bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of hyperemesis gravidarum with the 5-HT3 antagonist ondansetron (Zofran)
Authors: Tincello D G , Johnstone M J
Published: December 2008

Ondansetron is a 5-hydroxytryptamine receptor antagonist which is known to be a highly effective anti-emetic drug for chemotherapy-associated nausea and vomiting and for postoperative nausea. We report here a case where ondansetron was used in severe hyperemesis gravidarum to avoid parenteral nutrition. The drug was used intermittently in every trimester with no apparent adverse effects on mother or infant.
Interferon-alpha in childhood haematological malignancies
Authors: Simkó R , Nagy K
Published: December 2008

The application of cytostatics has brought about a breakthrough in the treatment of childhood haematological malignancies in the past 20 years. Chemotherapy appears to be least successful in the rare, low and very high mitotic index diseases, which often have an enormous tumour-burden. The suitability of chemotherapy in minimal residual leukaemia is also of some doubt. In these situations a ‘conservative’ treatment may be more appropriate. Because interferon-alpha has a distinct mechanism of action, and a broad-spectrum haematopoietic inhibitory activity, it is relatively nontoxic and noncancerogenic, and it may have a role in the treatment of malignant haematological disorders, either as a mono- or combination therapy. The exact indications and dosages for interferon in childhood malignancies are far from clear. Up to now, it has proved to be most efficacious in small tumour masses, providing a theoretical basis for application in minimal residual disease. Controlled clinical data, however, are not yet available. It remains to be determined whether or not interferon can be added to current chemotherapy protocols without a significant reduction of dose. Hopefully, a deeper understanding of the activities of interferon will allow us to plan better trials with combination treatments.
Bladder cancer
Authors: Leung H Y , Griffiths T R , Neal D E
Published: December 2008

Bladder cancer is the fourth most common cancer in England and Wales. The most common presenting symptom is macroscopic haematuria. The management options for superficial and invasive bladder cancer depend on the stage at presentation. Most superficial bladder cancers are managed by transurethral resection and cytoscopic follow-up. The prognosis for patients with invasive bladder cancer is less good. The role of chemical, radiotherapeutic and surgical intervention are discussed.
Spontaneous healing of osteitis fibrosa cystica in primary hyperparathyroidism
Authors: Gibbs C J , Millar J G , Smith J
Published: December 2008

A 24-year-old man with primary hyperparathyroidism and osteitis fibrosa cystica developed acute hypocalcaemia. Spontaneous healing of his bone disease was confirmed radiographically and by correction of the serum alkaline phosphatase. Hypercalcaemia associated with a raised serum parathyroid hormone recurred 90 weeks after the initial presentation. During the fourth neck exploration a parathyroid adenoma was removed, resulting in resolution of his condition. Haemorrhagic infarction of an adenoma was the most likely cause of the acute hypocalcaemic episode.
Expanding the role of the nurse in the Accident and Emergency department
Authors: Neades B L
Published: December 2008

In response to the increasing demands upon the Accident and Emergency department and supported by changes within the scope of professional practice of the qualified nurse, Accident and Emergency nurses have expanded their role within the multidisciplinary team. The article reviews the development of this expanded role for the nurse within the Accident and Emergency team and discusses its implications.
Wernicke-Korsakoff syndrome
Authors: Zubaran C , Fernandes J G , Rodnight R
Published: December 2008

Alcohol abuse is one of the most serious problems in public health and the Wernicke-Korsakoff syndrome is one of the gravest consequences of alcoholism. The pathology is often undiagnosed in its less evident presentations, therefore an accurate diagnostic approach is a critical step in treatment planning. Treatment is based on restoration of thiamine, although this is insufficient to prevent the psychological decline of a great number of patients. The cognitive impact of the pathology is derived from the interaction of alcoholic neurotoxicity, thiamine deficiency and personal susceptibility. In this article, the literature concerning Wernicke-Korsakoff syndrome is reviewed.
Warwickshire consultants' ‘training the trainers’ course
Authors: Whitehouse A
Published: December 2008

To train junior hospital doctors more quickly and effectively as envisaged by the Calman reforms, consultants will need to develop their adult education skills. This paper describes a course set up and attended by a mixed group of Warwickshire consultants to improve their understanding of these skills. The course organisation and content is described and the ‘learner-centred education’ model, educational supervision techniques, giving feedback on performance, goal setting, learning contracts and other topics covered are explained. A 12-month interval questionnaire evaluation by attendants shows that the principles taught in the course were being widely applied a year later. Thus, at a modest cost, consultants can receive a valuable basic training in adult education.
Malignant change in a chronic skin lesion induced by an intravenous cannula
Authors: Nkere U U , Banjar A
Published: December 2008

A cutaneous wound subjected to continuous irritation has an increased potential for malignant degeneration. The types of trauma that may give rise to the initial injury are diverse and have been well documented. We report a case of one such lesion in a 65-year-old man who had a persistent right forearm wound for over three years. The wound arose from the site of venous cannula puncture. Malignant transformation occurred in a manner comparable to that seen in other chronic lesions (Marjolin's ulcer).
Reversible acute renal failure induced by losartan in a renal transplant recipient
Authors: Ostermann M , Goldsmith D J A , Doyle T , Kingswood J C , Sharpstone P
Published: December 2008

