bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer Waiting Times: What is the Value of a Lymphoma Waiting Time?
Authors: Savage Sah , Wotherspoon HA , Pentland D , Fitzsimons EJ
Published: March 2011

Background and Aim

Waiting times for patients with lymphoma have been reported across the United Kingdom since 2005. Lymphoma however, is not a single disease but a wide spectrum of lymphoid tumours that range from the most malignant to the most indolent, from highly curable to incurable. We now question the value of the current system that reports lymphoma waiting time on a quarterly basis and makes no allowance for the different types of lymphoma.

Method

Four hundred and sixty nine cases of lymphoma were registered in the west of Scotland in 2004. Complete datasets were available on 428. Patient demographic data, subtypes of lymphoma, biopsy site and referral urgency data were linked to the waiting times analysis for 2004 for the three major lymphoma subtypes, Hodgkin Lymphoma (HL), Diffuse Large B Cell (DLBC) and follicular Non Hodgkin Lymphoma (NHL).

Results

Patients with HL were younger, more likely to receive urgent referral and have a diagnosis made from neck node biopsy than the other two groups. Patients with DLBC NHL however had the shortest interval between presentation and the start of treatment and were subsequently more likely to receive treatment within 62 days than patients with either follicular NHL (p<0.001) or HL (p<0.05).

Conclusion

Lymphoma subtype is a major factor determining the rate of progress from presentation to the start of treatment, hence the waiting time.
Lipoma arborescens masquerading as popliteal aneurysm; a case report
Authors: Chopra R , Dussa CU , Morgan G , Al-Mokhtar N
Published: March 2011

Lipoma arborescens is an uncommon pseudo tumoral synovial lesion commonly affecting the knee joint. We report a case of Lipoma arborescens with an unusual presentation mimicking leaky popliteal artery aneurysm.
Pulmonary Stenosis due to Right Ventricular Outflow Tract Metastasis from a Uterine Sarcoma
Authors: Kholeif MA. , Qubbany AW. , Mando MT. , Satti MB.
Published: March 2011

A 50 year-old woman presented with dyspnoea and symptoms and signs of systemic venous congestion. Examination revealed murmur of pulmonary stenosis. Echo-Doppler, CT scanning and Magnetic Resonance Imaging showed a large right ventricular tumour obstructing the right ventricular outflow tract. She had a hysterectomy for menorrhagia 9 years previously, and resection of a lump involving the right trapezius a month prior to her deterioration. Pathology demonstrated low-grade endometrial stromal sarcoma. She deteriorated acutely in hospital due to pulmonary embolism from superimposed thrombosis. Anticoagulation, followed by radiotherapy resulted in marked clinical improvement. Two years later, the patient remains well. Cardiac metastasis from ESS is rare. Diagnosis is established by echocardiography, CT and cardiac MRI, which allow structural and functional evaluation of the tumour. MRI seems to be the most useful modality. Treatment is palliative or curative resection. This is the first case report of cardiac ESS showing good response and prolonged survival after radiotherapy. Prophylactic anticoagulation should be considered as pulmonary embolism can cause marked deterioration.
Prolonged Ventilation in Thyroid Storm
Authors: Wake D J , Lamb J V , Babu N , Campbell IW
Published: March 2011

Thyroid storm (crisis) is uncommon but may be life threatening and is recognised by an exaggeration of the clinical features of thyrotoxicosis. Proximal myopathy is a well recognised presenting feature of Graves disease. Respiratory muscle weakness may also commonly occur in thyrotoxicosis but is often undiagnosed. We report a case of thyroid storm with rapid atrial fibrillation, severe agitation and extreme widespread muscle weakness. The respiratory muscles were so compromised that a respiratory arrest occurred. Ventilation was required for 7 weeks until full recovery occurred.
Hormone Replacement Therapy (HRT) or Etidronate for Osteoporosis in Postmenopausal Asthmatics on Glucocorticoids: a Randomised Factorial Trial
Authors: Campbell IA , Douglas JG , Francis RM , Prescott RJ , Reid DM
Published: March 2011

Introduction

The study was designed to establish the effects of HRT on osteoporosis and fractures over five years in postmenopausal women with asthma receiving regular glucocorticoids and to compare with etidronate.

Methods

Postmenopausal patients receiving inhaled and/or oral glucocorticoids were randomly assigned to HRT, cyclical etidronate, HRT plus cyclical etidronate or no treatment for five years. The trial was multi-centre and aimed to recruit 750 patients. Outcomes were fractures and changes in bone mineral density (BMD).

Results

For reasons detailed in the discussion section of the text, only 50 patients were entered. Three did not fulfil the eligibility criteria and were excluded from the analysis. Among the remaining 47 patients, three (6%) experienced new, symptomatic fractures, one on etidronate and two in the no treatment group. New or worsening morphometric fractures of the thoracolumbar spine occurred in 50% of the 22 patients with spinal radiographs on entry and at five years (one HRT, three etidronate, two HRT plus etidronate and five on no treatment). BMD improved by approximately 1% per annum in those receiving HRT and/or etidronate; comparisons of HRT vs no HRT tended to favour HRT but were only statistically significant at proximal femur. The same trends emerged in the etidronate vs no etidronate comparison, but none reached the 5% level of statistical significance.

