bluuebunny/crossref_metadata_2025 huggingface dataset:
Case report: Bladder extrophy variant
Authors: Lawther S , Fyfe AHB , Powls A
Published: March 2011

Bladder extrophy is an uncommon anomaly. We report a male variant presenting with a low set umbilicus and hypoplastic hemiscrotum. Further imaging reveals divergent recti, widened pubic symphysis and renal ectopia. We discuss our investigation and management and review the literature on the topic.
Cervical Lymphadenopathy Resulting in a Diagnosis of Lymphoma
Authors: Savage SAH , Wotherspoon HA , Fitzsimons EJ , Mackenzie K
Published: March 2011

Background and Aims

Currently there is no protocol in the west of Scotland for the investigation of a patient with a lymph node in the neck which might contain lymphoma. The aim of this audit was to examine the current management of these patients.

Methods

Data were collected on 112 patients diagnosed as having lymphoma from a neck node biopsy within a 12 month period from 1st November 2004 to 31st October 2005. Biopsy data were collected in combination with the first point of consultation, investigations used to arrive at diagnosis and any associated complications.

Results

Eighty seven percent of patients underwent excision biopsy with complications noted in 7%. Fine needle aspiration cytology (FNAC) was carried out in 60% of which 34% were ultrasound guided. Core biopsy was carried out in 17% of which 63% were ultrasound guided. Forty-five percent of patients were first referred to ear, nose and throat (ENT) surgery, 17% to general surgery, 14% to haematology, 13% to general medicine and 11% to other specialties.

Conclusion

This audit shows that there was a wide range of first points of consultation and diagnostic procedures used. It is recommended that there should be access for all patients with cervical lymphadenopathy to a weekly neck lump clinic with standardised protocols for lymphoma diagnosis. This should ensure that patients are diagnosed accurately and treated in a timely manner.
Medical Needs and Survival of NHS Continuing Care Residents
Authors: Moylan T , Roberts M , Murray S
Published: March 2011

Background and Aims

To determine the medical needs and survival of patients admitted to NHS continuing care beds for the frail elderly.

Methods

A retrospective cohort study of admissions during one year to 222 beds in south-east Glasgow. Case-sheet review identified the diagnoses on admission. Medical interventions were allocated to one of six predetermined categories. Mortality data was collected up to four years after admission.

Results

One hundred and eighty nine patients (65 male and 133 female) were admitted, 183 (92%) for NHS continuing care. The overall survival at three months was 47.8% and 38.5% at six months. In total 1585 interventions were recorded, 56.3% of admissions required one or more major intervention. Seventy eight (75.7%) of these were managed in the continuing care setting avoiding transfer to an acute hospital bed.

Conclusions

Older people resident in NHS continuing care have a short life expectancy and require frequent medical interventions. Much of this can be provided in the NHS continuing care setting avoiding admission to the acute sector. Shift of care for these patients to private nursing homes may not provide such support.
The Use of Cell Salvage during Obstetric Procedures: An Audit of Scotland's Maternity Units
Authors: Harkness M , Clark V
Published: March 2011

Background

Concerns about the safety and supply of donor blood mean that clinicians are increasingly looking for alternatives to allogenic blood transfusion. One such alternative is cell salvage. Theoretical concerns about the safety of giving salvaged blood to obstetric patients have so far limited its use in maternity patients, but its use in obstetrics is now growing.

Aims

To determine how many Scottish maternity units use cell salvage and what barriers anaesthetists see to its use in obstetrics.

Methods

A survey was posted to one consultant anaesthetist at each of Scotland's 18 consultant led maternity units.

Results

Two out of 18 maternity units in Scotland use cell salvage. Perceived barriers to use include lack of machine, insufficient cases and lack of familiarity with the technology. Only 4/15 anaesthetists saw safety concerns as a barrier to using the technology.

Conclusion

It would appear that practical issues such as staff training and maintaining familiarity with the technology are greater barriers to the use of cell salvage during obstetric procedures than concerns over safety or financial costs. Although cell salvage would appear to be safe, its use in obstetrics must be accompanied by ongoing audit and detailed data should be collected for each case.
Salmonella Infantis Subdural Empyema in a Healthy Infant.
Authors: Soliman R.S. , Clerihew L. , Jollands A. , Kirkpatrick M. , Mowle D
Published: March 2011

Focal intracranial infections such as brain abscess, subdural empyema, or epidural abscess are unusual manifestations of salmonellosis found almost solely in immuno-compromised patients. We describe an unusual case of an 11-month old immuno-competent girl with a Salmonella Infantis subdural empyema. The case responded well to surgical drainage and long course of antibiotic treatment.
Successful Use of National Cancer Registry Data to Monitor the Effective Use of Imatinib for Treating Chronic Myeloid Leukaemia
Authors: Shepherd P , Dhanapala C , Maguire C , White J , Drummond M , Holyoake T , Johnson PRE
Published: March 2011

Imatinib is a tyrosine kinase inhibitor, which selectively antagonises the BCR-ABL molecular pathway which causes chronic myeloid leukaemia (CML). Imatinib was first approved by the Scottish Medicines Consortium (SMC) in January 2002 with the recommendation that its use be audited. The cost of the drug has major financial implications for health resources.

