bluuebunny/crossref_metadata_2025 huggingface dataset:
Renal Power Doppler Ultrasound Does Not Predict Renal Scarring after Urinary Tract Infection
Authors: Narchi H , Donovan R
Published: March 2011

Objective

Young children may develop renal scarring following a urinary tract infection (UTI) especially after pyelonephritis which is difficult to diagnose. Permanent renal scars are diagnosed by dimercapto-succinic acid (DMSA) scan several months later. To decrease unnecessary exposure to radiation, we investigate the role of renal power Doppler (RPD) in predicting those who may not require a late DMSA scan.

Methods

Children under four years of age with a first UTI underwent an RPD study soon after diagnosis, and a DMSA scintigraphy six months later. The predictive values of the early RPD to detect DMSA renal scarring were calculated.

Results

Twenty three children (median age 30 months) were enrolled: 13 had a febrile presentation, two with bacteraemia. Permanent scarring occurred in three children (13%). In the 46 kidney units studied, initial RPD was abnormal in two and late DMSA abnormal in three units. Overall concordance between RPD and DMSA was 93.5%. The sensitivity of RPD for renal scar as per DMSA was 33.3%, specificity 97.7%; positive predictive value 50% and a negative predictive value of 95.4%.

Conclusions

RPD offered no advantage over ultrasound to predict renal scarring and cannot be recommended to predict renal scarring following UTI.
Direct to Consumer Advertising via the Internet, a Study of Hip Resurfacing
Authors: Ogunwale B , Clarke J , Young D , Mohammed A , Patil S , Meek RMD
Published: March 2011

Background and Aims

With increased use of the internet for health information and direct to consumer advertising from medical companies, there is concern about the quality of information available to patients. The aim of this study was to examine the quality of health information on the internet for hip resurfacing.

Methods

An assessment tool was designed to measure quality of information. Websites were measured on credibility of source; usability; currentness of the information; content relevance; content accuracy/completeness and disclosure/bias. Each website assessed was given a total score, based on number of scores achieved from the above categories websites were further analysed on author, geographical origin and possession of an independent credibility check.

Results

There was positive correlation between the overall score for the website and the score of each website in each assessment category. Websites by implant companies, doctors and hospitals scored poorly. Websites with an independent credibility check such as Health on the Net (HoN) scored twice the total scores of websites without.

Conclusions

Like other internet health websites, the quality of information on hip resurfacing websites is variable. This study highlights methods by which to assess the quality of health information on the internet and advocates that patients should look for a statement of an “independent credibility check” when searching for information on hip resurfacing.
Use of Radiology by General Practitioners Making Orthopaedic Referrals: a Cross-Sectional Study
Authors: Morley NCD , Robertson H , Millar J , Finlayson DF
Published: March 2011

Background

In orthopaedic clinics, patients can be x-rayed during their visit to the surgeon. Could radiographs carried out in primary care be more efficiently carried out when the patient meets the surgeon?

Aims

To quantify and describe use of radiological investigations by general practitioners (GPs), when referring to orthopaedics.

Methods

We made a retrospective examination of 294 referral letters for detail regarding x-ray investigation of the condition prompting the letter. We used referral letters assessed by the recipient as ‘routine’. We excluded those addressed to a particular surgeon because of subspecialty interest or prior care.

Results

Twenty one percent (62) of referrals described an investigation that did not contribute to management prior to the patient's clinic appointment.

Conclusions

A significant number of patients travelled specifically for an x-ray. In some of these cases the radiographs could be delayed until the clinic visit without compromising care.

Discussion

We suggest that GPs seeing patients with musculoskeletal problems should consider referral to an orthopaedic surgeon prior to requesting x-rays. X-ray investigation in the orthopaedic clinic may be more convenient for the patient and surgeon.
An Observational Study of the Impact of a Rehabilitation Admission on Readmission Data
Authors: Petrie RXA , Mountain DA
Published: March 2011

Background and Aim

Specialist psychiatric rehabilitation services are changing in response to overall redesign of psychiatric services. The assumed therapeutic gains of these services have not been established or quantified, and their role in contemporary practice has not been formally articulated. The aim of this observational study is to examine the impact of an admission to psychiatric rehabilitation wards at the Royal Edinburgh Hospital on readmission data post-discharge.

Method

Thirty-five admissions were included in the sample. Simple measures of outcome were used: the number of days spent in hospital; number of Mental Health Act uses; number of admissions. This information was obtained from case notes and from data collected routinely on the Patient Information Management System. These measures were examined in the two-year periods before and after a rehabilitation admission.

Results

In the two-year period following the index admission there was a significant reduction in all these measures compared to the two-year period before the index admission: mean number of bed days (p < 0.001); number of uses of the Mental Health Act (p < 0.001); number of readmissions (p < 0.01).