Discussion

For postmenopausal patients receiving glucocorticoids for asthma, HRT appears as effective as etidronate in preventing loss of BMD over five years and may have a similar effect on fracture prevention.
Weight Changes Following Lower Limb Arthroplasty: a Prospective Observational Study
Authors: Abu-Rajab RB , Findlay H , Young D , Jones B , Ingram R
Published: March 2011

The aim of this study was to assess patterns of weight loss/gain following total hip or knee joint replacement.

Four hundred and fifty primary lower limb arthroplasty patients, where the current surgery was the last limiting factor to improved mobility, were selected.

Over a one year period 212 gained weight (mean 5.03kg), 92 remained static, and 146 lost weight. The median change was a weight gain of 0.50Kg (p=0.002). All patients had a significant improvement in Oxford outcome scores. Hip arthroplasty patients were statistically more likely to gain weight than knee arthroplasty patients.

A successful arthroplasty, restoring a patient's mobility, does not necessarily lead to subsequent weight loss. The majority of patients put on weight with an overall net weight gain. No adverse effect on functional outcome was noted.
Evaluation of the Effect of Local Corticosteroid Injection and Anti-inflammatory Medication in Carpal Tunnel Syndrome
Authors: Gurcay E , Unlu E , Gurcay AG , Tuncay R , Cakci A
Published: March 2011

Background and Aims

To evaluate the effect of local corticosteroid injection versus non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of carpal tunnel syndrome (CTS), 32 patients were included in this study.

Methods

A prospective, randomised clinical trial, assessing functional findings by Functional Status Scale (FSS), Jebsen Taylor Test (JTT) and electrophysiologic examinations, analysed on initial visit and at the third month after treatment. Group A was treated with betamethasone injection and group B with NSAIDs, both with concomitant use of wrist splints.

Results

The mean age of the patients was 40.8±11.2 (range 21–64) years. There was a significant improvement in FSS in groups A and B at the third month. In JTT, ‘writing’, ‘picking up small common objects’ and ‘picking up large heavy objects’ activities were improved in group A; ‘writing’ and ‘stacking checkers’ activities were improved in group B. Statistically significant improvement was observed in peak sensory conduction velocity and distal motor latency in groups A and B. Mixed nerve conduction velocity and compound sensory action potential were improved in group A.

Conclusions

The results showed that neither of the groups demonstrated superior results. We conclude that local steroid injection and NSAIDs with concomitant use of wrist splints may offer patients with CTS variable and effective treatment options for the management of functional scores and nerve conduction parameters.
Non Hodgkin's lymphoma presenting with bone pain and no lymphadenopathy
Authors: Nelson F , McKay GA
Published: March 2011

A 40-year-old female who was an ex-intravenous drug user on methadone presented to the Emergency department reporting all over body pain and was subsequently found to have a diagnosis of non-Hodgkin's B cell lymphoma in the absence of lymphadenopathy. She did not respond to chemotherapy and pain management was difficult. This case demonstrates three things. Firstly, clinicians should be aware that ex- or current intravenous drug users presenting with pain may have significant pathology. Secondly, pain management in patients on methadone can be difficult. Lastly, the case describes an atypical but recognised presentation of lymphoma with bone involvement but no lymphadenopathy.
Fatal acute fulminant hepatic failure caused by parenteral amiodarone: A case report and review of the literature
Authors: Murphy BP , Coldeway J , Raeside DA
Published: March 2011

Parenteral amiodarone is used frequently in acutely ill patients, but it can be associated with hepatotoxicity. We present a case of fatal fulminant hepatic failure attributable to intravenous amiodarone. We review the literature and explore possible reasons for the severe reaction seen in our patient.
A Comparison of Rural and Urban Rheumatoid Arthritis Populations
Authors: Basu N , Steven M
Published: March 2011

Introduction

There is evidence to suggest that remote populations have poorer clinical outcomes in certain disease processes such as asthma and cancer. This study looks to identify any disparities in the management of patients with rheumatoid arthritis in the context of rurality.

Methods

A retrospective observational study was performed on all 1314 patients with a diagnosis of rheumatoid arthritis who have been under the care of the principal rheumatologist at Raigmore Hospital, Inverness, between the years 1994 and 2004 inclusive. Rurality was defined according to the Scottish Household Survey. Populations were assessed in terms of age; sex; duration of diagnosis; number of years of Disease Modifying Anti-Rheumatic Drugs (DMARD) therapy, prednisolone use and the number of musculoskeletal practical interventions undertaken (eg joint aspiration or replacement).

Results

Two thirds of patients were considered rural dwellers. No significant difference was established between the populations with regards to management. DMARD therapy had been prescribed in 77% of rural patients vs 70% of their city counterparts for a mean 5.4 and 4.0 years respectively. The proportion of patients exposed to prednisolone therapy and who underwent musculoskeletal procedures were equivalent.

Conclusions

Rural dwellers, with rheumatoid arthritis in the Highlands of Scotland, do not appear to be disadvantaged in regards to their disease management in comparison to the urban population.
CT Scanning in Stroke Patients: Meeting the Challenge in the Remote and Rural District General Hospital
Authors: Todd AW , Anderson EM
Published: March 2011

Introduction

National audit data allow crude comparison between centres and indicate that most Scottish hospitals fail to meet current guidelines for CT scanning of the brain in stroke patients. This study identifies some of the reasons for delay in performing CT scans in a largely rural population.

