: Seidman Guy I.
Published: January 2017

Israel presents an intriguing conundrum: on the one hand, it provides quality healthcare in a near-universal healthcare system; on the other, it has maintained healthcare costs level at approximately 7.7% of GDP. This comes at a time when all western nations struggle with one or both sides of the equation: how to offer affordable, good quality health care to the population while curbing the sharp rise in health related costs. This paper explains both how Israel has achieved this “flat line” effect and the social and political costs of this achievement.
Conservative Surgery for Vesicocolic Fistula
Authors: Lewis S L , Abercrombie G F
Published: January 2017

Vesicocolic fistula due to diverticular disease of the colon is conventionally treated by resection of the diseased bowel and closure of the vesical defect. Three cases are described in which separation of the viscera and simple suture of the vesical and colonic defects was carried out. A greater omental graft was interposed between the rectum and bladder. Two of the patients are well 12 and 26 months postoperatively. The third patient died a year postoperatively from a complication of her diverticular disease.
Histamine and its Release from Nasal Polyps: Preliminary Communication
Authors: Drake-Lee A B
Published: January 2017

Two hundred consecutive patients admitted for polypectomy had no evidence of an increased incidence of allergic disorders. Mast cell degranulation was found on transmission electron microscopy and this resulted in considerable quantities of histamine in polyp extracellular fluid (124–7300 ng/ml). RAST levels of allergen-specific IgE to house-dust mite and mixed-grass pollens were raised in 4 out of 28 cases in polyp fluid, and in only one matched serum. In vitro challenge of polyp tissue with allergen extract and anti-IgE suggested an IgE-mediated response in only 4 of 36 patients.
Incidence of Ocular Injuries from Road Traffic Accidents after Introduction of Seat Belt Legislation
Authors: Vernon S A , Yorston D B
Published: January 2017

A prospective study was performed to characterize any change in the pattern of ocular injuries following the introduction of compulsory front seat belt wear on 1 February 1983. During a 24-week period in 1981 (1 February to 31 July), 24 patients with eye and adnexal injuries as a result of motor car road traffic accidents (RTAs) were seen at the Bristol Eye Hospital: 12 of these patients required emergency surgery. In the identical period two years later (1 February to 31 July 1983), only 6 patients suffered ocular injury from RTAs: 3 of these required emergency surgery. All patients in the latter series obeying the legislation on seat belt use were injured by flying glass, indicating a possible change in pattern of injury. The decrease in incidence of ocular injuries from RTAs between the two series was shown to be statistically significant. The compulsory fitting of laminated glass to all new cars in Great Britain and Europe is strongly advised.
Erythema Ab Igne in Chronic Pancreatic Pain: A Diagnostic Sign
Authors: Mok Daniel W H , Blumgart Leslie H
Published: January 2017

Two patients with severe chronic pain of pancreatic origin are described. In both there was severe back pain and an area of erythema ab igne lay directly over the portion of the pancreas giving rise to the pain. In both patients therapy directed at these areas of diseased pancreas resulted in relief of symptoms. The presence of erythema ab igne on a patient's back at the level of T12-L2 should arouse suspicion of underlying pancreatic pathology, and this may be valuable in a disease with remarkably little to find on clinical examination. In one patient early obstruction of the pancreatic duct by pancreatic carcinoma caused distal chronic pancreatitis and back pain many months before the onset of obstructive jaundice.
Drugs and Exposure Treatment in Phobic and Obsessive-Compulsive Disorders
Authors: Marks Isaac
Published: January 2017

Several classes of drugs have been used with behavioural treatments in phobic and obsessive-compulsive disorders (Marks 1981). Sedatives like barbiturates, benzodiazepines and alcohol have not been found to be of lasting benefit and in high doses may actually be counterproductive because what is learned under the influence of the drug usually fails to transfer to the drug-free state. Beta-blockers too have not had durable effects. Antidepressants seem to be of greater value.
Temporary Loop Ileostomy
Authors: Raimes S A , Mathew V V , Devlin H B
Published: January 2017