Conclusion

There was an improvement in patient outcome measures following a rehabilitation admission.
Duplex cryptorchid testis presenting as a strangulated hernia: A Case Report
Authors: Clancy Marc , Renwick Bryce
Published: March 2011

Testicular duplication is an extremely rare condition. It is usually asymptomatic or found incidentally at examination. In this case a relatively common clinical scenario proves to represent a duplex, cryptorchid testis. The aetiology of this condition, its management and implications for malignancy and fertility are reviewed.
Long term treatment with rifampicin for pruritis has implications for warfarin use
Authors: Bound BL , Johnstone L , McKay GA
Published: March 2011

Warfarin is an established treatment method for anticoagulating patients following diagnosis of deep vein thrombosis (DVT). We present a patient who was on rifampicin treatment for pruritis, secondary to primary biliary cirrhosis (PBC), who was diagnosed with a DVT post operatively. A therapeutic INR was not obtained following fourteen days of warfarin treatment due to a drug interaction with rifampicin. We review the use of rifampicin for pruritis in PBC and the mechanism of interaction between warfarin and rifampicin.
Epidemiology of Fungal Scalp Infections in the West of Scotland 2000 – 2006
Authors: Alexander CL , Brown L , Shankland GS
Published: March 2011

Background

Fungal infections of the scalp commonly affect the paediatric population and are caused by dermatophytes which have the ability to invade the keratinised structures of skin, hair and nails. This study analyses the changes in the epidemiology of fungal scalp infections in the West of Scotland during the period 2000 – 2006.

Methods

Skin and hair from scalp specimens sent by General Practitioners and Dermatologists throughout the West of Scotland were examined microscopically for the presence of fungal hyphae and/or spores and cultured to determine the identity of the fungi.

Results

The most common dermatophyte to be isolated from scalps during 2000–2006 was Trichophyton violaceum with 29 reported cases followed by 23 cases of Trichophyton tonsurans infection. During 2000-2002, over 90% of patients were British but during 2003–2006, greater than 50% of patients were of non-UK origin. The majority of T. violaceum and T. tonsurans infections during this study were from patients originating in either Africa or Pakistan and were from people known to be seeking asylum in the UK.

Conclusions

The overall increase and the change in pattern of reported fungal scalp infections in the West of Scotland may be explained by the migration of people to Scotland from Africa or Pakistan where T. violaceum and T. tonsurans are endemic. The increase in numbers of infections in the later period of this study reflects an increase in the awareness of General Practitioners and Dermatologists to send samples to Clinical Mycology.
Urban and Rural Risks of Lyme Disease in the Scottish Highlands
Authors: Mavin S , Hopkins PC , MacLennan A , Joss AWL , Ho-Yen DO
Published: March 2011

Background

This paper investigates the pattern of Lyme disease testing and infection within the Highland region of Scotland.

Methods

Data from all Highland samples tested during 2004-2006 were analysed according to result and patient's residence in relation to the eight fold Scottish Executive's urban/rural classification, and distance from woodland.

Results

In total, 1602 patients were tested for Lyme disease, 0.71% of the Highland population. From these, 104 (6.5%) were seropositive. There were more patients tested, and seropositive patients from rural than urban locations, 1113 vs 489, and 79 vs 25 respectively. There were also significantly more seropositive patients per patients tested from rural locations (χ2, p < 0.0001). The number of patients tested and seropositive patients increased as the rural areas become more remote. The likelihood of being tested for Lyme disease also increased as the distance between a patient's residence and woodland decreased. The relative risk of being tested elevated by 74% for those patients living within 200 metres of woodland.

Conclusions

Those living in the most rural areas of Highland and those living closest to woodland have an increased risk of being tested and having Lyme disease.
Impact of EUS-FNA in the Management of Patients with Oesophageal Cancer
Authors: Morris JM , Suzuki H , McKernan M , Stephen M , Stuart RC , Stanley AJ
Published: March 2011

Background and Aim

Endoscopic Ultrasound (EUS) has increased the staging accuracy of oesophageal cancer. The addition of EUS guided fine needle aspiration (EUS-FNA) appears superior to standard EUS for nodal staging. Our aim was to study the impact of EUS-FNA in the management of patients with oesophageal cancer.

Methods

We studied patients undergoing EUS for this indication between May 2003 and May 2006. EUS was performed in patients who were candidates for radical therapy following CT scanning. If suspicious non-peritumoural nodes were seen on EUS, EUS-FNA was undertaken. Further staging was performed as appropriate and all cases were discussed at our multidisciplinary meeting. Results and decisions were prospectively recorded.

Results

One hundred and ninety one patients underwent EUS for staging of oesophageal cancer during this period and 44 EUS-FNA were performed in 42 patients (mean age 62.2 years). Sixty two per cent of patients had adenocarcinoma and 48% sampled nodes were < 10mm diameter. Overall, 48% nodes were positive and two “suspicious” for malignancy. Following a positive EUS-FNA and MDM discussions, 15 patients had palliative and two neoadjuvant therapy. Eleven patients with a negative EUSFNA underwent radical therapy. Therefore, EUS-FNA appeared to alter management in 28 (67%) patients.

