bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute fulminant neuropathy in a patient with Churg – Strauss syndrome
Authors: Ng K K P , Yeung H M , Loo K T , Chan H M , Wong C K , Li P C K
Published: December 2008

We report a patient with an acute neuropathy initially mimicking Guillain-Barré syndrome, both clinically and electrophysiologically. Persistent eosinophilia, positive antineutrophil cytoplasmic antibody and eosinophilic vasculitis in sural nerve biopsy later confirmed Churg-Strauss syndrome. Since vasculitic neuropathy can present in an acute and fulminant form, the role of early antibody testing and sural nerve biopsy in atypical cases of acute neuropathy is emphasized.
Anticoagulants for venous thrombosis
Authors: Toh C H
Published: December 2008

The anticoagulant agents heparin and warfarin were introduced before the era of randomised clinical trials. As a result, the indications, dosages and monitoring techniques of these drugs have undergone re-evaluation in multiple clinical trials in the past years. Low molecular weight heparin has been developed, which has led to new approaches in anticoagulant management. Current levels of laboratory, pharmacology and clinical knowledge in the treatment of venous thromboembolism are discussed.
The prevalence of Addison's disease in Coventry, UK
Authors: Willis A C , Vince F P
Published: December 2008

The prevalence of Addison's disease (chronic adrenal failure) has not been widely investigated and is usually given as 39 in a million. We conducted a prevalence study using a postal survey of general practitioners in Coventry. Three quarters (139/188) replied, representing 79/85 (93%) of the practices. Thirty cases of Addision's disease were found from a total patient list of 323852, of which a third were tuberculous in origin and two-thirds non-tuberculous (12/30 autoimmune, 8/30 unclassified). We conclude that Addison's disease is 2.4 times more common than previously reported. The tuberculous group was older, 65 vs 52 years (p < 0.05), and had had the disease for longer than the non-tuberculous group, 20 vs 12 years (p < 0.05). There was no significant difference in the age at diagnosis.
Respiratory arrest during dipyridamole stress testing
Authors: Hillis G S , Al-Mohammad A , Jennings K P
Published: December 2008

There is an increasing usage of radionuclide scanning to assess myocardial perfusion, with dipyridamole, the most commonly used stress agent. Although this is an effective, and usually very safe, means by which to assess myocardial blood supply, there have been several incidents of acute bronchospasm in asthmatic patients. There have, however, been no previous reports of respiratory arrest occurring in patients with emphysema. This case illustrates the dangers of administering intravenous dipyridamole, or even adenosine, to patients with chronic lung disease.
Complete gastric outlet obstruction following acid ingestion complicated by acute pancreatitis and disseminated intravascular coagulation
Authors: Ahmed Z , Mohyuddin Z
Published: December 2008

A case is described where accidental acid ingestion resulted in the development of oesophageal stricture and complete gastric outlet obstruction. Following a smoothly conducted pre-surgery endoscopic examination the patient developed acute pancreatitis, which, on initial clinical examination, was diagnosed as a viscus perforation. The severity of pancreatitis was such as to lead to disseminated intravascular coagulopathy and ultimately death. The interest lies in the fact that pancreatitis was precipitated in a previously traumatised stomach by such an innocuous procedure as fibre-optic endoscopy.
Effects of cabergoline in a pituitary adenoma secreting follicle-stimulating hormone
Authors: Leese G , Jeffreys R , Vora J
Published: December 2008

A patient with a pituitary adenoma secreting follicle-stimulating hormone with co-existent primary hyperaldosteronism is described. After his second transsphenoidal surgery, the patient developed a Staphylococcus aureus pituitary abscess. Symptoms improved after abscess drainage. Subsequent cabergoline therapy arrested the deterioration of symptoms. and decreased serum follicle-stimulating hormone concentrations. Cabergoline may be a useful treatment for aggressively growing non-prolactin-secreting pituitary adenomas.
The andropause: fact or fiction?
Authors: Burns-Cox N , Gingell C
Published: December 2008

The so-called andropause is an ill-defined collection of symptoms in a group of men who may have low but may also have normal androgen levels. Unlike the proven benefits of hormone replacement therapy in women, the effects of testosterone supplementation in men are equivocal. It may increase sexual interest, but rarely to a level thought adequate by the patient. It has no proven beneficial effect on erectile dysfunction and other possible beneficial effects on haemopoesis, bone metabolism, lipids and fibrinolysis have yet to be demonstrated. With the availability of the testosterone patch, sustained increases in the serum testosterone levels will be readily achieved and could theoretically significantly affect the behaviour of subclinical prostate cancer. At the present time, testosterone replacement therapy in hypogonadal men is of proven clinical benefit; this is not the case, however, for eugonadal men with symptoms attributed to the andropause. The symptoms of the andropause fatigue can readily be explained by stress and there is no scientifically valid, placebo-controlled study that shows any benefit for testosterone supplements in this not uncommon group of patients.
Hippocratic fingers in Behçet's disease
Authors: Benekli M , Güllü İ H
Published: December 2008