Summary: A refinement of the technique for constructing the temporary loop ileostomy using a subcutaneous absorbable bridge is described. This leaves the skin surface uncluttered and allows immediate fitting of a watertight appliance. Clinical experience in 22 patients confirms that this is a safe, simple defunctioning stoma with few complications and in our practice has also replaced the loop colostomy as the covering stoma for difficult colorectal anastomoses.
Virus Infections in Immunocompromised Patients: Their Importance and Their Management
Authors: Sutton R N P , Itzhaki R F , Christophers J , Saldanha J , Gannicliffe A , Anderson H
Published: January 2017

Opportunistic viral infections were investigated in 156 adult patients admitted over one year to a medical oncology service: 35% of the total group and 65% of those with acute leukaemia experienced viral infections, 79% of which were with viruses of the herpes group. Surprisingly few enteric viruses were recovered. Reactivation of herpes simplex virus in the brains of these immunosuppressed patients was suggested by the demonstration by nucleic acid hybridization of herpes simplex virus DNA sequences in neurones and endothelial cells in patients with evidence of past infection with virus. Acyclovir was effective in therapy and prophylaxis. Twenty-three strains from 7 patients were tested for sensitivity to this antiviral: in 3 instances clinical resistance was observed but the strains were fully sensitive in vitro, as were all other strains tested.
The Nose after Laryngectomy
Authors: Moore-Gillon Victoria
Published: January 2017

Previous studies of nasal function after laryngectomy have suggested that patients must accept complete and irreversible anosmia as an inevitable consequence of the operation, and that this is due to interruption of a poorly defined neuronal interaction between larynx and nose. In this study nasal function was investigated in 23 laryngectomees and 10 patients about to undergo laryngectomy. Scanning electron microscopy showed a more densely ciliated nasal epithelium in the laryngectomees compared with the preoperative controls, and nasal mucociliary transport, measured by saccharine clearance, was significantly faster ( P < 0.01) in laryngectomees. Olfactory acuity, as determined by the threshold for detection of insufflated pyridine vapour, was normal in laryngectomees. Some laryngectomees did have a relatively normal sense of smell; these were shown to be those who had discovered a technique of sniffing using buccopharyngeal rather than respiratory musculature.

These findings have obvious implications for the rehabilitation of laryngectomees, many of whom may otherwise have to contend with distressing anosmia as well as the other physical and psychological consequences of the operation.
Problems in Diagnosis of Popliteal Aneurysms
Authors: Downing R , Ashton F , Grimley R P , Slaney G
Published: January 2017

Clinical features and errors in diagnosis have been assessed in a retrospective study of 62 popliteal aneurysms in 40 patients, 22 of whom had bilateral aneurysms. Only 29% of patients complained of pain or swelling behind the knee, while 31% of aneurysms had produced distal ischaemia presenting as intermittent claudication, 9 aneurysms had thrombosed producing ischaemic rest pain in 6 legs, and 4 aneurysms had ruptured. Although 94% of aneurysms were suspected or confidently diagnosed by palpation alone, only 43% of patients had had the correct diagnosis made at the time of initial referral. Treatment was delayed in 12 patients, 8 of whom subsequently required amputation.

Popliteal aneurysm should be suspected in patients with a prominent popliteal pulse who present with intermittent claudication, and in patients with acute ischaemia of the leg who may have a thrombosed aneurysm requiring surgical exploration.
Anaesthesia for Minor Procedures in Children with Malignant Disease
Authors: Hain W R , Tomlinson J H , Barbor P R H
Published: January 2017

