bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-Effectiveness of Investigations for Invasive Bladder Cancer
Authors: Hunt M T , Woodhouse C R J
Published: March 2018

The results of diagnostic and staging investigations in consecutive cases of invasive transitional cell carcinoma of the bladder are reviewed. Urine culture, urine cytology and intravenous urography had positive results in a high percentage of cases. As diagnostic investigations they are cost-effective but certainly do not remove the obligation to perform cystoscopy and examination under anaesthetic.

Isotopic bone scan and liver scan showed metastases in 4 and one cases respectively and only when there were clinical signs of disseminated disease. Chest X-ray showed metastases in one case. These investigations are not cost-effective. Lymphangiography was positive in 12 of the 94 cases and, although expensive (£70), is still a staging investigation of value in planning treatment.
Building or Extending a Hospital Department: Radiology a Path through the Planning Minefield (3)
Authors: Roebuck E J , Manton D J , Fordham G L
Published: March 2018

This is the third of a series of articles on the planning and building of a new radiology department or the extension of an old one. While the series focuses on a radiology department, 'it will be of interest to anyone who is planning any part of a hospital, particularly in the detailed information about the planning process and the part to be played by hospital staff during the subsequent building and commissioning. (The first article in the series appeared in the January issue, p 40.)
Blood Loss Associated with Uncemented Total Hip Replacement: Hypotension Does not Affect Blood Loss
Authors: Wittmann F W
Published: March 2018

Twenty-seven patients who were moderately hypotensive during uncemented total hip replacement were compared with a group of normotensive patients. There was no statistical difference (P < 0.05) in blood loss measured at time of operation, following operation or in the calculated loss. Hypotension, which is known to be dangerous in the elderly, conferred no benefit and should be avoided.
Benign Thoracic Pain
Authors: Bruckner F E , Allard S A , Moussa N A
Published: March 2018

Seventy-three patients with mid-dorsal and/or unilateral chest pain seen consecutively in the rheumatology clinic by a single clinician over a three-year period were studied, after exclusion of visceral disease. The majority were young women. The pain was dull and continuous, was aggravated by coughing and sneezing and relieved by rest. There was frequently tenderness over the thoracic spine (T4–5) and an adjacent rib, and pain at extremes of thoracic spinal movement in one or two directions was invariable. Cutaneous hyperaesthesia in a radicular distribution was found in 16.4%, but there were no other neurological abnormalities. This clinical picture is probably the result of a thoracic disc prolapse, though confirmation by myelography was not thought to be ethically justified. The condition settled in most of the patients following manipulative treatment and advice on back care. No patient developed spinal cord compression. It is concluded that this is a common benign condition which deserves wider recognition.
Skin Clips are Contraindicated when there is Nickel Allergy
Authors: Oakley A M M , Ive F A , Carr M M
Published: March 2018

Four patients are described who developed generalized dermatitis following surgical wound closure with disposable skin clips. In 3 of them a vesicular palmar eczema was a prominent feature. They were found to have contact allergy to nickel, a component of the clips. If skin clips are to be used to close a surgical wound, it should be established that the patient is not allergic to nickel.
An Inner-City General Medical Ward Round in the Mid-1980s
Authors: Baron J H , Bush A
Published: March 2018

Few patients seen in 1983 on a general medical ward round in an inner-city hospital presented difficulty in diagnosis or management. Most had major social problems, especially from alcohol, self-neglect and dementia.
Five-Year follow up of Patients Treated with Inpatient Psychotherapy at the Cassel Hospital for Nervous Diseases
Authors: Rosser R M , Birch S , Bond H , Denford J , Schachter J
Published: March 2018

Twenty-eight patients who were admitted consecutively to a single-adult unit of the Cassel Hospital in 1977/8 were followed up 5 years after discharge. Those who were found to have improved at the end of treatment remained well 5 years later. These could be distinguished by their combination of neurotic psychopathology, considerable depression, superior intelligence, and lack of a chronic outpatient history. Patients who had improved 5 years after discharge did not show these characteristics, but had all spent at least 9 weeks on the waiting list and had the capacity to form close and helpful relationships. Patients who were judged to have improved were less dependent on the Health Service and their economic productivity was improved, often as a consequence of returning to education or training. Those who did not improve clinically continued to be admitted to hospital and tended to become less economically productive.
Hypercalcaemia in Primary Squamous Cell Carcinoma of the Stomach
Authors: Raju G C , Barton E N , Marchack D , Naraynsingh V
Published: March 2018

Hypercalcaemia associated with neoplastic disease is well recognized1,2, and has potentially serious consequences if not corrected promptly. We report a case of primary squamous cell carcinoma of the stomach associated with hypercalcaemia, an association that seems not to have been reported previously.
Effect of a surgical day unit on waiting lists
Authors: Lakhani S , Leach R D , Jarrett P E M
Published: March 2018