Digital clubbing has been a well recognised feature of several distinct clinical conditions, including respiratory, cardiac, and gastrointestinal diseases since the Hippocratic era. However, clubbing associated with Behçet's disease has not been reported before. We describe a case of clubbing in a young man with Behçet's disease, in the absence of any other apparent aetiology and propose that clubbing might be an accompanying feature of Behçet's disease.
Renal cell carcinoma with solitary metastases appearing during 18 years of follow-up
Authors: Siekierska-Hellmann M , Sworczak K , Lewczuk A , Błaut K , Boj E
Published: December 2008

We present a case of renal cell carcinoma with solitary metastases to the thyroid, the post-nephrectomy scar and the lungs, appearing during an 18-year period following nephrectomy.
Pyridoxine deficiency: new approaches in immunosuppression and chemotherapy
Authors: Trakatellis A , Dimitriadou A , Trakatelli M
Published: December 2008

Pyridoxine deficiency leads to impairment of immune responses. It appears that the basic derangement is the decreased rate of production of one-carbon units necessary for the synthesis of nucleic acids. The key factor is a pyridoxine enzyme, serine hydroxymethyltransferase. This enzyme is very low in resting lymphocytes but increases significantly under the influence of antigenic or mitogenic stimuli, thus supplying the increased demand for nucleic acid synthesis during an immune response. Serine hydroxymethyltransferase activity is depressed by deoxypyridoxine, a potent antagonist of pyridoxal phosphate, and also by known immunosuppressive or antiproliferative agents. The combination of these agents is additive.

Our results lead us to suggest the following medical applications: (a) combination of deoxypyridoxine with immunosuppressive or chemotherapeutic drugs may be effective in cases of immunosuppressive therapy or organ transplantation, (b) the development of special agents directed against the serine hydroxymethyltransferase apoprotein may prove to be a valuable medical tool, since this enzyme presents an excellent target for chemotherapy, (c) lymphocytes of individual patients could be used to design tailor-made specific immunosuppressive or chemotherapeutic treatment, and (d) the serine hydroxymethyltransferase activity of lymphocyte culture presents an excellent indicator for the evaluation of potency of immunosuppressive, chemotherapeutic or genotoxic compounds in a simple and rapid test.
The management of postherpetic neuralgia
Authors: Bowsher D
Published: December 2008

Postherpetic neuralgia is defined as pain persisting, or recurring, at the site of shingles at least three months after the onset of the acute rash. Thus defined, at least half of shingles sufferers over the age of 65 years develop postherpetic neuralgia. In addition to increasing age, less important risk factors for postherpetic neuralgia are pain severity of acute shingles and trigeminal distribution. Postherpetic neuralgia accounts for 11–15% of all referrals to pain clinics and would, in fact, be far more effectively dealt with in primary care. Effective treatment of acute shingles by systemic antivirals at the appropriate time may have some effect in reducing the incidence of postherpetic neuralgia, making it easier to treat with tricyclics and greatly reducing scarring (25% of all cases affect the face). Pre-emptive treatment with low-dose tricyclics (ami- or nor-triptyline 10–25 mg nocte) from the time of diagnosis of acute shingles reduces the incidence of postherpetic neuralgia by about 50%. Established postherpetic neuralgia should be vigorously treated with adrenergically active tricyclics in a dose rising over two or three weeks from 10–25 mg to 50–75 mg. Positive relaxation should also be used. Carbamazepine, like conventional analgesics, is of little or no value. Failure of tricyclics to effect relief within eight weeks calls for specialist treatment. North American practitioners in particular believe that some opioids (e.g., oxycodone) may be helpful in otherwise intractable cases.
Nitric oxide and cardiovascular disease
Authors: McIntyre M , Dominiczak A F
Published: December 2008

Endothelium-derived nitric oxide is an important regulatory molecule in cardiovascular function. Reduced availability of nitric oxide has been implicated in the pathogenesis of hypertension and atherosclerosis.
The overlap between syncope and falls in the elderly
Authors: Shaw F E , Kenny R A
Published: December 2008

Syncope and falls are often considered to be two separate diagnoses with two separate sets of aetiologies. However, although it remains controversial, the existence of an overlap between syncope and falls is becoming increasingly acknowledged. In the elderly, determining the cause of a fall can be difficult. Approximately 30% of cognitively normal elderly people are unable to recall documented falls three months later and a witness account for syncopal events is unavailable in about 50% of patients. We have found that in almost 40% of patients in whom an attributable diagnosis of carotid sinus syndrome was made, the only presenting symptoms were falls alone or falls with dizziness; syncope was denied. Amnesia for loss of consciousness can be demonstrated in over 20% of all patients with a diagnosis of carotid sinus syndrome and in 50% of those patients who present only with falls or falls and dizziness. There is a suggestion from studies in postprandial hypotension and orthostatic hypotension, where similar haemodynamic changes are found in patients complaining of either syncope or falls, that this phenomenon may be generalisable. The importance of the presence of an overlap between syndrome and falls in the elderly lies in the healthcare implications of missed diagnoses of cardiovascular syncope for which there are established effective treatments. Consideration of syncope in the differential diagnosis of unexplained falls should reduce the numbers of falls for which no attributable diagnosis is found and result in an improved standard of health care for elderly patients who fall.
Diazoxide treatment for insulinoma: a national UK survey
Authors: Gill G V , Rauf O , MacFarlane I A
Published: December 2008

