bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuing education for medical professionals: a reflective model
Authors: Brigley S , Young Y , Littlejohns P , McEwen J
Published: December 2008

The Royal Colleges and their Faculties have moved continuing professional development up the agenda of doctors in the UK. The low educational value and failure to change professional practice of much continuing medical education has led to criticism of its emphasis on formal, didactic teaching and academic knowledge. The ubiquitous scientific or technical bias in medical education makes questionable assumptions about the nature of professional knowledge, how professionals learn, and the linkage of theory and practice in professional work. Given its narrow conception of professional knowledge, it is hardly surprising that the effectiveness of continuing medical education has proven difficult to evaluate.

These points of criticism suggest that a more systematic and coherent approach to continuing education is required. The adoption of the concept of continuing professional development, which draws on learning by reflective practice, marks an important step in this direction. Continuing professional development emphasises self-directed learning, professional self-awareness, learning developed in context, multidisciplinary and multilevel collaboration, the learning needs of individuals and their organisations, and an inquiry-based concept of professionalism. It also involves a widening of accountability to patients, the community, managers and policymakers, and a form of evaluation which is internal, participatory and collaborative rather than external and scientific in character.
Selenium-induced thyroid dysfunction
Authors: Hofbauer L C , Spitzweg C , Magerstädt R A , Heufelder A E
Published: December 2008

Administration of the anti-oxidative trace element selenium is currently being evaluated for its benefits in patients with inflammatory diseases. However, little is known about the risks of selenium. We report on a patient in whom, along with standard therapy, administration of large intravenous doses of selenite for sepsis secondary to pneumonia resulted in development of marked hypothyroidism. In addition, severe iodine deficiency was noted, and supplementation with iodine led to normalisation of thyroid function.
Neutrophilic dermatoses: pyoderma gangrenosum and Sweet's syndrome
Authors: Lear J T , Atherton M T , Byrne J P H
Published: December 2008

Pyoderma gangrenosum and Sweet's syndrome are classified as neutrophilic dermatoses as they exhibit intense dermal inflammatory infiltrates composed of neutrophils with little evidence of a primary vasculitis. They share several characteristics and respond to immunosuppressives. Aetiology is felt to represent a manifestation of altered immunologic reactivity. Patients with both conditions concurrently have been described. Diagnosis is based on clinical and histopathological findings. However, clinically the typical forms of the two conditions are quite distinct: pyoderma showing cutaneous ulceration with a purple undermined border and Sweet's syndrome having tender, erythematous, nonulcerated plaques and nodules. Approximately 50% of cases of pyoderma are associated with a specific systemic disorder. These include inflammatory bowel disease, rheumatoid arthritis, non-Hodgkin's lymphoma and myeloproliferative disorders. Many associations with Sweet's syndrome have been described, including acute myeloid leukaemia, myeloma and adenocarcinomas, and haematological malignancy. There is overlap between the two conditions with lesions categorised as Sweet's syndrome being clinically more characteristic of atypical pyoderma and vice versa. We believe that pyoderma and Sweet's syndrome represent a continuum of spectrum of disease. The reason for the clinical differences between the conditions is unclear and merits further investigation but may be explained by varying levels of intensity and extent of the inflammatory process. This review will describe the pathogenesis, clinical features, diagnosis, associations and treatment of the two conditions.
Tropical liver abscess
Authors: Yeoh K G , Yap I , Wong S T , Wee A , Guan R , Kang J Y
Published: December 2008

Forty-one consecutive cases of liver abscesses seen at the National University Hospital, Singapore from 1988 to 1994 were reviewed. Twenty-seven cases (65%) were pyogenic, six (15%) amoebic, two (5%) tuberculous and six (15%) indeterminate. The predominance of pyogenic abscesses is in marked contrast to previous studies from the region a decade ago in which amoebic abscesses were the commonest type. The commonest pathogen causing pyogenic abscess was Klebsiella pneumoniae. Two cases were due to Mycobacterium tuberculosis, and this organism needs to be actively looked for in smears and cultures of aspirated material. As the majority of organisms isolated were resistant to ampicillin, empirical antibiotic treatment for suspected pyogenic abscess should include gentamicin or a cephalosporin. Percutaneous needle aspiration of the abscess was performed for 85% of pyogenic abscesses and surgery was necessary in only two cases because of complications. We found that percutaneous aspiration of liver abscess is helpful to confirm the diagnosis, provides a better bacteriological culture yield, gives a good outcome, and may uncover clinically unsuspected conditions like malignancy and tuberculoma which may mimic the presentation of liver abscesses. We recommend routine cytological examination of aspirated abscess material as well as stains and cultures for acid-fast bacilli.
Signs and symptoms in patients with salivary gland hypofunction
Authors: Longman L P , Higham S M , Bucknall R , Kaye S B , Edgar W M , Field E A
Published: December 2008

Salivary gland hypofunction can have a devastating effect on oral health and may be an indicator of systemic disease such as Sjögren's syndrome. This prospective study investigates the oral and non-oral signs and symptoms in 120 patients with objective evidence of salivary gland hypofunction (ie, an unstimulated whole salivary flow of < 0.2 ml/min). Patients were questioned about symptoms associated with decreased oral function; non-oral symptoms were also noted. The underlying cause of salivary gland hypofunction was established on the basis of clinical and laboratory findings and further investigations.