Methods

All imatinib usage since its first prescription in Scotland in September 2000 to July 2003 was audited through pharmacy records and through the Scotland Leukaemia Registry (SLR), an existing national registry of patients with CML.

Results

One hundred and four patients in Chronic Phase (CP), 36 in Accelerated Phase (AP) and five in Blast Phase (BP) received imatinib. The median duration of therapy was not reached for CP, 17 months for AP, and two months for BP patients. Major (complete) cytogenetic response rates were 74% (63%) and 38% (24%) respectively for CP and AP. Overall survival for all CP patients from the start of imatinib therapy was 94% at one year, 91% at two years and 83% at three years. An audit of the effectiveness of the SLR as an auditing agency, showed complete registration in 95% of cases.

Conclusions

We believe such data collection should be an important ongoing resource for assessing outcomes in a rare form of leukaemia but one which already has major implications for health economics and will continue to do so given the future development of dual tyrosine kinase inhibitors for imatinib resistant cases.
Popliteal Aneurysms: Does Size Matter ?
Authors: Saha S , Salman M , May A
Published: March 2011

When considering the management of popliteal aneurysms, not only the size but also the nature, symptoms and state of collateral and distal circulation must be taken in to account. We present a patient who required operative management of a symptomatic 3cm popliteal aneurysm of the left leg whilst a conservative approach chosen for the right leg which had an asymptomatic 17 × 13.1 cm popliteal aneurysm, the largest of its kind reported within the English literature.
Endosalpingiosis Masquerading as Ovarian Carcinoma and Presenting on Cervical Smear
Authors: Mcintosh A , Teo UL , Millan DWM , Alexander-Sefre F
Published: March 2011

Background

Endosalpingiosis is a common, pathological finding with no symptoms. Histological differentiation of endosalpingiosis from malignancy can be a challenge to pathologists and hence potential for unwarranted surgical intervention exists.

Case

We report a case of endosalpingiosis with an unusual initial presentation of an abnormal cervical smear suggestive of adenocarcinoma. This finding was further supported by laparoscopic findings resembling ovarian carcinoma, hence leading to major surgical intervention. The final pathology revealed no evidence of neoplastic changes.

Conclusion

Greater awareness of endosalpingiosis and its masquerading features is needed to avoid unnecessary surgical interventions.
Primary Adrenal Lymphoma Presenting with Cauda Equina Syndrome
Authors: Choi Keun , Kim Eui Bae , Dae Kim Sang , Choi Yoon Seok , Park Kyong Hwa , Lee Ju-Han , Oh Sang Cheul , Seo Jae Hong , Shin Sang Won , Kim Yeul Hong , Kim Jun Suk
Published: March 2011

Primary adrenal lymphoma (PAL) is an extremely rare extranodal lymphoma. Moreover, cauda equina syndrome (CES) as a first sign of a primary adrenal lymphoma is very exceptional. Here, we report a 35-year-old man was admitted because of primary adrenal lymphoma presenting with CES. He was treated with chemotherapy including rituximab, cyclophosphamide, vincristine, adriamycin, and prednisolone (R-CHOP). At present 30 months after chemotherapy of R-CHOP, the patient is considered free of tumor. The good results obtained for our case could be due to the relative early detection by CES and the use of combination of monoclonal antibody (R-CHOP).
Detection of Adverse Events in a Scottish Hospital Using a Consensus-based Methodology
Authors: Williams DJ , Olsen S , Crichton W , Witte K , Flin R , Ingram J , Campbell MK , Watson M , Hopf Y , Cuthbertson BH
Published: March 2011

Objective

To determine, using a consensus based methodology, the rate and nature of adverse events (AEs) among patients admitted to acute medicine, acute surgery and obstetrics in a large teaching hospital in Scotland.

Methods

Retrospective case-note review of 450 medical, nursing and medication records to identify and classify adverse events.

Results

For 354 patients whose length of stay was greater than 24 hours, the overall adverse event rate was 7.9% which ranged from 0% in obstetrics, 7.2% in acute medicine to 13% in acute surgery. Among all AEs, 43% were deemed preventable by a consensus group and 59% of the AEs contributed to a proportion of the patients’ hospital stay or led to hospital readmission. Whilst nurse identification of adverse events was highly specific (94%), its sensitivity was poor (43%). Only 10% of the identified AEs were identified by the hospital's voluntary reporting system for adverse events. The estimated additional cost of adverse events in terms of bed days was £69,189 which if extrapolated Scotland-wide could cost £297 million per annum.

Conclusions

This study supports the need to continue the traditional retrospective record review to identify adverse events. The current hospital-based reporting of adverse events does not provide a complete measure of adverse events and needs to be complemented by other measures.
Manipulation Under Anaesthesia and Early Physiotherapy Facilitate Recovery of Patients with Frozen Shoulder Syndrome
Authors: Ng CY , Amin AK , Narborough S , McMullan L , Cook R , Brenkel IJ
Published: March 2011

Aim

The aim of this study was to examine the efficacy of manipulation under anaesthesia (MUA) followed by early physiotherapy in treating frozen shoulder syndrome.