A survey of UK patients receiving the drug diazoxide, revealed 40 patients with insulinoma on this treatment. Mean age (± SD) was 67 ± 18 years, and 74% were female. Duration of treatment was 7 ± 6 years (range 1–22). Most (55%) patients were treated with diazoxide because of tumour non-localisation (including failed previous surgery). Metastatic disease (20%) and poor surgical risk (10%) were other indications. Side-effects (notably fluid retention and hirsutism) were common (47%) but not troublesome. Treatment was highly effective—59% were symptom free and 38% had only occasional symptoms. Only one patient had frequent hypoglycaemia despite treatment. We conclude that diazoxide is effective in the management of insulinoma. Side-effects are common but not problematic. Treatment should be considered for all patients not cured by surgery, or unsuitable for surgical treatment.
Spontaneous spinal epidural haemorrhage complicating transjugular intrahepatic portosystemic stent shunting
Authors: McLellan S , de Silva R , Sandercock P A , Hayes P C , Dillon J , Redhead D
Published: December 2008

A patient with chronic liver disease and portal hypertension who developed acute spinal cord compression following transjugular intrahepatic portosystemic stent shunting is described. Radiological and pathological examinations revealed an epidural haematoma.
Peripheral arterial pseudoaneurysm treated by ultrasound-guided compression
Authors: Cheung Y-C , Wan Y-L
Published: December 2008

Ultrasound-guided compression repair of a pseudoaneurysm is a simple, safe and effective therapy, and has been proposed as a first-line treatment for pseudoaneurysms caused by catheterization. Herein, we report a case of a pseudoaneurysm arising from a sport injury which was treated by this method. Obliteration of the track of the pseudoaneurysm induced manual thrombosis and successfully converted the pseudoaneurysm to haematoma. Understanding the mechanism and the procedure is the basis of success in the use of this treatment.
Fabry's disease: a multidisciplinary disorder
Authors: Peters F P J , Sommer A , Vermeulen A , Cheriex E C , Kho T L
Published: December 2008

Fabry's disease is an X-linked hereditary disorder resulting in accumulation of a glycolipid (galactosylgalactosyl glucosylceramide) due to deficiency of alpha-galactosidase A. The diagnosis can be made by histopathologic examination of skin biopsy, low activity of alpha-galactosidase in leucocytes and genetic examination. Treatment is symptomatic. We want to stress the multidisciplinary collaboration necessary to deal with this condition, in order to prevent acceleration of symptoms.
Velocardiofacial syndrome
Authors: Pike A C , Super M
Published: December 2008

Velocardiofacial syndrome is a syndrome of multiple anomalies that include cleft palate, cardiac defects, learning difficulties, speech disorder and characteristic facial features. It has an estimated incidence of 1 in 5000. The majority of cases have a microdeletion of chromosome 22q11.2. The phenotype of this condition shows considerable variation, not all the principal features are present in each case. Identification of the syndrome can be difficult as many of the anomalies are minor and present in the general population.
Superior mesenteric artery syndrome
Authors: Ahmed A R , Taylor I
Published: December 2008

Superior mesenteric artery syndrome is a rare and controversial form of upper intestinal obstruction in which the third part of the duodenum is compressed by the overlying superior mesenteric artery. Any disease process decreasing the angle between the superior mesenteric artery and the abdominal aorta can result in the external compression of the duodenum and subsequent intestinal obstruction. The aetiology, presentation, investigation and management of this unusual condition are discussed.
Post-transplant hyperlipidaemia
Authors: Jindal R M
Published: December 2008

The correction of post-transplant hyperlipidaemia warrants the judicious and timely use of pharmacological agents with dietary modification and exercise. Reduction in hyperlipidaemia may have some role in decreasing the incidence of chronic rejection of allografts. The awareness that the morbidity and mortality of atherosclerotic disease may be lowered by active intervention will result in a better quality of life for transplant recipients.
Using audit to improve senior house officer training
Authors: Johansen A
Published: December 2008

The British Geriatrics Society has described 16 training objectives for senior house officers (SHOs) in geriatric medicine. We have developed these into an audit standard, and in a controlled trial we consider the effectiveness of audit as a means of monitoring and improving SHO training.

SHOs from three hospitals were sent a questionnaire asking about the adequacy of formal and informal training for each objective; there was a response rate of 87%. Results were presented at an audit meeting in one hospital, inadequacies of training identified and the hospital's programme of teaching modified appropriately. Two control hospitals remained unaware of the audit findings and were therefore unable to modify their training programmes. Re-audit at six months completed the audit cycle; the control hospitals showing no change between the two audits. In the intervention hospital the adequacy of training over the 16 objectives improved from 59% at first audit to 73% at re-audit. The initial audit had highlighted three target objectives as needing special attention; here the improvement from 38% to 69% was even more impressive, and statistically significant at p < 0.05 on chi 2 test.