A 56-year-old man who received a live-related renal transplant in 1988 was started in 1995 on the selective angiotensin II antagonist losartan (Dupont-Merke) to treat worsening hypertension. Two months later because of pulmonary oedema, loop diuretics were started. Within two weeks, serum creatinine had increased from 245 to 571 mumol/l, and the patient became oliguric. A systolic bruit was noted over the graft. Renal angiography showed a 90% stenosis of the transplant renal artery. Losartan was withdrawn, with prompt improvement in renal function. A successful percutaneous transluminal angioplasty performed a few days later resulted in further improvement in renal function accompanied by a significant diuresis.
Ursodeoxycholic acid in the treatment of liver diseases
Authors: Saksena S , Tandon R K
Published: December 2008

Ursodeoxycholic acid is a dihydroxy bile acid with a rapidly expanding spectrum of usage in acute and chronic liver diseases. The various mechanisms of action of this hydrophilic bile acid include direct cytoprotection, detergent action on dysfunctional microtubules, immunomodulation and induction of hypercholeresis. Its efficacy in primary biliary cirrhosis and primary sclerosing cholangitis as an adjunct to medical therapy has been well established. Newer indications include its use in the management of chronic hepatitis, cirrhosis, post liver transplant rejection, graft-versus-host disease and acute viral hepatitis, where it not only relieves symptoms of cholestasis but also arrests ongoing hepatocyte necrosis.
The journal club
Authors: Valentini R P , Daniels S R
Published: December 2008

As the body of medical literature continues to expand, physicians must develop the necessary skills to keep up with the vast amount of information available. The journal club provides a forum to allow residents to remain current with the literature while also teaching them the methods to evaluate it critically. Those readers wishing to start a journal club or revive an existing one should begin by designating a leader and defining the conference goals. Emphasizing the importance of this conference in the educational process while allowing it to be structured to optimise resident interest and attendance will help to ensure its success. Periodic evaluation of this conference will allow the organisers to assess the concordance of the resident's goals with those of the faculty. Formal evaluation will also provide an objective assessment of the knowledge gained by the house-staff through participation in journal club.
The assessment of acute calf pain
Authors: Banerjee A
Published: December 2008

Acute calf pain can be due to a variety of causes. The identification of patients requiring screening for deep vein thrombosis can be achieved from the history and physical examination. For emergency department use, initially noninvasive assessment with ultrasound scanning can not only demonstrate thrombosis but also other lesions, including popliteal cysts and masses producing venous compression. This is a cost-effective strategy suitable for the assessment of the ambulatory patient. Some subgroups of patients with proven deep vein thrombosis may require further investigation for the predisposing cause.
Pneumonitis induced by sulphasalazine
Authors: Peters F P J , Engels L G J B , Moers A M J
Published: December 2008

We describe a 65-year-old woman with eosinophilic pneumonitis induced by sulphasalazine. Laboratory findings revealed peripheral eosinophilia. The chest X-ray showed bilateral infiltrations, which disappeared after sulphasalazine was discontinued.
Generic inhaled salbutamol versus branded salbutamol. A randomised double-blind study
Authors: Williamson I J , Reid A , Monie R D , Fennerty A G , Rimmer E M
Published: December 2008

Generic substitution of salbutamol lags behind that of other drugs in Scotland and a negative perception by both patients and doctors may explain this. The aim of this study was to assess whether, in clinical practice, there was any difference in efficacy between branded salbutamol (Ventolin) and a generic preparation. Asthmatic patients using a Ventolin metered-dose inhaler at least twice a day for symptom relief were entered into a double-blind cross-over study, comparing Ventolin, blinded Ventolin and a generic salbutamol in random order for two weeks each. Daily peak flows, inhaler use and bronchodilator response were recorded. At the end of each treatment period patients rated their inhaler against their usual Ventolin on a 5-point scale. Forty patients were entered into the study; 90% received 1000 micrograms or more of inhaled steroids per day. Eleven patients dropped out during the run-in phase. In the remaining 29 patients, no significant difference between treatments could be found in any of the objective parameters measured. Fifty-five per cent of patients said they could detect a difference between the inhalers, and 45% noted a difference between their usual Ventolin and the open or blinded Ventolin. This study showed clinical equivalence between a generic and branded salbutamol. Patients' own assessment of their relief inhaler seems to be influenced by factors other than efficacy. The study highlights that careful encouragement is required when changing to a generic product and has particular implications for the forthcoming conversion to CFC-free products.
Haemopoietic growth factors
Authors: Ketley N J , Newland A C
Published: December 2008

Haemopoietic growth factors are involved in the production of the various blood cells from progenitors in the bone marrow, making them useful in a range of clinical situations. The genes for several of them have been cloned and their production engineered by recombinant technology, making them widely available. Myeloid growth factors are used to support patients in the aftermath of chemotherapy and bone marrow transplantation and have potential application in the treatment of infectious diseases. Erythropoietin is widely used for patients with anaemia due to failure of marrow production, having established its effectiveness in chronic renal failure. Thrombopoietin has recently been described and may provide a means to alleviate thrombocytopenia. Current indications and areas of recent reappraisal are addressed in this review.
Pneumococcal vaccine
Authors: Hattotuwa K L , Hind C R K
Published: December 2008

