bluuebunny/crossref_metadata_2025 huggingface dataset:
Transternal repair of a giant Morgagni hernia causing cardiac tamponade in a patient with coexisting severe aortic valve stenosis
Authors: Nenekidis Ioannis , Anagnostakou Vania , Zisis Charalambos , Prokakis Christos , Koletsis Efstratios N , Apostolakis Efstratios , Dedeilias Panagiotis
Published: March 2011

Background

Foramen of Morgagni hernias have traditionally been repaired by laparotomy, lapascopy or even thoracoscopy. However, the trans-sternal approach should be used when these rare hernias coexist with other cardiac surgical diseases.

Case presentation

We present the case of a 74 year-old symptomatic male with severe aortic valve stenosis and global respiratory failure due to a giant Morgagni hernia causing additionally cardiac tamponade. The patient underwent simultaneous repair of the hernia defect and aortic valve replacement under cardiopulmonary bypass. The hernia was repaired through the sternotomy approach, without opening of its content and during cardiopulmonary reperfusion.

Conclusions

Morgagni hernia can rarely accompany cardiac surgical pathologies. The trans-sternal approach for its management is as effective as other popular reconstructive procedures, unless viscera strangulation and necrosis are suspected. If severe compressive effects to the heart dominate the patient's clinical presentation correction during the cardiopulmonary reperfusion period is mandatory.
Activity-dependent disruption of intersublaminar spaces and ABAKAN expression does not impact functional on and off organization in the ferret retinogeniculate system
Authors: Speer Colenso M , Sun Chao , Chapman Barbara
Published: March 2011

In the adult visual system, functionally distinct retinal ganglion cells (RGCs) within each eye project to discrete targets in the brain. In the ferret, RGCs encoding light increments or decrements project to independent On and Off sublaminae within each eye-specific layer of the dorsal lateral geniculate nucleus (dLGN). Here we report a manipulation of retinal circuitry that alters RGC action potential firing patterns during development and eliminates the anatomical markers of segregated On and Off sublaminae in the LGN, including the intersublaminar spaces and the expression of a glial-associated inhibitory molecule, ABAKAN, normally separating On and Off leaflets. Despite the absence of anatomically defined On and Off sublaminae, electrophysiological recordings in the dLGN reveal that On and Off dLGN cells are segregated normally. These data demonstrate a dissociation between normal anatomical sublamination and segregation of function in the dLGN and call into question a purported role for ABAKAN boundaries in the developing visual system.
Oral dosing with papaya latex is an effective anthelmintic treatment for sheep infected with Haemonchus contortus
Authors: Buttle David J , Behnke Jerzy M , Bartley Yvonne , Elsheikha Hany M , Bartley David J , Garnett Martin C , Donnan Alison A , Jackson Frank , Lowe Ann , Duce Ian R
Published: March 2011

Background

The cysteine proteinases in papaya latex have been shown to have potent anthelmintic properties in monogastric hosts such as rodents, pigs and humans, but this has not been demonstrated in ruminants.

Methods

In two experiments, sheep were infected concurrently with 5,000 infective larvae of Haemonchus contortus and 10,000 infective larvae of Trichostrongylus colubriformis and were then treated with the supernatant from a suspension of papaya latex from day 28 to day 32 post-infection. Faecal egg counts were monitored from a week before treatment until the end of the experiment and worm burdens were assessed on day 35 post-infection.

Results

We found that the soluble fraction of papaya latex had a potent in vivo effect on the abomasal nematode H. contortus, but not on the small intestinal nematode T. colubriformis. This effect was dose-dependent and at tolerated levels of gavage with papaya latex (117 μmol of active papaya latex supernatant for 4 days), the H. contortus worm burdens were reduced by 98%. Repeated treatment, daily for 4 days, was more effective than a single dose, but efficacy was not enhanced by concurrent treatment with the antacid cimetidine.

Conclusions

Our results provide support for the idea that cysteine proteinases derived from papaya latex may be developed into novel anthelmintics for the treatment of lumenal stages of gastro-intestinal nematode infections in sheep, particularly those parasitizing the abomasum.
Concurrent partnerships and HIV: an inconvenient truth
Authors: Epstein Helen , Morris Martina
Published: March 2011

The strength of the evidence linking concurrency to HIV epidemic severity in southern and eastern Africa led the Joint United Nations Programme on HIV/AIDS and the Southern African Development Community in 2006 to conclude that high rates of concurrent sexual partnerships, combined with low rates of male circumcision and infrequent condom use, are major drivers of the AIDS epidemic in southern Africa. In a recent article in the Journal of the International AIDS Society, Larry Sawers and Eileen Stillwaggon attempt to challenge the evidence for the importance of concurrency and call for an end to research on the topic. However, their “systematic review of the evidence” is not an accurate summary of the research on concurrent partnerships and HIV, and it contains factual errors concerning the measurement and mathematical modelling of concurrency.