Minor invasive procedures in children with leukaemia can be very distressing for patients, parents and staff. In Nottingham a combined clinic has been established with an anaesthetist as an integral member of the team. General anaesthesia, usually by inhalation, is frequently employed. From May 1980 to September 1984, 515 anaesthetics were given to 97 patients. Records are kept to allow analysis of the clinic's function. With close personal contact, induction of anaesthesia becomes increasingly a matter of cooperation between patient and anaesthetist, removing much of the fear of these procedures. The development of this service is described and the reasons for its success are discussed.
Periostitis in Secondary Syphilis: A Place for Bone Scintigraphy
Authors: Veerapen K , Bruckner F E , Halsey J P , Davidson F , Saeed A
Published: January 2017

Two cases of secondary syphilis are reported with periostitis as the main presenting feature. Technetium-99m bone scintigraphy was found to be superior to radiography in both defining the extent of involvement and in picking up early lesions.
Recombinant Human Gamma-Interferon in Primary Hepatocellular Carcinoma
Authors: Forbes Alastair , Johnson Philip J , Williams Roger
Published: January 2017

A phase II trial of recombinant human gamma-interferon in the treatment of unresectable primary hepatocellular carcinoma is reported. The trial was terminated prematurely after recruitment of only 7 patients because of unacceptable toxicity, predominantly renal. There was no evidence of response in any of the 7 patients but some evidence that disease progression was more rapid during the treatment period.
Three Times Daily or 8-Hourly
Authors: Nigam R , Loveday B J , Grainger S L , Maxton D G
Published: January 2017

The timing of drug ingestion over 24 hours was assessed in 58 outpatients taking drugs three times daily. The mean time between 1st and 2nd dose was 5.7 hours, 2nd and 3rd 6.1 hours and between 3rd and 1st of the next day 12.2 hours. Based on a simulation of hydralazine pharmacokinetics, such irregular administration would increase peak levels by 10% and decrease trough levels by 64% compared with regular 8-hourly doses.
Clinical Experience of Clerks and Dressers: A Three-Year Study of Birmingham Medical Students
Authors: Lockwood D N J , Goldman L H , McManus I C
Published: January 2017

A survey of the clinical experience of junior medical clerks and surgical dressers on their first clinical attachment in the Birmingham University Teaching Hospitals was organized by students over a three-year period. A typical clinical student had performed basic clinical procedures such as putting up a drip, doing an ECG, bladder catheterization and seen a wide range of other procedures. Most students felt involved in the work of the firm, had clerked routine admissions, and regularly attended the firm's emergency admission night. Consultants on most firms were felt to be concerned about student progress. Students attached to district general hospitals gained a wider range of clinical experience than those at established teaching hospitals. Student-run audit is a useful way of monitoring the clinical experience gained by medical students.
Physiological Responses to Psychological Challenge under Hypnosis in Patients Considered to Have the Hyperventilation Syndrome: Implications for Diagnosis and Therapy
Authors: Freeman L J , Conway A , Nixon P G F
Published: January 2017

Thirty patients who were considered to have the hyperventilation syndrome on clinical grounds (history and observation) were referred for testing: 29 patients completed a forced hyperventilation provocation test, and 28 underwent hypnosis during which time a psychological challenge was introduced which was meaningful to each individual patient. In 19/27 of these patients the PetCO2 fell by an average of 18.2 mmHg and persisted spontaneously for more than three minutes. In 10 normal controls studied in a similar fashion there was an average fall of 5 mmHg. The difference in response between responders and controls/non-responders was highly significant ( P< 0.001). A review of the literature is presented, for comparison. It is considered that a psychological challenge under hypnosis may have important implications for diagnosis and therapy in some patients considered to have the hyperventilation syndrome.
Unilateral Block and Spinal Anaesthesia
Authors: Jenkins J G
Published: January 2017

Unilateral block is a rare complication of spinal anaesthesia. A case where a unilateral block occurred following the administration of a spinal anaesthetic, and where a second spinal anaesthetic to complete the block was successfully administered, is reported. The possible causes of unilateral block are discussed.
Why Doctors Don't Use Computers: Some Empirical Findings
Authors: Anderson J G , Jay S J , Schweer H M , Anderson M M
Published: January 2017