Streptococcus pneumoniae is a frequent cause of pneumonia and meningitis. This article looks at the pneumococcal vaccine, its uses, efficacy, and adverse effects and how vaccination may be improved. We also look at the role of the new conjugate vaccines.
Unsuspected thyrotoxicosis and hyperemesis gravidarum in Asian women
Authors: Chong W , Johnston C
Published: December 2008

This report describes three women with hyperemesis gravidarum caused by previously undiagnosed thyrotoxicosis. All three women were eight weeks pregnant and only one woman had typical features of thyrotoxicosis. Hyperemesis could not be controlled by anti-emetics. The patients were successfully treated with antithyroid drugs. Anti-thyroid treatment does not need to be continued once resolution of symptoms and thyrotoxicosis have occurred.
Supervised drug administration in patients with refractory hypertension unmasking noncompliance
Authors: Cronin C C , Higgins T M , Murphy M B , Ferriss J B
Published: December 2008

Noncompliance with medication is common, particularly in asymptomatic conditions such as hypertension that require long-term treatment, and is often unsuspected. We describe two patients with refractory hypertension in whom noncompliance was confirmed by a precipitous fall in blood pressure when antihypertensive medications were given under direct supervision.
Genes and the development of vascular disease
Authors: Foy C A , Grant P J
Published: December 2008

Clinical vascular disease occurs as the result of the chronic development of atherosclerosis, often with acute occlusive thrombus formation as the final event. Both atherosclerotic and thrombotic disorders are complex processes resulting from genetic and environmental interactions. We review genes currently implicated as risk factors and the approaches for identifying novel genetic risk factors.
Solitary ileocolic arteriovenous malformation: spongostan and silk therapeutic embolisation
Authors: Alcalde M , Jiménez G , Díaz P , García-Díaz M , Pascasio J M , Moro R , Zapata J , López-Santamaría A
Published: December 2008

A debilitated patient with liver cirrhosis and poor haemostasis had a severe lower gastrointestinal haemorrhage. A superior mesenteric arteriogram revealed an early persistent and promiment draining vein in the ileocolic artery. Two fragments of Spongostan and silk were used to embolise the bleeding artery and the haemorhage ceased immediately. No infarction of the embolised area was observed and the bleeding was controlled.
Massive arterial bleeding from a single rectal vessel
Authors: Harrison J D , Calatayud A , Thava V R , Kirby R M
Published: December 2008

We report a case of massive rectal haemorrhage arising from a single ectatic arterial vessel above the haemorrhoidal cushion in normal rectal mucosa. Use of an anal retractor enable identification of the bleeding vessel and avoided a major laparatomy.
Langerhans cell histiocytosis (histiocytosis X)
Authors: Lam K Y
Published: December 2008

There has been a renewed interest in Langerhans cell histiocytosis in recent years due both to advances in basic research and to improvements in diagnostic and treatment approaches. In this article, we review the various aspects of the disease and the potential implications of these recent scientific researches for our understanding and management of the disorder.
Handbooks, learning contracts, and senior house officers: a collaborative enterprise
Authors: Parsell G
Published: December 2008

Efforts to bring about improvements in hospital-based education and training for senior house officers over the last few years have raised issues which are gradually being addressed. One of these is the lack of understanding by many clinical teachers of educational principles and their application to senior house officer training. This study describes how volunteer consultants in five specialties in a North West District General Hospital worked together to develop an educational structure for senior house officers. An audit of education and training was carried out across the hospital to help identify problem areas. An education specialist worked with consultants to develop, implement and evaluate a handbook based on adult learning principles. The handbook incorporated a learning contract, formal review process and a curriculum of learning objectives for each specialty. In parallel, consultants created in-house videos which were used to raise awareness of clinical teachers in the hospital about these educational issues. Preliminary evaluation showed positive responses by both senior house officers and consultants to both the study and its outcomes.
Paraplegia due to thoracic disc herniation
Authors: Pal B , Johnson A
Published: December 2008

Disc herniation at the thoracic the spine level is more common than generally thought. Localisation of pain may be vague and may erroneously point to cardiopulmonary, gastrointestinal, genito-urinary or even psychiatric disease. Magnetic resonance imaging is the investigation of choice, especially if spinal cord compression is suspected.
Pancreatic adenocarcinoma: why and when should it be resected?
Authors: Ravichandran D , Johnson C D
Published: December 2008

Adenocarcinoma of the pancreas is a common and dreadful disease with an extremely poor prognosis. In practice, only a few patients are cured but surgical resection, although feasible in less than 20% of patients, offers maximum prolongation of life and provides good palliation of symptoms. This can now be performed safely, even in elderly patients, in specialist units. Better radiological imaging and laparoscopy allow selection of resectable tumours effectively. All patient with pancreatic cancer should now be assessed for surgical resection and potentially suitable patients should be referred to a specialist team at an early stage.
Sudden death in Whipple's disease
Authors: McGettigan P , Mooney E E , Sinnott M , Sweeney E C , Feely J
Published: December 2008

Despite antibiotic therapy, some patients with uncomplicated Whipple's disease die suddenly and inexplicably. We describe one such patient who died following unexplained cardiorespiratory arrest and was found to have chronic active myocarditis related to the causative organism. We postulate myocarditis as a cause of sudden death.
Creutzfeldt-Jakob disease in the elderly
Authors: de Silva R , Findlay C , Awad I , Harries-Jones R , Knight R , Will R
Published: December 2008

