bluuebunny/crossref_metadata_2025 huggingface dataset:
Causes of the acute abdomen: add thrombophilia to your list
Authors: Skinner Liam J , Kelly John , O'Donnell Martin J , Cotter Paule
Published: May 2014

A47-year-old male was admitted with a 2-week history of periumbilical discomfort. For 48 hours before admission, the patient suffered from associated vomiting and anorexia. Upon admission the abdominal pain had become more severe and began to radiate to both flanks.

His past medical history included a deep vein thrombosis 18 months previously. He was taking Tegretol for epilepsy (seizure free for many years) and regular inhalers for asthma. He had no recent episode of prolonged immobility. He was a non-smoker and did not drink alcohol.

On examination, he was obese (96 kg). He had a low grade pyrexia with a sinus tachycardia (120 beats per minute). He was normotensive. Abdominal examination revealed tenderness over the umbilical and epigastric areas. At this stage, there was no evidence of guarding or rigidity and bowel sounds were present.

Investigations including serum bioprofile, amylase, coagulation screen, chest X-ray, plain film of abdomen and ultrasound of abdomen were all reported as normal. Full blood count revealed a moderate leucocytosis (13.2 × 109/litre).

At this stage he was managed conservatively with intravenous fluids and antibiotics. However, over the next 12 hours, the patient's condition deteriorated and he developed diffuse peritonism with guarding and rebound tenderness. He was prepared for theatre. Laparoscopy demonstrated haemosanguinous fluid and gangrenous loops of small bowel. Laparotomy confirmed the presence of a 24” gangrenous segment of distal jejenum and proximal ileum. Perioperatively, this segment was noted to have good arterial pulsation with obvious clot in the venous arcades. Formal resection with end to end anastomosis was completed. Postoperative recovery was uneventful. After surgery he was anticoagulated with unfractionated heparin.

Histology confirmed mesenteric venous infarction. In view of the past history of deep vein thrombosis, a thrombophilia screen was performed. Our patient was heterozygous positive for the factor V leiden mutation. He was anticoagulated and discharged on warfarin indefinitely (under ongoing review).
Statins: where are we now?
Authors: Cowie Martin R
Published: May 2014

Statin therapy reduces the risk of cardiac events by 30% in both primary and secondary prevention. Although fine-tuning of the evidence will occur as more clinical trials report, the challenge is now to implement the evidence to the benefit of patients.
Organizing the care of lung cancer patients
Authors: Fergusson Ronald J , Borthwick Diana
Published: May 2014

For years lung cancer has been the Cinderella of malignant disease, perceived as being self-inflicted and incurable. The government has put cancer management high on its agenda and is setting targets for clinicians to aim at. This article looks at the changes which are occurring in the way lung cancer is managed.
Spinal anaesthesia for caesarean section: current clinical practice
Authors: Burns SM , Cowan CM
Published: May 2014

Spinal anaesthesia has evolved as the preferred anaesthetic technique for most cases of caesarean section. Having been extensively studied and refined over the years, there are few situations where a spinal is absolutely contraindicated. While general anaesthesia will always have a place in obstetrics, in experienced hands a spinal offers safety, efficacy and an improvement in maternal morbidity.
Bisoprolol in chronic heart failure
Authors: Davis Mark
Published: May 2014

The evidence for the use of beta-blockers in heart failure is substantial. Latest recommendations and guidelines suggest that most heart failure patients should be on a drug regimen of an angiotensin-converting enzyme inhibitor, diuretic and a beta-blocker. However, despite the evidence from trials, the majority of patient are not yet treated appropriately, with only 5% receiving a beta-blocker.
Female urinary incontinence: aetiology and pathophysiology
Authors: Freeman Robert M
Published: May 2014

Genuine stress incontinence and detrusor instability are the main causes of female urinary incontinence. Treatments are not always satisfactory and a better understanding of the aetiology and pathophysiology should result in more successful therapies and aid prevention.
Importance of components of postgraduate education in obstetrics and gynaecology: surveys of trainees and trainers
Authors: Myerson NA , Saunders PG
Published: May 2014

Postgraduate medical education has many elements. Some are long-established while others such as formal teaching programmes and computer-aided learning are relatively new. The opinions of trainees and trainers differ as to which elements have the most educational value. Information technology is not highly rated by either group.
Managing disputes within medicine: is there a role for alternative dispute resolution?
Authors: Thomas Paul
Published: May 2014

Managing complaints from disappointed patients is now so frequent that it has become part of dayto- day professional life. Doctors are under fire from many directions — they are obliged to cooperate with the NHS complaints procedures, must respond to separate legal complaints and are vulnerable to patients complaining directly to the General Medical Council (GMC). The cumulative effect of this three-pronged attack is to draw the profession’s attention to the need to maintain standards but also to battle-harden individuals against the worry and annoyance which such complaints invoke.
The molecular genetics of human herpesvirus 8
Authors: Gill Jas , Powles Tom , Bower Mark
Published: May 2014