Eighty-five per cent of patients reported symptoms of decreased oral function in addition to oral dryness. Non-oral signs and symptoms were reported by 106 patients. Fifty-three per cent of patients were diagnosed as having Sjögren's syndrome. The prevalence of the following non-oral signs and symptoms were significantly higher in patients with Sjögren's syndrome, than in those without; a history of dry/irritated eyes, salivary gland swelling, dry skin and reduced lacrimal flow. Salivary gland hypofunction is associated with a wide range of oral and non-oral signs and symptoms. Several of these are of potential value as triggers for the clinician to identify patients with Sjögren's syndrome, and should serve to prompt referral for specialist investigation.
Haematuria
Authors: Rockall A G , Newman-Sanders A P , al-Kutoubi M A , Vale J A
Published: December 2008

Many serious and potentially treatable diseases of the urinary tract may have haematuria as their only manifestation. However, asymptomatic microscopic haematuria detected by dipstick testing may be seen in up to 16% of screening populations. The great majority of such cases will have no sinister underlying cause, particularly in those under 40 years of age, and so the schedule of further investigations, some of which may be invasive, time-consuming and expensive, needs to be rationalised. In addition, the increasing popularity of ‘fast track’ clinics for the investigation of haematuria enhances the need for a clear strategy of investigation. Analysis of the epidemiology of asymptomatic haematuria and its causes combined with a consideration of the risk-benefit profile of the available investigations, makes it possible to set out an algorithm for the initial management of this common finding. Careful clinical assessment and basic laboratory tests for renal function, analysis of the urinary sediment and cytological examination of the urine are followed by ultrasound and plain radiography of the urinary tract. Flexible cystoscopy under local anaesthetic is central to the algorithm in patients of all ages. The importance of a nephrological opinion and consideration of renal biopsy, especially in younger patients with other evidence of glomerular disease, is stressed. The role of intravenous urography in excluding pathology of the upper urinary tract, especially in patients over the age of 40, is also considered.
Cardiac tamponade
Authors: Ball J B , Morrison W L
Published: December 2008

Cardiac tamponade is a cardiological emergency requiring prompt treatment in order to avoid a fatal outcome. It can complicate a number of medical conditions and it is important, therefore, that all practitioners are aware of its presentation, diagnosis and management. These are outlined. We suggest that, with certain specific and important exceptions, percutaneous catheter pericardiocentesis is to be recommended in the management of cardiac tamponade. We include a review of 51 consecutive cases treated at our own institution. Catheter pericardiocentesis was successful in 49 (96%) cases and 36 (80%) patients did not require any further intervention. There were no major and only two minor complications which required no additional treatment. We review previous literature concerning percutaneous pericardiocentesis. Using recommended procedures, pericardiocentesis is successful in 90–100% of cases and major complications are rare.
Malakoplakia and colorectal adenocarcinoma
Authors: Bates A W , Dev S , Baithun S I
Published: December 2008

We report a case of malakoplakia in association with colonic adenocarcinoma. Tumour-associated malakoplakia in the gastrointestinal tract is a rare finding, generally confined to the colon. It may be locally aggressive, with invasion of pericolic tissues, but is always located adjacent to the tumour. This contrasts with the often more diffuse, multifocal distribution of colonic malakoplakia in association with other pathologies.
Parkinson's disease
Authors: Playfer J R
Published: December 2008

Parkinson's disease is a common disabling disease of old age. The diagnosis of idiopathic Parkinson's disease is based on clinical signs and has poor sensitivity, with about 25% of patients confidently diagnosed as having the disease actually having other conditions such as multi-system atrophy and other parkinsonism-plus syndromes. Benign essential tremor and arteriosclerotic pseudo-parkinsonism can easily be confused with Parkinson's disease. The cause of Parkinson's disease remains unknown. Speculative research highlights the role of oxidative stress and free radical mediated damage to dopaminergic cells. Parkinson's disease is the one neurodegenerative disorder in which drugs have been demonstrated to be of value. There is now a wide variety of drugs and formulations available, including anticholinergics, amantidine, L-dopa, dopamine agonists including apomorphine, selegiline and soon to be available catechol-O-methyltransferase inhibitors. Disabling side-effects of treatment, fluctuations, dyskinesias and psychiatric problems require strategic use of the drugs available. There is an increasing potential for neurosurgical intervention.
Learning contracts in higher professional training: a user's guide
Authors: Brambleby P , Coates R
Published: December 2008