Creutzfeldt-Jakob disease (CJD) is typically described as a pre-senile dementia. However, cases do occur in the elderly and a case of sporadic CJD in an 86-year-old patient is described. The database of the UK national surveillance unit has been studied, and the age-specific incidences for various age groups over the period 1980–93 calculated. Cases of CJD in those over 80 years old have been identified and their clinical characteristics examined. There is no evidence that CJD presents atypically in the elderly, or that large numbers of cases are being missed in the elderly due to poor ascertainment.
Missed curable carcinoma of the pancreas presenting as chronic pancreatitis
Authors: Wharton S M , Rahman Z , Johnson C D
Published: December 2008

We present a case of pancreatic malignancy which presented as chronic pancreatitis. The diagnostic difficulties are discussed. We recommend that when there is any doubt about a diagnosis of chronic pancreatitis with a pancreatic mass, then early resection is appropriate.
Information technology in medical education: current and future applications
Authors: Mooney G A , Bligh J G
Published: December 2008

Information technology has the potential to revolutionise the way medicine is learned by students and healthcare professionals. This potential was recognised by the General Medical Council in their 1993 report Tomorrow's doctors in which the need for future generations of doctors to be familiar with the application and scope of information technology is described. This paper focuses on the use of computers as aids to learning medicine and discusses two key applications of information technology to medical education: multimedia and the internet. The current use and potential for these areas of information technology are described and future developments discussed.
Male pseudohermaphroditism due to 5 alpha-reductase-2 deficiency in an Arab kindred
Authors: al-Attia H M
Published: December 2008

Six Arabs subjects (three postpubertal, two prepubertal and one pubertal) from three interrelated Omani families with male pseudohermaphroditism due to 5 alpha-reductase-2 deficiency were evaluated. These subjects had been raised as girls since birth as they were born with a clitoral-like phallus and ambiguous external genitalia of pseudovaginal perineoscrotal hypospadias with separate urethral and vaginal orifices. They underwent variable degrees of increased muscular habitus and phallic enlargement during puberty and beyond. Gynaecomastia was absent and the body and facial hair was insignificant. After diagnosis, a transition to male social sex occurred in two cases, one of which was interventional. Two retained the female social sex, one of which was also interventional, while the other two maintained an equivocal gender status. This report provides new data on the characterisation of 5 alpha-reductase-2 deficiency in various clusters.
Ectopic Cushing's syndrome and pulmonary carcinoid tumour identified by [111In-DTPA-D-Phe1]octreotide
Authors: Matte J , Roufosse F , Rocmans P , Schoutens A , Jacobovitz D , Mockel J
Published: December 2008

The differential diagnosis and management of Cushing's syndrome remain difficult, particularly for ectopic adrenocorticotropin (ACTH) syndromes resulting from small bronchial carcinoids. We report the case of a 41-year-old man with ectopic ACTH-dependent Cushing's syndrome. Two computed tomography scans of the thorax were normal and magnetic resonance imaging of the chest showed a 6-mm hyperintense T1-weighted area close to the left pulmonary hilus, interpreted as probably vascular by the radiologists. An [111In-DTPA-D-Phe1]octreotide scintigraphy scan demonstrated a positive image for somatostatin receptors in exactly the same location and surgery confirmed the presence of a small ACTH-secreting carcinoid tumour in the upper left lung lobe which was resected. Surgery cured the hypercorticism of the patient. The differential diagnosis of Cushing's syndrome and the procedure for localisation of an ACTH source are discussed.
First-aid treatment of epistaxis–confirmation of widespread ignorance
Authors: Strachan D , England J
Published: December 2008

A survey of 500 members of the public was carried out in which they were asked how they would deal with a nose bleed. Only 50 out of 443 responses were judged as being correct, confirming a clinical impression, long held by those dealing with epistaxis, that there is a high level of ignorance as to the correct first aid treatment. The survey also suggested that the lack of knowledge was not confined to the general public but evident in those trained in healthcare.
The neuroleptic malignant syndrome: a logical approach to the patient with temperature and rigidity
Authors: Balzan M V
Published: December 2008

The neuroleptic malignant syndrome is a rare, potentially fatal, adverse reaction to neuroleptic drugs characterised by severe rigidity, high temperature and autonomic dysfunction. In the light of the hypothesized pathophysiology of this condition, a rational approach to the management of patients presenting with temperature and rigidity is provided. The aims of this approach are three-fold: to reduce the incidence of the condition, to be able to recognise it early so as to treat before life-threatening complications arise, and to be able to recognise early those conditions which mimic neuroleptic malignant syndrome, so as not to delay their specific treatment.
Giant cell arteritis presenting as renal vasculitis
Authors: Govil Y K , Sabanathan K , Scott D
Published: December 2008

Giant cell arteritis commonly presents with headache, polymyalgia, and visual signs and symptoms. Other neurological, respiratory or vascular symptoms occur in 10–30% of patients. It is extremely rare for giant cell arteritis to present initially with haematuria. Here we describe a case which presented with fever and haematuria, which emphasise the need to be vigilant about the diagnosis of giant cell arteritis as an underlying cause.
The role of surgery in pseudomembranous enterocolitis
Authors: Viswanath Y K S , Griffiths C D M
Published: December 2008