Human immunodeficiency virus (HIV)-related Kaposi’s sarcoma (KS) is 10 times commoner in homosexual men than in other transmission groups and is four times more frequent in HIV-positive patients who acquired their infection from blood transfusions than in haemophiliacs. These observations lead Beral et al (1990) to propose that a second infectious agent could account for the prevalence of KS in immunodeficient patients and a cohort study of gay men with AIDS suggested that frequent faeco-oral contact was a possible transmission mode for the putative infectious agent (Beral et al, 1992).
Snoring: recent developments
Authors: Jones TM , Swift AC
Published: May 2014

Despite limited evidence validating its efficacy, surgery to overcome snoring is commonly undertaken. This article looks at the development of snoring surgery to present day, highlighting its limitations and outlining current methods being used to target the surgery more effectively.
Responding to trainee doctors in difficulty
Authors: Ikkos George
Published: May 2014

Appropriate workload, good clinical and educational supervision and rigorous appraisal routines will prevent a number of trainees developing difficulties. When difficulties do occur the presence of such arrangements will facilitate appropriate emotional and practical handling of these problems.
Rheumatoid arthritis: a viral aetiology?
Authors: Griffiths David
Published: May 2014

Viruses are often proposed as potential aetiological agents in rheumatoid arthritis (RA). However, this hypothesis is based primarily on circumstantial evidence rather than on experimental data. This editorial discusses specific viral candidates for RA and highlights some of the difficulties in proving disease causation.
Acute pancreatitis
Authors: Cartmell MT , Kingsnorth AN
Published: May 2014

Acute pancreatitis is a common disease. As knowledge of its pathophysiology improves, evidence is found to confirm and refute present management and also to suggest new approaches. This article addresses some of these areas in the context of the management of acute pancreatitis.
Time to stop bullying and intimidation
Authors: Hicks Brendan
Published: May 2014

Bullying remains a familiar part of the health professional culture, despite the caring nature of doctors' work. Trainee doctors who feel threatened in the clinical workplace develop less effectively and are less likely to ask for advice or help when they need it. Most people who bully are not intrinsically bad people, but they must be helped to change, in the interests of patients as well as staff.
Management of urticaria
Authors: Greaves Malcolm
Published: May 2014

Urticaria is a very common and disabling disorder. Recent advances in understanding of pathomechanisms has led to important advances in diagnosis and treatment. However, the cause in many patients remains obscure and the treatment poorly effective.
The modern geriatric day hospital
Authors: Black David A
Published: May 2014

Geriatric day hospitals have played a major role in the rehabilitation of older people, although the evidence base has proved thin. As the provision of geriatric medicine changes, they need to develop new roles such as responding to subacute crises, providing specialist services and ensuring comprehensive geriatric assessment before long-term care.
Penile cellulitis
Authors: Aldeen Taha , Mantell Janet
Published: May 2014

A37-year-old married man presented to his GP with a 4-day history of itching and painless swelling of his penis. He was treated with a compound antifungal, anti-inflammatory disinfectant cream (Timodine cream, Reckitt & Colman, Hull) without response. Three days later, the patient attended the accident and emergency department at his local hospital with the same complaint. He was diagnosed as having an ‘infected penis’, and was advised instead to attend the genitourinary medicine (GUM) clinic.

At the GUM clinic, the patient denied any history of allergy or genital trauma before his complaint. He was in a monogamous sexual relationship with his wife, and only practised peno-insertive vaginal intercourse. He had sexual intercourse 2 weeks previously. There was no significant past medical history.

On examination, he was overweight and apyrexial. There was a painless diffusely swollen penis with a ring of crusts at the tip of the foreskin and purulent discharge around the glans penis. There was no urethral discharge and no inguinal lymphadenopathy (Figure 1). There was tenderness on attempting to retract the foreskin. Routine urinalysis for pyuria and proteinuria were negative. Screening for urethral gonococcal and chlamydial infections were negative. However, culture of the purulent discharge taken from the subpreputial sac grew beta-haemolytic group A Streptococcus pyogenes. The patient was initially treated with a 2-week course of amoxycillin and flucloxacillin, and his condition improved dramatically after 4 days.
Bicalutamide treatment for locally advanced prostate cancer
Authors: Anderson John
Published: May 2014

In men with locally advanced prostate cancer, bicalutamide 150mg monotherapy provides a similar disease outcome to medical or surgical castration. However, castration is associated with loss of sexual interest and function, decreased energy and an increased risk of osteoporotic fractures. Bicalutamide 150mg monotherapy has less impact on sexual interest and physical capacity than castration.
Tuberculosis as a cause of chronic epididymo-orchitis in a male Caucasian
Authors: McVie JL , Bani-Hani K , Bury RW , Duthie R , Walker SJ
Published: May 2014

A69-year-old retired white businessman was referred with a 6-week history of painful swelling of the left side of his scrotum. He had received two courses of broad-spectrum antibiotics from his GP which failed to relieve his symptoms. There was no history of scrotal trauma. There was nothing of note in his past medical history apart from angina and chronic laryngitis. On examination the right side of his scrotum was entirely normal, but the left was tense, tender, warm and approximately three times normal size. A scrotal ultrasound demonstrated a normal left testis with a large hydrocele. The left epididymis was enlarged in it's transverse diameter with high vascularity, consistent with epididymitis.