If the doctor undergoing higher professional training is to make best use of the attachment to a training location, and that training location is to make the most efficient use of the contribution of the trainee, then a written framework such as a learning contract can meet the needs of both. The first stage is to list the learning needs of the individual trainee and to match them with the work experience offered by the training location. Next, the work programme for the coming six to 12 months should be formalised in a learning contract, spelling out the tasks to be performed and the expected training benefit. This is then reviewed at agreed intervals and a written appraisal made. At the end of the attachment the trainee, trainer and any outside accrediting or auditing body, has a written account of what was expected, what was achieved, and the performance of trainee and trainer.
Octreotide scanning for carcinoid tumours
Authors: Critchley M
Published: December 2008

The somatostatin analogue octreotide may be used in the diagnosis of carcinoid and other neuroendocrine tumours. Radionuclide scanning following intravenous injection of 111Indium-labelled octreotide (111In-DTPA-pentetreotide) provides a sensitive, non-invasive method of localising somatostatin-positive tumours. The technique may also be used to identify patients who may respond to ‘cold’ octreotide therapy and to monitor therapeutic efficacy.
The role of ultrasound in the diagnosis of a large, rapidly growing, thyroid mass
Authors: King A D , Ahuja A T , King W , Metreweli C
Published: December 2008

The value of ultrasound in the diagnosis of a large rapidly growing thyroid mass was assessed in a study of 42 patients with a large (> 3 cm) rapidly growing (< two months) solitary mass. Haemorrhage into a thyroid nodule was present in 31 patients and thyroid malignancy in 11. Ultrasound of haemorrhage into a thyroid nodule revealed a large cystic mass in all 31 patients containing internal debris (22), septations (three), or a combination of both (six). The malignant causes of a large rapidly growing mass were lymphoma (two), anaplastic carcinoma (four) and metastasis (five). Ultrasound of these thyroid malignancies revealed a mass with a smooth, well-defined margin and strikingly low homogeneous echogenicity in all cases. Patients with thyroid metastases had evidence of widespread metastatic disease elsewhere. Lymphoma was differentiated from anaplastic carcinoma on fine-needle aspiration cytology or surgical biopsy. Ultrasound was of value in differentiating between a benign haemorrhagic nodule and a malignant tumour. The various malignant tumours had similar appearances, however, and could not be distinguished on ultrasound.
Cranial and peripheral neuropathy due to Epstein-Barr virus infection
Authors: Gavin C , Langan Y , Hutchinson M
Published: December 2008

A case of Epstein-Barr virus infection with neurological complications is described. An 18-year-old man developed cranial neuropathy and peripheral sensorimotor polyneuropathy three weeks after a sore throat. Though severely affected initially, he made a good recovery and no specific therapeutic intervention appears to have influenced his clinical course.
Male breast tuberculosis
Authors: Jaideep C , Kumar M , Khanna A K
Published: December 2008

Tuberculosis of the breast is rare and tuberculosis of the male breast is not a recognised entity. We describe a man with tuberculosis of the breast which was clinically thought to be a malignancy.
Yellow nail syndrome
Authors: Hershko A , Hirshberg B , Nahir M , Friedman G
Published: December 2008

The yellow nail syndrome was defined as a clinical entity in the 1960s. Although nail abnormalities were the first sign to be noticed, this syndrome is now known to involve multiple organ systems and its association with other diseases is well described. A review of the medical literature is provided.
Dehydration in the terminally ill—iatrogenic insult or natural process?
Authors: Chadfield-Mohr S M , Byatt C M
Published: December 2008

The question of whether terminally ill patients should artificially be given fluids has been debated since before palliative care became a recognised specialty. Arguments have been adduced from physiological, comfort, legal psychological, and emotional perspectives. Palliative care specialists agree that the priority is preventing the symptoms associated with dehydration, rather than the dehydration itself. However, the majority of terminally ill patients are cared for in settings outside hospices, and those admitted to hospital will tend to be exposed to a more technical approach. There are no randomised controlled trials in this area, and although an ethical minefield, we should not be afraid to manage individual patients according to the principles of palliative care where control of symptoms, not normalising of physiological variables, is the primary objective.
Testicular carcinoma
Authors: O'Callaghan A , Mead G M
Published: December 2008

Testicular cancer is the commonest malignancy in young males and its incidence has more than doubled in the last 25 years. For clinical purposes, two tumour types are identified, seminoma and non-seminoma germ cell tumours (loosely known as teratomas). Stage I disease is confined to the testes and is managed surgically, with adjuvant chemotherapy or radiotherapy as appropriate. Cisplatin-based chemotherapy is the cornerstone of treatment for metastatic disease, with cure rates exceeding 80%. Early diagnosis and cure should be the aim in all patients. To this end, those with testicular symptoms should be evaluated promptly by ultrasound, and in young male patients presenting with the clinical picture of metastatic disease, germ cell tumour should top the list of differential diagnoses.
Chronic pancreatitis and pancreatic carcinoma
Authors: Evans J D , Morton D G , Neoptolemos J P
Published: December 2008

The differential diagnosis between pancreatic cancer and chronic pancreatitis is very important as the management and prognosis of these two diseases is different. In most patients with pancreatic disease, the diagnosis can be established but there is a subgroup of patients in whom it is difficult to differentiate between these conditions because the clinical presentation is often similar and currently available diagnostic tests may be unable to distinguish between an inflammatory or neoplastic pancreatic mass. This paper reviews the aetiology, pathology and clinical features of these diseases and discusses the limitations of conventional diagnostic methods and how newer techniques may be of value in the differential diagnosis.
Moyamoya disease
Authors: Farrugia M , Howlett D C , Saks A M
Published: December 2008