Methods

In a prospective trial conducted between 26th August 2002 and 25th June 2004 in 86 patients with frozen shoulder syndrome, MUA was performed as a day procedure. Main outcomes were Disabilities of the Arm, Shoulder and Hand (DASH) score, a visual analogue score (VAS) for pain and range of movement, which were measured preoperatively and at six weeks postprocedure.

Results

Fifty (58.1%) patients had complete data. The average age was 54.5 years. The mean duration of symptoms until MUA was 13 months. The mean DASH score decreased from 48.07 to 15.84 (p<0.0005). The mean VAS reduced from 6.07 to 1.88 (p<0.0005). Flexion improved from 104.18 to 157.56 (p<0.0005); abduction from 70.48 to 150.00 (p<0.0005); and external rotation from 13.88 to 45.62 (p<0.0005).

Conclusion

MUA combined with early physiotherapy alleviates pain and facilitates recovery of function in patients with frozen shoulder syndrome.
Vasculitis and Limb Threatening Ischaemia
Authors: Cornell RL , Fraser SCA , Dhillon VB
Published: March 2011

Giant cell arteritis (GCA) is the most common systemic vasculitis in patients over 50 years. Classically patients present with temporal pain and visual disturbance, with less than 9% presenting with extracranial involvement. We present three cases GCA presenting with limb threatening ischaemia. Each diagnosis was made after clinical suspicion prompted measurement of inflammatory markers. Following treatment with high dose steroid each patient made a rapid and dramatic recovery and avoided unnecessary major surgical revascularisation or lower limb amputation.
Periodontitis and Type 2 Diabetes: Is Oxidative Stress the Mechanistic Link?
Authors: Allen EM , Matthews JB , O'Connor R , O'Halloran D , Chapple ILC
Published: March 2011

Periodontitis is a common, chronic inflammatory disease initiated by bacteria which has an increased prevalence and severity in patients with type 2 diabetes. Recent studies indicate that the co-morbid presence of periodontitis can, in turn, adversely affect diabetic status and the treatment of periodontitis can lead to improved metabolic control in diabetes patients. Current evidence points to a bidirectional interrelationship between diabetes and inflammatory periodontitis. The importance of oxidative stress-inflammatory pathways in the pathogenesis of type 2 diabetes and periodontitis has recently received attention. Given the bidirectional relationship between these two conditions, this review discusses the potential synergistic interactions along the oxidative stress-inflammation axis common to both type 2 diabetes and periodontitis, and the implications of this relationship for diabetic patients.
Familial Esophageal Atresia
Authors: El-Nabulsi B , Carachi R
Published: March 2011

The population incidence of oesophageal atresia is 1 in 3000 live birth. Most cases are sporadic but familial cases have been reported. The etiology of oesophageal atresia is multifactorial pathogenic mechanism, in which environmental and polygenic factors contribute to the development of the anomaly. Only 6–7% of cases have abnormal karyotype on chromosomal analysis. When a family history of oesophageal atresia exist, the parents should be offered genetic counseling. Antenatal screening by detailed ultrasound scans which should be done at expert centers. After birth the pediatrician should role out an oesophageal atresia by the passage of a nasogastric tube.
Aggressiveness of Inflammation in Histological Prostatitis – Correlation with Total and Free Prostate Specific Antigen Levels in Men with Biochemical Criteria for Prostate Biopsy
Authors: Stimac G , Reljic A , Spajic B , Dimanovski J , Ruzic B , Ulamec M , Sonicki Z , Kraus O
Published: March 2011

Background and Aims

Although prostatitis can contribute to the lack of prostate specific antigen (tPSA) specificity, there is disagreement concerning the effect of histological inflammation on free PSA (fPSA). We investigated the correlation between aggressiveness of histological inflammation and tPSA, fPSA and f/tPSA in patients without detectable prostate cancer (PC).

Methods

The study included 106 patients with tPSA <10 ng/mL, without clinical prostatitis and with biopsy negative for PC. The inflammation in prostate biopsies was scored for aggressiveness using the four-point scale reported by Irani. The patients were divided into two groups of less aggressive and more aggressive inflammation and compared by use of regression analysis.

Results

The median tPSA, fPSA and f/tPSA levels were 6.39 ng/mL, 1.1 ng/mL and 16% in the less aggressive inflammation group and 7.3 ng/mL, 0.79 ng/mL and 10.7% in the more aggressive inflammation group, respectively. There was no significant between-group difference in tPSA levels (P=0.16), however, statistically significant between-group differences were recorded in fPSA and f/tPSA levels (P<0.001 both). Spearman's analysis yielded a significant negative correlation of inflammation aggressiveness with fPSA (r=-0.34; P<0.001) and f/tPSA (r=-0.45; P<0.001). Free PSA and f/tPSA were lower in the group with more aggressive inflammation.

Conclusions

Histological inflammation has a high prevalence in cancer-free prostate biopsy specimens and exerts similar effects on fPSA and f/tPSA levels as PC. Our study suggests histological prostatitis to be an important cause of decreased fPSA and f/tPSA values; therefore, when it is identified, antibiotic or anti-inflammatory therapy should be introduced to reduce the percentage of men with a continuing indication for prostate biopsy.
The Association Between Drug Related Deaths and Prior Contact with Hospital-Based Services
Authors: Thanacoody RHK , Jay J , Sherval J
Published: March 2011

Reducing drug related deaths has been identified as a health priority by the Scottish Executive.