The patient was started on oral antibiotic therapy. After 1 weeks treatment the left side of the scrotum had reduced slightly in size but remained painful. Eighteen ml of clear fluid was aspirated from the hydrocele and was sent for culture and sensitivity. No organisms were found. By this stage he had been under review for 9 weeks and had taken antibiotics for a total of 24 days. He requested orchidectomy as he felt unwilling to tolerate the discomfort. At operation an abscess cavity was found surrounding the epididymus and extending close to the external ring. Tissue and a swab was sent for culture and sensitivity and for acid-fast bacilli and the left testicle was removed. His postoperative recovery was complicated by a discharging sinus which resolved with irrigation.

The histology report showed extensive areas of necrosis throughout the testis and epididymis with prominent epitheliod cells and many Langhans' type multi-nucleated cells. The appearance was that of florid granulomatous inflammation of the testis and epididymis consistent with a mycobacterium infection. Initial stains for acid-fast bacilli were negative. Subsequently acidfast bacilli were seen in the tissue sample and swabs using oramine phenol counterstained with Ziehl-Nielsen stain. There was a positive culture using Lowenstein Jensen medium, the mycobacteria were sent to a reference laboratory and the species identified as Mycobacterium tuberculosis. He was started on antitubercular treatment. His chest X-ray and intravenous urogram are normal and he remains well 9 months after diagnosis.
Investigating eosinophilia in patients returned from the tropics
Authors: Gyawali Pranab , Whitty Christopher JM
Published: May 2014

In patients who have returned from the tropics, eosinophilia usually signifies infection with worms. This paper gives an approach to investigating these patients systematically. The key element is a good travel history leading to targeted investigations.
The first reported sudden fatality from pulmonary artery compression by a thymic cyst
Authors: Hart Simon R , Ashton-Key Margaret
Published: May 2014

A 21-year-old previously well female student presented to accident and emergency having woken in the early hours of the morning with severe chest pain. On arrival she appeared, very unwell and breathless. For 1 week she had complained of a severe upper respiratory tract infection associated with chest pain which had been attributed to pleurisy. There was a strong family history of coronary heart disease but no risk factors for venous thrombosis or history of drug abuse. Over the next few minutes she began to look moribund with breathlessness and confusion. During physical examination, which was normal apart from tachypnoea and tachycardia, she had a cardiac arrest.

Advanced cardiopulmonary resuscitation for electromechanical dissociation was commenced and after two cycles the rhythm changed to ventricular fibrillation. Tension pneumothorax was excluded by intercostal fine needle aspiration and an endotracheal tube inserted. After 20 minutes of resuscitation, sinus rhythm was restored with a blood pressure of 100/50 mmHg. Physical examination revealed no rash, normal abdominal examination and no abnormal respiratory signs. She regained consciousness and sat up in an agitated state for about 30 seconds. An arterial blood gas showed pO2 10 KPa, pCO2 4 KPa, pH 6.97, bicarbonate 7.3 mmol/litre. Haemoglobin was 12g/dl, total white cell count 18.2 (neutrophils 5, lymphocytes 10). Electrolytes were normal.

A chest radiograph and electrocardiogram were about to be taken when cardiac output was lost during another electromechanical dissociation arrest. Resuscitation was restarted having established central venous access, which showed a central venous pressure of about +10 cmH20. Over the next 30 minutes cardiac output could not be re-established and nearly an hour after the initial cardiac arrest the patient was pronounced dead.

Post-mortem revealed an 8.0 cm diameter non-communicating cyst in the mediastinum. This was adherent to the left atrium anteroinferiorly and there was external compression of the pulmonary artery anterosuperiorly. It was unilocular, tense, thin-walled and collapsed when punctured revealing a cloudy white serous fluid.

The trachea contained thick secretions consistent with resolving pneumonia and there were multiple pulmonary foci of consolidation. There were bilateral pleural effusions each measuring 300 ml and pulmonary oedema, but no evidence of pulmonary emboli. Otherwise, the heart, pericardium and cardiovascular system were normal apart from a small blood-stained pericardialeffusion.

Histological examination showed that the cyst had a thin fibrous wall and was lined by cuboidal cells. Immunohistochemistry showed that these cells were positive for the specific cellular antibodies CAM 5.2 and AUA 1 indicating an epithelial rather than mesothelial origin. These findings are consistent with tissue of thymic origin.
Infliximab: a new treatment for rheumatoid arthritis
Authors: Emery Paul
Published: May 2014

Infliximab, a chimeric mouse human monoclonal antibody, is an anti-TNF treatment for rheumatoid arthritis. In the past there was a sizeable group of people who had exhausted disease-modifying antirheumatic drugs (DMARDs) and were left largely untreated. This has been revolutionized by treatments such as infliximab which have been shown to be effective for patients in whom standard DMARDs have failed.
Acute gastric distension: a lesson from the classics
Authors: Ramamurthi RJ , Tatman A
Published: May 2014

Acute gastrothorax may masquerade as a tension pneumothorax. Once the diagnosis is suspected, a nasogastric tube should be passed to release the gastric distension and confirm the diagnosis (Fein et al, 1993). This article describes a case where, despite having made the correct diagnosis, the authors were unable to pass a nasogastric tube in a child who was rapidly deteriorating.
How to write a peer review
Authors: Paice Elisabeth
Published: May 2014