Conclusion

EUS-FNA appears to help direct patients towards appropriate treatment strategies.
Parathyroid carcinoma. Mini-series of patients successfully treated with minimally invasive surgery using intra-operative PTH assays, and literature review.
Authors: Komolafe OO , McMinn AG , Doughty JC , Wilson CR
Published: March 2011

Parathyroid cancer is a rare cause of primary hyperparathyroidism, with a surgeon anecdotally expected to see a single case in his/her entire career. In our unit, however, we have treated three patients recently. The accepted optimal treatment of parathyroid cancer is radical resection at the initial surgery, but a low index of suspicion means that most parathyroid cancers are not identified pre- or intra-operatively. This results in the majority of patients having inadequate surgery. All three patients were treated by minimally invasive surgery, with radical en bloc resection based on intra-operative suspicion of malignancy. Pre-operative imaging guides the neck exploration, and intra-operative PTH assays confirm excision of the source of excess PTH. All patients have remained well with no recurrence to date. We review the literature on parathyroid cancer, and suggest features that point to a parathyroid tumour being malignant.
Cerebral venous thrombosis and pulmonary thromboembolism with thyrotoxicosis
Authors: Corry LA , Walker NL , Byrne J , Walker ID , Kennon B
Published: March 2011

An elevated level of factor VIII is a recognised risk factor for thromboembolism. This case report describes a patient with elevated factor VIII levels secondary to hyperthyroidism. She presented with a triad of clinical hyperthyroidism, pulmonary emboli and cerebral venous thrombosis. This case highlights the importance of considering thromboprophylaxis in patients with clinical hyperthyroidism.
The Prevalence of Chronic Kidney Disease in Rheumatology Outpatients
Authors: Hill AJ , Thomson RJ , Hunter JA , Traynor JP
Published: March 2011

Background

The introduction of routine reporting of estimated glomerular filtration rate coupled with a new definition of chronic kidney disease (CKD) has led to an unprecedented focus on kidney disease in many patient groups. In light of this, we performed an audit of patients attending the rheumatology clinics to assess the prevalence of CKD in this population.

Methods

Over a four week period, we reviewed the renal function of all patients attending the rheumatology clinics and day ward at our hospital (n=351). Renal function was assessed using the 4-variable MDRD formula. We then interviewed those patients with estimated glomerular filtration rate (eGFR) of 59 ml/min or lower.

Results

We found a prevalence rate of 18% for stage 3 CKD or lower in our audit population. Surprisingly, 60.3% of patients in this category were not aware of any problems with their kidneys (n=38).

Conclusions

The prevalence rate of 18% for stage 3 CKD or lower is significantly higher than the five per cent reported within the general population. As a result of this audit, we now plan to ensure that these patients undergo measurement of blood pressure, eGFR, and urinalysis on a six to twelve monthly basis.
Practical Barriers to the Implementation of Early Goal Directed Therapy in the UK: Trainee Skills and Awareness
Authors: Mcnally Sj , Mackinnon M , Hawkins M
Published: March 2011

The Surviving Sepsis Campaign (SSC) recommends Early Goal Directed Therapy (EGDT) in the treatment of septic shock, which requires key critical care skills and knowledge. This study evaluates the availability of these skills in Specialist Registrars in acute hospital specialities in the UK. A questionnaire was sent to Specialist Registrars in Anaesthetics, General Surgery and General Medicine throughout Scotland. One hundred and eighty five responses were obtained. One hundred percent of anaesthetists, 70% of surgeons and 51% of physicians were aware of EGDT. Only 62 trainees (6% of surgeons, 79% of anaesthetists, 19% of physicians) had the full complement of skills and knowledge to implement EGDT. This study demonstrates that non-anaesthetic registrars in the UK lack both knowledge and skills required to provide EGDT. The main deficit was in awareness, demonstrating that knowledge of EGDT is not penetrating into specialities beyond anaesthesia. It is now time for the SSC to specifically target non-anaesthetic specialities.
An Overview of the Surgical Aspects of Lower Limb Venous Disease
Authors: Parnaby Cn , Welch Gh , Stuart Wp
Published: March 2011

Summary Points

Lower limb venous disease encompasses a wide spectrum of pathology, the importance of which relates to high prevalence rather than mortality. The complications of chronic venous insufficiency (CVI), namely lipodermatosclerosis and chronic venous ulceration, represent a major burden to healthcare providers and a high degree of personal morbidity for patients. Management is based upon accurate clinical diagnosis supported by non-invasive imaging. Open surgical and minimally invasive techniques are used to treat varicose veins. Chronic skin complications of CVI require a multi-disciplinary approach.
The Doctor's Casebook – A Process of Discovery
Authors: Fraser S , Ayres C
Published: March 2011

Background and Aims

A bound manuscript describing the medical cases seen by a mid-eighteenth century Scottish doctor was discovered in the possession of the first author's family. The identity of the doctor is not revealed in the book. The aims were to identify the doctor and understand the significance of this book in the context of Scottish medical history of that period.

Methods

The process of investigation involved transcribing the book in order to undertake detailed study of the text, with particular focus on style of writing, location, and the names of patients and doctors mentioned. This information was then used in searches of the Wellcome Library for the History and Understanding of Medicine, London and the Department of Special Libraries and Archives of the University of Aberdeen as well as searches of the internet.

Results

The author was discovered to be a doctor working in Aberdeenshire in the middle of the eighteenth century. His style of writing suggests an educational purpose, with a particular interest in midwifery, and evidence of teaching midwifery techniques to students. He associated with other prominent local doctors of the time and was aware of the current thinking being put forward by his contemporaries. He had a particular association with Dr John Gregory, with whom he not only worked, but whose extended family he also treated.