Thus, although a questionnaire approach is inevitably subjective and affected by SHO satisfaction, the discipline of audit appeared effective in identifying and correcting deficiencies in an SHO training programme.
Simple urine testing could avoid delay in the diagnosis of rapidly progressive glomerulonephritis
Authors: Howse M , Main J
Published: December 2008

Four cases of rapidly progressive glomerulonephritis are presented. In all four there was a two to three month delay between the onset of symptoms and appropriate diagnosis, referral and treatment. It is likely that simple stick testing of urine would have given a vital diagnostic clue and allowed earlier referral and treatment.
Corticosteroid therapy in Riedel's thyroiditis
Authors: Vaidya B , Harris P E , Barrett P , Kendall-Taylor P
Published: December 2008

We report a case of Riedel's thyroiditis presenting with a systemic illness, life-threatening stridor and a stony hard goitre. Diagnosis was confirmed by open thyroid biopsy. Treatment with corticosteroid resulted in a dramatic improvement. A possible autoimmune mechanism in the pathogenesis of Riedel's thyroiditis is discussed.
Malignant hyperthermia
Authors: Ben Abraham R , Adnet P , Glauber V , Perel A
Published: December 2008

Malignant hyperthermia is a rare autosomal dominant trait that predisposes affected individuals to great danger when exposed to certain anaesthetic triggering agents (such as potent volatile anaesthetics and succinylcholine). A sudden hypermetabolic reaction in skeletal muscle leading to hyperthermia and massive rhabdomyolysis can occur. The ultimate treatment is dantrolene sodium a nonspecific muscle relaxant. Certain precautions should be taken before anaesthesia of patients known to be susceptible to malignant hyperthermia. These include the prohibition of the use of triggering agents, monitoring of central body temperature and expired CO2, and immediate availability of dantrolene. In addition, careful cleansing of the anaesthesia machine of vapours of halogenated agents is recommended. If these measures are taken, the chances of an MH episode are greatly reduced. When malignant hyperthermia-does occur in the operating room, prompt recognition and treatment usually prevent a potentially fatal outcome. The most reliable test to establish susceptibility to malignant hyperthermia is currently the in vitro caffeine-halothane contracture test. It is hoped that in the future a genetic test will be available.
Hyperosmolar nonketotic coma precipitated by lithium-induced nephrogenic diabetes insipidus
Authors: Azam H , Newton R W , Morris A D , Thompson C J
Published: December 2008

A 45-year-old man, with a 10-year history of manic depression treated with lithium, was admitted with hyperosmolar, nonketotic coma. He gave a five-year history of polyuria and polydipsia, during which time urinalysis had been negative for glucose. After recovery from hyperglycaemia, he remained polyuric despite normal blood glucose concentrations; water deprivation testing indicated nephrogenic diabetes insipidus, likely to be lithium-induced. We hypothesize that when this man developed type 2 diabetes, chronic polyuria due to nephrogenic diabetes insipidus was sufficient to precipitate hyperosmolar dehydration.
Severe cholestatic hepatitis following cloxacillin treatment
Authors: Goland Sorel , Malnick Stephen D H , Gratz Raia , Feldberg Edith , Geltner David , Sthoeger Zev M
Published: December 2008

We describe a 77-year-old woman who developed fatigue, fever, a maculopapular rash and severe cholestatic hepatitis two weeks after receiving cloxacillin and ofloxacin.
Disease-associated malnutrition in the year 2000
Authors: Pennington C R
Published: December 2008

Malnutrition is associated with increased morbidity and mortality and is common in patients admitted to hospital. Nutritional status is not routinely assessed on admission, and nutritional depletion escapes recognition in the majority of affected patients. Nutritional status declines during hospital stay, and this trend is most marked in patients who are already malnourished on admission. Techniques for nutritional support are available, their appropriate use leads to improved nutritional status and clinical outcome in most patients. There is evidence that the current use of artificial nutrition is suboptimal and associated with a high complication rate. The introduction of clinical guidelines and the formation of nutrition support teams will improve nutritional management in the future. The development of new substrates and ‘pharmaconutrition’ is likely to further improve the outcome for many patients. There will remain a need for more studies to define the cost efficacy of artificial nutrition across a broad spectrum of clinical practice.
Diabetic retinopathy
Authors: Infeld D A , O'Shea J G
Published: December 2008

Diabetic retinopathy is the commonest cause of blindness amongst individuals of working age. The onset of retinopathy is variable. Regular ophthalmic screening is essential in order to detect treatable lesions early. Retinal laser therapy is highly effective in slowing the progression of retinopathy and in preventing blindness. As the sufferers of diabetes mellitus, the commonest endocrine disorder, now constitute approximately 1–2% of Western populations, concerted multidisciplinary effort must be made towards cost-effective community screening by the medical community.
Thymectomy for myasthenia gravis
Authors: Urschel J D , Grewal R P
Published: December 2008