Methods

This audit study assesses the delays from onset of symptoms, time of admission and request received to CT scan in stroke patients for three different in-patient groups as well as those managed in the community.

Results

The reasons for delay in CT scanning varied between different patient groups but for one group of in-patients, changes in booking procedure and introduction of a second CT scanner increased the proportion scanned within 48 hours of request from 65% to 96%.

Discussion

Further developments including the introduction of Saturday and Sunday routine CT scanning, radiologist reporting from home and additional CT scanners placed in remote hospitals may be expected to improve these figures further. Target times of three hours from onset of symptoms to scan to allow thrombolysis may however be impossible to meet for all stroke patients in rural areas.
The Risk of Malignancy Index for Ovarian Tumours in Northeast Scotland – a Population Based Study
Authors: Harry VN , Narayansingh GV , Parkin DE
Published: March 2011

Background and Aims

The Scottish Intercollegiate Guidelines Network (SIGN) recommends the use of the Risk of Malignancy Index (RMI) for ovarian tumours, a scoring system based on ultrasound findings, menopausal status and CA 125 level, in the pre-operative evaluation of pelvic masses. The aim of this study was to investigate the accuracy of this as a predictive method of discriminating benign from malignant disease.

Methods and Results

All women who underwent oophorectomy in 2004 at Aberdeen Royal Infirmary for suspected primary ovarian pathology were evaluated. The RMI was calculated and these results were compared with the final histopathology. The sensitivity of the RMI for diagnosing malignant ovarian disease was 94% (32/34) while the specificity was 70% (76/108).

Conclusions

Compared to previous studies, the RMI score was highly sensitive in detecting malignant disease, although not as specific in excluding benign lesions, particularly cystadenomas and endometriomas. This can be improved by the refinement of imaging techniques as well as the use of laparoscopy in particular cases. The RMI score may also be especially valuable in directing referrals to a specialised centre.
Neonatal Head Injuries Revisited
Authors: King J , Haddock G
Published: March 2011

Background

Between 1999 and 2005, 51 neonates were admitted to the regional Neonatal Surgical Unit (NSU), Glasgow with a diagnosis of head injury. The aim of this retrospective study was to compare this cohort with those from an earlier review of similar cases.

Methods and Results

Cases were reviewed using a structured data collection proforma. Information obtained was then compared with the results of an identical review carried out in the same Unit between 1990 and 1996. In the present series, the majority of the injuries were caused by a fall (n=39 [78%]) and resulted in scalp haematomata (n=31 [62%]) and associated skull fractures (n=30 [60%]). Only one patient required significant intervention.

Conclusion

Comparing the two study periods, there has been a marked increase in the number of cases admitted with a diagnosis of head injury (n=51 v n=25). There has also been an increase in the number of intracranial haemorrhages reported, associated with an increase in the number of CT scans performed. Non-accidental injury remains uncommon in this patient group. Outcome was excellent for all patients.
Neurocardiogenic syncope and narcolepsy – an unusual but important combination
Authors: Krishnan Unni , Ramrakha Punit S , Money-Kyrle Andrew
Published: March 2011

Syncope is a common presenting symptom in cardiology clinics. An accurate and detailed delineation of the history is important in arriving at the correct underlying diagnosis. Here we present an instance of syncope, which was initially diagnosed as neurocardiogenic syncope. On further assessment following persistent symptoms, this was correctly diagnosed as narcolepsy. We discuss the specific clues in the history and the diagnostic approach to this rare but important condition. We also highlight the possibility of coexisting autonomic disturbances in such cases, which may mislead the clinician if not considered carefully.
Cardiac instability due to Pneumomediastinum during second stage of labour
Authors: Rafi J , Muppala H , Schaefer B
Published: March 2011

This case reports spontaneous pneumomediastinum in the second stage of labour leading to cardiovascular instability. Forceps were used to expedite delivery. Examination revealed characteristic crepitus of subcutaneous emphysema in the neck region, which was confirmed on chest X-Ray and CT scan. The patient was managed in the high dependency unit (HDU) for 48 hours and made a full recovery.
Professional Opinions of the Use of Telemedicine in Child & Adolescent Psychiatry
Authors: Mitchell Sarah A , Maclaren Andrew T , Morton Michael , Carachi Robert
Published: March 2011

The Telemedicine project at Yorkhill Hospital, Glasgow was set up in 2004 to aid in the rapid diagnosis of children at a distant location. The Child and Adolescent Mental Health Services (CAMHS) are now the largest users. CAMHS use this service for clinical work, service development and to aid research.

Twenty four CAMHS professionals with experience of the telemedicine facility were asked to complete questionnaires outlining their opinions on the strengths and weaknesses of the facility; 19 responded. The results showed a wide variety of professionals use the facility and that clinical work makes up the majority of the use. An advantage to rural populations in Scotland was considered the most important benefit. Saving time and an improved method of communication were also highlighted as important. Failure of technology and problems with sound quality were highlighted as drawbacks. Seventy nine percent of subjects stated that they preferred Telemedicine to Telephone conferencing.