The peer review process is a quality control for scientific publication. Well done, it helps editors to improve their journals and protects readers from wasting time on ill-conceived, redundant, irrelevant or erroneous literature. Badly done it can act as an obstacle to innovation. This article tells you how to be a first rate peer reviewer.
Understanding sampling: representativeness matters
Authors: Davis Julian PL , Crombie Iain K , Davies Huw TO
Published: May 2014

Sampling, or selecting a group of people to represent a whole population, lies at the heart of almost all research designs. There are many ways of going about this, each of which presents its own problems. The trick is to obtain a good-sized sample that is truly representative of the population as a whole.
Post stroke depression
Authors: Gall Angela
Published: May 2014

Depression following stroke is common. Although it is highlighted as an issue in stroke guidelines, guidance on diagnosis or management is not given. This paper presents the original research from a literature review of Medline and the Cochrane Database on stroke and depression, and discusses some of the clinical implications of the findings.
St John's wort for depression: what's the evidence?
Authors: Kelly Brendan D
Published: May 2014

There is a moderate amount of evidence to suggest that St John's wort is better than placebo in the short-term management of mild to moderate depressive illness, but there is increasing concern over reports of drug interactions. This article examines the scientific evidence and discusses relevant clinical issues.
Systemic treatment of metastatic breast cancer
Authors: Johnston Stephen RD
Published: May 2014

This article reviews recent advances in the treatment of metastatic breast cancer, in particular the results of randomized controlled phase III clinical trials. These have led to the evidence-based introduction of several new drugs including aromatase inhibitors, taxanes and bisphosphonates, some of which have been shown to impact on overall survival.
Capacity to consent: issues and controversies
Authors: Mukherjee Sujoy , Shah Ajit
Published: May 2014

Capacity to consent has major ethical and legal implications, but it is often poorly understood and inadequately practiced. Varied literature on the subject is reviewed with a view to discuss the legal and clinical aspects and strategies to improve current practice.
Benign salivary gland disease
Authors: Bradley PJ
Published: May 2014

The majority of benign clinical problems that present affect the major salivary glands — parotid and submandibular. However, there are numerous minor salivary glands located in the mucosa of the head and neck which have the same predilection to the same diseases that affect the major glands but to a lesser frequency.
Pseudomembranous colitis without diarrhoea following Helicobacter pylori eradication therapy
Authors: Lau CF , Fung TT , Tung SYM , Wong AMC , Loo CK , Lam KM , Hui PK
Published: May 2014

A 73-year-old man with a known history of hypertension and gout was admitted into hospital having had chest and epigastric discomfort for 3 days. His chest discomfort was not related to exertion, and there was no recent history of antibiotic or non-steroidal anti-inflammatory drug intake. His bowel habit was normal. Physical examination was unremarkable except for mild ankle oedema. Per rectum examination revealed brownish stool and no mass was felt.
Colorectal cancer surveillance post-surgery
Authors: Huang Andy , Tsavellas George , Hindle Kirsten S
Published: May 2014

Current surveillance methods for detecting recurrence after apparently curative colorectal cancer resection are insensitive and have not been shown to significantly improve survival. New surveillance methods based on molecular, flow cytometric and immunohistochemical detection of small numbers of tumour cells may prove more sensitive in detecting early recurrent cancer and may improve outcome.
Producing a multimedia CD-ROM
Authors: Vogel Mira , Bennett GCJ
Published: May 2014

The multimedia capabilities of modern computers promise a rich contribution to medical education, integrating video, animation and graphics as a single courseware package. Using the new generation of design tools, computer-assisted learning material can be successfully created in-house.
Investigation of faecal incontinence
Authors: Buchanan Gordon N , Nicholls Tanya , Solanki Deepa , Kamm Michael A
Published: May 2014

Most patients with faecal incontinence require only a full history (information about other predisposing causes) and examination (assessment for faecal impaction and evaluation of sphincter function and structure). When necessary, anorectal physiological studies, endoanal ultrasound and magnetic resonance imaging allow accurate characterization of sphincter function and structure.
Undiagnosed sinusitis leading to orbital cellulitis
Authors: Bhargava Deepa , Sankhla Dilip , Chand Pratap
Published: May 2014

Six patients who presented with symptoms and signs of orbital cellulitis during the period 1995—1999 had undiagnosed sinusitis as the underlying cause. All patients were ethnic Omanis (Arabs) coming from different geographical areas of Oman. Their ages ranged from 5 years to 72 years; five were male and one was female. All patients had eye symptoms and signs of pain, swelling, chemosis, restricted eye movements and proptosis with headache and fever. The patients were hospitalized and underwent ophthalmological, neurological, radiological and nasal endoscopic examination. None of these patients presented primarily to otolaryngology, as they did not have symptoms of sinusitis. They were referred to otolaryngology after computed tomography (CT) scan established the diagnosis of sinusitis as the cause of orbital cellulitis. The ethmoid sinus was the predominant sinus involved (Figures 1 and 2). Nasal endoscopy revealed some features common to five patients; these included generalized mucosal oedema, congestion and mucopurulent secretion, which on culture grew Pseudomonas aeruginosa in one patient and Streptococcus pneumoniae and Moraxella catarrhalis in the others.
Management of cerebral palsy: the neurologist's view
Authors: Carr LJ
Published: May 2014