Conclusions

The author of this casebook was identified as Dr David Skene, and this adds to our knowledge of this important figure of the Scottish Enlightenment who had a particular interest in midwifery and campaigned for the proper instruction of midwives
Feeding Babies in the Battle to Combat Infant Mortality a Century Ago
Authors: Weaver L
Published: March 2011

At the end of the nineteenth century Glasgow, like many large industrial European cities, had an infant mortality rate (IMR) of well over 100 deaths per 1000 live births. Recognition that ‘improper feeding’ was a significant factor in accounting for this prompted public health authorities to establish infant milk depots, to support breast-feeding mothers and to provide artificial milk feeds for their babies if necessary. The initiative was led by the medical officer of health of Glasgow, Archibald Chalmers, who promoted welfare services for mothers and infants during the first decade of the 20th century. However these initiatives were questioned by an up-and-coming paediatrician, Leonard Findlay, who was to go on to be Glasgow's first professor of medical paediatrics in 1924. Nevertheless IMRs started to go down from 1900 and have continued steadily ever since; and while artificial infant milks clearly posed a risk to the health of babies, attention to infant nutrition, growth and feeding may have played a part in initiating and perpetuating this decline in IMR and improving infant survival and welfare during the last century.
Esophageal lipoma presenting as a paraesophageal omental hernia in a 68-year-old man: Report of a case
Authors: Han Yong , Lu Qiang , Gu Zhongping , Wang Xiaoping , Li Xiaofei
Published: March 2011

A case of esophageal lipoma resembling a paraesophageal omental herniation is described herein. A 68-year-old male with symptoms of epigastric gas pains was noted. A barium swallow examination showed a large mass in the lower esophagus, which could move up and down along the esophagus easily and intermittently. Computed tomography scan of the chest and upper abdomen demonstrated a mass with fatty like density at the lower thoracic esophagus. A left posterior-lateral thoracotomy was performed. Histological examination revealed large mature lipocytes and lipoma of the esophagus was diagnosed. Diagnosis and treatment of lipoma of the esophagus were discussed.

Lipomas of the esophagus are extremely rare benign tumors with an overall incidence of only 0.4%[1]. The leading clinical presentations of esophageal lipoma included dysphagia, mass regurgitation and signs of compression of the tumor. Preoperative diagnosis can be confirmed by CT, magnetic resonance imaging (MRI) and endoscopic ultrasonography. The present report describes a patient who suffered from an esophageal lipoma with symptoms of epigastric gas pains with a burning retrosternal sensation, which resembling a paraesophageal omental herniation. We also discuss the associated diagnosis and treatment of lipoma of the esophagus.
Superior Mesenteric Artery (Wilkie) Syndrome complicated by Pneumomediastinum
Authors: Mackay G , Mackay Ck , Walker L
Published: March 2011

Superior mesenteric artery syndrome is characterised by vascular compression of the third part of the duodenum, resulting in obstructive symptoms. This case has been selected for its unusual presentation with pneumomediastinum and for the strikingly abnormal cross-sectional findings. We present the case of a young male of asthenic build, who was admitted to hospital with a history mimicking Boerhaave's syndrome (spontaneous oesophageal perforation). Radiological features included pneumomediastinum, but also an astonishing degree of gastric and duodenal dilatation. Extraluminal retroperitoneal air was also noted, further complicating the patient's presentation. We explore the relevant imaging and surgical findings, and relate these to an initially puzzling diagnostic dilemma.
Two Novel Mutations Causing Familial Benign Hypocalciuric Hypercalcaemia in Three Scottish Families
Authors: Hinnie J , Vass JK , Rolfe E , Marchesi VA , MacFarlane FC , McShea L , McKibbin CC , Henderson P , Gaffney D
Published: March 2011

Background and Aims

Familial benign hypocalciuric hypercalcaemia (FBHH) is a benign autosomal dominantly inherited condition which results in elevated serum calcium and low urinary calcium. This condition is of clinical interest because it can be mistakenly diagnosed as primary hyperparathyroidism (PHP). In most cases FBHH can be shown to be due to a mutation in the calcium sensing receptor (CASR) gene and we aimed to find the causative mutation in three Scottish kindreds with FBHH.

Methods

We used a combination of denaturing gradient gel electrophoresis and direct DNA sequencing to detect mutations in the CASR gene.

Results

We detected a mutation in the CASR gene in each of the three kindreds. Two different mutations were detected (the same one was present in two kindreds). Neither mutation has been reported previously. All hypercalcaemic individuals from each kindred had the appropriate mutation while all normocalcaemic individuals did not.

Conclusion

In the vast majority of kindreds with FBHH which have been reported previously, the CASR mutation responsible is private to that kindred. In three Scottish kindreds we have identified two new mutations.
Acute Caffeine Ingestion: Clinical Features in Patients Attending the Emergency Department and Scottish Poison Centre Enquiries Between 2000 and 2008
Authors: Waring WS , Laing WJ , Good AM , Malkowska AM
Published: March 2011

Background and Aims

Little information is available regarding the healthcare burden associated with deliberate caffeine ingestion. The present study sought to establish the impact of caffeine ingestion on hospital attendances and Poisons Centre enquiries in Scotland.