Moyamoya disease is a rare cerebrovascular condition of uncertain aetiology commonly affecting young persons. The disease is mainly seen in Japanese patients. We report two cases of moyamoya disease in Caucasian women and review the postulated aetiological factors and associated conditions as well as the spectrum of invasive and non-invasive imaging modalities useful in the diagnosis and follow-up of the disease, with particular reference to the developing role of magnetic resonance imaging and angiography.
Rapid diagnosis of asymptomatic hereditary haemochromatosis by detection of the Cys282Tyr mutation in the HLA-H gene
Authors: Aslam S , Standen G R
Published: December 2008

Hereditary haemochromatosis is an autosomal recessive disorder characterised by life-long excessive accumulation of iron. A candidate gene for hereditary haemochromatosis has recently been reported (HLA-H) and a specific missense mutation (Cys282Tyr) has been identified in 85% of patients with the disorder. We describe the rapid detection of this mutation using the polymerase chain reaction and restriction endonuclease digestion. The usefulness of this test for early diagnosis of hereditary haemochromatosis in asymptomatic family members is highlighted.
Association of sarcoidosis, low-grade B-lymphoma and epidermoid carcinoma
Authors: Romero J , Ramón y Cajal S , Vargas J A , Pérez-Maestu R , Salas C , Regueiro C A , Aragon G
Published: December 2008

We report on a case of the so-called sarcoidosis-lymphoma syndrome in a 65-years-old man diagnosed as having sarcoidosis and, four years later, neurosarcoidosis. The diagnoses of epidermoid carcinoma of the skin and of stage IV monocytoid, small cell lymphocytic lymphoma were made five and seven years, respectively, after the initial diagnosis of sarcoidosis. It has been suggested that the increased mitotic activity of lymphocytes observed in sarcoidosis, favours their malignant transformation. Hypothetically, sarcoidosis might also influence the development of epidermoid carcinomas by depletion of circulating T4 lymphocytes and decreased resistance to oncogenic viruses that could lead to decreased tumour rejection in the epithelia exposed to carcinogenic stimuli.
Treatment of progressive renal failure and nephrotic syndrome with azathioprine and prednisolone
Authors: Baker L R I , Tucker B , Macdougall I C , Oommen R
Published: December 2008

Four patients with idiopathic membranous glomerulonephritis, heavy proteinuria and progressive renal failure received azathioprine and prednisolone. Renal function improved in all four and proteinuria declined sharply in three. We suggest that treatment with azathioprine and prednisolone may be of benefit in this form of idiopathic membranous glomerulonephritis.
Tamoxifen for retroperitoneal fibrosis
Authors: Frankart L , Lorge F , Donckier J
Published: December 2008

Retroperitoneal fibrosis, either idiopathic or associated with aortic inflammatory aneurysm, is a chronic fibrotic disease that causes progressive obstruction of ureters and vessels around the lower abdominal aorta. Treatment is often difficult (surgery) or hazardous (steroids). We report a case of a woman with retroperitoneal fibrosis associated with aortic inflammatory aneurysm, who was successfully treated with oral tamoxifen.
Exercise electrocardiogram and single vessel coronary artery disease
Authors: Chauhan A , Thuraisingham S I , Stone D L
Published: December 2008

The aim of this study was to assess the efficiency of exercise tests in identifying ischaemia in the territories supplied by the three main coronary arteries. We prospectively analysed 578 patients with single vessel coronary disease (> 50% stenosis in one vessel and completely normal other vessels). Patients with single vessel coronary artery disease were divided into three groups: patients with significant left anterior coronary artery disease (group 1, n = 234); patients with significant right coronary artery disease (group 2, n = 201); patients with significant left circumflex disease (group 3, n = 143). Our study, which is the largest prospective study of patients with angiographically documented single vessel coronary artery disease, suggests that the exercise electrocardiogram is a poor predictor of circumflex coronary artery ischaemia. In addition, the site of ST depression identified from the electrocardiogram was a poor predictor of the site of myocardial ischaemia. No single lead could distinguish between the three groups and the location of coronary stenosis could not be predicted by location of ST depression.
Symmetrical Brodie's abscess
Authors: Chambler A F W , Chapman-Sheath P J , Pearse M F , Hollingdale J
Published: December 2008

Chronic recurrent multifocal osteomyelitis is often confused with symmetrical Brodie's abscess as it has a similar pathogenesis. We report an otherwise healthy 17-year-old boy presenting with a true symmetrical Brodie's abscess. We conclude that a symmetrical Brodie's abscess presenting in an otherwise healthy patient is a separate clinical condition with a different management protocol.
Prostatic meningeal carcinomatosis presenting as delirium tremens
Authors: Rubins J B , Guzman-Paz M J
Published: December 2008