The results show the Telemedicine facility is perceived as a positive addition to CAMHS in Scotland. Therefore, its use should be encouraged in other areas of medicine and surgery.
Body Mass Index and Weight Distribution
Authors: Pengelly Cdr , Morris J
Published: March 2011

It has been accepted for many years that being overweight or obese, as indicated by a body mass index (BMI) of 25 or over for the former and 30 or over for the latter, is associated with impairment of long term health and prognosis. The World Health Organisation (WHO) has indicated that, in Caucasians, waist measurements of 94cm or more in men, and 80cm or more in women have similar adverse effects on health, with increased risks at 102 cm or more in men and 88 cm in women.

The role of waist-hip ratio (W/H) and whether it represents a better index than waist (W) measurement alone is being debated; many papers favour waist measurement alone. But two papers in 2005 discussing 27,098 subjects, 12,461 of whom had myocardial infarction and 14,637 controls, come down firmly in favour of W/H and were followed by a Lancet Editorial entitled ‘Farewell to Body Mass Index?’

Life assurance companies at medical examination usually request height and weight measurements (and therefore BMI). Most ask for waist measurements and a few hip measurements in addition (and therefore W/H).

The authors have reviewed the data in 816 consecutive subjects for life assurance examination in whom BMIs, Ws and W/Hs were all recorded. In these the evidence supports the use of W as the best indicator of risk in men (634 cases), but not in the relatively small number of women (182 cases) in whom H appeared better.

We believe that BMI, W and W/H should be recorded in every subject at life assurance examination so that the insurance companies in the long term will be able to reach valid conclusions about their individual and collective value
Consultants in Scotland: Survey of Educational Qualifications, Experience and Needs of Scottish Consultants
Authors: Schofield Sj , Nathwani D , Anderson F , Monie R , Watson M , Davis Mh
Published: March 2011

Aims

To survey Scotland's NHS consultants regarding their teaching roles; educational qualifications/training; attitudes to educational qualifications; perceptions of health boards’ attitudes to educational activities; usefulness of various educational courses and preferred delivery methods

Methods

Postal questionnaire (n=3615)

Results

Sixty two percent response rate (n=2246). 98% had one or more roles in education/training. 54% spent more time in educational roles than job-plan allocations. 6% had educational qualifications. 30% rated educational qualifications valuable to their educational role; 21% to their career. 48% had not attended any educational training. 19% of respondents rated their health board as supportive of their educational activities. Respondents rated dealing with underperforming students (74%), dealing with challenging behaviour (63%), appraising students (63%), trainee assessment (61%) and feedback (58%) as the most useful topics

Conclusions

Scottish consultant involvement in educational activities is virtually universal but consultants perceive they need more time than allocated in job plans. Most consultants had no teaching qualifications. Nearly half had no formal training for educational activities. Educational qualifications were valued by a minority regarding both career development and educational activities. Increased access to staff development for teaching is required as NHS sources are not meeting the need for teacher training of consultant staff.
Evaluation of a General Practice Based Hepatitis C Virus Screening Intervention
Authors: Anderson Em , Mandeville Rp , Hutchinson Sj , Cameron So , Mills Pr , Fox R , Ahmed S , Taylor A , Spence E , Goldberg Dj
Published: March 2011

Background

In 2003 an estimated 37,500 of Scotland's population was chronically infected with HCV; 44% were undiagnosed former injecting drug users (IDU) - a priority group for antiviral therapy

Aim

To evaluate a hepatitis C virus (HCV) screening intervention

Design

Outcome measures among two similar General Practice populations in an area of high HCV and drug use prevalence, one of which was exposed to an HCV screening intervention, were compared

Methods

Thirty to fifty four year old attendees of the intervention practice were opportunistically offered testing and counselling, where clinically appropriate, (November 2003– April 2004) Outcomes: HCV test uptake, case detection, referral and treatment administration rates.

Results

Of 584 eligible attendees, 421 (72%) were offered and 117 (28%) accepted testing in the intervention practice; no testing was undertaken in the comparison practice Prevalences of HCV antibody were 13% (15/117), 75% (3/4) and 91% (10/11) among all tested persons, current IDUs and former IDUs respectively. For 4/15 (27%) evidence of binge drinking following the receipt of their positive result, was available. Of the 11 referred to specialist care because they were HCV RNA positive, nine attended at least one appointment. Two received treatment: one had achieved a sustained viral response as of February 2008.

Conclusion

While non targeted HCV screening in the general practice setting can detect infected former IDU, the low diagnostic yield among non IDUs limited the effectiveness of the intervention. A more targeted approach for identifying former IDUs is recommended. Additionally, the low uptake of treatment among chronically infected persons four years after diagnosis demonstrates the difficulties in clinically managing such individuals. Strategies, including support for those with a history of problem alcohol use, to improve treatment uptake are required.
The Use of CT Angiography in Acute Subarachnoid Haemorrhage in Eastern Scotland
Authors: White P , Macpherson R , Sellar R
Published: March 2011

Introduction

Early confirmation of aneurysmal cause for SAH can expedite patient management and thus minimise rebleed risk. CT Angiography is the first-line method for diagnosing the cause of SAH in most UK regions. We wanted to assess the use of CTA in this context in the East of Scotland and determine how imaging delays contribute to overall delay from ictus to aneurysm treatment.