Methods

Retrospective analyses of clinical data from patients attending the Royal Infirmary of Edinburgh after acute caffeine ingestion, and TOXBASE enquiries from Scotland regarding caffeine poisoning between 2000-2008 inclusive. Cochran-Armitage trend tests were used to evaluate changes in annual admissions and TOXBASE enquiries.

Results

There were 43 hospital attendances due to deliberate caffeine ingestion, representing 0.2% of all poisoning cases. The median (interquartile range) stated dose was 1040 mg (600-1500 mg). Minor gastrointestinal symptoms were common, and no patient developed features of severe toxicity. There were 1418 enquiries to TOXBASE concerning caffeine poisoning, representing 0.2% of all poisoning enquiries from Scotland. The proportions of hospital admissions and TOXBASE enquiries due to caffeine ingestion have remained constant.

Conclusion

Caffeine ingestion is uncommon, and results in only a small number of hospital attendances and Poisons Centre enquiries. In contrast to patterns reported elsewhere, the prevalence of caffeine abuse has not increased in Scotland over recent years.
Indiscriminate Coagulation Screening of Acute Medical Admissions: National Cost Ramifications.
Authors: Hughes MA , Duckworth AD , Edmond I , Tan LL , Ripley DP , Tucker J , Leslie PJ
Published: March 2011

Background

Routine coagulation screening constitutes poor medical practice and is wasteful of resources. We aimed to determine the extent of inappropriate coagulopathy screening of acute medical admissions in a Scottish general hospital.

Methods

One hundred consecutive medical admissions were prospectively analysed, assessing whether or not a coagulation screen had been conducted on admission and whether or not this was indicated according to current hospital guidelines. Following targeted dissemination of guidelines to appropriate front door medical and nursing staff the audit was repeated.

Results

Pre-education, 58% of those for whom coagulation screening was not indicated were being tested. After targeted education, this figure was reduced to 32%. Preeducation, 81% of all patients in whom coagulation screening was indicated were tested. After targeted education, this figure was 86%.

Conclusion

Indiscriminate coagulation screening is widespread amongst medical admissions to our unit. With simple targeted education, we reduced the rate of inappropriate testing by 26% without reducing the rate of appropriate testing. In a small district general hospital (where the mean local cost for processing a haematology specimen is £8.59) this translates into a saving of £21,000 per annum. Extrapolated nationwide this represents a cost saving of £1.15 million per annum in Scotland.
James Willocks and the Innovation of Fetal Cephalometry
Authors: Nicolson M , Fleming JEE
Published: March 2011

James Willocks (1928–2004), a Glasgow obstetrician, was an important pioneer of obstetric ultrasound and the originator of the first clinically useful technique of fetal cephalometry. He collaborated with Tom Duggan, an engineer, who designed and built an electronic cephalometer to be used in conjunction with a Kelvin Hughes industrial flaw detector. Working in the Royal Maternity Hospital, Willocks was able to measure the biparietal diameter to an accuracy of better than 2mm. This major innovation enabled fetal growth in the third trimester to be accurately charted and thus greatly improved the detection of placental insufficiency, as well as the management of antepartum haemorrhage, hypertension and other complications of late pregnancy.
Metastatic breast cancer deluding as a papular skin rash.
Authors: Deshpande A , Mumba E , Mukhopadhyay B
Published: March 2011

Dermatological metastases from internal malignancies are relatively less common than other sites. We describe an interesting case of an elderly lady who initially presented with symptomatic normocytic anaemia, and then developed a widespread papular rash over a period of ten days. The rash was found to be metastatic breast cancer.
Prevalence of Genetic Haemochromatosis and Iron Overload in Patients Attending Rheumatology and Joint Replacement Clinics
Authors: Donnelly Sc , Joshi Ng , Thorburn D , Cooke A , Reid G , Neilson M , Capell H , Stanley Aj
Published: March 2011

Background &aims

Genetic Haemochromatosis (GH) is common in North European and Celtic populations and is associated with arthropathy. We aimed to measure the frequency of the common GH mutations (C282Y and H63D), the carrier frequency of C282Y and markers of iron overload in patients who were referred to our rheumatology and joint replacement clinics.

Methods

Unselected patients attending these clinics were anonymously tested for the described mutations. Transferrin saturation and serum ferritin were also measured and if elevated, the patients had predictive counselling then named GH mutation testing. The carrier and mutation frequencies were also determined in 340 local controls.

Results

One hundred and sixty-one unselected patients attending these clinics were studied. The C282Y mutation carrier frequency was 1 in 5.2 in patients compared with 1 in 8.1 in controls (p<0.005). The overall mutation frequencies were similar in patients and controls. One patient was found to be a homozygous for the C282Y mutation and eight were compound heterozygotes. Seven other patients had a raised ferritin, one of whom was a C282Y heterozygote.