We report an unusual case of prostatic carcinomatous meningitis and remind clinicians to maintain a high index of suspicion of meningeal involvement when patients with advanced prostatic cancer present with cerebral symptoms, back pain, or neurologic findings. The diagnosis may require repeated cytologic examinations of cerebrospinal fluid, and immunocytochemical stains should be considered to confirm a prostatic source if malignant cells are identified. Androgen ablative therapy may give prolonged remissions, especially in patients with previously untreated tumours.
Treatment of vitamin D deficient osteomalacia may unmask autonomous hyperparathyroidism
Authors: Taylor A V G , Wise P H
Published: December 2008

Two cases of vitamin D deficient osteomalacia with secondary hyperparathyroidism are presented. In both cases treatment with vitamin D replacement therapy resulted in elevated calcium levels and a failure of parathormone levels to normalise, indicating autonomous parathyroid activity. Subsequent surgery in one case resulted in removal of a parathyroid adenoma. The importance of osteomalacia and its complications are discussed.
An obstetrics and gynaecology graduate residency programme in Venezuela
Authors: Faneite P
Published: December 2008

We present our experience on the design and development of a gynaecology and obstetrics graduate residency programme, developed in the Department of Obstetrics and Gynecology at the Dr Adolfo Prince Lara Hospital, Puerto Cabello, Venezuela, in which medical specialists and residents participate synergistically. From January to September 1993, curricular activities were planned and students selected. The programme started in October 1993, with six residents for a three-year programme. Courses were given by medical specialists from the Department. In addition to a Programme Coordinator, there is also a Residents' Coordinator, appointed for a two-month term of office; specific functions were assigned for residents occupying this position. All the programmed activities for three years were accomplished, including lectures and rotations, with an important record of surgical interventions. In our grade system, residents got an average of 18 over a maximum of 20 points. Residents also participated as speakers in workshops, special courses and national medicinal meetings, in which they presented a total of nine papers. Activities were evaluated bimonthly in meetings with students and each semester by the Graduate Committee. The first class graduated in September 1996. Results suggest that resident participation in graduate programmes is an important part of their education.
An audit of prostate-specific antigen and clinical symptoms in general practice
Authors: Ramachandran S , Foster M C , Thomas D R , Roalfe A K , Hall R A
Published: December 2008

The objective was to devise local guidelines for the referral of patients with suspected prostatic carcinoma following evaluation by a retrospective audit of the value of the prostate-specific antigen concentration, together with age, urological symptoms, and digital rectal examination in the diagnosis of carcinoma of the prostate. Relevant details were collected from the notes of 582 patients from general practice and hospital. The significant diagnostic factors were ascertained by stepwise logistic regression. Prostate-specific antigen concentration, digital rectal examination and significant terminal dribbling were the most powerful factors in the diagnosis of carcinoma of the prostate. When prostate-specific antigen concentration was considered in isolation, a value of 6.5 ng/ml appeared appropriate for referral. Age was not significant, perhaps due to the narrow patient age range. The significant diagnostic factors were built into an algorithm calculating the probability of carcinoma of the prostate. This algorithm, together with prostate-specific antigen concentration results and digital rectal examination findings, forms the basis of the referral guidelines and a subsequent prospective study.
Angioplasty and stenting in the carotid and vertebral arteries
Authors: Crawley F , Brown M M , Clifton A G
Published: December 2008

Carotid and vertebral artery percutaneous transluminal angioplasty and stenting are new, experimental techniques. Their potential uses are discussed and the results and complications reported to date are reviewed.
Interprofessional learning
Authors: Parsell G , Bligh J
Published: December 2008

Effective care in hospitals and in the community requires doctors, nurses and other healthcare professionals to work together to achieve the best possible outcomes for patients. In the UK, a shift in emphasis towards a primary care led service and recent changes to the ways in which healthcare is funded and organised, are profoundly affecting traditional patterns of working. Boundaries which define the roles and responsibilities of individual professions are becoming less clear and there is increasing overlap of knowledge and skills. The provision of effective patient care now depends much more on the individual practitioner's understanding of the need to collaborate within and between healthcare teams in community settings and the care provided in hospitals. This paper describes some of the ways in which those providing education and training for the professions are seeking to create opportunities for learners which will not only help them to understand the complexities of working in a multiprofessional healthcare environment, but also enable them to develop the skills and attitudes they need for interprofessional working. However, it is not yet established whether ‘learning together’ during basic training will result in better ‘working together’ in practice. Higher education institutions are understandably cautious about adopting new learning methods which make extra demands on decreasing resources. More studies are therefore needed to show whether interprofessional learning during basic education has an impact on future working practice.
Advance directives and living wills
Authors: Stewart K , Bowker L
Published: December 2008

Under certain circumstances, living wills or advance directives may carry legal force in the UK. This paper traces the development of advance directives, clarifies their current legal position and discusses potential problems with their use. Case histories are used to illustrate some of the common dilemmas which doctors may face.
Recognition and management of hypercholesterolaemia in patients awaiting elective coronary artery bypass grafting
Authors: Asimakopoulos G , Barlow C , Pillai R
Published: December 2008