Pseudomembranous enterocolitis is an inflammatory bowel disorder caused by Clostridium difficile toxins. Classical presentation includes abdominal pain, pyrexia, diarrhoea and leucocytes. The management is mainly conservative but in extreme cases surgery is necessary. Resectional procedures (colectomy) carry a better prognosis than diversion procedures (colostomy). A careful history, a high index of suspicion, and early diagnosis and treatment would reduce the associated morbidity and mortality of this condition. The aetiopathogenesis, pathology, clinical presentation, diagnosis, differential diagnosis, complications, medical and surgical management are reviewed, and three case reports briefly discussed. A management algorithm is also suggested.
An adolescent girl with abnormal liver profile
Authors: Nair S , Pitchumoni C S
Published: December 2008

A 17-year-old previously healthy high school student who lived in a dormitory was referred to our office by her private physician for evaluation of abnormal liver function tests. She was sexually active with one partner but denied any current or past substance abuse. The patient was not taking any medications or nutritional supplements. Family history was unremarkable. Physical examination revealed scleral icterus and minimal hepatomegaly. Spleen was not palpable. The liver function tests are shown in table 1. Total leucocyte count was 6.3 × 109/l with 53% lymphocytes. The platelet count was normal. Anti-Hbc IgM antibody was negative, so were anti-HAV IgM and anti-HCV antibodies. HBsAg was negative and anti-HBs antibody was positive. Erythrocyte sedimentation rate was 16 mm in the first hour. An abdominal sonogram was done to evaluate a persistent elevation in alkaline phosphatase and it showed only hepatomegaly.
Nasal ventilation
Authors: Simonds A K
Published: December 2008

Nasal intermittent positive pressure ventilation is likely to have an increasing role in the management of acute ventilatory failure, weaning, and chronic ventilatory problems. Further improvements in ventilator and mask design will be seen. Appropriate application is likely to reduce both mortality and admissions to intensive care, while domiciliary use can improve life expectancy and/or quality of life in chronic ventilatory disorders. As with any new technique, enthusiasm should not outweigh clear outcome information, and possible new indications should always be subject to careful assessment.
Three visual techniques to enhance interprofessional learning
Authors: Parsell G , Gibbs T , Bligh J
Published: December 2008

Many changes in the delivery of healthcare in the UK have highlighted the need for healthcare professionals to learn to work together as teams for the benefit of patients. Whatever the profession or level, whether for postgraduate education and training, continuing professional development, or for undergraduates, learners should have an opportunity to learn about and with, other healthcare practitioners in a stimulating and exciting way. Learning to understand how people think, feel, and react, and the parts they play at work, both as professionals and individuals, can only be achieved through sensitive discussion and exchange of views. Teaching and learning methods must provide opportunities for this to happen. This paper describes three small-group teaching techniques which encourage a high level of learner collaboration and team-working. Learning content is focused on real-life health-care issues and strong visual images are used to stimulate lively discussion and debate. Each description includes the learning objectives of each exercise, basic equipment and resources, and learning outcomes.
Pyrexia, anaemia and acute renal failure secondary to omeprazole
Authors: Landray M J , Ringrose T , Ferner R E , Arnold I R
Published: December 2008

We present the case of a 77-year-old woman who initially presented with pyrexia of unknown origin, anaemia and mild renal impairment. When her omeprazole was stopped she improved rapidly. When omeprazole was re-started she developed fever and acute renal failure, which again settled quickly on discontinuation of omeprazole. This case demonstrates how drugs can cause severe multisystem disorders that may appear to be infective or inflammatory.
Elevated glycated haemoglobin in non-diabetic patients is associated with an increased mortality in myocardial infarction
Authors: Chowdhury T A , Lasker S S
Published: December 2008

Diabetes is associated with increased mortality following acute myocardial infarction compared to the general population. Elevated glycated haemoglobin (HbA1c) in diabetic patients is also associated with increased mortality following acute myocardial infarction, while mild elevation in HbA1c are associated with impaired glucose tolerance. The aim of this study was to determine the influence of HbA1c on outcome of acute myocardial infarction in 253 non-diabetic patients, 46 of whom died in one year. In univariate analysis, risk factors for death included smoking, glucose, cholesterol and HbA1c. In logistic regression analysis HbA1c was an independent risk factor for death. Over one-third of the fatality group had an HbA1c in the highest quartile, compared to one-fifth of the surviving group (p = 0.02). Elevated HbA1c is a risk marker for short-term mortality following acute myocardial infarction in non-diabetic subjects.
Cytomegalovirus infection associated with ulcerative colitis in immunocompetent individuals
Authors: Rachima C , Maoz E , Apter S , Thaler M , Grossman E , Rosenthal T
Published: December 2008

Gastrointestinal infection with cytomegalovirus (CMV) is usually found in immunocompromised patients and rarely affects immunocompetent subjects. We describe two immunocompetent patients who had primary CMV infection, and in both the disease was associated with ulcerative colitis. Both patients recovered from the CMV infection spontaneously.
Pneumonitis secondary to the influenza vaccine
Authors: Johnston S D , Kempston A , Robinson T J
Published: December 2008