Methods

A prospective audit of aneurysmal SAH admissions over a three month period to the Neurosciences Unit in Edinburgh was performed. The time from diagnosis of SAH to aneurysm imaging with CTA and/or DSA and time from aneurysm confirmation to definitive treatment was ascertained.

Results

Twenty nine patients with aneurysmal SAH were admitted during the audit. Four patients had CTA expeditiously after SAH was diagnosed; the remaining 25 patients had a substantially greater wait for aneurysm imaging, involving transfer to a neuroscience centre. Average excess delay was 17 hours for CTA (72 hours for DSA).

Discussion

CTA is a widely available and accurate method of determining the cause of SAH. Performing immediate CTA after SAH is confirmed could reduce delays to aneurysm treatment by up to 64%. By thus reducing rebleeds post SAH, immediate CTA could reduce poor outcomes in the East of Scotland.
A Mental Health Assessment and Support Team for Community Elders in Fife (EAST)
Authors: Stevenson G , Ewing H , Keith J
Published: March 2011

Background

The aging population combined with the increased recognition of the need to assess elderly patients with mental health difficulties in their own environment encouraged service redesign in Fife with the focus on community assessment of older people with mental health needs.

Aims

To establish and assess the functioning of a joint Health and Social Services enhanced assessment and support team (EAST) for community-dwelling elders with significant mental health needs living in a Scottish health region, and to determine the impact of this team on the requirement for acute psychogeriatric hospital services.

Methods

Prospective three-year data collection of service activity involving EAST and the local psychogeriatric acute inpatient and day hospital facilities.

Results

EAST assessed 111 patients during the study, 83% with a diagnosis of dementia. The mean duration of assessment was six weeks with 9% of patients receiving an overnight home assessment and 6% requiring hospital admission. Overall there was a substantial reduction in utilization of both acute psychogeriatric admission beds and day hospital placements.

Conclusions

Multi-agency community assessment of elders with mental health problems can be addressed effectively without recourse to hospital admission, which may allow resource release for further service developments.
Castleman's Disease of the Parotid Gland: A Case Report
Authors: Lee Yong Sang , Hong Soon Won , Lee Seung Chul , Nam Kee-Hyun , Chung Woong Youn , Chang Hang Seok , Park Cheong Soo
Published: March 2011

Castleman's disease is a lymphoproliferative disorder of unknown etiology. Although it may occur at any site where lymph nodes are located, it has rarely been found in the salivary glands.

We describe here a patient with intraparotid Castleman's disease. A 29-year-old woman presented with a history of right cheek swelling for 2 months. Physical examination and computed tomography showed a well-demarcated, round-shaped, homogeneous, enhancing mass in the right parotid gland that seemed to involve the superficial lobe. A right superficial parotidectomy was performed, during which the facial nerve was well preserved. Final pathological report demonstrated intraparotid lymph node showing hyperplasia with Castleman's disease. At 5-year follow up, the patient is free of disease.
Clinical Audit: Management of Acute Severe Asthma in West Glasgow
Authors: Bayes Hk , Oyeniran O , Shepherd M , Walters M
Published: March 2011

Background

The UK has 75,000 hospital admissions and over 1,500 deaths from asthma annually. The British Thoracic Society (BTS) guidelines represent the recognised standard for acute asthma management. We assessed the degree of conformity with these guidelines in an acute medical unit.

Methodology

Data from consecutive admissions were collected prospectively. Practice was audited in October -December 2005 and October 2006 - January 2007. Between cycles an educational programme was instigated.

Results

Fifty-eight patients were included. Clinical parameters were well recorded in both cycles. Peak expiratory flow was consistently under-recorded (72% at admission; 67% in monitoring). Severity assessment was documented at 55% and 66% in cycle one and two respectively. Of these, the assessment was incorrect in 33% in cycle one and 21% in cycle two. All misclassifications of severity were underestimates. All life-threatening attacks were not identified. No improvement occurred between cycles. Overall, 60% of patients were inappropriately treated according to BTS guidelines, 40% due to under-treatment. Under-treatment occurred more frequently in cycle two compared with cycle one (57% vs. 24%, p=0.007), predominantly due to inadequate treatment of life-threatening asthma.

Conclusion

Management of acute asthma in a large, urban teaching hospital is suboptimal. Educational intervention failed to improve care; more comprehensive strategies are required.
Drugs in Sport
Authors: Munby J
Published: March 2011

This paper briefly reviews the misuse of some drugs and medicines by some individuals seeking an advantage in competitive sports. Probably the most abused class of substances is the anabolic androgenic steroids, much employed by competitive athletes and body builders, but also widely used by individuals in gymnasia, where the motivation is essentially to improve perceived body image. The clinician's job may be seen as minimising risk to consumers of such drugs and medicines, but access to users is inevitably incomplete because of the dubious legality of all such misuse.
Femoroacetabular Impingement
Authors: Hussain SM , Paton D , Shah K , Patil S
Published: March 2011

Femoroacetabular impingement has been proposed as one of the causes leading to osteoarthritis of the hip. Features are mostly seen in young active individuals. Two morphological types, cam and pincer have been identified. Prompt clinical and radiological examination with appropriate surgical intervention can alleviate the symptoms and delay the degenerative changes associated with this condition.
An overview of common lower extremity soft tissue injuries in athletes
Authors: Lakkol S , Singisetti K , Anand S
Published: March 2011

Lower limb soft tissue injuries are commonly encountered in sports medicine especially in athletes and long distance runners. Dilemmas can exist in identifying the correct aetiology as it can frequently be multifactorial. Management of such injuries in lower limbs is evolving as more people perform physical exercise and play sport. This article is an overview of common lower limb soft tissue injuries seen in athletes.