Practical prevention‐oriented research on concurrency is only just beginning. Most interventions to raise awareness about the risks of concurrency are less than two years old; few evaluations and no randomized‐controlled trials of these programmes have been conducted. Determining whether these interventions can help people better assess their own risks and take steps to reduce them remains an important task for research. This kind of research is indeed the only way to obtain conclusive evidence on the role of concurrency, the programmes needed for effective prevention, the willingness of people to change behaviour, and the obstacles to change.
Circulating herpes simplex type 1 (HSV-1)-specific CD8+T cells do not access HSV-1 latently infected trigeminal ganglia
Authors: Himmelein Susanne , St Leger Anthony J , Knickelbein Jared E , Rowe Alexander , Freeman Michael L , Hendricks Robert L
Published: March 2011

Background

Therapeutic vaccines can be designed to enhance existing T cell memory populations for increased protection against re-infection. In the case of herpes simplex virus type 1, recurrent disease results from reactivation of latent virus in sensory ganglia, which is controlled in part by a ganglia-resident HSV-specific memory CD8+T cell population. Thus, an important goal of a therapeutic HSV-1 vaccine would be to enhance this population.

Methods

HSV-1-infected mice were treated with TAK-779 to block CCR5- and CXCR3-mediated CD8+T cell migration during both acute and latent infections. Additionally, HSV-1-specific CD8+T cells were transferred into HSV-1 latently infected mice to mimic the effect of a therapeutic vaccine, and their migration into trigeminal ganglia (TG) was traced during steady-state latency, or during recovery of the TG-resident memory CD8+T cell population following stress-, and corticosterone-induced depletion and HSV-1 reactivation from latency. Bromodeoxy uridine (BrdU) incorporation measured cell proliferation in vivo.

Results

TAK-779 treatment during acute HSV-1 infection reduced the number of infiltrating CD8+T cells but did not alter the number of viral genome copies. TAK-779 treatment during HSV latency did not affect the size of the TG-resident memory CD8+T cell population. Transferred HSV-specific CD8+T cells failed to access latently infected TG during steady-state latency, or during recovery of the TG resident HSV-specific CD8+T cell population following exposure of latently infected mice to stress and corticosterone. Recovery of the HSV-specific CD8+T cell population after stress and corticosterone treatment occurred with homeostatic levels of cell division and did not require CD4+T cell help.

Conclusions

Our findings are consistent with the notion that the CD8+T cells in latently infected TG are a tissue-resident memory (Trm) population that is maintained without replenishment from the periphery, and that when this population is disrupted, it recovers without proliferation or detectable recruitment of HSV-specific CD8+T cells from the blood. The compartmentalization of the HSV-specific CD8+memory T cell population in latently infected TG will complicate the design of therapeutic vaccines.
Assessment of disease-severity scoring systems for patients with sepsis in general internal medicine departments
Authors: Ghanem-Zoubi Nesrin O , Vardi Moshe , Laor Arie , Weber Gabriel , Bitterman Haim
Published: March 2011

Introduction

Due to the increasing burden on hospital systems, most elderly patients with non-surgical sepsis are admitted to general internal medicine departments. Disease-severity scoring systems are used for stratification of patients for utilization management, performance assessment, and clinical research. Some widely used scoring systems for septic patients are inappropriate when rating non-surgical patients in a non-intensive care unit (ICU) environment mainly because their calculations require types of data that are frequently unavailable. This study aimed to assess the fitness of four scoring systems for septic patients hospitalized in general internal medicine departments: modified early warning score (MEWS), simple clinical score (SCS), mortality in emergency department sepsis (MEDS) score, and rapid emergency medicine score (REMS).

Methods

We prospectively collected computerized data of septic patients admitted to general internal medicine departments in our community-based university hospital. We followed 28-day in-hospital mortality, overall in-hospital mortality, and 30- and 60-day mortality. Using a logistic regression procedure we calculated the area under ROC curve (AUC) for every scoring system.

Results

Between February 1st, 2008 and April 30th, 2009 we gathered data of 1,072 patients meeting sepsis criteria on admission to general internal medicine departments. The 28-day mortality was 19.4%. The AUC for the MEWS was 0.65-0.70, for the SCS 0.76-0.79, for the MEDS 0.73-0.75, and for the REMS, 0.74-0.79. Using Hosmer-Lemeshow statistics, a lack of fit was found for the MEDS model. All scoring systems performed better than calculations based on sepsis severity.

Conclusions

The SCS and REMS are the most appropriate clinical scores to predict the mortality of patients with sepsis in general internal medicine departments.
Dating the age of admixture via wavelet transform analysis of genome-wide data
Authors: Pugach Irina , Matveyev Rostislav , Wollstein Andreas , Kayser Manfred , Stoneking Mark
Published: March 2011

We describe a PCA-based genome scan approach to analyze genome-wide admixture structure, and introduce wavelet transform analysis as a method for estimating the time of admixture. We test the wavelet transform method with simulations and apply it to genome-wide SNP data from eight admixed human populations. The wavelet transform method offers better resolution than existing methods for dating admixture, and can be applied to either SNP or sequence data from humans or other species.
Estimating the longitudinal relaxation time T1 in surface NMR
Authors: Walbrecker Jan O. , Hertrich Marian , Lehmann-Horn Jochen A. , Green Alan G.
Published: March 2011