The pathophysiological role of the thymus in myasthenia gravis, and the mechanism of therapeutic effect of thymectomy, are incompletely understood. Nevertheless, thymectomy is a valuable treatment modality in selected patients with generalised myasthenia gravis. There are several types of thymectomy operation, but no one operative approach is clearly superior to the others. Total removal of the thymus gland is essential. Additional excision of associated mediastinal and cervical tissue, that may harbor ectopic thymic rests, is a controversial surgical issue. Surgeons that advocate thymectomy through small, cosmetically favourable, incisions usually believe that simple removal of the thymus gland is an adequate operation. Surgeons that emphasise the importance of removing extrathymic tissue, in addition to the thymus gland, usually favour greater operative exposure through a median sternotomy. To minimise operative morbidity, surgery for myasthenia gravis requires a multidisciplinary (neurology, surgery, anaesthesia) approach to peri-operative care.
Trends in the management of gastro-oesophageal reflux disease
Authors: Lee J M , O'Morain C A
Published: December 2008

Gastro-oesophageal reflux disease is common, with up to 10% of the general population experiencing heartburn on a daily basis. It is a chronic condition and follow-up studies indicate the presence of symptoms at least 20 years after initial diagnosis. In addition to lifestyle modifications, management usually involves the use of an acid suppressant from the H2-receptor antagonist or proton pump inhibitor groups or a prokinetic agent at some stage. In terms of initial symptom resolution and mucosal healing the proton pump inhibitors are consistently superior to the other available agents. However, while it is possible to keep the majority of patients in remission while taking medications, almost all patients have a recurrence of symptoms within six months of stopping medications. The introduction of laparoscopic fundoplication has produced promising initial results but the long-term benefits of this procedure remain to be established. The role of Helicobacter pylori eradication in the management of gastro-oesophageal reflux disease needs further evaluation.
Lymphogranuloma venereum as a cause of rectal strictures
Authors: Papagrigoriadis S , Rennie J A
Published: December 2008

Rectal strictures are uncommon in young patients without a history of malignancy, inflammatory bowel disease or previous surgery. Lymphogranuloma venereum of the rectum has been described as a rare cause of rectal strictures in the western world, mainly in homosexual men and in blacks. It presents with nonspecific symptoms, rectal ulcer, proctitis, anal fissures, abscesses and rectal strictures. Clinical and endoscopic findings as well as histology resemble Crohn's disease, which may be misdiagnosed. Serology is often positive for Chlamydia trachomatis but negative serology is not uncommon. We present two young black women who suffered from chronic diarrhoea, abdominal pain and weight loss. There was no previous history and investigations showed in both cases a long rectal stricture. Serology was positive in one patient. They were treated with erythromycin and azithromycin and they both underwent an anterior resection of the rectum. Postoperative histology confirmed the presence of lymphogranuloma venereum of the rectum. We conclude that rectal lymphogranuloma venereum is a rare cause of rectal strictures but surgeons should be aware of its existence and include it in the differential diagnosis of unexplained strictures in high-risk patients.
Sarcoidosis of the paranasal sinuses treated with hydroxychloroquine
Authors: Hassid S , Choufani G , Saussez S , Dubois M , Salmon I , Soupart A
Published: December 2008

A case of sarcoidosis of the paranasal sinuses is reported. Biopsies of the sinus mucosa showed typical noncaseating granulomas. Hydroxychloroquine, which is known to be active on the cutaneous form of sarcoidosis, was used here with success and is proposed as an effective alternative to high-dose systemic steroids.
Age-related macular degeneration
Authors: O'Shea J G
Published: December 2008

Macular degeneration is now responsible for approximately 95% of blindness and partial sighted registrations in the UK. This review has been written specifically to make the general medical community of the UK aware of the prevalence and clinical manifestations of aged-related macular degeneration. The review encompasses the risk factors, the disabilities and problems experienced by suffers of the condition and current therapeutic options. Age related macular degeneration increases in prevalence in our community from 0% among people under 55 years old to 18.5% among those 85 years or older. There is a marked female preponderance. The exudative form of the disorder is commoner. Treatment remains supportive for most patients with macular degeneration although a minority will benefit from macular laser photocoagulation.
Compression syndromes caused by substernal goitres
Authors: Anders H J
Published: December 2008

Enlargement of the thyroid is common, especially in areas of endemic iodine deficiency. Substernal enlargement of a goitre can cause compression of several mediastinal structures. As a consequence of tracheal compression and tracheomalacia, syndromes of chronic respiratory distress occur and intercurrent upper respiratory infections may lead to acute respiratory failure. Superior vena cava syndrome secondary to compression by a substernal goitre may be complicated by venous thrombosis. Although dysphagia is the most frequent oesophageal symptom of a substernal goitre, upper gastrointestinal bleeding from ‘downhill’ oesophageal varices may be an initial presentation. Arterial compression or thyrocervical steal syndrome by large substernal goitres occasionally cause cerebral hypoperfusion and stroke. Recurrent and phrenic nerve palsies, as well as Horner's syndrome, occur secondary to non-malignant mediastinal goitres and may resolve after surgery. Substernal goitres rarely cause therapy-resistant pleural effusions, chylothorax and pericardial effusion. In conclusion, although cervical goitres are easily recognised, the initial presentation of mainly substernal goitres may be unusual.
Mechanical ventilation: simplifying the terminology
Authors: Kapadia F
Published: December 2008