Lower extremity soft tissue injuries are common among athletes and non-athlete runners.1 Running injuries can be defined as pain or symptoms associated with running or starting within a specific time span from the beginning of a training programme, which forces the individual to stop training or decrease intensity.2 The knee is the commonest site involved comprising up to 44% of running injuries.2,3 This article outlines the natural history, pathophysiology, investigation and management of common conditions.
A review of the prevention of head, neck and facial injuries in ice hockey
Authors: Webb MSL , McLatchie G R
Published: March 2011

Ice hockey is one of the fastest and most physical team sports. With projectiles (pucks) travelling at over 100mph and players travelling at up to 30mph wielding sticks and skating on razor sharp blades, there is potential for significant injury.

In 1961, an insurance survey reported over 100 closed head injuries, with one death. This led to research into helmets and subsequent mandatory use.

Facial protection was first developed in 1972 initially for goalkeepers. By 1976 all amateur players were required to wear full facial protection.
Torted caecal appendix epiploica mimicking acute appendicitis in childhood
Authors: Jackson CR , Hosie GP
Published: March 2011

We describe a case of a torted caecal appendix epiploica causing acute abdominal pain. This entity has not been described in children. This case also illustrates the use of laparoscopy in the diagnosis and management of acute abdominal pain in childhood
Pseudotumour Cerebri associated with Disodium Pamidronate
Authors: Hrabovsky MR , Ang Ghee Soon , Whyte I F
Published: March 2011

Pseudotumour cerebri has been associated with a number of systemic agents including Vitamin A and tetracycline. To our knowledge, there have been no reported cases caused by Disodium Palmidornate. We report a case of Disodium Palmidronate induced pseudotumour cerebri, confirmed with rechallenge and resulting in significant visual consequences
CT Guided Lung Biopsies: An Audit Cycle
Authors: Saraswat L , Azmat O , Shannon H.
Published: March 2011

Aim

To re-audit the practice of CT guided lung biopsies

Standard

British Thoracic Society guidelines

Methods

The present audit of CT guided lung biopsies has been undertaken to assess if changes in practice instituted following an initial audit in 2003/2004 has improved the diagnostic yield and impacted on the complication rate.

Results

97 biopsies were carried out in 90 patients. The overall diagnostic rate was 85.6 % (66 true positive and 17 true negatives). There were 14 (14.4%) false negatives. 28 (28.9%) patients developed a pneumothorax and 6 patients (6.2%) required insertion of chest drain.

Conclusion

The overall diagnostic rate is within the BTS standard and is higher than the previous audit (85.6 % compared to 81 % in the previous audit). The number of biopsies performed has increased significantly. The complication rate for pneumothorax is higher than the BTS standard. The technique of biopsy has also changed with most biopsies now being core biopsies rather than fine needle aspiration (FNA).
Use of hand-held echocardiography to facilitate the management of cardiac disease in older people
Authors: Sumukadas Deepa , Witham Miles D , Gillespie Neil D
Published: March 2011

Access to echocardiography remains suboptimal for many older patients; hand-held echocardiography may improve access to this investigation. New methods of service provision may, however, not always result in appropriate use by clinicians. The aim of this study was to test whether the provision of handheld echocardiography in a geriatric medicine service results in appropriate requests and changes in patient management. The methodology involved in this, was a prospective study of 100 patients referred for hand-held echocardiography in a geriatric medicine service. Information on reason for request, time from request to study, medical history, echocardiography history and medication were collected. Clinicians were asked how results had changed management 7–14 days after the investigation. The mean age of participating patients was 82.6 years. Echo requests were deemed appropriate in 93% of cases. Median time from request to echo was three days for inpatients and 14 days for outpatients. Fifty percent (50/100) of echos led to a change in cardiovascular management; a total of 75 separate changes in cardiovascular management resulted. Seventy-six percent of changes were deemed appropriate; 10% inappropriate and insufficient information was present for 14% of decisions. Provision of hand-held echocardiography allowed rapid investigation of patients for selected abnormalities. Requests were appropriate and appropriate changes to patient management occurred in most patients.
How are surgical theatres in rural Africa utilized? A review of five years of services at a district hospital in Ghana
Authors: Damien P , Nabare C , Baiden F , Kwara E , Apanga S , Etego-Amengo S
Published: March 2011