Surface nuclear magnetic resonance (NMR) is a noninvasive geophysical method that is primarily used in hydrological investigations of shallow aquifers. An important parameter in surface-NMR experiments is the relaxation time T1. Information on pore structure and even hydraulic permeability/conductivity may be inferred from accurate estimates of this parameter. Estimates of T1 are usually obtained by evaluating the spin response of groundwater molecules to excitation by two sequential electromagnetic pulses, the second of which is delayed and phase-shifted by π relative to the first. We have discovered that variations of the excitation field with distance from the transmitter and common imperfections in the transmitted pulses introduce considerable bias in estimates of T1 (e.g., errors as large as 50%). We assess the significance of these problems via numerical simulations based on the Bloch equation. As a result of this assessment, we propose a novel yet simple modification to the T1 acquisition method that resolves the identified problems. Our new scheme involves applying two types of double-pulse sequence, one in which the second pulse is phase-shifted by π relative to the first (i.e., the current procedure) and one in which the second pulse is in phase with the first. Subtracting the voltage responses measured after each of the two double-pulse experiments eliminates the bias, thus allowing T1 to be reliably estimated under general surface-NMR conditions.
Geophysics Master’s Theses
Authors: Akerberg Peeter
Published: March 2011

Geophysics publishes titles of relevant master's theses in print and online. URL links to full theses also will be published if provided. To submit a title for consideration, complete the appropriate submission form at http://seg.org/dissertationabstracts and e-mail it to dissertationabstracts@seg.org.
Inhibition of Glyceroneogenesis by Histone Deacetylase 3 Contributes to Lipodystrophy in Mice with Adipose Tissue Inflammation
Authors: Zhang Jin , Henagan Tara M. , Gao Zhanguo , Ye Jianping
Published: March 2011

We have reported that the nuclear factor-κB (NF-κB) induces chronic inflammation in the adipose tissue of p65 transgenic (Tg) mice, in which the NF-κB subunit p65 (RelA) is overexpressed from the adipocyte protein 2 (aP2) gene promoter. Tg mice suffer a mild lipodystrophy and exhibit deficiency in adipocyte differentiation. To understand molecular mechanism of the defect in adipocytes, we investigated glyceroneogenesis by examining the activity of cytosolic phosphoenolpyruvate carboxykinase (PEPCK) in adipocytes. In aP2-p65 Tg mice, Pepck expression is inhibited at both the mRNA and protein levels in adipose tissue. The mRNA reduction is a consequence of transcriptional inhibition but not alteration in mRNA stability. The Pepck gene promoter is inhibited by NF-κB, which enhances the corepressor activity through activation of histone deacetylase 3 (HDAC3) in the nucleus. HDAC3 suppresses Pepck transcription by inhibiting the transcriptional activators, peroxisome proliferator-activated receptor-γ, and cAMP response element binding protein. The NF-κB activity is abolished by Hdac3 knockdown or inhibition of HDAC3 catalytic activity. In a chromatin immunoprecipitation assay, HDAC3 interacts with peroxisome proliferator-activated receptor-γ and cAMP response element binding protein in the Pepck promoter when NF-κB is activated by TNF-α. These results suggest that HDAC3 mediates NF-κB activity to repress Pepck transcription. This mechanism is responsible for inhibition of glyceroneogenesis in adipocytes, which contributes to lipodystrophy in the aP2-p65 Tg mice.
Loss of IGF-IEa or IGF-IEb Impairs Myogenic Differentiation
Authors: Matheny Ronald W. , Nindl Bradley C.
Published: March 2011

Actions of protein products resulting from alternative splicing of the Igf1 gene have received increasing attention in recent years. However, the significance and functional relevance of these observations remain poorly defined. To address functions of IGF-I splice variants, we examined the impact of loss of IGF-IEa and IGF-IEb on the proliferation and differentiation of cultured mouse myoblasts. RNA interference-mediated reductions in total IGF-I, IGF-IEa alone, or IGF-IEb alone had no effect on cell viability in growth medium. However, cells deficient in total IGF-I or IGF-IEa alone proliferated significantly slower than control cells or cells deficient in IGF-IEb in serum-free media. Simultaneous loss of both or specific loss of either splice variant significantly inhibited myosin heavy chain (MyHC) immunoreactivity by 70–80% (P < 0.01) under differentiation conditions (48 h in 2% horse serum) as determined by Western immunoblotting. This loss in protein was associated with reduced MyHC isoform mRNAs, because reductions in total IGF-I or IGF-IEa mRNA significantly reduced MyHC mRNAs by approximately 50–75% (P < 0.05). Loss of IGF-IEb also reduced MyHC isoform mRNA significantly, with the exception of Myh7, but to a lesser degree (∼20–40%, P < 0.05). Provision of mature IGF-I, but not synthetic E peptides, restored Myh3 expression to control levels in cells deficient in IGF-IEa or IGF-IEb. Collectively, these data suggest that IGF-I splice variants may regulate myoblast differentiation through the actions of mature IGF-I and not the E peptides.
Missing-in-metastasis MIM/MTSS1 promotes actin assembly at intercellular junctions and is required for integrity of kidney epithelia
Authors: Saarikangas Juha , Mattila Pieta K. , Varjosalo Markku , Bovellan Miia , Hakanen Janne , Calzada-Wack Julia , Tost Monica , Jennen Luise , Rathkolb Birgit , Hans Wolfgang , Horsch Marion , Hyvönen Mervi E. , Perälä Nina , Fuchs Helmut , Gailus-Durner Valérie , Esposito Irene , Wolf Eckhard , de Angelis Martin Hrabé , Frilander Mikko J. , Savilahti Harri , Sariola Hannu , Sainio Kirsi , Lehtonen Sanna , Taipale Jussi , Salminen Marjo , Lappalainen Pekka
Published: March 2011