We report a 58-year-old man who developed respiratory distress and interstitial shadowing on chest X-ray 10 days after receiving the influenza vaccine. He failed to respond to intravenous antibiotics but his clinical condition, hypoxia and chest X-ray changes improved dramatically on oral steroids. The clinical diagnosis was pneumonitis secondary to recent influenza vaccination.
Increased serum CA 19-9 antibodies in Sjögren's syndrome
Authors: Safadi R , Ligumsky M , Goldin E , Ilan Y , Haviv Y S , Nusair S
Published: December 2008

A 67-year-old woman with a history of thyroiditis presented with recent intermittent epigastric pain and nausea. Hyperamylasaemia, oedema of the pancreas, and high serum levels of lipase and CA 19-9 were found. Xerostomia and dry eyes developed later, accompanied by an abnormal Schirmer's test. The diagnosis of Sjögren's syndrome was confirmed by increased anti-Ro and anti-La antibodies and the histological findings of parotid gland biopsy. Two additional cases of Sjögren's syndrome with elevated serum CA 19-9 are also described. These observations of elevated serum lipase and serum CA 19-9 in Sjögren's syndrome without evidence of malignancy may reflect pancreatic involvement in this disorder.
Acute barium intoxication following ingestion of ceramic glaze
Authors: Thomas M , Bowie D , Walker R
Published: December 2008

A case of deliberate overdose of barium sulphide in a psychiatric setting is presented, with resulting flaccid paralysis, malignant arrhythmia, respiratory arrest and severe hypokalaemia, but ultimately with complete recovery. The degree of paralysis appears to be related directly to serum barium levels. The value of early haemodialysis, particularly with respiratory paralysis and hypokalaemia, is emphasised.
De Quervain's subacute thyroiditis presenting as a painless solitary thyroid nodule
Authors: Bianda T , Schmid C
Published: December 2008

We describe a 39-year-old woman presenting with a painless solitary thyroid nodule, initially without signs suggesting thyroiditis. The serum level of thyrotropin was suppressed whereas those of thyroxine and triiodothyronine were normal. Fine needle aspiration cytology showed no signs of inflammation or malignancy. One week later, the patient felt pain and tenderness on her neck, and erythrocyte sedimentation rate and C-reactive protein were markedly elevated. Thyroid scintigraphy showed a suppressed thyroid pertechnetate uptake. At that time, the diagnosis of subacute thyroiditis was made. Upon treatment with steroids the patient's symptoms as well as the thyroid nodule resolved. This case illustrates that subacute thyroiditis de Quervain may present as a solitary, painless nodule with suppressed thyrotropin and should therefore be considered in the differential diagnosis of such lesions.
Sudden death associated with group A streptococcal infection in an 8-year-old girl with undiagnosed hypertrophic cardiomyopathy
Authors: Bragonier R , Oades P
Published: December 2008

An 8-year-old girl died suddenly without prior symptoms. Post-mortem examination identified both systemic group A streptococcal infection and hypertrophic cardiomyopathy. She had no history of cardiac symptoms and was not in a high-risk group for sudden death due to hypertrophic cardiomyopathy. We believe the disseminated but asymptomatic group A streptococcal infection precipitated her early death from hypertrophic cardiomyopathy. Sudden unexpected death during systemic infection should be followed by post-mortem examination to look for evidence of hypertrophic cardiomyopathy, as this diagnosis has genetic implications for other family members.
Oesophageal subepithelial fibrosis: an extension of oral submucosal fibrosis
Authors: Misra S P , Misra V , Dwivedi M , Gupta S C
Published: December 2008

Fifty-five patients with oral submucosal fibrosis and an equal number of patients with no evidence of the disease were studied. All patients underwent upper gastrointestinal endoscopy and any abnormality was noted. Multiple oesophageal biopsies were obtained from the upper end of the oesophagus and from any endoscopically observed abnormality. The histological changes in the two groups were assessed blindly by an experienced histopathologist. Histological abnormalities were noted in the oesophageal mucosa in 2% of controls and 66% of patients with oral submucosal fibrosis (p < 0.0001). In the control group, acanthosis was seen in one patient, while in the patient group atrophy of the squamous epithelium was evident in 52%, hyperkeratosis in 52%, parakeratosis in 30%, dyskeratosis in 14%, acanthosis in 14%, and papillomatosis and mild dysplasia in 2% patients. Subepithelial collagenization was seen in 32 (64%) patients. The oesophageal abnormalities were seen more frequently in patients who had consumed Pan masala, Gutka, betel nut, tobacco or a combination of some or all of these, with or without betel leaf, for > or = 5 years compared to those consuming them for a shorter period of time (91% vs 46%, p < 0.001). It is concluded that oral submucosal fibrosis is not a disease confined to the oral cavity; the oesophagus may also be involved in about two-thirds of patients.
Medical education in the USA—adult-friendly?
Authors: Whitehouse A
Published: December 2008