Conclusion

The C282Y carrier frequency is significantly higher in patients attending rheumatology and joint replacement clinics than in controls. Screening of these patients for GH should be considered.
Use of a Chaperone during Breast Examination: The Attitude and Practice of Consultant Breast Surgeons in the United Kingdom
Authors: Sinha S , De A , Williams Rj , Vaughan-Williams E
Published: March 2011

Background

Professional guidelines and clinical practice regarding use of chaperones vary substantially in different health care settings. Although there are several studies in primary care practice, no such studies are available in a breast care setting. We have undertaken a questionnaire survey of practicing consultant breast surgeons in the UK regarding the use of a chaperone during breast examination.

Method

A self-completion questionnaire, with 18 items was developed, piloted, modified and mailed to 400 consultant breast surgeons across the UK.

Result

302/400 questionnaires were returned (76%). Sixty-five per cent had a policy on the use of chaperone. Although 73% always offer a chaperone, the majority never documented the offer (74%) or identity (73%). Overall use of chaperone was significantly higher among male (82%), compared to female surgeons (38%, p<0.001). The majority said that patient embarrassment (54%) and the availability of a nurse (57%) strongly influence chaperone use unlike patient's age, marital status, ethnicity, anxiety, instinct. Seventy per cent of respondents believed that the presence of a chaperone was important for medico-legal protection of doctor and patient (55%).

Conclusion

Our study shows that the majority of consultant breast surgeons in the UK use a chaperone. The overall use of a chaperone in secondary breast care setting is higher compared to previous studies in primary care. Documentation of the offer and identity of the chaperone is very poor.
Closure of Loop Ileostomies: Is Early Discharge Safe and Achievable?
Authors: Ihedioha U , Muhtaseb S , Kalmar K , Donnelly L , Muir V , Macdonald A
Published: March 2011

A prospective audit of the complications associated with reversal of a loop ileostomy was carried out between March 2000 and March 2005. The complication rate, length of inpatient hospitalisation and re-admission rate were assessed in 100 patients, in a single clinical practice. The median (interquartile range) length of time between the primary procedure and closure was 133 days (120 – 270) days. Median length of inpatient stay was two days (one - three) days. The overall complication rate was 18 %. One patient had a post-operative leak leading to local abscess formation. This was drained surgically after initial failure with radiological drainage. A second patient had a late leak, three weeks after closure, leading to fistula formation. This patient required surgical resection of the anastomosis after failure of conservative management. Twelve patients were re-admitted with small bowel obstruction (12%), of whom 11 were managed conservatively, while one underwent further surgery. There was one post- operative death as a result of acute cardiac failure secondary to undiagnosed hypertensive cardiomyopathy.

Thus early discharge following closure of a loop ileostomy, can be achieved with an acceptably low serious complication rate.
The Strange Case of Sir Henry Gray
Authors: Adam A , Hutchison Jd , Scotland Tr
Published: March 2011

Sir Henry Williamson Gray was a prominent Aberdeen surgeon who took up the post of Chief of Surgery at the Royal Victoria Hospital, Montreal in 1923. In what subsequently became known as “The Sir Henry Williamson Gray Affair” in the annals of McGill University, his career was ruined and his reputation left in tatters. The authors examine the available evidence and conclude that Gray was treated unfairly. They hope they have helped restore his name and reputation.
A Thirty year old primigravida immigrant presents with florid pulmonary oedema during Mid Cavity Forceps Delivery due to mitral stenosis
Authors: Mcaree S. , Johnstone C. , Irvine G.
Published: March 2011

With an increase in the level of immigration to the United Kingdom, there are more challenging cases presenting to the clinician with language and cultural differences as well as old friends revisited in terms of pathology In this case we present a 31 year old primigravida North African immigrant who managed to evade a diagnosis of Mitral Stenosis until presenting with acute pulmonary oedema during a Md Cavity Forceps Delivery (MCFD) under epidural anaesthesia This was a late diagnosis confounded by language barriers and a return of a classic condition perhaps more read about than actually seen in clinical practise. Issues related to the management of mitral stenosis are discussed along with some reflection on difficult communication issues, which exemplify the findings in the recent CEMACH 2007 report1.
Bronchial Carcinoid Tumour in Pregnancy
Authors: Cornell Rl , Wilkens J , Cooper Tk , Beattie Gj , Sethi T
Published: March 2011

Breathlessness is a commonly encountered symptom in pregnancy. The differential diagnosis for acute breathlessness in pregnancy is broad and possibilities range from physiological changes and psychological causes to acute respiratory disorders, which include pulmonary embolism (PE), acute asthma, infection and pneumothorax. It is rare to find a malignancy as the underlying cause of breathlessness. We report a case of severe breathlessness and chest pain in a 26-year-old woman presenting at 36 weeks gestation. A chest radiograph was normal but a computertomogram (CT) identified a mass, which was subsequently demonstrated to be a malignant bronchial carcinoid tumour. Although abdominal carcinoid tumours have been reported in the literature, to our knowledge, this is the first reported pulmonary carcinoid tumour, presenting during pregnancy.
Sensori-neural hearing loss in Sensory ataxic neuropathy, dysarthria and ophthalmoparesis (SANDO): A Case Report
Authors: Achar P , Kumar Bn
Published: March 2011

Objective

To report a case of bilateral sensorineural hearing loss in a patient with sensory ataxic neuropathy, dysarthria and ophthalmoparesis (SANDO).