MIM/MTSS1 is a tissue-specific regulator of plasma membrane dynamics, whose altered expression levels have been linked to cancer metastasis. MIM deforms phosphoinositide-rich membranes through its I-BAR domain and interacts with actin monomers through its WH2 domain. Recent work proposed that MIM also potentiates Sonic hedgehog (Shh)-induced gene expression. Here, we generated MIM mutant mice and found that full-length MIM protein is dispensable for embryonic development. However, MIM-deficient mice displayed a severe urinary concentration defect caused by compromised integrity of kidney epithelia intercellular junctions, which led to bone abnormalities and end-stage renal failure. In cultured kidney epithelial (MDCK) cells, MIM displayed dynamic localization to adherens junctions, where it promoted Arp2/3-mediated actin filament assembly. This activity was dependent on the ability of MIM to interact with both membranes and actin monomers. Furthermore, results from the mouse model and cell culture experiments suggest that full-length MIM is not crucial for Shh signaling, at least during embryogenesis. Collectively, these data demonstrate that MIM modulates interplay between the actin cytoskeleton and plasma membrane to promote the maintenance of intercellular contacts in kidney epithelia.
Prospective Study of Laparoscopic Adjustable Gastric Banding in the West of Scotland
Authors: Jenkins J.T. , Modak P. , Galloway D.J.
Published: March 2011

Obesity is an increasing problem in Scotland and Laparoscopic Adjustable Gastric Bands (LAGB) are an effective method of weight reduction. Most outcome data are reported from high volume units with extensive experience or dedicated bariatric practice. We aimed to assess an experienced laparoscopic surgeon's outcome working outwith a dedicated bariatric practice in the west of Scotland.

Methods

All LAGB procedures performed by a single surgeon were prospectively assessed from 1997 to 2004. LAGB were inserted using pars flaccida approach. Patient selection was based on BMI >35 or significant obesity related co-morbidities. Outcomes included percentage excess weight loss (%EWL) and excess BMI loss (EBL). We assessed total operating time to assess the learning curve for LAGB placement.

Results

125 patients were assessed (107 F:18 M). 123 patients were in regular follow-up (98%). Median age was 44 years (range 25-63). Mean follow-up was 34 months (range 11-91). Median initial BMI was 49 (range 37-73). 31% were BMI 35-45, 36% were BMI 45-50 and 33% were BMI>50. %EWL at 1,3 and 5 years was 45, 58 and 74, respectively. EBL at 1, 3 and 5 years was 11.7, 16.1, and 21.7, respectively. Complications included 4 converted procedures, 1 failed band insertion after conversion and reoperation for removal in five. Eight patients had tubing access port problems requiring intervention. The median overall total operation time was 80 minutes (range 50 - 160).

Conclusions

In this cohort LAGB insertion by an experienced laparoscopic surgeon is safe with few re-operations. Satisfactory weight loss is obtained and patient compliance with follow-up is high.
Noxious Arousal Induces T Wave Abnormalities in Healthy Subjects
Authors: Dweck Marc R , Lang Christopher C , Neilson James MM , Flapan Andrew D
Published: March 2011

Background

Sudden arousal has been associated with sudden cardiac death in individuals with ischaemic heart disease, cardiac arrhythmias and the congenital long QT syndrome. This study aimed to determine the effects of arousal on ventricular repolarisation in normal individuals by examining the dynamic QT-interval-heart rate relationship and T-wave morphology changes under various ‘arousal’ scenarios.

Methods

18 healthy subjects (6 female, 12 male, median age 22) underwent four separate 24-hour ECG recordings using 2-channel Holter recorders. The protocol contained five different arousal events: Natural Waking (woke naturally, then stood up); Morning Alarm (woken by alarm in the morning, then stood up); Night Alarm (woken by alarm during the night, then stood up); Morning Alarm-Remain Lying (woken by alarm in the morning but remained supine) and Lying to Standing (stood up from a supine position during the day). Holter recordings were analysed using a commercial package for dynamic assessment of the QT-RR relationship.

Results

In the twenty minutes after arousal no changes were seen in overall QT-RR relationship in any of the groups. However, marked T-wave morphology changes, including T wave inversion, were observed in all the arousal events. Postural changes only accounted for a small proportion of change in T wave morphology.

Conclusions

In healthy subjects noxious arousal causes marked changes in the morphology of the T wave. This may reflect abnormal adaptation of repolarisation to sudden changes in heart rate and autonomic tone.
Scottish Anatomy Departments: Adapting to Change
Authors: Pryde F R , Black S M
Published: March 2011

Objectives

To document changes to the academic infrastructure of Scottish departments of anatomy over the past 20 years and compare the strategic approaches adopted by each institution to ensure continued provision of the subject to medical students

Design

Interviews with principal anatomy staff members to obtain targeted information (staff numbers, staff recruitment, student numbers, staff:student ratio and contact hours in the medical curriculum) by investigating three temporal snapshots chosen at 10 year intervals (academic years 1983/4, 1993/4 and 2003/4)

Participants

Principal teaching staff members from the anatomy departments at the five Scottish medical schools: University of Aberdeen, University of Dundee, University of Edinburgh, University of Glasgow and the University of St Andrews. Additional information was forthcoming from the admissions office of each University.