The attitudes of 148 medical students, 141 residents, and 644 practising physicians towards computer applications in medicine were studied. The results indicate that physicians recognize the potential of computers to improve patient care, but are concerned about the possibility of increased governmental and hospital control, threats to privacy, and legal and ethical problems. In general, all three groups are uncertain as to the potential effects of computers on their traditional professional role and on the organization of practice. Practising physicians, however, express more concern about these potential effects of computers than do medical students and residents. While attitudes appear to be somewhat independent of prior computer experience, they significantly affect the extent to which physicians use a computer-based hospital information system. This may be a major reason for the slow introduction of clinical computer systems.
The ‘Holding Function’ of Dynamic Psychotherapy in a Custodial Setting: A Review
Authors: Cox Murray
Published: January 2017

The dual connotation of words such as security or identity, which both forensic psychiatry and dynamic psychology regard as their own, is nowhere more evident than in relation to the words ‘hold’ and ‘holding’. The dictionary entry under ‘hold’ includes ‘keep fast, keep possession, detain, remain unbroken, grasp, not give way, adhere to, maintain, hold out — hope — possibility’. Whereas, a group of patients at Broadmoor, an alternative source of information, offered the following associations: ‘We are held … we can't walk through the gates … we hold ourselves here by what we've done … we need to be able to hold out … we need someone to hold us … we need someone to hold on to’. Indeed, one patient felt that he had let go of the therapist ‘too soon’, thus recalling the words of Stevie Smith:

‘You have weaned me too soon, you must nurse me again’ ( The Wanderer).
Treatment of Giant Cell Tumour of the Femoral Head and Neck
Authors: Tibrewal Sheo B
Published: January 2017

Giant cell tumours of the femoral head and neck treated at the Nuffield Orthopaedic Centre between 1970 and 1982 were reviewed to evaluate the effectiveness of primary treatment by curettage and bone grafting. All 4 cases recurred within two years, necessitating the likelihood of recurrence following curettage and bone grafting, particularly at this anatomical site, is stressed, and the possibility that hip replacement arthroplasty be considered the primary treatment of choice is discussed.
Carcinoma of the Colon — Association with Low Dietary Vitamin A in Females: Preliminary Communication
Authors: Tomkin G H , Scott Louise , Ogbuah C , O'Shaughnessy Margaret
Published: January 2017

Seventeen patients with non-metastatic carcinoma of the colon (9 male, 8 female) were compared with age- and sex-matched controls in a study examining the relationship of diet and altered cholesterol metabolism with carcinoma of the colon. Bile acid excretion in the faeces was significantly less in cancer patients ( P > 0.001), and a significantly lower intake of retinol ( P > 0.01) and vitamin A ( P > 0.05) was demonstrated in female cancer patients. There was no difference between patients and controls in hepatic cholesterol enzyme activity or in fasting plasma lipid levels.
Anticonvulsant Drugs and Bone Disease in the Elderly
Authors: Harrington M G , Hodkinson H M
Published: January 2017

Elderly psychiatric inpatients were studied to find the prevalence of osteomalacia in those taking anticonvulsant medication ( n = 19) and a comparison group not taking these drugs ( n = 37). Only one biopsy-proven case was discovered among the anticonvulsant group, and none in the comparison group. This was an unexpectedly low rate. The clinical and biochemical data (including alkaline and acid phosphatase isoenzymes) were further analysed to detect subclinical osteomalacia, but none was found. A difference between the two subgroups was found for total and liver alkaline phosphatase only. The possible explanations for these unexpected findings are discussed. The effect of anticonvulsants on vitamin D and bone metabolism is reviewed and the hypothesis that drug-induced changes in vitamin D metabolism are responsible for the bone changes described in earlier series is questioned.
Interactions between Calciotropic Hormones
Authors: Bradbeer J N
Published: January 2017