The recently published Scandinavian Simvastatin Survival Study showed that long-term treatment with simvastatin, in patients with ischaemic heart disease and serum cholesterol levels between 5.5 and 8.0 mmol/l, improved survival. The present study was conducted in order to evaluate whether patients with ischaemic heart disease awaiting coronary revascularisation are aware of their serum cholesterol levels and whether raised levels are being treated adequately. One hundred consecutive patients admitted from our waiting list for elective coronary artery bypass grafting, with or without valve replacement, were included in the study. The patients were asked whether they had a history of raised serum cholesterol and, if so, how this was being treated. Fasting serum cholesterol levels were subsequently taken in the morning before surgery. Forty-six patients gave a positive history of raised blood cholesterol levels; 25 of these were on cholesterol-lowering medication at the time of admission, 15 were on a lipid-lowering diet and six were not being treated. Thirty-one (67%) of these 46 patients had a serum cholesterol of more than 5.5 mmol/l, compared with 30 (56%) of the 54 patients without a positive history of hypercholesterolaemia, and 61% of the total 100 patients. These data suggest that an inadequate number of patients awaiting coronary artery bypass grafting are aware of their cholesterol status. The management of hypercholesterolaemia among these patients could be improved.
Advanced Trauma Life Support instructor training in the UK: an evaluation
Authors: Moss G D
Published: December 2008

The paper reports on a questionnaire evaluation of the UK-based ATLS (Advanced Trauma Life Support) instructor course. The trainee instructors who responded were mainly at consultant grade with some senior registrars. The course was regarded as being very effective in achieving most of its objectives and in raising the confidence of postgraduate medical instructors, especially those lacking previous training in instructional methods. This is particularly so for practical skills training. The least effective areas of the course concern small group teaching and questioning techniques.
Occupational hydrocarbon exposure and nephrotoxicity: a cohort study and literature review
Authors: Pai P , Stevenson A , Mason H , Bell G M
Published: December 2008

Hydrocarbon exposure has been shown to play an important role in the development of renal dysfunction in several occupational settings. In this study, renal screening was performed in a group of paint sprayers with exposure to hydrocarbon-based paints, recruited from a car manufacturing plant where personal protective equipment was widely used. The hydrocarbon exposure scores and various markers of renal injury were compared between these subjects and a group of paint sprayers from a previous study who did not use personal protective equipment regularly. Cumulative hydrocarbon exposure scores were calculated from a validated questionnaire. Serum creatinine, urinary total protein, albumin, transferrin, retinol-binding protein, and N-acetylglucosaminidase were evaluated, Both groups experienced heavy hydrocarbon exposure but sprayers who regularly used personal protective equipment had significantly reduced exposure scores due to improved skin and respiratory protection. A significant number of sprayers from both groups had elevated levels of serum creatinine. Interestingly, urinary N-acetylglucosaminidase activity, a marker of proximal tubular damage, was abnormal in a significant proportion of sprayers in the unprotected group but normal in those with improved protection.

Our results are in keeping with the hypothesis that hydrocarbon exposure through paint spraying may result in active proximal tubular damage which may be reduced by improvement of protection at the worksite. However, renal impairment independent of tubular injury may result from chronic paint exposure, even with improved protection.
Neurocysticercosis
Authors: Garg R K
Published: December 2008

Neurocysticercosis is the most common parasitic disease of the central nervous system. Varied clinical manifestations occur, due to deposition of larvae of the parasite Taenia solium in cerebral parenchyma, meninges, spinal cord, muscles, eyes and skin. The diagnosis of neurocysticercosis can be made with a fairly high degree of accuracy with the help of computed tomography and magnetic resonance imaging. Serological tests and histopathological examination of subcutaneous nodules provide additional support in establishing the diagnosis. The anticysticercal drugs albendazole and praziquantel have been extensively used, and found to be effective for all types of neurocysticercosis. However, recently controversy has been raised about their safety, and long-term clinical usefulness. Preventive health measures, such as provision of safe drinking water and excretion disposal, still offer the best ways to manage this disease.
Common bile duct stenting for choledocholithiasis: a district general hospital experience
Authors: Bowrey D J , Fligelstone L J , Solomon A , Thomas G , Shandall A A
Published: December 2008

The favoured treatment of common bile duct stones is endoscopic sphincterotomy and stone extraction. The management of those cases where duct clearance is not possible is controversial. At our institution it has been policy to insert an endoluminal stent. We report a retrospective review of the outcome of patients stented for common bile duct stones. The study population was 14 men and 22 women, with a median age of 73 years (range 23–89 years). Treatment-related morbidity was seen in nine patients (25%), comprising cholangitis (5), pancreatitis (3), and cholecystitis (1). Three of these patients died; all were over the age of 75 years and had been stented on a long-term basis. These data suggest that endobiliary stents can be employed with an acceptable complication rate. We suggest that patients under the age of 75 years be stented only as a temporising measure, but that patients over 75 years or those unfit on physiological grounds can be stented on a long-term basis as definitive treatment.
Vitamin D replacement in Asians with diabetes may increase insulin resistance
Authors: Taylor A V G , Wise P H
Published: December 2008