Results

Over the past 20 years the Scottish anatomy schools have weathered a variety of external and internal influences and each school has adopted very individual strategies to the delivery and maintenance of their subject. Some schools have unquestionably been more affected than others but all have responded in a unique way to the demands of the disciplines they choose to subserve. In general, each school has seen a decline in the compliment of teachers (staff + demonstrators) whereas the student number has increased dramatically. Each department has micromanaged its proportions of lectures, dissecting room practical time and tutorials to best fit their student base, staff capabilities and the requirements of, and/or alterations to, the medical curriculum offered in their institution.
Osteoporosis Assessment and Treatment in Older Patients who Have Sustained a Hip Fracture
Authors: Lowdon Douglas W , Quinn Catherine , Mole Pat , Leese Graham P
Published: March 2011

Background and aims

Currently fracture sufferers are not being assessed or treated for osteoporosis. Osteoporosis guidelines differ in their secondary prevention recommendations, with the Scottish Intercollegiate Guideline Network (SIGN) advocating bone densitometry in all fracture patients and anti-resorptive treatment only if evidence-based criteria are confirmed, but the National Institute of Clinical Excellence (NICE) technology appraisal recommends treatment for all older females without this bone densitometry confirmation. We aimed to determine the rate of referral for bone densitometry, the numbers achieving SIGN criteria for anti-resorptive therapy, and the rate of osteoporosis treatment in patients with hip fracture

Methods

A retrospective review of all patients older than 65 years who had sustained a hip fracture in Tayside between April 2003 and July 2005 was performed

Results

Only 8.6% of hip fracture patients underwent bone densitometry, of which 90.6% of females older than 75 years met SIGN criteria for anti-resorptive treatment. 74.3% of all patients referred for bone densitometry were treated with an anti-resorptive agent, compared to only to 12.7% of the large majority group who were not assessed for osteoporosis

Conclusion

Osteoporosis investigation and therefore treatment remains sub-optimal in hip fracture patients. Almost all females, older than 75 years, with a hip fracture met evidence-based criteria for anti-resorptive treatment. NICE guidance, recommending anti-resorptive treatment without bone densitometry confirmation of reduced bone mineral density, should maybe be implemented for this specific group of patients in an attempt to increase osteoporosis treatment rates.
Treatment of Hepatitis B related Polyarteritis Nodosa presenting with mononeuritis multiplex
Authors: Reid John M , Coleman Richard J
Published: March 2011

We describe the case of a male patient who presented with mononeuritis multiplex due to polyarteritis nodosa following recent hepatitis B infection. Despite immunomodulatory treatment, the condition progressed with renal and small bowel involvement and the patient died. This case illustrates the difficulty in treating this multisystem disorder and we review the literature on its pathogenesis and treatment.
Primary Hypoparathyroidism Resistant to Conventional Therapy
Authors: Hall L , Gallacher SJ
Published: March 2011

A 28 year old man with primary hypoparathyroidism failed to respond to treatment with calcium and vitamin D analogues. Despite extensive investigation no reason for this was found and he is now successfully treated with teriparatide (synthetic human PTH)
Refractory case of Interstitial Cystitis associated with Sjogren's syndrome: Beneficial effect of Steroids in Treatment
Authors: James NVM , Bheri MM , Taube M , Bheri MM
Published: March 2011

Interstitial Cystitis (IC) is of unknown aetiology, but recently has been associated with Sjogren's syndrome. This association is much stronger than was originally recognised. In these patients the question has always been whether the bladder symptoms were a manifestation of IC or an autoimmune process. The beneficial response seen in some patients to steroids tends to support the latter. We report a case of severe IC associated with Sjogren's syndrome in whom bladder symptoms responded to a course of steroids where other conventional management did not help. We believe that a high index of suspicion for the association of these two diseases would help treat some of the refractory cases of IC with a trial of corticosteroids.
Spontaneous Avulsion Fracture Of The Calcaneus In A Non-Diabetic Patient
Authors: Thomas L , Mcnaughton GW
Published: March 2011

Doctors working in Emergency Medicine are well aware of the common mechanism of injury causing and the clinical appearances of fractures of the calcaneus. We report a rare case of an avulsion fracture of the calcaneus. Although avulsion fractures are a well-recognised complication of diabetic neuropathy they can occasionally occur in non-diabetic patients. The pathology and management of these fractures is further discussed.
Comparative Evaluation of Laparoscopic Versus Open Nephrectomy in Children
Authors: Sekaran P , Mackinlay Ga , Lam J
Published: March 2011

Background and Aims

To assess the benefits of laparoscopic nephrectomy in children as compared to open surgery and to ascertain whether or not the retroperitoneal technique offers any surgical advantage over the transperitoneal approach.

Methods and Results

This study gathered retrospective data on a consecutive series of 51 paediatric patients comparing; operative time, length of hospital stay and analgesic requirement. Results show that when laparoscopic surgery is compared with the open technique it took 25 mins longer to perform, there was a shorter post operative stay by 2.5 days, and a 50% reduction in morphine use. Patients who had the retroperitoneal technique were discharged from hospital within one day.

Conclusions

Compared to previous studies, the findings in this study suggest that there are distinct benefits in laparoscopy for children. There is some evidence in favour of the retroperitoneal technique. Patients are in hospital for shorter periods and need less analgesia.
Do multidisciplinary team members correctly interpret the abbreviations used in the medical records?
Authors: Parvaiz M , Singh Gk , Hafeez R , Sharma H
Published: March 2011

Background and Aims

Abbreviations are commonly used in the medical world to save time and space whilst writing in the patients’ case notes. As various specialties have evolved, each has developed a collection of commonly used abbreviations within its practice, which may not be easily recognisable to those working as an allied branch. The purpose of this study was to assess whether we, the multidisciplinary team members, interpret the abbreviations used in the medical records correctly?