The effect of a surgical day unit (SDU) on the waiting lists of a busy district general hospital is reported over a 4-year period. During this time, 18 (15%) of the general surgical beds were closed for financial reasons. A real saving rather than an apparent one is reported due to the work expansion in the SDU.
X-ray and Ultrasound Localization of Non-Palpable Breast Lesions and Difficulties in Management
Authors: Tate J J T , Royle G T , McDonald P , Guyer P B , Taylor I
Published: March 2018

Seventy-four patients who have had biopsy of a non-palpable breast lesion are reviewed. A double-dye localization technique was used in 88% while in 12% localization of the lesion was best achieved by ultrasound mammography. Biopsy was successful in 70 patients (95%) at the first attempt. The overall incidence of malignancy was 20%, being greater in asymptomatic patients (32%) than in patients with mastalagia (16%). Re-excision of the biopsy site in these patients showed residual cancer in 33%. It is suggested that both careful examination of the operative specimen and postoperative mammography may be necessary to ensure that the original lesion has been removed. Re-excision of the biopsy site appears to be necessary when the histology is malignant.
Inflammatory Abdominal Aortic Aneurysms
Authors: Cheatle T , Hickman P , Grimley R P
Published: March 2018

About 10% of all abdominal aortic aneurysms are characterized by an exuberant inflammatory reaction consisting of a dense white sheath over the aneurysm with peri-aortic fibrosis. The aetiology is unknown. There are characteristic ultrasonic and CT appearances but the condition is usually diagnosed at laparotomy. Surgery is the best treatment, keeping peri-aortic dissection to a minimum. Steroid therapy may occasionally be indicated where the situation is considered inoperable or when the patient declines surgery. If hydronephrosis is present because of ureteric involvement, surgical ureterolysis, as for retroperitoneal fibrosis, should be considered.
The Role of Chest Radiography in Patients Presenting with Anterior Chest Pain to the Accident & Emergency Department
Authors: Russell N J , Pantin C F A , Emerson P A , Crichton N J
Published: March 2018

The chest radiological findings and outcomes of 120 consecutive patients attending the Accident & Emergency Department with anterior chest pain were recorded prospectively to investigate the value of routine chest radiography in their management. Twenty-one patients (17.5%) were excluded because of incomplete information. Thirty-seven radiological abnormalities were identified in 33 (33%) of the remaining 99 chest X-rays. Seventeen of the abnormalities identified in 14 (14%) of the chest X-rays were clinically significant. The casualty officer's interpretation of 70 (70%) of the chest X-rays was correct, but 36 errors were made interpreting the other 29 chest X-rays. Of these errors, 19 were false negative errors, resulting in the mismanagement of two patients and 17 false positive errors, resulting in the mismanagement of four patients. It appears that a routine chest X-ray provides little information of practical value in the management of patients with anterior chest pain attending an Accident & Emergency Department, unless the training of medical students and junior doctors in the interpretation of chest X-rays is improved.
Parasuicide in Central London 1984-1988
Authors: Fuller G N , Rea A J , Payne J F , Lant A F
Published: March 2018

Experience of a central London unit dedicated to the care of patients following parasuicide between 1984 and 1988 is reviewed. There were 1160 admissions, which accounted for 11% of all acute adult medical admissions. The female to male ratio was 1.3, with a peak rate for females below 25 years and for males between 20 and 35. Unemployment was found to be a risk factor for parasuicide in men. Benzodiazepines were the most frequently used drug in parasuicide (35%), followed by paracetamol (13%) and aspirin (9%).
Dependence of Retinopathy (and other Complications) on Glycaemic Control and on Weight over 5/10 Years from Diagnosis of Type II Diabetes
Authors: Boucher B J , Tsoumanis J , Noonan K , Holmes J
Published: March 2018

Glycosylated haemoglobins and weights were recorded for 200 consecutive diabetic clinic attendere seen yearly for 5 years, 76 of whom were also seen up to 10 years from diagnosis of type 2 diabetes, representing 1380 patient years. Weight fluctuation (≥3 kg) was associated with increased final prevalence of hypertension, macroalbuminaemia and a raised creatinine (P≤ 0.002) but this relationship was abolished by correction for higher initial weight. Average giycaemia over 5/10 years [itself related to initial weight in women on tablets (N=53) but not others, and to waist but not waist/hip ratio], correlated with prevalence and severity of retinopathy (N=200; r=0.38, P≤0.0006) seen also in the subgroup of patients on tablets (N=145, P≤0.006). At HbA1 levels ≥10.5% an increased prevelance of retinopathy was seen in those on insulin (W=37, P≤0.001) and an increased prevalence of peripheral vascular disease was seen in men but not women (x2=2.87, P≤0.01) as well as in the prevalence of neuropathy. These findings suggest that good glycaemic control is of value in type 2 diabetes and less easily achieved in obesity.
A Multi-Observer Study Examining the Radiographic Visibility of Fishbone Foreign Bodies
Authors: Ell S R , Sprigg A , Parker A J
Published: March 2018