There is presently considerable ambiguity and confusion relating to ventilator terminology. This can be eliminated using a simple approach, visualising mechanical ventilation as an inspiratory pump, and defining trigger, limit, and cycling in this context. The trigger is the signal that starts a breath by opening the inspiratory valve, the limit is the factor which controls the way gas flows into the lung, and the cycle is the signal that stops the breath by closing the inspiratory valve and opening the expiratory valve. By identifying these three basic parameters, one can precisely dissect and interpret any of the vast ventilatory terminology.
‘Rescue’ after failed thrombolysis for acute myocardial infarction
Authors: Mahy I R , Jennings K P
Published: December 2008

Prompt restoration of coronary artery patency in acute myocardial infarction is associated with substantial improvements in morbidity and mortality. The pivotal role of thrombolysis and aspirin in achieving these goals is well established. However, despite the success of thrombolytic therapy in large trials, clinical assessment in individual patients often suggests that reperfusion has not occurred after initial therapy. This review considers the validity of such bedside predictions and discusses whether such patients should be managed differently.
Cardiac syncope due to transient coronary artery occlusion: the role of percutaneous angioplasty
Authors: Burn S , Schilling R , Kaye G C
Published: December 2008

A case of cardiac syncope is presented, associated with single vessel coronary disease. The mechanism of the syncope would appear to be a ventricular arrhythmia with transmural myocardial ischaemia due to transient occlusion of the diseased coronary artery. The symptoms and electrocardiographic abnormalities were reproduced and subsequently abolished by percutaneous coronary angioplasty.
A simple instrument for assessing stress in clinical practice
Authors: Sonino N , Fava G A
Published: December 2008

Methods to assess the role of stress factors in patients with medical conditions are often rather complex, require specific training, and are difficult to use in clinical practice. We attempted to develop a short index tailored to a busy clinical setting, which would be easy to use while providing adequate individual information. This index (Psychosocial Index) was largely derived from well-established instruments, such as Kellner's Screening List for Psychosocial Problems. In addition, on the basis of the patient's self-report of items, the clinician is asked to rate four dimensions of the patient's life: stress, wellbeing, psychological distress, and illness behaviour. The questionnaires of 34 female patients with functional medical disorders were first rated by an internist and afterwards, blindly, by a psychiatrist. Agreement between the two raters was excellent, as measured by the intraclass correlation coefficient. It is hoped that this Psychosocial Index may provide a new tool for psychosomatic research and practice.
Abdominal tuberculosis
Authors: Kapoor V K
Published: December 2008

Tuberculosis has staged a global comeback and forms a dangerous combination with AIDS. The abdomen is one of the common sites of extrapulmonary involvement. Patients with abdominal tuberculosis have a wide range and spectrum of symptoms and signs; the disease is therefore a great mimic. Diagnosis, mainly radiological and supported by endoscopy, is difficult to make and laparotomy is required in a large number of patient. Management involves judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation. The disease, though potentially curable, carries a significant morbidity and mortality.
Excimer laser ophthalmic surgery: evaluation of a new technology
Authors: Infeld D A , O'Shea J G
Published: December 2008

The aim of this article is to provide information and an overview of the potential risks and benefits of excimer laser surgery, a new and promising technique in ophthalmic surgery. Although this review concentrates on the use of the laser for refractive purposes, novel therapeutic techniques are also discussed. It is hoped that this will enable general practitioners, optometrists and physicians to provide appropriate advice and counselling for patients.
Antidepressants are not drugs of abuse or dependence
Authors: Lichtigfeld F J , Gillman M A
Published: December 2008

There is a view among both the lay and medical audience that antidepressants are addictive. Non-compliance may arise as a result, with fatal consequences in some cases. In spite of the fact that anti-depressants have not proved to be drugs of abuse or dependence, confusion exists in the literature, particularly regarding the definition of the terms misuse and abuse in opioid addicts. Here, antidepressants are used to treat the depressive component of the addictive syndrome and have proved effective. In some instances, however, misuse of antidepressants has been found in methadone-treated addicts, which may be due to an enhancement of the effects of methadone. These effects have led some people to believe, wrongly, that antidepressants are substances of abuse. Our findings, from a review of the literature, show that such use of antidepressants by methadone patients is by definition misuse and not abuse. Further, the known withdrawal symptoms which occasionally follow cessation of anti-depressant therapy are not, on their own, an indication of addictive potential. We therefore conclude that antidepressant drugs are not substances of abuse and dependence.
The effect of reduction of door-to-needle times on the administration of thrombolytic therapy for acute myocardial infarction
Authors: Kelion A D , Banning A P , Shahi M , Bell J A
Published: December 2008