Methods and Results

We analysed orthopaedic inpatient admission case notes (n = 45) for the use of abbreviations (n = 57) and their appreciation by different members of the multidisciplinary team (n = 175) by means of a standardised questionnaire. We found a wide variation in understanding and interpretation of orthopaedic abbreviations among health care professionals. Even the orthopaedic surgeons could answer correctly 57.2% only, followed by physiotherapists (49.9%). Non-orthopaedic groups produced significantly less number of correct answers than the orthopaedic surgeons (p <0.019). Interestingly, nursing and physiotherapy departments produced significantly fewer mal-interpretations than the orthopaedic surgeons (p <0.023).

Conclusions

Whilst abbreviations may indeed save time, the use of confusing abbreviations is unacceptable. We recommend that acronym obsession should be discouraged in order to reduce possible clinical error.
What is New in Chronic Myeloid Leukaemia?
Authors: Heaney NB , Holyoake TL
Published: March 2011

Chronic myeloid leukaemia is a relatively rare condition, though it has stimulated widespread interest as a consequence of both the stem cell basis and the success of rationally designed therapies. This review will outline some of the issues involving the aetiology of the disease and how this relates to current and future therapies.
Metastatic Glucagonoma transforming to Insulinoma following Chemotherapy
Authors: Iqbal N. , Byard A. , Singh B. M. , Buch H. N.
Published: March 2011

A 75 year-old man diagnosed to have a glucagonoma and as he was deemed unfit for curative surgery, was managed conservatively. Over the next 7 years as a result of increase in tumour size and development of hepatic metastases he became progressively more symptomatic and chemotherapy was administered for palliation. Six months later, he experienced several episodes of symptomatic hypoglycaemia, which persisted despite withdrawal of insulin therapy. Biochemical assessment confirmed spontaneous endogenous hyperinsulinaemia. Hypoglycaemic symptoms responded partially to somatostatin analogues although over the next few months he continued to deteriorate and 8 years after the initial diagnosis died of tumour-related cachexia. This patient presents an unusual scenario where a neuroendocrine tumour initially presented as a glucagonoma with subsequent change in the predominant hormone secretion to insulin. In view of its temporal association, we postulate that following chemotherapy; one cell type was more successfully reduced as compared to others, resulting in predominance of insulin secreting cells.
The Use of the Artificial Urinary Sphincter in the West of Scotland: a Single Centre 10-year Experience
Authors: Ramsay AK , Granitsiotis P , Conn IG
Published: March 2011

Background

The artificial urinary sphincter (AUS) has been used successfully to treat sphincter weakness incontinence in males over the past 30 years. Postoperative complications are well-recognised, but patient satisfaction remains high.

Methods

We performed a retrospective single centre study of all patients who had an artificial urinary sphincter inserted over a 10-year period. We assessed patient satisfaction and continence post operatively as well as complication rate and need for revision or replacement surgery.

Results

Thirty-eight male patients (mean age 57 years) and 1 female patient had an AMS 800 (American Medical systems) AUS inserted between 1995 and 2005. Five (13%) patients have required replacement surgery to date. Male patients were divided into two groups according to the aetiology of their incontinence: neuropathic (n=11) and non-neuropathic (n=27). Social continence was achieved in all patients. Three (11%) non-neuropathic patients developed complications. Revision surgery was undertaken in 4 (15%) of non-neuropathic patients and in 1 (9%) neuropathic patient. The mean lifespan of the AUS in patients who required further surgery is 6.6 years.

Conclusion

For patients with severe sphincter weakness incontinence the AMS 800 AUS is a safe and reliable solution. Our results are comparable with previous published studies of larger patient numbers from dedicated reconstructive units.
Sir John Charnley (1911-1982): Inspiration to Future Generations of Orthopaedic Surgeons
Authors: Donald SM
Published: March 2011

For young doctors embarking on a career in medicine, the decision on which path to take is often influenced by their experiences as an undergraduate student and, in particular, by those doctors and teachers who have stimulated and encouraged them. Likewise, inspiration can be derived from studying the life and work of eminent practitioners of the past. A final year elective module provided me with the opportunity to undertake a detailed critique of an aspect of the history of medicine of my choosing, which enabled me to investigate the history of hip replacement. This opened my eyes to the prodigious contribution of Sir John Charnley in the field of orthopaedics. His commitment to the practice and advancement of medical science is indeed an inspiration. This account of John Charnley's work is a testimony to the lifetime achievements of one man, whose hard work and dedication have brought enormous benefit to generations of patients the world over.
A patient with nodular regenerative hyperplasia of the liver, Graves' disease and pulmonary hypertension
Authors: McNeill A
Published: March 2011

Nodular regenerative hyperplasia (NRH) of the liver has been associated with a variety of autoimmune disorders; including Rheumatoid disease, CREST and diabetes mellitus. Here a case in which NRH presented concurrently with Graves' disease is reported, and possible mechanisms for the association discussed.
Clinical Management of Children with Suspected or Confirmed E. coli O157 Infection
Authors: Pollock KGJ , Beattie TJ , Reynolds B , Stewart A , Cowden JM
Published: March 2011