Aims

This study investigates the association between drug related deaths in the Lothian region and prior contact with hospital-based services in the Edinburgh Royal Infirmary.

Design/Setting

Retrospective analysis of 90 drug related deaths in Lothian from 2003-2005. Hospital episodes within five years of death were identified by searching the electronic patient record system within the Edinburgh Royal Infirmary.

Findings

Seventy-five of the 90 drug related deaths occurred in the hospital catchment area. Forty five of these 75 deaths (60%) occurred in patients who had used hospital-based services in the previous five years. The median time from hospital contact to deaths was five months and median number of hospital attendances/admissions was three (range 1 – 26).

Conclusion

Liaison between emergency departments, clinical toxicology services and community based drug addiction services is important to identify drug misusers at high risk. A hospital-based specialist nurse-led liaison service may be able to fulfil this role.
To See or Not to See? ……. That is the question: An analysis of out-patient follow-up arrangements and non-attendance in a community paediatric population
Authors: Cordiner D , Logie L , Becher Jc
Published: March 2011

Objective

To investigate the relationship between the number of outpatient appointments made; the distance traveled to attend these and the proportion of these appointments missed.

Design

Retrospective Cohort Study.

Setting

Community Paediatrics.

Participants

Eighteen pre-school children on the Special Needs Register.

Results

With an increase in the number of appointments made and the distances involved in attending these, the number of missed appointments tends to increase.

Conclusions

We need to educate parents as to the importance of follow-up, include families in decision making about appointments and rationalize the number of appointments made.
Emergency Percutaneous Endovascular Stenting of a Spontaneous Ruptured Popliteal Aneurysm
Authors: Rj Drummond , Murch C , Kettlewell S
Published: March 2011

Spontaneous rupture of a popliteal aneurysm is a relatively uncommon event with a significant risk of limb loss. The elderly patient with multiple co-morbidities presents a particular risk for surgical intervention in these cases.

In this case we present such a situation successfully treated by endovascular means with a satisfactory outcome.
Acute limb ischemia as a first presentation of a thyrotoxic patient: A Case Report
Authors: Yassin Musaab , Canna Khalid , Bain Donald
Published: March 2011

Introduction

Arterial embolism in thyrotoxic atrial fibrillation is more common than is realized and can be the first presentation of undiagnosed hyperthyroidism.

Report

Acute limb ischemia as a first presentation of hyperthyroidism

Discussion

A medical condition can modify a surgical approach to achieve successful results.
Exercise at Altitude
Authors: Drust B , Waterhouse J
Published: March 2011

Altitude poses physiological challenges to the sports participant in excess of those encountered at sea level. The main problem is hypoxia and the reduction in oxygen transport capacity, which is linked to the fall in alveolar oxygen tension. Training at altitude is imperative as preparation for competing there in aerobic events. The acute adaptations on exposure to moderate altitudes may be beneficial for subsequent performance at sea level, and this has led to the use of altitude training camps, though their advantages have not been conclusively demonstrated. The benefits of altitude training depend on a variety of factors, including individual characteristics and environmental training variables.
Sports pre-hospital immediate care courses in the United Kingdom - attempting to “treat” sudden cardiac death.
Authors: Hanson Jonathan Richard
Published: March 2011

A description of the current state of sports pre-hospital immediate care training for pitchside doctors and physiotherapists in the United Kingdom. The background and development of such courses is covered, as are the major skills and revalidation procedures. Course credibility through professional regulation and instructor selection is discussed, as are the differences between the sports pre-hospital courses and traditional in-hospital resuscitation and trauma courses. Official policy from the Faculty of Sports and Exercise Medicine in the UK is considered and recommendations for change suggested.
Survey of Anaphylaxis Management by General Practitioners in Scotland
Authors: Lowe G , Kirkwood E , Harkness S
Published: March 2011

Aim

To obtain a snapshot of how patients with potentially lifethreatening allergies are managed within a Primary Care setting.

Methodology

A questionnaire-based survey sent to all General Practitioners in Scotland.

Results

Six hundred and thirteen replies were suitable for analysis. Ninety percent of respondents had prescribed adrenaline auto-injector pens, almost exclusively the EpiPen device. Less than half were personally confident in their use and only 17% had access to a dummy trainer pen for demonstration purposes. Twenty seven percent would prescribe one auto-injector only. Six percent reported accidental mis-firing of adrenaline pens, although with no serious sequelae. Refusal of pens by patients was noted by 1%. In the event of an anaphylactic emergency, 90% of respondents would use adrenaline as first-line treatment, although only half would use the UK Resuscitation Council recommended adult dose of 0.5mg by the intramuscular route (or 0.3mg by auto-injector). Eleven percent would give adrenaline by the slower subcutaneous route and 3% by the intravenous route. Thirty six percent had themselves treated such a case outside of hospital. Sixty two percent of respondents would seek specialist investigation of anaphylaxis, although only 31% felt that ready access was available. Frequent concerns were raised about current provision of care for patients with allergic disease and their own ability to deal with this.