In the United States of America, the Area Health Education Center (AHEC) system of training residents has allowed high-quality postgraduate education to flourish. This paper describes the evolution of the AHECs in the context of medical education over the past 50 years. The arrangements for programme administration and design, resident assessment and appraisal, training of trainers in educational methods, and the accreditation of training programmes are discussed. The fast-evolving UK postgraduate education scene can learn some useful lessons from the US system.
Total gastrointestinal endoscopy in the management of Peutz-Jeghers syndrome
Authors: De Luca N , Chia Y , Gorard D A
Published: December 2008

Peutz-Jeghers syndrome was diagnosed in a 51-year-old woman presenting with iron deficiency anaemia. Upper gastrointestinal endoscopy and colonoscopy revealed several hamartomatous polyps in the stomach, duodenum and colon, which were removed. At a combined surgical-endoscopic procedure, 42 hamartomatous polyps were removed from the small intestine by snare polypectomy. This enteroscopic procedure reduces symptoms, may protect against future intestinal obstructive episodes and their associated surgery, and may reduce the risk of developing gastrointestinal malignancy.
FREE REPRESENTABLE IDEMPOTENT COMMUTATIVE RESIDUATED LATTICES
Authors: OLSON JEFFREY S.
Published: December 2008

The structure of simple and directly indecomposable members of the variety RICRL of representable idempotent commutative residuated lattices is described. These descriptions are employed to determine the size and structure of free algebras in RICRL, using existing theory on the Fraser–Horn and Apple properties. A formula for the free spectrum of RICRL is given.
EQUATIONAL COMPLEXITY OF THE FINITE ALGEBRA MEMBERSHIP PROBLEM
Authors: McNULTY GEORGE F. , SZÉKELY ZOLTÁN , WILLARD ROSS
Published: December 2008

We associate to each variety of algebras of finite signature a function on the positive integers called the equational complexity of the variety. This function is a measure of how much of the equational theory of a variety must be tested to determine whether a finite algebra belongs to the variety. We provide general methods for giving upper and lower bounds on the growth of equational complexity functions and provide examples using algebras created from graphs and from finite automata. We also show that finite algebras which are inherently nonfinitely based via the shift automorphism method cannot be used to settle an old problem of Eilenberg and Schützenberger.
AN INTERPOLATION THEORY APPROACH TO SHELL EIGENVALUE PROBLEMS
Authors: BEIRÃO DA VEIGA L. , LOVADINA C.
Published: December 2008

The asymptotic behavior of the smallest eigenvalue in linear shell problems is studied, as the thickness parameter tends to zero. In order to cover the widest range of mid-surface geometry and boundary conditions, an abstract approach has been followed, and the Real Interpolation Theory has been used as main tool. A result concerning the ratio between the bending and the total elastic energy is proved. Furthermore, an example of application to cylindrical shells is detailed.
WAVE EQUATION WITH SECOND-ORDER NON-STANDARD DYNAMICAL BOUNDARY CONDITIONS
Authors: VAZQUEZ JUAN LUIS , VITILLARO ENZO
Published: December 2008

The paper deals with the well-posedness of the problem [Formula: see text] where u = u(t, x), t ∈ ℝ, x ∈ Ω, Δ = Δx denotes the Laplacian operator with respect to the space variable, Ω is a bounded regular (C∞) open domain of ℝN (N ≥ 1), Γ = ∂Ω, ν is the outward normal to Ω, k is a constant. We prove that it is ill-posed if N ≥ 2, while it is well-posed when N = 1. In the one-dimensional case, we give a complete existence, uniqueness and regularity theory. We also give some existence result for regular initial data when N ≥ 2 and Ω is a ball.
A COLLABORATIVE LEARNING MATRIX FOR COMBINING SCIENCE WITH STAKEHOLDER INVOLVEMENT TO PRIORITIZE WATERSHED IMPLEMENTATION IN ARKANSAS' NONPOINT SOURCE STATE MANAGEMENT PLAN
Authors: MORGAN ROBERT , MATLOCK MARTY
Published: December 2008

In 2004, the Ecological Engineering Group at the University of Arkansas received a grant to update Arkansas' nonpoint source pollution (NPS) management program. A stakeholder involvement process was developed that used collaborative learning (CL) and comparative risk assessment (CRA) to prioritise watersheds for NPS implementation. The relative ecological risk posed by nonpoint pollution to each watershed was assessed and values assigned using available water quality, GIS, and demographic data. This risk assessment was the foundation to a CL exercise. Through the CL process, the knowledge and experience of scientists, administrators and laypersons were used. Watersheds prioritised through the CRA became eligible for section 319(h) funding from EPA. This study evaluated the substantive legitimacy of the stakeholder process. Overall, stakeholders were found to be satisfied. The repeatability of the process made it a valuable improvement to Arkansas' NPS program.
PARTICULATE MATTER AIR POLLUTION REDUCTION SCENARIOS IN OSAKA, HOUSTON, BANGKOK AND SEOUL: A PROSPECTIVE HEALTH BENEFITS ANALYSIS
Authors: VOORHEES A. SCOTT , KIM OANH NGUYEN THI , PONGKIATKUL PRAPAT , KIM YOON SHIN , JINSART WANIDA , UCHIYAMA IWAO , LIMPASENI WONGPUN
Published: December 2008