Scotland continues to report higher rates of infection with Escherichia coli O157 than elsewhere in the UK. Infection with E. coli O157 usually manifests as acute, afebrile, painful, bloody diarrhoea and is the commonest cause of Haemolytic Uraemic Syndrome (HUS), an important cause of childhood renal failure. In 1996 an outbreak of E. coli O157 infection in Central Scotland, resulted in over 500 cases and 17 deaths. Ten years on, high-profile outbreaks of E. coli O157 infection in Scotland still result in cases of HUS and fatalities. We sought to identify outcomes and describe pre-hospital clinical management strategies using prospective, national surveillance of paediatric HUS cases, from 2003 to 2006 inclusive. We recommend that children who present with acute, afebrile, and painful bloody diarrhoea be referred to hospital as early as possible for appropriate clinical management.
The Changing Face of Infection: a Comparative Review of Admissions to a Regional Infection Unit Over Three Decades.
Authors: Franklin G.F , Robson D , Cadwgan A , Macfarlane TV , Douglas JK , Hamilton D , Mackenzie AR , Laing RBS , Douglas JG
Published: March 2011

Background and Aims

Our group previously published retrospective analyses of 12 months of admissions to the Grampian Regional Infectious Diseases Unit from 1980-81 and from 1991. This study aimed to collect data in 2001 and to compare annual admission numbers, diagnoses, duration of stay and outcome in 1980-81, 1991 and 2001.

Methods

Data on all admissions was collected prospectively throughout 2001. This was compared with the previously published data.

Results

Total admissions rose from 605 in 1980-81 to 900 in 1991 and to 1152 in 2001. Sixty one percent of admissions in 1980-81 were confirmed as having infection compared to 72% in 1991 and to 83% in 2001. The most common reason for admission in 2001 was skin and soft tissue infection, but this was only the ninth commonest reason in 1981. Mean length of stay fell from 9.6 days in 1980-81 to 7.4 days in1991 and to 5.5 days in 2001. The mortality rate fell from 3.1% in 1981 and 1991 to 1.0% in 2001.

Conclusions

This study demonstrates significant changes in type, number and outcome of admissions to a regional infection unit. We discuss possible reasons for these changes.
Hypertension
Authors: McManus F , Freel EM , Connell JMC
Published: March 2011

Hypertension is a common condition affecting one in four adults. It is a leading cause of cardiovascular morbidity and mortality and appropriate treatment strategies that are both clinically and cost effective are key to the management of this condition. Recent guidelines have focused on addressing total cardiovascular risk and recommended rational combinations of antihypertensives as well as highlighting the importance of lifestyle intervention. Recent advances have increased understanding of the pathogenesis of hypertension and have opened the possibility of novel interventions for treatment.
Variations in all Cause and Cardiovascular Mortality by Country of Birth in Scotland, 1997-2003
Authors: Fischbacher CM , Steiner M , Bhopal R , Chalmers J , Jamieson J , Knowles D , Povey C
Published: March 2011

Background and Aims

Country of birth provides a proxy for ethnic group for recent migrants. Major differences in mortality by country of birth have been demonstrated in England and Wales, but similar published data for Scotland are lacking. We aimed to examine variations in mortality by country of birth for Scottish residents.

Methods

We calculated standardised mortality ratios by country of birth for Scottish residents aged 25 years and over between January 1997 and March 2003.

Results and Conclusion

Comparisons with England and Wales showed high allcause, coronary heart disease (CHD) and stroke mortality among Scottish residents born in Scotland, Northern Ireland, the Republic of Ireland, India and Hong Kong. However, most country of birth groups had similar or lower mortality than the Scottish born. These are the first data on mortality by country of birth in Scotland and they demonstrate major variations. Comparisons within the Scottish population might be interpreted as reassuring, since they do not show the excesses in CHD mortality by country of birth reported in England and Wales. However, the use of England and Wales as a comparison group shows a substantial excess of CHD risk among South Asians in Scotland, comparable to that reported in England and Wales.
Scalded Skin Syndrome Caused by a Methicillin Sensitive Staphylococcus aureus of a type not commonly associated with exfoliative toxins in Scotland.
Authors: Soliman R.S. , Morrison D. , Husselbee K. , Phillips G.
Published: March 2011

A three-year-old boy was admitted to the hospital with a three-day history of chickenpox and a one-day history of fever and enlarging skin lesions on his chest, trunk, and around his neck. The lesions were enlarged and skin peeling over the chest wall was noted. Despite starting him on Flucloxacillin/Aciclovir, new lesions were noted with blisters over chest, legs, arms and buttocks. A clinical diagnosis of Staphylococcal Scalded Skin Syndrome (SSSS) was made and laboratory results confirmed Methicillin sensitive Staphylococcus aureus (MRSA) isolation. The isolates were sent to Scottish MRSA reference lab (SMRSARL) for typing and toxin detection. The isolate from this child was positive for the exfoliative toxin A (eta) gene and negative for exfoliative toxin B, toxic shock syndrome toxin, panton-valentine leukocidin and entertoxins A, B, C, D, E. By Pulse Field Gel Electrophoresis (PFGE) this isolate was identified as MLST Type 88 clone which has been associated with skin lesions in other countries.
Neurocardiogenic syncope precipitated by digoxin.
Authors: Petrie CJ , MacDonald M , Lindsay MM
Published: March 2011