Conclusion

Investment is required, both to provide basic training and ongoing support for Primary healthcare staff in the management of allergic disease, and also for necessary accompanying specialist support.
Scottish Stroke Research Network: the first three years
Authors: McCormick K , Langhorne P , Graham FEJ , McFarlane C ,   CLOTS collaboration
Published: March 2011

Research networks were introduced in the UK to facilitate and improve clinical research and stroke was seen as a priority topic for local research network development. The Scottish Stroke Research Network (SSRN) is one of 11 stroke research networks in the UK. In this article we review the progress of the Scottish Stroke Research Network in the three years since inception.

Between 2006–2009 the number of active hospital research sites has increased from 10 to 22 expanding to involve 20 stroke research nurses. There was a corresponding 58% increase in recruitment of participants into stroke studies, from 376 in 2006/07 to 594 in 2008/09. The majority (17/20) of our current studies are interventional. Data from one of these, the CLOTs trial (Clots in Legs Or sTocking after Stroke), demonstrates that the annual recruitment in Scotland increased from a median of 94 (range 6–122) patients per year in the six years before the SSRN, to 140 (135–158) patients per year after SSRN involvement. We currently screen about 50% of Scottish stroke patients and approximately 5% of Scottish stroke patients are participating in research studies that we support.

The SSRN has made good progress in the first three years. Increasing the recruitment of screened patients remains a challenge.
Historical Notes on Cancer Metastasis in Animals
Authors: Onuigbo WIB
Published: March 2011

The old literature on the transportation of cancer from the primary seat to the secondary sites mostly dealt with the human disease. Therefore, the present work notes the counterpart observations documented on animals by the old masters from 1846 to 1896.
Current Practice of Obtaining Informed Consent for Local Steroid Injection among the Shoulder and Elbow Surgeons in United Kingdom
Authors: Lim CS , Miles J , Peckham TJ
Published: March 2011

Background

Local steroid injection is a common procedure and not without risks.

Aim

To establish the current practice of obtaining informed consent for local steroid injection among shoulder and elbow surgeons in the UK.

Methods

A postal questionnaire survey was distributed to 176 orthopaedics surgeons in UK who were members of the British Elbow and Shoulder Society.

Results

68% of the surgeons considered local steroid injection invasive. 88% of the surgeons obtained verbal consent only. Of these, only 19% recorded the discussion. Almost all the surgeons (96%) explained the desired effects and 26% provided statistical evidence of local steroid injection. About 88% of the surgeons mentioned other drugs included in the injection. Only 13% of them mentioned the dose of the steroid used. 82% and 77% of the surgeons offered alternative treatment options and the right to refuse injection respectively. 85% and 59% of the surgeons discussed local and systemic risks of steroid injection, respectively. The most common risk mentioned by the surgeons is short term increase of pain.

Conclusions

Majority of the surgeons used verbal consent only for local steroid injection. The consent discussion was not regularly documented in case notes and the information delivered varies.
Aberdeen's Plague Epidemic of 1647–48
Authors: Jillings K
Published: March 2011

This article discusses the plague epidemic that broke out in Scotland in the mid 1640s, particularly its effects on the city of Aberdeen where it remained virulent from April 1647 until the end of the following year. Prevailing medical understandings of disease causation and transmission will be discussed, and it will be shown that governments attempted to restrict outbreaks in accordance with these beliefs. The spread of plague throughout Scotland from 1644 will be summarised, with the focus on the impact of the disease on Aberdeen in 1647–48. The surviving council registers and other primary sources will be used to show how the city's governors responded to the dual threat of miasma and contagion in well-established ways.
Lower urinary tract symptoms and sexual dysfunction: an audit of sexual symptoms among patients attending a nurse-led prostate clinic
Authors: Milburn J A , Campbell D , Gunn I G
Published: March 2011

Significant numbers of men with lower urinary tract symptoms (LUTS) also report symptoms of sexual dysfunction (SD). The prevalence of SD in patients referred to a prostate assessment clinic, was assessed using a confidential questionnaire. Fifty-six percent of patients reported difficulties in maintaining an erection and 48% felt that improving their sexual function would benefit their quality of life. None of the referral letters from primary care mentioned symptoms of SD. Patients with LUTS seen in primary and secondary care should be assessed for SD and offered appropriate advice and management.
Pathological femoral fracture caused by primary bone tumour: a population-based study
Authors: Godley K , Watts A C , Robb J E
Published: March 2011

This population-based study aimed to analyse the demographic, clinical and histological features of patients with a malignant primary bone tumour of the femur presenting with a pathological fracture. Eighty-four patients were identified from a prospectively gathered national tumour database between 1960 and 2004. Demographic data, presenting features, tumour location, histological diagnosis, treatment, local recurrence, metastasis and survival data were gathered. An estimate of the annual incidence was obtained using population data from the General Register Office and was 0.4 per million population per annum. The mean age was 56 years (range 4–87 years) with a bimodal distribution and 46% were men or boys. Forty-one percent of patients presented with a history of trauma. The average duration of symptoms before presentation was 1–3 months. The most common histological diagnoses were osteosarcoma (14 patients) and Paget's sarcoma (12 patients). The local recurrence rate was 38% and the overall five-year survival was 22%. The prognosis was made worse by local tumour recurrence, the development of metastasis and age at diagnosis greater than 21 years. Limb salvage surgery did not alter the prognosis. Patients who present with pathological fracture of a primary malignant bone tumour, carry a poor prognosis in all tumour types and no improvement in survival was identified over the period of the study.
Improving prescribing of antiosteoporosis discharge medication in fractured neck of femur patients: a completed audit cycle
Authors: Goodwin Susie J , Walker Nolan D
Published: March 2011