Method

Case report and review of literature on mitochondrial disorders to facilitate understanding of the type of hearing loss.

Case report

We present a 37 year old lady diagnosed with SANDO, who was seen in the ENT department with a history of progressive hearing loss for 6 months. Audiogram showed bilateral trough shaped sensorineural hearing loss, dipping at 1 KHz. Earlier, this patient had presented to the neurology department with classical neurological signs of progressive sensory ataxia. Diagnosis of SANDO was confirmed by muscle biopsy and mitochondrial studies.

Conclusion

This is the first case report on SANDO documenting associated hearing loss in ENT literature. Further studies are required to explain the pattern of hearing loss in these patients
Colonic perforation secondary to migrated biliary stent. Case report of an unusual complication, and literature review
Authors: Hunter K , Siddiqui T , Komolafe Oo , Chong Dcs
Published: March 2011

Endoscopic stents are widely used to facilitate biliary drainage in hepatic, biliary and pancreatic conditions. Migration of the stent is a potentially serious complication. We report a case of migration of a biliary stent to the sigmoid colon at which point the stent perforated the colon and become lodged subcutaneously. The patient was managed successfully by local exploration to retrieve the stent without bowel resection. We also review the literature on complications caused by migrated biliary stents.
Hepatic artery pseudo aneurysm rupture precipitated by pneumonia: An Unusual Case
Authors: Muthukumarasamy G , Watt D , Davidson A , Newland A
Published: March 2011

We present a unique case of hepatic artery pseudo aneurysm rupture associated with pneumonia. A 67 year old woman admitted to our hospital with productive cough, pleuritic chest pain and shortness of breath. She was diagnosed to have community acquired pneumonia and was treated with antibiotics. On third day of admission she developed acute abdominal pain and haemorrhagic shock. Contrast CT scan showed left hepatic artery pseudo aneurysm rupture, a rare emergency condition associated with high mortality rate. She underwent percutaneous endovascular coiling and made a complete recovery.
Eye Injuries in Sport
Authors: MacEwen CJ , McLatchie GR
Published: March 2011

Most ocular injuries involve only the external eye. However, in approximately one-third of cases the intraocular structures are damaged with potentially sight threatening consequences. A small number of sports, such as soccer, rugby, hockey and the racquet sports are responsible for most injuries. Sport is responsible for between 25-40% of all eye injuries severe enough to require hospital admission. Most of these are recognised as being largely preventable and methods of reducing the number and severity of such injuries are of prime importance.
Women and Sport
Authors: O'Brien M , Robertson A
Published: March 2011

Women have historically taken part in sports for many centuries. The first recorded female game competitions were the Herean Games in approximately 1,000 BC, named after the Goddess Hera. Held at Olympia in Greece, these games were for women alone and were thought to have originated as part of ancient fertility rights.

Historically there is evidence of sporting activities involving women, but nothing of significance until after the 1948 summer Olympic Games, when 385 female athletes participated. Over the last six decades there has been a noted rise in the number of female athletes, reaching its maximum with the 2008 Beijing Olympics, where over 42% of the 11,028 athletes were women.

Similarly in 2006, at the Turin Winter Olympics in Italy, 40% of the 2,500 athletes were females. In the 2012 Olympics, the Olympic Committee anticipates that approximately 44% of all athletes participating will be female.

Despite there being a significant rise in the number of elite athletes in the UK, there appears to be an overall decrease in the amount and intensity of physical exercise undertaken by teenage girls. This is considered to be due to the fact that physical education is no longer an integral part of the school curriculum in the UK. There is, however, a small but significant group of elite athletes who start to train at a very early age (9-10 years old) especially in gymnastics, skating, swimming and athletics.
Sport and Exercise Medicine - the state of play
Authors: McLatchie GR
Published: March 2011

The delivery of clinical services and the organisation and teaching of Sport and Exercise Medicine in the UK were developed in concept as long ago as 1912. It accelerated, particularly over the last 36 years, until the Faculty of Sport and Exercise Medicine of the Royal Medical Colleges of the United Kingdom was established at the Royal College of Surgeons of Edinburgh. From the concept of a hobby for doctors interested in sport to its coming of age as a medical speciality Sports Medicine has a long and fragmented history. This is well documented in Volume 36 of the Wellcome Witnesses to Twentieth Century Medicine entitled ‘The Development of Sports Medicine in Twentieth-century Britain’. This short paper describes the role played by the key organisations in Sport and Exercise Medicine in the United Kingdom during the late 20th century and the early part of the 21st century.
The effects of sports involvement in youth
Authors: Maffulli N , Longo UG , Gougoulias N , Loppini M , Denaro V
Published: March 2011