We present a 72-year-old man with worsening cardiac failure, atrial fibrillation and recurrent syncope precipitated by the prescription of digoxin. Neurocardiogenic syncope was diagnosed however the patient died prior to definitive treatment. Post-mortem revealed primary amyloid as the unifying diagnosis.
An Atypical Case of Neuralgic Amyotrophy with Respiratory Muscle Weakness: Case Report and Review of Literature
Authors: Reid Jm , Forster A , Fitch PS , Smith FW , Coleman RJ
Published: March 2011

This report is of an atypical case of neuralgic amyotrophy with a Horner's syndrome, bilateral brachial plexus, lumbar plexus and phrenic nerve involvement. The diagnosis is confirmed based on a classical history and examination findings with typical neurophysiological investigations for this condition. This report also highlights the novel use of positional magnetic resonance imaging to investigate patients with respiratory muscle weakness. This case report expands the recognised clinical features of neuralgic amyotrophy and the literature concerning atypical features of this condition is reviewed.
Laparoscopic Hernia Repair
Authors: Tse Gh , de Beaux AC
Published: March 2011

The laparoscope was first invented in the early 20th century. The first laparoscopic hernia repair was in 1990. Despite almost 20 years of laparoscopic hernia repair experience, open hernia surgery remains the main stay of hernia surgery today. This review looks at current evidence and guidelines on the use of laparoscopic hernia repair surgery.
Dr John Rankin; His Life, Legacy and the 50th Anniversary of the Rankin Stroke Scale.
Authors: Quinn Tj , Dawson J , Walters M
Published: March 2011

Dr John Rankin (1923—1981) is one of the many distinguished alumni of the former University Department of Materia Medica and Therapeutics, Stobhill Hospital Glasgow. While his varied international career encompassed pulmonary physiology, occupational medicine and public health, he remains best remembered in the United Kingdom for his early stroke publications. In a series of articles published 50 years ago in the Scottish Medical Journal he described early rehabilitative stroke medicine using a novel grading system. Half a century on Rankin's eponymous stroke scale has become the endpoint of choice in acute stroke trials. This paper describes Rankin's remarkable career and the legacy of his work, with a particular focus on his stroke research and grading system.
IGF-II Secreting Solitary Fibrous Tumour of the liver presenting with hypoglycaemia
Authors: Hill David , Livingstone Kerry , Thomson James E , Perry Colin , Wark Gwen
Published: March 2011

We report the case of an 84-year-old man who presented with collapse secondary to hypoglycaemia and was found to have a hepatic Solitary Fibrous Tumour (SFT) secreting Insulin-like Growth Factor II (IGF-II). Solitary fibrous tumours of the liver are very rare tumours and have occasionally been described in association with hypoglycaemia. SFT's of other organs have been associated with production of IGF-II but to our knowledge however there are no reports of a SFT of the liver with confirmed IGF-II hypersecretion, and we suggest that this mechanism underlies the hypoglycaemia seen in this case.
A Survey of Attention Deficit Hyperactivity Disorder Follow-up Services Provided by Child and Adolescent Psychiatry Departments in Scotland
Authors: Skilling GD , Robinson J , Fielding S
Published: March 2011

Background/Aim

Current clinical guidelines offer few recommendations for follow-up of patients diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). We aimed to establish what follow-up services were in place for children and young people with ADHD across Scotland, to highlight variations within these services and to examine their level of adherence to those national guidelines on follow-up which do exist.

Method

A postal survey of child and adolescent psychiatry departments across Scotland was carried out. Seventeen departments were contacted and the response rate was 100%. We compared results from areas with and without designated ADHD follow-up teams. We looked specifically at numbers and type of professional involved and the structure of the follow-up services provided.

Results and Conclusion

Forty one percent of services had a designated ADHD follow-up team. These services held a significantly higher proportion of regular ADHD clinics and involved more staff from different professional groups. There were wide variations in services provided by child and adolescent psychiatrists for ADHD follow-up across Scotland. Further research on the effects on prognosis and outcome of designated ADHD services would allow for the enhancement of current clinical guidelines and more effective service planning and provision.
Quality in Healthcare and the Quest for Improvement
Authors: Teasdale GM
Published: March 2011

Improvement in the quality of healthcare is desired by everyone. Delivering this however, is hindered by lack of clear, widely embraced perceptions of what is encompassed within quality and how improvement can best be brought about. This paper, written from the viewpoint of a clinician now with a responsibility for this field in Scotland, presents a multidimensional concept of quality, as encompassing effectiveness, safety, patient centeredness, timeliness, efficiency and equity. This approach allows views about the relative importance of the various components to differ but also to be reconciled and the different standpoints made coherent. The principal kinds of interventions, aimed to improve one or more aspects of quality, are presented and the need for much greater evidence about their value, alone or in combination is noted. Nevertheless, there is increasing recognition of the importance of emphasising the human factors of attitude, culture and behaviour that provide the best assurance of quality of care to individuals. NHS Quality Improvement Scotland has a key role in searching out knowledge about how improvement is achieved and in engaging with patients and NHS staff to ensure that the necessary advances are achieved in Scotland.
A case of Haemophilus Parainfluenzae endocarditis during pregnancy
Authors: Wijesinghe N , Mills G , Lin Z , Waymouth S , Sebastian C , McAlister H
Published: March 2011

Infective endocarditis during pregnancy is rare and results in high maternal and fetal mortality. We report a case of Haemophilus parainfluenzae endocarditis in a pregnant woman with complex management issues and a late, unexpected embolic complication.