Fracture liaison specialist nurses at our institute, perceived deficiency in the level of prescription of osteoporosis secondary prevention medication on discharge of fractured neck of femur (NOF) patients. This aspect of management was therefore audited over two cycles with the aim of evaluating and improving current practice. A prospectively maintained database was utilized to establish identity, demographic data and specialist nurse treatment recommendation for all fractured NOF patients over an initial 12-month period. Computerized immediate discharge letters were reviewed to identify whether the recommended medication had been prescribed. Following the initial audit, fluorescent drug kardex stickers detailing simple treatment recommendations were introduced, and a second audit cycle was carried out using identical methods over the subsequent 12-month period. Primary audit demonstrated that discharge prescriptions included the recommended secondary prevention medications in 50.9%. Following the introduction of fluorescent drug chart stickers detailing the recommendations, re-audit demonstrated improvement to 84.6%. In conclusion, an improvement in the practice of prescription of osteoporosis medications on discharge was demonstrated following the introduction of fluorescent drug kardex stickers.
Tuberculous paraspinal abscess: a case of mistaken identity
Authors: Crooks Michael G , Hill Adam T
Published: March 2011

We present the case of a 35-year-old man of Pakistani origin presenting with a history suggestive of tuberculosis. Chest x-ray revealed left upper zone consolidation and mediastinal widening felt to be consistent with mediastinal lymphadenopathy. Bronchoalveolar lavage failed to yield acid-fast bacilli (AFB) and therefore CT thorax was requested with a view to surgical referral for mediastinal node biopsy. CT thorax revealed a large paravertebral abscess to be the cause of apparent mediastinal widening. CT guided biopsy confirmed Mycobacterium tuberculosis on culture. On reflection, there was preservation of the right paratracheal stripe on chest x-ray indicating that this was not mediastinal lymphadenopathy but a paravertebral mass as illustrated on CT.
Abnormal per rectal bleed
Authors: Singh Arvinder
Published: March 2011

A 3-year old girl presented to our A&E with a complaint of an acute event of per rectal bleed. The parent had given a history of a visit to a nearby waterfall one day ago. Upon admission she developed hypotension and had a fainting episode due to the excessive passing of blood per rectum. The case report shows how the appropriate investigations were carried out and the twist behind the cause.
A Dynamic Model of Sponsored Search Advertising
Authors: Yao Song , Mela Carl F.
Published: March 2011

Sponsored search advertising is ascendant—Forrester Research reports expenditures rose 28% in 2007 to $8.1 billion and will continue to rise at a 26% compound annual growth rate [VanBoskirk, S. 2007. U.S. interactive marketing forecast, 2007 to 2012. Forrester Research (October 10)], approaching half the level of television advertising and making sponsored search one of the major advertising trends to affect the marketing landscape. Yet little empirical research exists to explore how the interaction of various agents (searchers, advertisers, and the search engine) in keyword markets affects consumer welfare and firm profits. The dynamic structural model we propose serves as a foundation to explore these outcomes. We fit this model to a proprietary data set provided by an anonymous search engine. These data include consumer search and clicking behavior, advertiser bidding behavior, and search engine information such as keyword pricing and website design.

With respect to advertisers, we find evidence of dynamic bidding behavior. Advertiser value for clicks on their links averages about 26 cents. Given the typical $22 retail price of the software products advertised on the considered search engine, this implies a conversion rate (sales per click) of about 1.2%, well within common estimates of 1%–2% [Narcisse, E. 2007. Magid: Casual free to pay conversion rate too low. GameDaily.com (September 20)]. With respect to consumers, we find that frequent clickers place a greater emphasis on the position of the sponsored advertising link. We further find that about 10% of consumers do 90% of the clicks.

We then conduct several policy simulations to illustrate the effects of changes in search engine policy. First, we find the search engine obtains revenue gains of 1% by sharing individual-level information with advertisers and enabling them to vary their bids by consumer segment. This also improves advertiser revenue by 6% and consumer welfare by 1.6%. Second, we find that a switch from a first- to second-price auction results in truth telling (advertiser bids rise to advertiser valuations). However, the second-price auction has little impact on search engine profits. Third, consumer search tools lead to a platform revenue increase of 2.9% and an increase of consumer welfare by 3.8%. However, these tools, by reducing advertising exposures, lower advertiser profits by 2.1%.
Crisis and Consumption Smoothing
Authors: Dutt Pushan , Padmanabhan V.
Published: March 2011