Cerebral palsy is a complex disorder which compromises motor abilities. Other systems are often involved and its effects on the child and their family may be profound. This article examines clinical aspects of cerebral palsy and discusses the approach to comprehensive management, with particular reference to the role of the neurologist.
The value of ultrasound in sports medicine
Authors: Healy JC
Published: May 2014

Musculoskeletal ultrasound is increasingly being used in the evaluation and treatment of sports-related injuries. This technique is widely available, rapid, and has a high patient acceptance. Its multiplanar capability and dynamic real-time imaging can be correlated with clinical symptoms and compared to contralateral asymptomatic structures.
The epidemiology of atopic dermatitis
Authors: Daniels Justin , Harper John
Published: May 2014

Atopic dermatitis is the most common chronic inflammatory skin disease and is a major cause of morbidity and suffering. This review examines its differing prevalence worldwide, its aetiology, and genetics.
Escitalopram: efficacy and tolerability in the treatment of depression
Authors: Baldwin David S
Published: May 2014

Escitalopram is a new antidepressant drug, available for clinical use in many countries. This review describes the properties of escitalopram, summarizes the results of randomized controlled trials, and suggests that escitalopram has advantages over citalopram in the treatment of depression.
X-linked severe combined immunodeficiency
Authors: Church AC
Published: May 2014

Severe combined immunodeficiency is one of the most common causes of primary immunodeficiencies in humans. Molecular biological techniques have allowed new, therapeutically useful treatments for these diseases to be introduced into clinical practice. This review will focus on the molecular basis and new treatments for X-linked severe combined immunodeficiency.
Outcomes of specialist registrar assessments
Authors: Tunbridge Michael , Dickinson David , Swan Pauline ,   Conference of Postgraduate Medical Deans of the United Kingdom
Published: May 2014

The present study analyses the record of in-training assessment grades of 12 822 specialist registrars in the UK over a 12-month period and the outcome of further assessments during the subsequent year.
Foxglove poisoning
Authors: Jowett Nigel I
Published: May 2014

A 39-year-old man presented to the emergency department with nausea, light-headedness and blurred vision. An hour earlier he had drunk an infusion of foxglove leaves boiled in water, which he had taken as a heart tonic. There was a previous history of drug abuse.
Asbestos-related disease
Authors: C Bolton , A Richards , P Ebden
Published: May 2014

Until the 1980s, asbestos was widely used throughout the UK. The incidence of asbestos-related disease is still climbing because of the long delay in developing the disease from the initial exposure. The spectrum of diseases encompasses malignant mesothelioma, asbestosis, asbestos-related lung carcinoma and benign pleural disease, including pleural plaques.
Chloramphenicol in the 21st century
Authors: Wareham David W , Wilson Peter
Published: May 2014

Chloramphenicol use has declined in the UK, despite it remaining highly active against a wide range of bacteria. This article will review the activity, pharmacology, toxicology, uses and potential uses of chloramphenicol in an era of increasing antimicrobial resistance.
Diagnosis and immediate care of soft tissue knee injuries
Authors: Patel RV , Haddad FS
Published: May 2014

There is good evidence that the primary assessment of knee injuries is poor (Bollen and Scott, 1996). The knee is the most commonly injured joint in sport and exercise, and soccer and rugby carry the highest risk (Nicholl et al, 1991). A basic approach comprising a thorough history and a full examination, including ‘look, feel, move and special tests’, is usually all that is needed (Apley and Solomon, 1994).
Pilot study of 360° assessment of personal skills to inform record of in training assessments for senior house officers
Authors: Whitehouse Andrew , Walzman Mike , Wall David
Published: May 2014

The assessment of a trainee doctor's human skills, including teamworking, communication and maintaining trust, is difficult but necessary to confirm competence and to alert trainees and trainers of potential problems before they become intractable. This study used 360° team observation reports for this purpose. The process was easy to administer and valued by trainees.
Priapism: a medical emergency
Authors: Kalsi JS , Arya M , Minhas S , Ralph DJ
Published: May 2014

Priapism is defined as a prolonged penile erection that fails to subside despite orgasm. It is a medical emergency which should be diagnosed and treated early to preserve erectile function and avoid corporal fibrosis resulting from anoxia of the corporal tissue. Decompression is usually successful with no permanent damage if treatment is provided within 12hours of onset.
Brain imaging: a key to understanding depression
Authors: Mitterschiffthaler Martina T , Kumari Veena , Sharma Tonmoy
Published: May 2014

According to the World Development Report 1993 one third of people with a mental illness suffer from a depressive disorder. There is a need for early diagnosis and effective treatment in order to limit the impact on patients' lives. Knowledge gained from brain imaging research may help to improve our understanding and treatment of depression.
Management of acute and chronic osteomyelitis
Authors: Ray Pinak S , Simonis Robert B
Published: May 2014

The incidence of acute and subacute osteomyelitis is declining. Vaccination has almost eradicated Haemophilus bone infection in infants. However, chronic traumatic osteomyelitis is becoming more frequent following an increase in motorcycle accidents and infected internal fixation of fractures. There are now effective means of treating this using the Ilizarov external circular frame.
Acute lower limb ischaemia
Authors: Engledow AH , Crinnion JN
Published: May 2014