Injury to young athletes may determine different residual symptoms, depending on the site of damage. This counters the beneficial aspects related to youth sports activities if an athlete must drop out because of the residual effects of injury. Injuries to the physis can result in limb deformities and leg length discrepancy. Articular damage may lead to the development of osteoarthritis, especially in association with high impact sport. Anterior cruciate ligament reconstructions in children are successful with modern techniques, without evidence of growth disturbances. Spine pathologies are associated more commonly with certain sports. Scant evidence is available to establish the long term results of youth sport participation. Further prospective studies are required to clarify this issue.
Growth factors and tendon healing
Authors: Oliva Francesco , Gatti Stefano , Porcellini Giuseppe , Forsyth Nicholas R , Maffulli Nicola
Published: March 2011

Recent attention has focused on the biological pathways by which tendons heal leading to the identification of some growth factors (GFs) with involvement in this process. No studies have been published on the time course of the various GFs during tendon healing process in vivo, in humans. We review what is known about these GFs and their role in tendon healing.
Education in Sports Medicine
Authors: Hureibi KA , Mclatchie GR
Published: March 2011

One of the innovative developments in Sports Medicine education has been the establishment of medical student options in Sport and Exercise Medicine. The first such option to attend the Department of Sports Medicine at the General Hospital, Hartlepool and the University of Sunderland took place in January and February of 1997 when twelve medical students were attached to the units for a seven week period. During this time they received formal lectures, clinical teaching, laboratory assessment of fitness, workshops on sports psychology, interpretation of X-rays and workshops on resuscitation and life support.

The subsequent introduction of Modernising Medical Careers by the Department of Health has made the undergraduate experience more significant in contributing to career decisions.

In the past, clinical education was almost exclusively provided in hospital but there is now much more emphasis on learning in ambulatory settings. Day surgery units can provide the students with better learning opportunities compared to hospital in-patients. It was in the day surgery unit that the students learned basic clinical skills such as suture techniques which could then be transferred to injuries in the field of play. As part of the practical aspects of Sports Medicine the students accompanied medical officers to rugby and football teams. They were particularly privileged to attend Premiership matches in both rugby and football and gain on-field expertise.

As part of the option, students in the 4th year of medicine were required to undertake a project which they selected themselves. The projects were presented to their teachers at the University Hospital of Hartlepool and at the University of Newcastle. Three of the projects are listed below and are available online at www.smj.org.uk .
Football injuries in women: a literature review
Authors: Brocklebank V , McLatchie G R
Published: March 2011

Football is a popular sport and it is estimated that women make up 22% of the 200 million players worldwide. The rate of injuries seen in women's football is similar to that in men's; ankle sprains making up most of the injuries in both sexes. However, there are some important sex specific injury patterns; in particular women are more likely to sustain an anterior cruciate ligament injury than men. Since this is an injury with major short term and long term implications the factors that might be responsible for the gender disparities have received attention. These include anatomical differences such as Q angle, neuromuscular characteristics (muscle imbalance), joint laxity and proprioception, and hormonal influences. Despite intense research fundamental questions remain unanswered so that, as yet, appropriately focussed measures to reduce the incidence of ACL injuries in women cannot be taken.
Successful use of Memantine in the treatment of severe phantom limb pain: case report and literature review
Authors: Neil MJE , Dale MC , Gillespie G
Published: March 2011

Phantom limb pain is a common and difficult neuropathic pain problem following limb amputation. Widespread pathophysiological processes in the central and peripheral nervous system have been implicated with the NMDA receptor likely to play a key role in the process. Conventional anti-neuropathic treatment with tricyclic antidepressants, anticonvulsants and ketamine are often either ineffective or cause unacceptable side-effects. Memantine is a clinically well tolerated NMDA receptor antagonist, licensed for use in Alzheimers dementia, that may offer a further therapeutic option when used early in the development of the condition. We describe the succesful use of memantine in the treatment of phantom limb pain to allow discontinuation of opioids with no side-effects.
Empysematous Cystitis: An unusual cause of haematuria
Authors: Oduyoye Olusegun , Ferrando Lucas , Norris Carol
Published: March 2011

Emphysematous cystitis is a rare disease entity caused by gas forming bacteria. Its clinical presentation can be non-specific; hence a high index of suspicion is needed in susceptible population. We report the case of a 93yr old male who presented with haematuria, fever and chills who was found to have Emphysematous cystitis.
Extracranial internal carotid artery aneurysm presenting with dysphagia and dysphonia
Authors: Nusrath M A , Mishra S , Paterson A W , Robson A K
Published: March 2011

Extra cranial aneurysms of the internal carotid artery are extremely rare. We report a case of an extracranial internal carotid aneurysm in a 71 year old lady who presented with a right parapharyngeal mass with longstanding symptoms of dysphagia and dysphonia. The importance of MRI/CT to establish a radiological diagnosis before fine needle aspiration cytology or open biopsy of such masses is highlighted.
Brugada Syndrome and Brugada ECG Pattern: Unusual Causes of ST Elevation
Authors: Ley S , Cameron A
Published: March 2011

Brugada Syndrome is a channelopathy that leads to ST elevation or right bundle branch block pattern in the right ventricular leads on ECG analysis and predisposes to ventricular tachyarrhythmias and sudden death. The ECG pattern can also be drug induced with several agents. This case describes a patient who presented after a mixed overdose of amitriptyline, olanzapine and alimemazine with ST elevation and T wave inversion on his ECG that were initially thought to be due to an Acute Coronary Syndrome.