The use of plain radiographs to localize a suspected fishbone foreign body is the subject of controversy. Accordingly radiographs of 14 species of fishbone, impacted in a soft tissue phantom, were assessed by a series of observers from the ENT department (consultant surgeons, senior registrars and house officers). The agreement was assessed by graphical description of the data and tested by a Spearman's rank correlation test The overall results showed that, for the clinician, radiography is very useful to detect the bones of: cod, haddock, lemon sole, cole fish, grey mullet and plaice; useful for red snapper, monk fish, gurnard and salmon; and unhelpful in detecting bones from herring, pike, mackerel and trout The use of radiographs to locate these impacted fishbones can be rationalized in the light of these findings.
AIDS-Related Malignancies
Authors: Spittle Margaret F
Published: March 2018

The management of AIDS-related malignancies demands that the cancer must be treated in the context of patients already suffering from a fatal disease. Management must be problem-orientated. The standard cancer treatment of such a patient may not be appropriate in the AIDS setting. The AIDS related malignancies are Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL) incuding primary cerebral lymphoma. Carcinoma of the cervix was recently added to this list, but has not been seen in this context in the UK.
ANCA Associated with Behçet's Disease
Authors: Burrows N P , Zhao H M , Norris P G , Lockwood C M
Published: March 2018

Behçcet's disease is a multisystem disorder affecting primarily mucocutaneous and ocular sites although the gastrointestinal, cardiovascular, central nervous and respiratory systems may also be involved. Hulusi Behçet, a Turkish dermatologist, first described Behçet's disease in 1937 and suggested a possible infectious aetiology1. The pathogenesis of this condition still remains unclear although it is likely that infection acts as a trigger in genetically susceptible individuals.

We report a patient with unusual cutaneous manifestations of Behçet's disease and antineutrophil cytoplasmic antibodies (ANCA) directed against the cytotoxic protein, bactericidal/permeability-increasing protein (BPI). This is the first report of Behçet's disease associated with this autoantibody.
Favourable Outcome of Scleroderma Renal Crisis
Authors: Collins D A , Patel S , Eastwood J B , Bourke B E
Published: March 2018

Severe hypertension and rapidly progressive acute renal failure is a well recognized complication of scleroderma, often referred to as the renal crisis, and widely thought to cause irreversible deterioration in renal function. With the advent of angiotensin-converting-enzyme inhibitors (ACE-I) the outlook for patients with this condition has dramatically improved. We report here one such patient.
Congenital Gingival Granular Cell Tumour
Authors: Anderson P J , Kirkland P , Schafler K , Moss A L H
Published: March 2018

Congenital gingival granular cell tumours are rare lesions which have only occasionally been reported in the UK. Clinical features are of a benign lesion which occurs almost exclusively in newborn, Caucasian females and the anterior maxilla is the commonest site. Treatment consists of local excision and is curative.

The terminology concerning this condition has been rather confused because of uncertainty regarding the histogenesis of these tumours and the similar histological appearance to adults granular cell myoblastoma occurring at other intraoral sites. The exact histogenesis of these tumours remains unresolved and they may be hamartomata.

We describe a new case occurring within the UK, which illustrates many of the common clinical features of the condition, with an accompanying literature review.
Physical Activity, the Compression of Morbidity, and the Health of the Elderly
Authors: Fries James F
Published: March 2018

The Compression of Morbidity hypothesis envisions a potential reduction of overall morbidity, and of health care costs, now heavily concentrated in the senior years, by compression of morbidity between an increasing age of onset of disability and the age of death, increasing perhaps more slowly1,2. For this scenario to be able to be widely achieved, largely through prevention of disease and disability, we need to identify variables which predict future ill health, modify these variables, and document the improvements in health that result3. Physical activity is perhaps the most obvious of the variables which might reduce overall lifetime morbidity.
Can a Lecture Influence Attitudes to Suicide Prevention?
Authors: Morgan H G , Evans Mark , Johnson Christine , Stanton Ruth
Published: March 2018