Salvage of the acutely ischaemic lower limb represents a large proportion of the emergency workload for the vascular surgeon. A successful outcome is dependent upon a careful clinical assessment and a prompt multidisciplinary approach to revascularization.
Forensic dentistry and human bite marks: issues for doctors
Authors: Pretty Iain A , Hall Rachel C
Published: May 2014

The human dentition can be used as a weapon of attack or defence. Bite mark injuries are common in cases of sexual assault, child abuse and homicide. Many bite injuries are first seen in casualty departments where quick and proper recovery of evidence can assist in analysing these injuries. This article describes different bite injuries, collection of evidence and comparative analysis methods.
The role of anti-IgE therapies in the treatment of asthma
Authors: Babu K Suresh , Holgate Stephen T
Published: May 2014

The prevalence of asthma, a chronic inflammatory disease often linked to allergy, is on the increase. The introduction of a blocking anti-IgE monoclonal antibody (omalizumab) as a new therapy has not only confirmed the pathogenic role of IgE in asthma but has also provided a novel therapy for a chronic severe disease where there are limited therapeutic options.
Female reproductive potential post-treatment for childhood cancer
Authors: Burton Kevin A , Wallace W Hamish B , Critchley Hilary OD
Published: May 2014

Survival post-treatment for childhood malignancy is now in excess of 70%. Hence female reproductive potential following treatment must be addressed. Issues concerning subsequent uterine and ovarian function, fertility options and importantly the ethics and safety of treatment approaches are discussed herein.
The use of prosthetics in hernia repair
Authors: Anwar S
Published: May 2014

Since the early 19th century different prostheses have been tried and tested to prevent recurrences after hernia repairs. This article reviews the evolution of prostheses and their use in hernia surgery. Tension-free mesh hernia repairs using polypropylene fibre seems to be associated with very low recurrence rates and minimal complications.
Neuroimaging of sexual arousal: research and clinical utility
Authors: Sumich AL , Kumari V , Sharma T
Published: May 2014

The treatment of sexual dysfunction or deviancy requires an understanding of the underlying neural substrates. Neuroimaging techniques offer insight into brain regions involved in sexual arousal and inhibition. The development of robust paradigms has implications for the assessment and treatment of sexual disorder in men and women.
The long-acting depot antipsychotic drugs
Authors: Pandarakalam James Paul
Published: May 2014

The novel antipsychotics have reduced the use of depot medications, but the introduction of the atypical depot antipsychotic has rekindled an interest in the long-acting antipsychotic formulations. The use of atypical antipsychotics is recommended, except where patients are otherwise stable on classical antipsychotics without unwanted side effects.
The eye in metabolic disease
Authors: Al-Khaier Ayman , Nischal Ken K
Published: May 2014

Eye involvement is a feature of many metabolic diseases; early identification of ocular changes may aid diagnosis and management of the underlying condition. This review aims to describe common metabolic conditions where ocular findings can help the diagnosis.
Training in breast reconstruction: a new chapter in breast surgery
Authors: Rainsbury Dick
Published: May 2014

Reconstruction of the breast after mastectomy was first popularized more than 30 years ago using implants, myosubcutaneous flaps, or a combination of these techniques. In the early days, there were concerns about the possible adverse effects of breast reconstruction (BR) on the development and detection of subsequent recurrence. This meant that most patients had to wait at least 2 years before undergoing delayed BR. Attitudes changed slowly as emerging evidence failed to confirm worries about oncological safety, but now immediate BR is becoming increasingly popular. A one-stage approach avoids many of the disadvantages of a delayed procedure, including greater morbidity, disability, psychological distress, cost and the inconvenience of two operations.
Where do we stand with chronic prostatitis? An update
Authors: Khastgir Jay , Dickinson Andrew J
Published: May 2014

Chronic prostatitis remains a difficult management problem, which reflects the fact that its aetiology remains incompletely understood. It is a common condition that is characterized by protracted symptoms and high morbidity. Although lacking a reliable diagnostic test, antibiotic therapy remains the mainstay of treatment in the majority of cases.
Management of maxillofacial injuries
Authors: Swinson Brian , Lloyd Tim
Published: May 2014

Maxillofacial injuries account for 5% of all acute attendances at accident and emergency units, and are often seen in the multiply injured patient. A systematic method of examining and investigating these patients is required for all staff involved with trauma patients and an understanding of the principles of their management will help to prioritize treatment needs.
Helping refugee doctors get their first jobs: the pan-London clinical attachment scheme
Authors: Ong Yong-Lock , Gayen Anita
Published: May 2014

Refugee doctors are a potentially valuable addition to the medical workforce in the UK. Despite this, they often have trouble getting jobs. An innovative structured clinical attachment scheme resulted in 17 out of 29 refugee doctors being appointed to jobs. Details of the scheme and the factors which may have influenced this outcome are discussed in this article.
Risk assessment for venous thromboembolism in acute medical illness
Authors: Hampton KK , Walker I
Published: May 2014