The objectives of this study were to assess potential health and productivity benefits for the year 2010 with five scenarios for reducing particulate matter (PM10 and PM2.5) air pollution in the cities of Osaka, Houston, Bangkok and Seoul. Assuming a uniform 10% decline in ambient PM levels, the preventible cases of: (1) premature mortality ranged from 35 in Houston to 379 in Seoul, (2) chronic bronchitis ranged from 95 in Houston to 1,631 in Seoul, (3) cardiovascular disease ranged from 68 in Houston to 818 in Seoul, (4) pneumonia ranged from 28 in Houston to 336 in Seoul, (5) asthma attacks ranged from 388 in Osaka to 96,876 in Seoul, and (6) acute bronchitis ranged from 186 in Houston to 2,973 in Seoul. The per million population central estimate of the purchasing power parity adjusted value of health and productivity benefits ranged from $25 million in Bangkok to $160 million in Osaka. There was a wide variability in measured PM10 levels across cities. Percentages of active monitors reporting concentrations above 50 μg/m3 (annual average) or 150 μg/m3 (24-hour average) in 2001–2002 were 0% in Houston, 5% in Osaka, 33% in Bangkok and 92% in Seoul. Assuming a non-uniform reduction in PM only at concentration hotspots with levels above air quality standards, the number of preventible cases of mortality ranged from 0 in Houston to 1,104 in Seoul. The central estimate of total benefits ranged from $0 in Houston to $240 million in Seoul.
TRAINING AN INTERDISCIPLINARY TEAM FOR VILLAGE WATER RESOURCES DEVELOPMENT IN ARMENIA
Authors: SORENSEN D. L. , GODDARD J. V. , MURADYAN S. G. , HILL R. W.
Published: December 2008

Environmental management is most successful when it is integral to the overall management of an institution. A technical and management team conducting community water resources development projects in which environmental management is based on institutional policy and environmental assessments is likely to effectively protect the environment, complete construction, and initiate operation of the new systems. Water resource development is inherently multidisciplinary but interdisciplinary sharing of information may not occur unless management establishes policies and procedures to facilitate it. Organisational learning should be facilitated to clarify the objectives of the project, including environmental protection, and to describe the informational needs of team members and resources available across the team disciplines. A village water supply program in Armenia demonstrated these principles. Environmental assessments conducted in collaboration with an effort to enhance the longevity of water supply wells led to interdisciplinary team-building and training for project managers and contractors. Improved cost-effectiveness and less environmental damage are anticipated.
Labels, Categories, Behaviors: Ed, Ld, and Emr Reconsidered
Authors: Hallahan Daniel P. , Kauffman James M.
Published: December 2008

Children traditionally labeled learning disabled, mildly emotionally disturbed, and mildly mentally retarded are considered within a behavioral rather than a categorical framework. A historical analysis reveals that the three areas have evolved from highly similar foundations. In addition, no behavioral characteristics can be found that are associated exclusively with any one of the three areas. Children who are usually identified as learning disabled, mildly disturbed, or mildly retarded reveal more similarities than differences. Consequently, successful teaching techniques do not differ among the three areas. A noncategorical orientation is recommended in which children are grouped for instruction according to their specific learning deficits rather than their assignment to traditional categories.
Stimulant Drugs and Learning Problems
Authors: Adelman Howard S. , Compas Bruce E.
Published: December 2008

This review of stimulant drug research highlights the perennial problem of experimental procedures being prematurely applied despite a lack of proven treatment efficacy. This intriguing area of research is summarized as it relates to learning problems. Critical analysis indicates (a) no satisfactory support for the efficacy of stimulants in improving academic learning and performance or behavior problems, and (b) no data regarding the possibility of long-term negative side effects. Thus, widespread use of drugs for learning problems is seen as premature and, until possible side effects are clarified, perhaps dangerous. Amphetamines administered to persons with learning problems are seen as producing the common effects usually attributed to such stimulants. These include mild to moderate improvement in nonacademic performance, concomitant reductions in activity, and shortening of response latency on tasks characterized as repetitious, mechanical, regulated by an external agent, and requiring concentration and sustained performance. Evidence has not clarified the generalizability or state dependency of such effects. Complex behavior, such as reasoning, problem solving, and socioemotional functioning, do not seem affected.
Deaf Students' Learning From Captioned Instruction: the Relationship Between the Visual and Caption Display
Authors: Nugent Gwen C.
Published: December 2008

This study examined the relationship between and instructional effectiveness of visuals and captions in videotape/film instruction for hearing-impaired students. Captioned instruction was prepared so that the visuals and captions presented redundant information; students could obtain facts from either the captions or the pictures. Three instructional treatments were prepared and tested with both deaf and hearing elementary/junior high students: (a) visuals + captions, (b) visuals alone, and (c) captions alone. Results showed that scores of students viewing visuals + captions were significantly higher than those of students seeing either visuals or captions alone. Findings underscore the importance of visuals in deaf education and confirm the effectiveness of instruction that combines pictorial and written presentation modes. Students are able to use both visuals and print in captioned instruction, and they evidently employ a strategy that allows them to alternate between the two and utilize each to its best advantage. Results also support the similarity of visual and verbal decoding capabilities of deaf and hearing students. Although an initial subject-matter knowledge deficit led to depressed scores for deaf students in comparison with those of the hearing, the same pattern of results emerged for both groups. A particular instructional format did not specifically benefit either deaf or hearing students, and neither group displayed unique capabilities in learning from the various presentations.