Optimal management of acute myocardial infarction requires rapid administration of thrombolytic therapy. However, only patients who fulfill the following specific criteria are likely to benefit from this treatment: admission within 12 hours of the onset of symptoms, no contraindications, ST elevation or possible new-onset left bundle branch block on the admission electrocardiogram. We employed an aggressive policy to reduce the delay between admission to hospital and the administration of thrombolysis (the ‘door-to-needle time’), and investigated whether this approach affected the accuracy of administration of thrombolysis. Patients admitted to the cardiac care unit with acute myocardial infarction, or who were thrombolysed, were identified retrospectively over two equivalent 4-month periods before and after implementation of our policy. Patients were considered eligible for thrombolysis if they fulfilled the criteria mentioned above. The mean (SD) door-to-needle time for all patients who received thrombolysis on admission decreased from 61(70) to 19(20) minutes (p = 0.0004). The proportion of patients eligible for thrombolysis who received treatment increased from 24/38 to 30/30 (p = 0.0002). However, the proportion of patients receiving thrombolysis who did not fulfill our criteria also increased, from 3/27 to 11/41 (p = 0.1). There were no complications of thrombolysis in the first study period, but two cerebrovascular accidents in the second period; both patients fulfiled our criteria for treatment. We conclude that simple educational measures greatly reduced door-to-needle times and led to a higher proportion of eligible patients receiving thrombolysis. However, greater pressure on medical staff to make rapid management decisions increased the proportion of patients being thrombolysed inappropriately.
White-centred retinal haemorrhages (Roth spots)
Authors: Ling R , James B
Published: December 2008

Roth spots (white-centred retinal haemorrhages) were classically described as septic emboli lodged in the retina of patients with subacute bacterial endocarditis. Indeed many have considered Roth spots pathognomonic for this condition. More recent histological evidence suggests, however, that they are not foci of bacterial abscess. Instead, they are nonspecific and may be found in many other diseases. A review of the histology and the pathogenesis of these white-centred haemorrhages will be provided, along with the work-up of the differential diagnosis.
Platelets, aspirin, and cardiovascular disease
Authors: Elwood P C , Hughes C , O'Brien J R
Published: December 2008

Aspirin was first synthesised 100 years ago and its preparation and marketing is generally reckoned to have been the foundation of the pharmaceutical industry. For most of the time since then it has been used for the relief of pain and fever. The modern phase of aspirin use commenced with the reporting in 1974 of a randomised controlled trial in the secondary prevention of death by low-dose aspirin given to patients who had suffered a myocardial infarct. Reports of other trials followed and an overview of the first six trials was presented to the inaugural meeting of the Society for Clinical Trials in Philadelphia in 1980. There have been two further major overviews and the most recent, based on 145 trials, established that low-dose aspirin reduces vascular events by around one third.

It has been estimated that, used appropriately, aspirin could prevent 100,000 premature deaths each year worldwide, at a cost of about 250 Pounds ($400) per life saved, and about 80 Pounds ($130) per cardiovascular event prevented. The evidence indicates that it is seriously underused at present. The aspirin story continues and trials are in progress to test other possible uses of aspirin, in vascular dementia, colorectal cancer, and cataract.
Myocardial infarction in a pre-menopausal woman with angiographically normal coronary arteries
Authors: Khan I A , Ansari A W
Published: December 2008

A young pre-menopausal non-drug-addict woman without risk factors for coronary artery disease suffered from a non-Q-wave acute myocardial infarction. She presented with epigastric pain and vomiting. Diagnosis of acute myocardial infarction was not suspected at first because of her young age and lack of risk factors. She was treated for gastritis but worsening of epigastric pain and its radiation to chest warranted the diagnosis of acute myocardial infarction, which was confirmed by serial serum cardiac enzymes. Subsequent coronary angiogram revealed normal coronary arteries.
MATRIX EQUATIONS AND HILBERT'S TENTH PROBLEM
Authors: BELL PAUL , HALAVA VESA , HARJU TERO , KARHUMÄKI JUHANI , POTAPOV IGOR
Published: December 2008

We show a reduction of Hilbert's tenth problem to the solvability of the matrix equation [Formula: see text] over non-commuting integral matrices, where Z is the zero matrix, thus proving that the solvability of the equation is undecidable. This is in contrast to the case whereby the matrix semigroup is commutative in which the solvability of the same equation was shown to be decidable in general.

The restricted problem where k = 2 for commutative matrices is known as the "A-B-C Problem" and we show that this problem is decidable even for a pair of non-commutative matrices over an algebraic number field.
DISCRETIZATION OF AN UNSTEADY FLOW THROUGH A POROUS SOLID MODELED BY DARCY'S EQUATIONS
Authors: BERNARDI CHRISTINE , GIRAULT VIVETTE , RAJAGOPAL KUMBAKONAM R.
Published: December 2008

The system of unsteady Darcy's equations considered here models the time-dependent flow of an incompressible fluid such as water in a rigid porous medium. We propose a discretization of this problem that relies on a backward Euler's scheme for the time variable and finite elements for the space variables. We prove a priori error estimates that justify the optimal convergence properties of the discretization and a posteriori error estimates that allow for an efficient adaptivity strategy both for the time steps and the meshes.
Relative and Discrete Utility Maximising Entropy
Authors: Harańczyk Grzegorz , Słomczyński Wojciech , Zastawniak Tomasz
Published: December 2008