The metatarsal cytochemical bioassay (CBA) for parathyroid hormone (PTH) was adapted to study interactions between PTH and certain vitamin D metabolites. Thus, while they had no effect in the system alone, both 1,25(OH)2D3 and 25(OH)D3 caused a dose-dependent potentiation of PTH-stimulated glucose 6-phosphate dehydrogenase activity in the hypertrophic chondrocytes of the rat metatarsal. 1,25(OH)2D3 was about 1000 times more potent than 25(OH)D3. Specificity is indicated by the lack of a similar effect when either oestradiol or 1,24,25(OH)3D3 or a lactone derivative of 1,25(OH)2D3 was used. Furthermore, the rapidity of the effect of 1,25(OH)2D3 and 25(OH)D3, within 8 minutes, favours a membranophilic mechanism rather than the conventional nuclear mechanism of steroid hormone action.
The Risks of Staying in London: A Review of Overseas Visitors Admitted to a London Hospital
Authors: Fuller G N , Journeaux S F , Corner K , Lant A F
Published: January 2017

A retrospective review of 103 acute admissions of overseas visitors to a central London hospital was performed. Admissions were most commonly due to infection (43 admissions) and to recurrence of preexisting disease (40 admissions). Patients over 60 years were frequently admitted with new diagnoses. Groups at risk of admission were identified and strategies to reduce admissions discussed.
Testing the Retrovirus Hypothesis of Manic Depression and Schizophrenia with Molecular Genetic Techniques
Authors: Gurling H M D
Published: January 2017

Crow's viral hypothesis of schizophrenia proposes that psychosis may be the result of mutagenesis caused by viral integration or transposition in human genomic DNA. Molecular genetic techniques can be used to systematically investigate this hypothesis. In a study of genomic lymphocyte DNA unexpected DNA polymorphisms which were probably insertions and deletions were found in specific human genomic retroviral (proviral) related sequences. However these changes were found exclusively in normal Icelandic individuals and are probably of evolutionary origin. The extent to which human retroviral insertion and deletion has taken place and the mobility of such sequences will help in understanding their evolutionary origin and might provide a source of polymorphic marker sequences that could be used in genetic linkage studies of disease.
Eye Care and the Medical Student: Where Should Emphasis Be Placed in Undergraduate Ophthalmology?
Authors: Vernon S A
Published: January 2017

The views of three groups of British doctors on the content and duration of an undergraduate ophthalmology course were identified by means of a questionnaire. Non-ophthalmic hospital consultants considered the duration of a course should be approximately two weeks shorter than general practitioners and ophthalmologists. There were also significant differences in opinion between ophthalmologists and the other two groups on course content, but results indicated that emphasis should be placed on topics involving the identification of treatable sight-threatening conditions, and the primary eye care function of recognition and management of common external eye disorders.
Changes in the Surgical Management of Early Breast Cancer in England
Authors: Morris J , Royle G T , Taylor I
Published: January 2017

A questionnaire survey of consultant surgeons in England indicates that there has been a considerable change in opinion over the past few years concerning the management of early breast cancer; only 39.1% would now perform mastectomy, whereas 64.4% would perform conservative surgery. The most common forms of management are simple mastectomy and axillary clearance (21.9%); wide excision, axillary clearance plus radiotherapy (20.1%); and wide excision plus radiotherapy alone (16.9%). The majority of the surgeons would offer patients a choice of surgery, but only 52% had access to a breast care nurse.
The Reduction of Low Density Lipoprotein Cholesterol by Metformin is Maintained with Long-Term Therapy
Authors: Rains S G H , Wilson G A , Richmond W , Elkeles R S
Published: January 2017