Venous thromboembolism (VTE) is an important cause of mortality and morbidity and its prevention is an everyday concern for clinicians. The major consequences of VTE are sudden death as a result of pulmonary embolism (PE) and the long-term problem of post-thrombotic syndrome. Evidence shows that acute VTE is associated with higher mortality than previously estimated, with up to 30% of patients with acute PE dying within 30 days of diagnosis (Heit, 2002).
The epidemiology and scale of the problem
Authors: O'Neill Terence W , Roy Dipak K
Published: May 2014

Osteoporosis is an important health problem because of its association with fragility fractures. This article reviews the epidemiology of osteoporosis including its occurrence, risk factors and health impact.
Helicobacter pylori: a clinician's view
Authors: Gibbons AH
Published: May 2014

Helicobacter pylori infection has been linked with a number of gastrointestinal diseases, such as peptic ulcer disease, gastric mucosaassociated lymphoid tissue lymphoma and gastric cancer. This article reviews some of the evidence for these associations, and discusses the latest recommended indications for eradication therapy.
A survey of the safety of doctors driving home after a night ‘on call’
Authors: Saklani AP , Shafi M , Nagabhushan J , Delicata RJ
Published: May 2014

The ‘on-call’ system for doctors within the health service maintains a continuity of care. However, allowing doctors to drive home after a night on call may pose a public hazard. The aim of this survey was to assess doctors' opinions regarding the safety of driving without adequate sleep.
Atrial myxomas: diagnosis and management
Authors: Banerjee Shrilla
Published: May 2014

The first published report of left atrial myxoma appeared in 1845, and in 1955 the first successful excision was performed (Straus and Merliss, 1945).
The hand X-ray in rheumatology
Authors: Kassimos Dimitrios , Creamer Paul
Published: May 2014

X-ray of the hands is the most valuable imaging modality in rheumatology. Joint disease may be identified by individual features such as joint space narrowing, erosions, new bone formation, subluxation and deformity, which may be diagnostic. In diseases such as rheumatoid arthritis presence of erosions on hand X-ray give a valuable measure of disease progression and response to therapy.
Flexible (part-time) preregistration house officer training: review of Thames and London deanery experiences
Authors: Peters Timothy J , Houghton Anita
Published: May 2014

Flexible training has been in greatest demand at the specialist registrar grade, and to a lesser extent in the senior house officer grade. This article describes the experiences of a much smaller group, flexible preregistration house officers.
The unstable shoulder
Authors: Wallace Andrew L , Alexander Susan , Gupte Chinmay M
Published: May 2014

Not all unstable shoulders are the same, and careful patient selection ensures proper treatment. Improved understanding of the mechanisms of stability, advances in imaging and arthroscopic technology mean that repeated visits to the emergency department with a painful dislocated shoulder should be a thing of the past.
Temporal arteritis in the absence of headache
Authors: Sibal Latika , Scoones David J , Bilous Rudy
Published: May 2014

A 75-year-old woman was admitted to hospital with diplopia on leftward gaze. She underwent thyroidectomy several years ago for thyrotoxicosis with subsequent hypothyroidism for which she was on thyroxine replacement. A microcytic, hypochromic anaemia had been diagnosed a few weeks before admission. She gave no history of headache, eye pain or visual loss. On examination, she was pale and had a left sixth nerve palsy. Tenderness over the temporal arteries was notably absent. A diagnosis of mononeuritis was made with a differential diagnosis of isolated ophthalmic Graves’ disease. Biochemical parameters were as shown in Table 1.

Abdominal ultrasound and computed tomography scan of the head were unremarkable; in particular, no swelling of the extraocular muscles was noted. An upper gastrointestinal endoscopy and colonoscopy were performed to investigate the anaemia. A mild Campylobacter-like organism test (for Helicobacter pylori infection) proved positive for gastritis, and areas of patchy erythematous mucosa of uncertain significance were seen. Temporal artery biopsy was performed 11 days after admission and while awaiting biopsy results, she was commenced on prednisolone 60 mg daily. Histopathology confirmed giant cell arteritis, showing fragmentation of the internal elastic lamina and an inflammatory cell infiltrate including lymphocytes and multinucleate giant cells (Figure 1).

Within a week of commencing steroids, her diplopia improved and resolved completely in 10 days. She was discharged on prednisolone 20 mg daily and followed up in the outpatient clinic. She remains on reducing doses of steroids along with etidronate and calcium supplementation.
Health-care-associated infection: morbidity, mortality and costs
Authors: Wilcox Mark
Published: May 2014

Health-care-associated infection is rightly an area of increasing attention, not least because of considerable resource issues. Not all infection is preventable. However, much is possible and is indeed obligatory to avoid unnecessary infection, and attendant morbidity, mortality and, increasingly, litigation.
Erythroderma: 90% skin failure
Authors: Balasubramaniam P , Berth-Jones J
Published: May 2014

Erythroderma is a life-threatening state of skin failure. This dermatological emergency often presents to an acute medical unit or accident and emergency department. Effective initial management is vital.
The Ottawa rules for ankle sprains
Authors: Bachmann Lucas M , Riet Gerben ter
Published: May 2014