The notion of utility maximising entropy (u-entropy) of a probability density, which was introduced and studied in [37], is extended in two directions. First, the relative u-entropy of two probability measures in arbitrary probability spaces is defined. Then, specialising to discrete probability spaces, we also introduce the absolute u-entropy of a probability measure. Both notions are based on the idea, borrowed from mathematical finance, of maximising the expected utility of the terminal wealth of an investor. Moreover, u-entropy is also relevant in thermodynamics, as it can replace the standard Boltzmann-Shannon entropy in the Second Law. If the utility function is logarithmic or isoelastic (a power function), then the well-known notions of Boltzmann-Shannon and Rényi relative entropy are recovered. We establish the principal properties of relative and discrete u-entropy and discuss the links with several related approaches in the literature.
Time-Reversibility in 2-Dimensional Systems
Authors: Romanovski Valery G.
Published: December 2008

We present an algorithm for finding the Zariski closure of the set of all time-reversible systems within a given family of two-dimensional autonomous systems of ODE's whose right-hand sides are polynomials. We also study an interconnection of time-reversibility and invariants of a subgroup of SL(2, ℂ).
Active Anti-Synchronization Between Identical and Distinctive Hyperchaotic Systems
Authors: Al-sawalha M. M. , Noorani M. S. M.
Published: December 2008

This paper brings attention to hyperchaos anti-synchronization between two identical and distinctive hyperchaotic systems using active control theory. The sufficient conditions for achieving anti-synchronization of two high dimensional hyperchaotic systems is derived based on Lyapunov stability theory, where the controllers are designed by using the sum of relevant variables in hyperchaotic systems. Numerical results are presented to justify the theoretical analysis strategy.
An Analysis of Private School Closings
Authors: Pandey Lakshmi , Sjoquist David L. , Walker Mary Beth
Published: December 2008

We add to the small literature on private school supply by exploring exits of K–12 private schools. We find that the closure of private schools is not an infrequent event and use national survey data from the National Center for Education Statistics to study closures of private schools. We assume that the probability of an exit is a function of excess supply of private schools over demand as well as of the school's characteristics, such as age, size, and religious affiliation. Our empirical results generally support the implications of the model.
Spending, Size, and Grade Span in K–8 Schools
Authors: Rubenstein Ross , Schwartz Amy Ellen , Stiefel Leanna , Zabel Jeffrey
Published: December 2008

Reorganizing primary school grade spans is a tractable and relatively inexpensive school reform. However, assessing the effects of reorganization requires also examining other organizational changes that may accompany grade span reforms. Using data on New York City public schools from 1996 to 2002 and exploiting within-school variations, we examine relationships among grade span, spending, and size. We find that school grade span is associated with differences in school size, class size, and grade size, though generally not with spending and other resources. In addition, we find class size and grade size differences in the same grade level at schools with different configurations, suggesting that school grade span affects not only school size but also class size and grade size. We find few relationships, though, between grade span and school-level performance, pointing to the need to augment these analyses with pupil-level data. We conclude with implications for research and practice.
Negotiation Analysis
Authors: Srivastava Sanjay
Published: December 2008

In this article, I address the question of negotiation analysis pertaining to the Cancun Ministerial of the World Trade Organization (WTO). Albeit, the deep differences between developed and developing countries on various trade issues could not be accommodated and the Cancun Ministerial finally collapsed, the coalitional diplomacy and the joint obstinate position taken by the developing countries were unparalleled and deserve concentrated analysis of negotiations and various strategies pursued during the Ministerial. The central contingent variable, in this study is the negotiation strategy pursued by the developing countries at Cancun. In more practical terms the coalitional diplomacy with special reference to the coalition of G-20 and distributive strategy used by the developing countries, have been investigated. Other derivative inquiries delineated here are: how developing countries adhered to and maintained their coalition G-20 at Cancun and the counter strategies of the developed world pertaining to moves made by the developing countries including endgame diplomacy.
Validity and Norms of a Hyperactivity Rating Scale
Authors: Spring Carl , Blunden Dale , Greenberg Lawrence M. , Yellin Absalom M.
Published: December 2008

Teachers rated 1337 school children to determine norms for a hyperactivity rating scale; teacher ratings of 45 hyperactive children, referred by physicians, were also obtained. Although hyperative and norm means were clearly separated, a nontrivial portion of hyperactive children had teacher ratings within the normal range. Norm data were factor-analyzed, and a hyperactivity factor was identified. Behaviors with the highest loadings on the hyperactivity factor yielded the largest differences between hyperactive and norm groups. Within the norm group, black children had the highest hyperactive ratings and oriental children had the lowest. Hyperactivity ratings were slightly higher for boys than for girls.
Congruence of Behavioral Ecologies: a Model for Special Education Programming
Authors: Thurman S. Kenneth
Published: December 2008

This article suggests a model for special education programming based on the three following dimensions: (a) competence, or the individual's ability to perform specific tests; (b) deviance, or the labels and perceptions placed on an individual's behavior by a particular social system; (c) tolerance for difference, or the fit between an individual and his/her behavioral environment. The suggested approach results in dealing with ecologies and bringing them into congruence. It is suggested that such congruence can be brought about not only by modifying the child's behavior, but also by dealing with the social-environmental system surrounding the child.