The dramatic impact of the current crisis on performance of businesses across sectors and economies has been headlining the business press for the past several months. Extant reconciliations of these patterns in the popular press rely on ad hoc reasoning. Using historical data on currency crisis episodes across the world, we show that the impact of the crisis on a firm's business is best understood by focusing on the impact of the crisis on the behavior of consumers. Our analyses show that consumer behavior in a crisis is characterized by consumption smoothing at various levels—intertemporal, intercategory, and intracategory. These behavioral adjustments result in significant reallocation of consumption expenditures. More importantly, the smoothing decisions because of a crisis are distinct and independent of the impact of changes in income and prices that accompany a crisis. Interestingly, there is marked variation in the patterns of consumption smoothing across different types of economies. Taken together, these results have important and interesting implications for managers, policy makers, and academics.
Efficient Methods for Sampling Responses from Large-Scale Qualitative Data
Authors: Singh Surendra N. , Hillmer Steve , Wang Ze
Published: March 2011

The World Wide Web contains a vast corpus of consumer-generated content that holds invaluable insights for improving the product and service offerings of firms. Yet the typical method for extracting diagnostic information from online content—text mining—has limitations. As a starting point, we propose analyzing a sample of comments before initiating text mining. Using a combination of real data and simulations, we demonstrate that a sampling procedure that selects respondents whose comments contain a large amount of information is superior to the two most popular sampling methods—simple random sampling and stratified random sampling—-in gaining insights from the data. In addition, we derive a method that determines the probability of observing diagnostic information repeated a specific number of times in the population, which will enable managers to base sample size decisions on the trade-off between obtaining additional diagnostic information and the added expense of a larger sample. We provide an illustration of one of the methods using a real data set from a website containing qualitative comments about staying at a hotel and demonstrate how sampling qualitative comments can be a useful first step in text mining.
Clinical Laboratory Detection of AmpC β-Lactamase
Authors: Rand Kenneth H. , Turner Bradley , Seifert Hilary , Hansen Christine , Johnson Judith A. , Zimmer Andrea
Published: March 2011

Plasmid-mediated AmpC-producing Escherichia coli and Klebsiella pneumoniae have been associated with poor clinical outcomes, but they are not readily identified in hospital microbiology laboratories. We tested 753 gram-negative bloodstream isolates for AmpC by using the EDTA disk test and the modified Hodge test (n = 172) and the modified Hodge test alone (n = 581). The 30-day mortality for the AmpC group was 9% (2/23) and was 6% (3/51) for the control group. The clinical response was similar: afebrile on day 2 (AmpC group, 16/23 [70%]; control group, 32/45 [71%]) and on day 4 (AmpC group, 19/22 [86%]; control group, 37/44 [84%]). Patients with isolates in the AmpC group were more likely to be in an intensive care unit at the time of the positive blood culture (P = .01) and more likely to be intubated (P = .05) than patients with isolates in the control group. Effective antibiotic treatment within the first 48 hours was given to 47 (92%) of 51 patients with isolates in the control group but to only 14 (61%) of 23 patients with isolates in the AmpC group (P = .001). The modified Hodge test and the EDTA disk test did not identify patients at risk for a poor outcome from AmpC-producing bacterial infections.
Relationship Between Molecular Subtype of Invasive Breast Carcinoma and Expression of Gross Cystic Disease Fluid Protein 15 and Mammaglobin
Authors: Lewis Gloria H. , Subhawong Andrea Proctor , Nassar Hind , Vang Russell , Illei Peter B. , Park Ben Ho , Argani Pedram
Published: March 2011

We investigated the expression of gross cystic disease fluid protein 15 (GCDFP) and mammaglobin (MGB) by immunohistochemical analysis in 71 invasive breast carcinomas (IBCs) subtyped into luminal (A and B), HER2, basal-like carcinoma (BLC), and unclassified triple-negative carcinoma (UTNC) by established surrogate immunohistochemical profiles. GCDFP and MGB were less likely to be expressed in BLC than in HER2 cancers (P = .000021 and P = .013, respectively) or luminal cancers (P = .00002 and P = .00008, respectively). However, the difference in GCDFP or MGB expression between HER2 and luminal cancers was not significant (P = 1.0 and P = .671, respectively). Our results suggest that luminal cancers demonstrate similar degrees of apocrine differentiation as HER2 cancers. Most BLCs and UTNCs are negative for MGB and GCDFP. Correlation with clinical findings may be needed to exclude the possibility of a metastasis to the breast when BLCs or UTNCs are encountered in a limited sample such as a core biopsy sample.
Common Genomic Aberrations in Basaloid Squamous Cell Carcinoma and Carcinosarcoma of the Esophagus Detected by CGH and Array CGH
Authors: Schaefer Inga-Marie , Enders Christina , Polten Andreas , Haller Florian , Frölich Andreas M.J. , Cameron Silke , Schüler Philipp , Schweiger Peter , Gunawan Bastian , Beham Alexander , Füzesi László
Published: March 2011