Although the extent of the unmet need for surgeries is well-known, little is known about the surgery performed in district hospitals in sub-Saharan Africa. We review five years of utilization of theatre services at the Kintampo Hospital in rural Ghana. The source of data was the theatre logbook and other hospital records for the period 2005–2009. During this time, 1391 surgeries were performed in the theatre. This approximates a rate of 250/100,000 population. Fifty-two percent were performed in patients aged 18–35 years. The most frequently performed surgeries were: caesarean sections (46%); hernia repair (41%); and other laparotomies (10%). The major indications were cephalopelvic disproportion, right inguinal hernia and typhoid perforation, respectively. Typhoid perforation was the main indication for surgery in children aged less than 10 years. The potential for an expansion of the scope of services should be explored in order to improve access to essential surgery for this population.
Donor Cell–Derived Leukemias/Myelodysplastic Neoplasms in Allogeneic Hematopoietic Stem Cell Transplant Recipients
Authors: Wang Endi , Hutchinson Charles Blake , Huang Qin , Lu Chuanyi Mark , Crow Jennifer , Wang Frances F. , Sebastian Siby , Rehder Catherine , Lagoo Anand , Horwitz Mitchell , Rizzieri David , Yu Jingwei , Goodman Barbara , Datto Michael , Buckley Patrick
Published: March 2011

We report 10 cases of donor cell leukemia (DCL). All cases except the case of chronic lymphocytic leukemia had anemia, neutropenia, and/or thrombocytopenia when DCL was diagnosed. Eight cases with sex-mismatched hematopoietic stem cell transplant (HCT) showed donor gonosomal complements, suggesting DCL. Clonal cytogenetic abnormalities were detected in 8 cases: 6 were monosomy 7/del(7q). In all 10 cases, engraftment studies confirmed donor cell origin. Retrospective fluorescence in situ hybridization in archived donor cells in 4 cases showed a low level of abnormalities in 2. Of 7 patients with clinical follow-up of 5 months or more, 1 (with acute myeloid leukemia) died of disease; 6 are alive, including 1 with myelodysplastic syndrome with spontaneous remission. Similar to reported cases, we found disproportional sex-mismatched HCTs, suggesting probable underdetection of DCL in sex-matched HCTs. The latency between HCT and DCL ranged from 1 to 193 months (median, 24 months), in keeping with the literature. Analyzing our cases, pooled with reported cases, with survival models showed much shorter latency for malignancy as primary disease, for T-cell large granular lymphocyte leukemia as type of DCL, and for umbilical cord blood as stem cell source.
Removal of Synaptic Ca2+-Permeable AMPA Receptors during Sleep
Authors: Lanté Fabien , Toledo-Salas Juan-Carlos , Ondrejcak Tomas , Rowan Michael J. , Ulrich Daniel
Published: March 2011

There is accumulating evidence that sleep contributes to memory formation and learning, but the underlying cellular mechanisms are incompletely understood. To investigate the impact of sleep on excitatory synaptic transmission, we obtained whole-cell patch-clamp recordings from layer V pyramidal neurons in acute slices of somatosensory cortex of juvenile rats (postnatal days 21–25). In animals after the dark period, philanthotoxin 74 (PhTx)-sensitive calcium-permeable AMPA receptors (CP-AMPARs) accounted for ∼25% of total EPSP size, and current–voltage (I–V) relationships of the underlying EPSCs showed inward rectification. In contrast, in similar experiments after the light period, EPSPs were PhTx insensitive with linearI–Vcharacteristics, indicating that CP-AMPARs were less abundant. Combined EEG and EMG recordings confirmed that slow-wave sleep-associated delta wave power peaked at the onset of the more quiescent, lights-on phase of the cycle. Subsequently, we show that burst firing, a characteristic action potential discharge mode of layer V pyramidal neurons during slow-wave sleep has a dual impact on synaptic AMPA receptor composition: repetitive burst firing without synaptic stimulation eliminated CP-AMPARs by activating serine/threonine phosphatases. Additionally, repetitive burst-firing paired with EPSPs led to input-specific long-term depression (LTD), affecting Ca2+impermeable AMPARs via protein kinase C signaling. In agreement with two parallel mechanisms, simple bursts were ineffective after the light period but paired bursts induced robust LTD. In contrast, incremental LTD was generated by both conditioning protocols after the dark cycle. Together, our results demonstrate qualitative changes at neocortical glutamatergic synapses that can be induced by discharge patterns characteristic of non-rapid eye movement sleep.
Axon Regeneration Can Facilitate or Suppress Hindlimb Function after Olfactory Ensheathing Glia Transplantation
Authors: Takeoka Aya , Jindrich Devin L. , Muñoz-Quiles Cintia , Zhong Hui , van den Brand Rubia , Pham Daniel L. , Ziegler Matthias D. , Ramón-Cueto Almudena , Roy Roland R. , Edgerton V. Reggie , Phelps Patricia E.
Published: March 2011

Reports based primarily on anatomical evidence suggest that olfactory ensheathing glia (OEG) transplantation promotes axon regeneration across a complete spinal cord transection in adult rats. Based on functional, electrophysiological, and anatomical assessments, we found that OEG promoted axon regeneration across a complete spinal cord transection and that this regeneration altered motor responses over time. At 7 months after transection, 70% of OEG-treated rats showed motor-evoked potentials in hindlimb muscles after transcranial electric stimulation. Furthermore, a complete spinal cord retransection performed 8 months after injury demonstrated that this axon regeneration suppressed locomotor performance and decreased the hypersensitive hindlimb withdrawal response to mechanical stimulation. OEG transplantation alone promoted reorganization of lumbosacral locomotor networks and, when combined with long-term training, enhanced some stepping measures. These novel findings demonstrate that OEG promote regeneration of mature axons across a complete transection and reorganization of spinal circuitry, both of which contribute to sensorimotor function.
Aversive Stimuli Alter Ventral Tegmental Area Dopamine Neuron Activity via a Common Action in the Ventral Hippocampus
Authors: Valenti Ornella , Lodge Daniel J. , Grace Anthony A.
Published: March 2011