We report three cases of vitamin D replacement in British Asians with vitamin D deficiency and non-insulin-dependent diabetes mellitus. In all cases, replacement resulted in an increase in insulin resistance and a deterioration of glycaemic control.
The potential role of soluble fibre in the treatment of hypercholesterolaemia
Authors: Coats A J S
Published: December 2008

The three major modifiable coronary risk factors are smoking, hypertension, and hypercholesterolaemia. Serum cholesterol levels are above the desirable level of 5.2 mmol/l in 79% of men and 65% of women aged between 35 and 50 years and thus are an important target for intervention. In this paper, the role of nonpharmacological intervention with soluble fibre in treating mild to moderate primary hypercholesterolaemia is reviewed. Evidence from controlled studies shows that soluble fibre can be effective in lowering cholesterol by clinically significant amounts. It is stressed, however, that risk factors for coronary heart disease are interactive and attention is shifting to addressing multiple rather that individual factors.
Assessment and treatment of nutritional status in stroke patients
Authors: Gariballa S E , Sinclair A J
Published: December 2008

Stroke illness imposes a heavy and costly work load on hospital and community care services, and life after stroke can be a miserable affair for stroke patients and their carers. Nutritional factors may have an important role in acute stroke and its outcome. From the limited amount of research undertaken it has been shown that a significant number of patients with stroke are undernourished on admission and their nutritional status deteriorates further as an in-patient. This is especially so for those who are most dependent, in whom undernutrition is also associated with increasing morbidity and mortality. There is some evidence that nutritional supplementation may improve nutritional status and reduce morbidity and mortality. However most clinically available nutrition screening instruments lack sensitivity and specificity, and abnormal nutritional indicators may simply reflect effects of age, functional disability, or severe underlying disease. Therefore, causal relationship cannot be assumed without a sufficiently powerful intervention study which adequately adjusts for the effects of non-nutritional factors, such as the number and severity of comorbid conditions on clinical outcome. Meanwhile, doctors, nurses and members of the multidisciplinary team looking after stroke patients should be made aware of the likely impact of poor nutritional status on clinical outcome.
Smoking and pursuit of thinness in schoolgirls in London and Ottawa
Authors: Crisp A H , Stavrakaki C , Halek C , Williams E , Sedgwick P , Kiossis I
Published: December 2008

It has been proposed that teenage girls often smoke cigarettes to protect themselves from the impulse to binge eat, with its feared weight-gain consequences, particularly when other measures such as greater dietary restraint have failed. The present study looked at the relationship between body mass index and standardised questionnaire responses concerning smoking, alcohol consumption, moods, weight changes, attitudes to body weight and shape, dietary patterns and menstruation in 1936 British (London) and 832 Canadian (Ottawa) schoolgirls. Data analysis revealed links between cigarette smoking and body weight/shape concerns, and awareness by subjects of these links; there was also a tendency for smokers in these two populations to be overweight but not grossly obese. Smoking was also related at all ages to being postmenarchal. The London population in particular revealed an association between smoking and a weight loss of 7 kg or more at some stage since puberty. Smoking was also linked, in a minority, with regular vomiting undertaken as a further defence against weight gain when overeating had occurred. These associations existed alongside the major and predictable association found between alcohol consumption and smoking. Similarities between the British and Canadian schoolgirls were striking in respect of rank order of reasons given for smoking and consequences of giving it up. Since smoking amongst older women is reportedly associated with below-average body weight it may indeed be effective in helping to curb weight gain. Our study provided little evidence of association between smoking and generalised anxiety or social anxiety (in either population), or depression (in the British cohort). We suggest that any preventive psychological approach to teenage female smoking should include attention to weight gain anxiety and consequent pursuit of thinness.
Diplopia in a swimmer due to badly fitting goggles
Authors: Plaut G S
Published: December 2008

An unusual effect of badly fitting swimming goggles is described. The goggles pressed on the trochlea of the left eye, interfering with the action of the superior oblique muscle. Diplopia resulted, which took several weeks to resolve.
Gastric rupture secondary to successful Heimlich manoeuvre
Authors: Majumdar A , Sedman P C
Published: December 2008

A fatal case of gastric rupture following the Heimlich manoeuvre is reported. This life-threatening complication has only been reported previously in seven patients with a high mortality rate. All patients should be assessed immediately following this manoeuvre for any potentially life-threatening complications.
Cutaneous sarcoidosis
Authors: Wilson N J E , King C M
Published: December 2008

Sarcoidosis is a multi-organ granulomatous disorder of unknown cause. Skin sarcoidosis occurs in about 25% of patients with systemic disease and may also arise in isolation. A wide range of clinical presentations of cutaneous sarcoidosis is recognised. The diagnosis rests on the presence of non-caseating granulomas on skin biopsy and the exclusion of other granulomatous skin disease. The treatment and overall prognosis of cutaneous sarcoidosis is primarily dependent on the degree of systemic involvement. In patients with aggressive disease limited to the skin immunosuppressive therapy may be indicated.
Spontaneous haemothorax: a cause of sudden death in von Recklinghausen's disease
Authors: Griffiths A P , White J , Dawson A
Published: December 2008