Basaloid squamous cell carcinoma (BSCC) and carcinosarcoma of the esophagus are rare entities, making up fewer than 2% of esophageal malignancies. Comparative genomic hybridization (CGH) in 1 case of BSCC and 2 cases of carcinosarcoma and subsequent array CGH in 1 case each of BSCC and carcinosarcoma revealed common chromosomal gains at 2p25.3-2p12, 7q21.3-7q22.3, and 11q13.2-11q13.4. Chromosomal losses at 13q31qter were observed in both carcinosarcomas. In addition, progression of genomic instability from in situ to invasive carcinosarcoma could be demonstrated by using array CGH. Our observations suggest a common genetic origin of BSCC and carcinosarcoma.
Mechanisms of chemical generation of volatile hydrides for trace element determination (IUPAC Technical Report)
Authors: D’Ulivo Alessandro , Dědina Jiří , Mester Zoltan , Sturgeon Ralph E. , Wang Qiuquan , Welz Bernhard
Published: March 2011

Aqueous-phase chemical generation of volatile hydrides (CHG) by derivatization with borane complexes is one of the most powerful and widely employed methods for determination and speciation analysis of trace and ultratrace elements (viz. Ge, Sn, Pb, As, Sb, Bi, Se, Te, Hg, Cd, and, more recently, several transition and noble metals) when coupled with atomic and mass spectrometric detection techniques. Analytical CHG is still dominated by erroneous concepts, which have been disseminated and consolidated within the analytical scientific community over the course of many years. The overall approach to CHG has thus remained completely empirical, which hinders possibilities for further development. This report is focused on the rationalization and clarification of fundamental aspects related to CHG: (i) mechanism of hydrolysis of borane complexes; (ii) mechanism of hydrogen transfer from the borane complex to the analytical substrate; (iii) mechanisms through which the different chemical reaction conditions control the CHG process; and (iv) mechanism of action of chemical additives and foreign species. Enhanced comprehension of these different mechanisms and their mutual influence can be achieved in light of the present state of knowledge. This provides the tools to explain the reactivity of a CHG system and contributes to the clarification of several controversial aspects and the elimination of erroneous concepts in CHG.
The role of second-person narration in representing mental states in Sylvia Plath's Smith Journal
Authors: Demjén Zsófia
Published: March 2011

This paper looks at instances of second person narration in the first journal published in The Unabridged Journals of Sylvia Plath (Kukil, 2000) in order to determine the potential that second person narration can have for the linguistic representation of mental states. The contributions of different disciplines (narratology, linguistics, psychology) to the study of second person narration are considered and their findings are re-applied to a non-fictional text. In a corpus-informed comparative analysis, the paper takes into consideration both perspectives from narratology and developments in the understanding of language use in the field of psychology to provide an interdisciplinary, but cognitively inclined perspective on the phenomenon.

Appearances of second person narration are chronologically tracked through the data and compared to biographical developments in Sylvia Plath's life; entries written in the first- and second person are compared to each other to determine linguistic differences using corpus methods; the results of the two analyses are then interpreted in the light of traditional functions attributed to second person narration in narratology, and in the light of research in narrative psychology. The paper aims to demonstrate that second person narration can project a sense of emotional depth and inner conflict as well as of emotional balance. However, the temporal orientation of a given text will influence which of these effects predominates.
Austen's fans and fans' Austen
Authors: Xu Jun
Published: March 2011

A corpus of Jane Austen's fanfic is constructed from sequels published in print and on line; it is then compared with a corpus of Austen's own writing, as well as one of contemporary romance fiction. Through analysis of the corpora, the “vertical intertextuality” of Austen's text and the fanfic corpus, and the “horizontal intertextuality” of contemporary romance fiction corpora and the fanfic corpus are articulated. The results illustrate that, although claiming to emulate her writing faithfully, Austen's fans reconstruct a modern Austen who is writing contemporary romance fiction through the “old” characters such as Elizabeth and Darcy. The different “Austens” emerging from this corpus research and other scholars' reading of Austen suggest that the death of the “Author” is only part of the story: we see not only the Author's death and the birth of the Reader, but a ghostly projection of a new “Author” in the reader's cultural context.
Representation of temporal sound features in the human auditory cortex
Authors: Nourski Kirill V. , Brugge John F.
Published: March 2011

Temporal information in acoustic signals is important for the perception of environmental sounds, including speech. This review focuses on several aspects of temporal processing within human auditory cortex and its relevance for the processing of speech sounds. Periodic non-speech sounds, such as trains of acoustic clicks and bursts of amplitude-modulated noise or tones, can elicit different percepts depending on the pulse repetition rate or modulation frequency. Such sounds provide convenient methodological tools to study representation of timing information in the auditory system. At low repetition rates of up to 8–10 Hz, each individual stimulus (a single click or a sinusoidal amplitude modulation cycle) within the sequence is perceived as a separate event. As repetition rates increase up to and above approximately 40 Hz, these events blend together, giving rise first to the percept of flutter and then to pitch. The extent to which neural responses of human auditory cortex encode temporal features of acoustic stimuli is discussed within the context of these perceptual classes of periodic stimuli and their relationship to speech sounds. Evidence for neural coding of temporal information at the level of the core auditory cortex in humans suggests possible physiological counterparts to perceptual categorical boundaries for periodic acoustic stimuli. Temporal coding is less evident in auditory cortical fields beyond the core. Finally, data suggest hemispheric asymmetry in temporal cortical processing.