Stress is a physiological, adaptive response to changes in the environment, but can also lead to pathological alterations, such as relapse in psychiatric disorders and drug abuse. Evidence demonstrates that the dopamine (DA) system plays a role in stress; however, the nature of the effects of sustained stressors on DA neuron physiology has not been adequately addressed. By using a combined electrophysiological, immunohistochemical and behavioral approach, we examined the response of ventral tegmental area DA neurons in rats to acute as well as repeated stressful events using noxious (footshock) and psychological (restraint) stress. We found that aversive stimuli induced a pronounced activation of the DA system both electrophysiologically (population activity; i.e., number of DA neurons firing spontaneously) and behaviorally (response to psychostimulants). Moreover, infusion of TTX into the ventral hippocampus (vHPC) reversed both behavioral and electrophysiological effects of stress, indicating that the hyperdopaminergic condition associated with stress is driven by hyperactivity within the vHPC. Therefore, the stress-induced activation of the DA system may underlie the propensity of stress to exacerbate psychotic disorders or predispose an individual to drug-seeking behavior. Furthermore, the vHPC represents a critical link between context-dependent DA sensitization, stress-induced potentiation of amphetamine responsivity, and the increase in DA associated with stressors.
Aging and a Peripheral Immune Challenge Interact to Reduce Mature Brain-Derived Neurotrophic Factor and Activation of TrkB, PLCγ1, and ERK in Hippocampal Synaptoneurosomes
Authors: Cortese Giuseppe P. , Barrientos Ruth M. , Maier Steven F. , Patterson Susan L.
Published: March 2011

For reasons that are not well understood, aging significantly increases brain vulnerability to challenging life events. High-functioning older individuals often experience significant cognitive decline after an inflammatory event such as surgery, infection, or injury. We have modeled this phenomenon in rodents and have previously reported that a peripheral immune challenge (intraperitoneal injection of liveEscherichia coli) selectively disrupts consolidation of hippocampus-dependent memory in aged (24-month-old), but not young (3-month-old), F344xBN rats. More recently, we have demonstrated that this infection-evoked memory deficit is mirrored by a selective deficit in long-lasting synaptic plasticity in the hippocampus. Interestingly, these deficits occur in forms of long-term memory and synaptic plasticity known to be strongly dependent on brain-derived neurotrophic factor (BDNF). Here, we begin to test the hypothesis that the combination of aging and an infection might disrupt production or processing of BDNF protein in the hippocampus, decreasing the availability of BDNF for plasticity-related processes at synaptic sites. We find that mature BDNF is markedly reduced in Western blots of hippocampal synaptoneurosomes prepared from aged animals following infection. This reduction is blocked by intra-cisterna magna administration of the anti-inflammatory cytokine IL-1Ra (interleukin 1-specific receptor antagonist). Levels of the pan-neurotrophin receptor p75NTRand the BDNF receptor TrkB (tropomyosin receptor kinase B) are not significantly altered in these synaptoneurosomes, but phosphorylation of TrkB and downstream activation of PLCγ1 (phospholipase Cγ1) and ERK (extracellular response kinase) are attenuated—observations consistent with reduced availability of mature BDNF to activate TrkB signaling. These data suggest that inflammation-evoked reductions in BDNF at synapses might contribute to inflammation-evoked disruptions in long-term memory and synaptic plasticity in aging.
Evaluation of bovine zona pellucida characteristics in polarized light as a prognostic marker for embryonic developmental potential
Authors: Koester M , Mohammadi-Sangcheshmeh A , Montag M , Rings F , Schimming T , Tesfaye D , Schellander K , Hoelker M
Published: March 2011

It has previously been demonstrated that zona pellucida imaging of human oocytes using polarized light microscopy is a clinically applicable method for the noninvasive assessment of oocyte quality. This study was designed to investigate whether zona pellucida characteristics of bovine oocytes and zygotes in polarized light may similarly serve as a useful marker for developmental competence in bovine reproductive biotechnologies. Zona birefringence intensity parameters of 2862 oocytes/zygotes were objectively evaluated with an automatic analysis system and correlated with oocyte/zygote quality. In detail, immature oocytes of good quality assessed with brilliant cresyl blue staining showed significantly lower zona birefringence than poor-quality counterparts (P<0.001). Afterin vitromaturation and classification according to maturational status, the birefringence intensity parameters were significantly different in those oocytes that reached metaphase II compared with arrested stages (P<0.001). Following either parthenogenetic activation or IVF with subsequentin vitroculture in a well-of-the-well system until day 9, superior development as determined by cleavage, blastocyst formation, and hatching ability was associated with lower zona birefringence intensity parameters. When early zygote-stage embryos were selected and assorted in groups based on zona birefringence (high/medium/low), the group of embryos derived from high-birefringence zygotes displayed a significantly compromised developmental potential compared with low-birefringence zygotes. These results clearly show that developmentally competent bovine oocytes/zygotes exhibit lower zona birefringence intensity parameters. Therefore, birefringence imaging of zona pellucida is a suitable technique to predict bovine preimplantation embryo development.