Patients presenting with acute ankle sprain are common in general practice and emergency departments. Many patients undergo radiography but only about 10–15% are diagnosed with a fracture of the ankle or mid-foot. The Ottawa ankle rules (Table 1) was developed to reduce the number of unnecessary radiographs (Stiell et al, 1992). The ankle assessment covers the ability to walk four steps (immediately after the injury or at the emergency department) and localized tenderness of the posterior edge or tip of either malleolus (four points). The midfoot assessment covers the ability to walk and the localized tenderness of the navicular or the base of the fifth metatarsal. The test is designed to rule out fractures of the malleolus and the mid-foot.
Comorbid chronic non-cancer pain and opioid use disorders
Authors: Littlejohn Christopher , Baldacchino Alex , Bannister Jonathan
Published: May 2014

Patients with chronic non-cancer pain and opioid dependence are difficult to treat effectively. This article reviews the common issues that arise in relation to assessment and treatment, and recommends the adoption of an integrated approach to this patient population.
Necrotizing enterocolitis
Authors: Hall Nigel , Pierro Agostino
Published: May 2014

Necrotizing enterocolitis is the principal cause of surgical referral in preterm neonates and the most common gastrointestinal emergency among infants. Its pathophysiology is unclear and it carries high levels of mortality and morbidity. This article provides an overview of necrotizing enterocolitis including risk factors, preventative strategies and medical and surgical management.
Therapy for intra-abdominal adhesions
Authors: Bullen Timothy F , Hershman Michael J
Published: May 2014

Therapy for adhesions encompasses their prevention and treatment. They are reduced in number and severity by good surgical technique but antiadhesion agents are useful adjuncts. Small bowel obstruction secondary to adhesions requires surgery following resuscitation if signs of peritonism develop. Otherwise a trial of conservative therapy is advocated.
A case of hypertension and hyperkalaemia
Authors: Michael Atef B , Wallis Peter
Published: May 2014

A52-year-old man was referred urgently to hospital by his GP because he had hyperkalaemia (7.3 mmol/litre; normal range 3.5–5.0 mmol/litre). Two months previously he was diagnosed as having diabetes mellitus when he was admitted to hospital with diabetic ketoacidosis. At that time his plasma sodium was 126 mmol/litre (normal range 133–147 mmol/litre), potassium 2.7 mmol/litre, urea 18 mmol/litre (normal range 2.5–7.5 mmol/litre) and creatinine 159 μmmol/litre (normal range 60–120 μmol/litre). Bendrofluazide, nifedipine and atenolol were stopped. Six weeks later he felt unwell, visited his doctor, and was found to be hypertensive. He was started on lisinopril 5 mg once daily. Ten days later he was still hypertensive, and lisinopril was increased to 10 mg once daily and routine plasma urea and electrolytes were measured.

His past medical history includes a Colles' fracture in 1992. At this time, hypertension and hyperkalaemia were noted and investigated. He was diagnosed as having Gordon's syndrome. Three of his daughters and two of his granddaughters were also found to have the syndrome. His father had been hypertensive and died suddenly at the age of 40 years. His uncle had also died suddenly at the age of 33 years.

On examination his height was 1.60 m, body mass index (BMI) was 30 kg/m2 and blood pressure was 168/75 mmHg. Heart, chest, abdominal, and neurological examination were normal. The electrocardiogram did not show manifestations of hyperkalaemia.

The hyperkalaemia was treated with insulin/glucose infusion. Lisinopril was stopped and bendrofluazide was started with normalization of plasma potassium level and blood pressure.
Investigation and treatment of myocardial ischaemia in critical care
Authors: Randles D , Nesbitt I
Published: May 2014

A 49-year-old man required a prolonged intensive care unit (ITU) stay for sepsis and multiorgan failure (MOF) following a laparotomy for gangrenous appendicitis. He had a history of myocardial infarction and previous coronary stent insertion. During attempts to wean from mechanical ventilation during his second week in ITU, he developed unstable angina associated with bradyarrhythmias and complete heart block.
Cruciate ligament reconstruction
Authors: Haddad Fares S , Oussedik Sam IS
Published: May 2014

Injuries to the cruciate ligaments of the knee can be disabling. Advances in treatment over recent years have made their early diagnosis imperative. Surgical reconstruction is not appropriate for all. Once surgical candidates have been identified a number of reconstructive options exist.
Latex allergy and otorhinolaryngological surgery
Authors: Khodaei I , Swift AC
Published: May 2014

Latex allergy in the otorhinolaryngology patient requires forward planning and coordination of management plans between the surgical, nursing and anaesthetic departments in order to ensure a safe outcome.
National Audit of Myocardial Infarction (MINAP): a project in evolution
Authors: Birkhead John , Walker Lynne
Published: May 2014

The National Audit of Myocardial Infarction (MINAP) is a national online electronic reporting and analysis system developed to monitor the process of care of patients with acute coronary syndromes (Birkhead et al, 2002). This project differs from a simple prospective registry of coronary heart disease, as it is designed primarily to provide hospitals with continuously updated contemporary analyses of the care of their patients.
Laser surgery in the management of sinonasal disease
Authors: Kaluskar SK
Published: May 2014

Better understanding of the pathophysiology of sinus disease, and improved technology and imaging modalities have changed nose and sinus surgery in recent years. Precise surgery of the ethmoid sinuses is now possible, improving ventilation and drainage of the sinuses. Newer technology has enhanced the scope of surgery and helped make sinus surgery safer.