Changes in serum lipoproteins were studied in 14 non-insulin dependent diabetics on long-term metformin therapy, after 6 weeks' placebo, and again 6 weeks after restarting active drug therapy. Withdrawal of metformin resulted in a rise of fasting blood glucose, HbAl, serum total and low density lipoprotein (LDL) cholesterol. Restarting the drug reversed these changes. Multivariate analysis showed that serum total and LDL cholesterol varied with treatment but not with glycaemic control Metformin can lower serum total and LDL cholesterol in non-insulin dependent diabetics and this effect is maintained long term.
Meningitis after Splenectomy
Authors: Selby C D , Toghill P J
Published: January 2017

Five splenectomized patients suffered six episodes of bacterial meningitis with positive cerebrospinal fluid cultures. They were admitted to the Nottingham hospitals between 1974 and 1985. The infecting organism in all cases was Streptococcus pneumoniae. Only one patient, who survived, had had pneumococcal vaccine; two patients died in spite of intensive therapy. There is now good evidence for giving prophylactic penicillin to asplenic patients but the efficacy of the pneumococcal vaccine remains uncertain.
Causes and Mortality in Patients Aged over 75 Years with Gastrointestinal Haemorrhage
Authors: Kafetz K , Wijesuriya V
Published: January 2017

One hundred and fifty-five patients aged 75 years and over with gastrointestinal haemorrhage were studied and compared with a series of patients aged under 75 years. The mortality in patients with gastric ulcer or gastric carcinoma was not affected by age. However, the mortality in patients with duodenal ulcer was greater in the over-75s (8/31 deaths in the over-75s, 4/77 deaths in the under-75s, P=0.01). There was no reluctance to operate on the over-75s. These results can be used to help construct future trials to improve treatment.
What, Consumer Feedback Surveys Again?: A Guide to Improving the Utility of Consumer Evaluations
Authors: Rocheleau Bruce , Mackesey Thomas
Published: January 2017

Although popular, consumer feedback surveys have not been very successful evaluative tolls in the sense of providing useful information to management. Lack of variability in client satisfaction and low survey response rates have been among the problems that have plagued consumer satisfaction studies. Four steps are discussed that help to overcome these problems. Each is illustrated by examples drawn from a client survey conducted in an integrated human services department. It is concluded that a consumer feedback survey can provide useful information well worth the cost of the study if sufficient preparation and imagination are devoted to designing and implementing the surveys.
Describing, Teaching, and Predicting Medical Problem-Solving: A Review
Authors: Vu Nu Viet
Published: January 2017

This article reviews: (a) the descriptive models and research findings of the processes and skills characterizing medical problem-solving, and (b) the recent investigations of teaching and predicting medical problem-solving ability. Results are discussed and suggestions for direction and design of future studies are provided in an effort to increase the usefulness of results for applications to medical education.
Emotional–behavioral resilience among children of first-time mothers with and without depression across the early childhood period
Authors: Giallo Rebecca , Gartland Deirdre , Woolhouse Hannah , Mensah Fiona , Westrupp Elizabeth , Nicholson Jan , Brown Stephanie
Published: January 2017

The deleterious effects of maternal depression on child emotional and behavioral development are well documented, yet many children exposed to maternal depression experience positive outcomes. The aim of this study was to identify psychosocial factors associated with the emotional–behavioral resilience of four-year-old children of first-time mothers experiencing depressive symptoms across the early childhood period. Data were from 1085 mother–child dyads in the Maternal Health Study collected prospectively at five time-points from pregnancy to child age four. Longitudinal trajectories of maternal depressive symptoms were identified, and children were regarded as resilient or competent if they scored in the normal range on the Total Difficulties subscale of the Strengths and Difficulties Questionnaire. We found that 22% of women had a pattern of moderate to high depressive symptoms, and within this group 78% of their children were identified as resilient. Maternal tertiary education and maternal involvement in home learning activities were unique predictors of children’s resilience. Higher maternal age at the time of pregnancy and financial security were factors associated with positive outcomes for all children. The findings highlight the importance of policy and intervention efforts to strengthen the quality of maternal–child interactions and the home learning environment to promote the emotional and behavioral functioning of children whose mothers are experiencing mental health difficulties in the early years of parenting.