Vasculopathy is a relatively frequent but poorly recognised manifestation of von Recklinghausen's neurofibromatosis. One of its more dramatic presentations is as spontaneous haemothorax. Clinicians and pathologists should be aware of this syndrome as a cause of sudden death in patients with neurofibromatosis.
The best management for ‘crescendo biliary colic’ is urgent laparoscopic cholecystectomy
Authors: Robertson G S M , Wemyss-Holden S A , Maddern G J
Published: December 2008

Gallbladder disease due to stones is well recognised as falling into two categories, presenting with either chronic symptoms or developing acute cholecystitis or other complications. We describe an intermediate group of 14 patients (11 women, three men, median age 31 years) presenting with 4–14 days of at least daily attacks of resolving biliary colic, who underwent early laparoscopic cholecystectomy within 24 hours of presentation. None had any evidence of acute inflammation, either at laparoscopy or on histology. Their surgery was straightforward with operating times ranging from 35-80 minutes and no complications. Patients with ‘crescendo biliary colic’ are often young women who can rarely afford invalidity. Rather than the current practice of analgesia for each attack and elective surgery weeks later, they are optimally managed by urgent laparoscopic cholecystectomy, preventing the development of complications and minimising the need for further medical involvement.
Telemedicine in the NHS for the millennium and beyond
Authors: Wallace S , Wyatt J , Taylor P
Published: December 2008

This article defines telemedicine, discusses evidence of its effectiveness, looks at its advantages and disadvantages (and barriers to implementation), and considers its role in the NHS for the millennium and beyond.
Abnormal liver function tests following inadvertent inhalation of volatile hydrocarbons
Authors: Pyatt J R , Gilmore I , Mullins P A
Published: December 2008

The use of aerosols containing volatile hydrocarbons in conditions of poor ventilation can result in accidental overexposure which can cause central nervous system effects and hepatic injury. We present a case in which inadvertent usage of an adhesive spray used to make greeting cards resulted in vague neurological symptoms and abnormal liver function tests both of which fully resolved on discontinuation.
SIMULATION OF THERMAL EFFECTS IN OPTOELECTRONIC DEVICES USING COUPLED ENERGY-TRANSPORT AND CIRCUIT MODELS
Authors: BRUNK MARKUS , JÜNGEL ANSGAR
Published: December 2008

A coupled model with optoelectronic semiconductor devices in electric circuits is proposed. The circuit is modeled by differential-algebraic equations derived from modified nodal analysis. The transport of charge carriers in the semiconductor devices (laser diode and photo diode) is described by the energy-transport equations for the electron density and temperature, the drift-diffusion equations for the hole density, and the Poisson equation for the electric potential. The generation of photons in the laser diode is modeled by spontaneous and stimulated recombination terms appearing in the transport equations. The devices are coupled to the circuit by the semiconductor current entering the circuit and by the applied voltage at the device contacts, coming from the circuit. The resulting time-dependent model is a system of nonlinear partial differential-algebraic equations. The one-dimensional transient transport equations are numerically discretized in time by the backward Euler method and in space by a hybridized mixed finite-element method. Numerical results for a circuit consisting of a single-mode heterostructure laser diode, a silicon photo diode, and a high-pass filter are presented.
DISSIPATIVE ENTROPY AND GLOBAL SMOOTH SOLUTIONS IN RADIATION HYDRODYNAMICS AND MAGNETOHYDRODYNAMICS
Authors: ROHDE CHRISTIAN , YONG WEN-AN
Published: December 2008

The equations of ideal radiation magnetohydrodynamics (RMHD) serve as a fundamental mathematical model in many astrophysical applications. It is well known that radiation can have a damping effect on solutions of associated initial-boundary-value problems. In other words, singular solutions like shocks can be prohibited.

In this paper, we consider discrete-ordinate approximations of the RMHD-system for general equations of state. If the magnetic fields are absent (i.e. if we consider radiation hydrodynamics), we prove the existence of global-in-time classical solutions for the Cauchy problem in one space dimension under an appropriate smallness condition on the inital data. We also show that counterparts of the compressive shock waves for the full RHD case and counterparts of the slow and fast MHD shock waves for the full RMHD-system can have structures in the presence of radiation if the amplitude is sufficiently small. Moreover, a new entropy function for the RMHD-system is presented.
Language Classes Defined by Generalized Quantum Turing Machine
Authors: Iriyama Satoshi , Ohya Masanori
Published: December 2008

Ohya and Volovich proposed a quantum algorithm with chaotic amplification to solve the SAT problem, which went beyond the notion of the usual quantum algorithm. In this paper, we generalize quantum Turing machines by rewriting the usual quantum Turing automaton in terms of a channel transformation. Moreover, we define some computational classes of generalized quantum Turing machines and show that we can describe the Ohya-Volovich (OV) SAT algorithm with completely positive channels.