Attitudes held by various groups of healthcare professionals with regard to suicide prevention were assessed using an attitude inventory before and after they attended a formal lecture. The lecture presented basic facts and statistics, discussed clinical techniques and challenged negative attitudes. Evidence is presented to suggest that a reduction in the proportion of expressed attitudes which were equivocal or negative towards the feasibility of suicide prevention in clinical practice, can be achieved by a lecture of this kind.
The Delayed Arrival: From Davy (1800) to Morton (1846)
Authors: Adams Aileen K
Published: March 2018

Dr Adams was previously consultant anaesthetist to Addenbrooke's Hospital, Cambridge, with a special interest in ophthalmic and neuroanaesthesia, and Associate Lecturer in Cambridge University. She was Dean of the Faculty of Anaesthetists of the Royal College of Surgeons of England in 1985, now the Royal College of Anaesthetists, of which she is currently Honorary Archivist/Curator. She was Hunterian Professor in the Royal College of Surgeons in 1993, and is a past president of the History of Anaesthesia Society.

Within the RSM she was president of the Section of Anaesthetics in 1985-1986 and of the Section of the History of Medicine in 1994-1995, having served as Honorary Secretary of each. She is now an Honorary Treasurer of the Society.
Major Vascular Injury during Lumbar Laminectomy
Authors: Ezra E , Richenberg J L , Smellie W A B
Published: March 2018

Major vascular injury during lumbar laminectomy is an extremely rare complication of one of the commonest surgical procedures performed in orthopaedic and neurosurgical units. Its occurrence may be associated with high morbidity and mortality, particularly if it is not diagnosed in the early stages. Early diagnosis and repair is associated with an improved prognosis in the long term. We illustrate these points with a description of two cases, and discuss the anatomical factors predisposing to these injuries and the importance of angiography in the management and early diagnosis of suspected cases.
The Consequences of Toxic Shock Syndrome in an 18-Month-Old Boy with 20% Scalds
Authors: Davis T C , Griffin N K
Published: March 2018

Toxic shock syndrome may complicate burns and scalds in young children1,2. However, it can occur in the district general hospital setting, where early recognition of the prodromal features to facilitate early therapy will depend on the knowledge and training of paediatricians and casualty staff.
How Can Acute Mountain Sickness be Quantified at Moderate Altitude?
Authors: Roeggla G , Roeggla M , Podolsky A , Wagner A , Laggner A N
Published: March 2018

Reports of acute mountain sickness (AMS) at moderate altitude show a wide variability, possibly because of different investigation methods. The aim of our study was to investigate the impact of investigation methods on AMS incidence. Hackett's established AMS score (a structured interview and physical examination), the new Lake Louise AMS score (a self-reported questionnaire) and oxygen saturation were determined in 99 alpinists after ascent to 2.94 km altitude. AMS incidence was 8% in Hackett's AMS score and 25% in the Lake Louise AMS score. Oxygen saturation correlated inversely with Hackett's AMS score with no significant correlation with the Lake Louise AMS score. At moderate altitude, the new Lake Louise AMS score overestimates AMS incidence considerably. Hackett's AMS score remains the gold standard for evaluating AMS incidence.
A Survey of the Current Methods Used in the UK to Assess Pituitary Function
Authors: Davies Melanie J , Howlett Trevor A
Published: March 2018

A national survey of the current methods used by specialists to evaluate pituitary function in the UK was performed by postal questionnaire. Seventy-three respondents, of whom 89% were consultants and 80% clinical endocrinologists, returned the questionnaire. Fifty per cent routinely used the insulin stress test (IST) to evaluate the hypothalamo-pituitary-adrenal (HPA) axis, while 50% routinely used tetracosactrin stimulation, there being little overlap between the two groups. This represents a significant change in clinical practice since the last survey in 1988. In those who used ACTH stimulation there was almost an equal split into those who administered the tetracosactrin intramuscularly (45%) or intravenously (47%). Furthermore, either the peak or 60 min Cortisol value was used by 71% when interpreting the result of the test, despite the fact that in previous studies only the 30 min Cortisol value has been shown to correlate with the IST result. The IST remains the most frequently used method to assess growth hormone reserve in adult subjects. The thyrotrophin-releasing-hormone and gonadotrophin-releasing-hormone tests are still used routinely by approximately a quarter of clinicians. These results provide data that could be used to develop guide-lines for the use of tests to investigate pituitary function.
Recurrent Aspergilloma of the Frontoethmoid Sinus in a Non-Immunocompromised Patient
Authors: Tierney Paul , Thomas Michael , Samuel Diaa , Patel Kalpesh S , Stafford Nicholas
Published: March 2018

Management of invasive aspergillosis of the paranasal sinuses requires sufficient experience to initiate appropriate investigations and then utilize the correct treatment protocol. Computed tomography (CT) or magnetic resonance imaging (MRI) is essential to show the extent of the disease and diagnosis is confirmed by histological analysis. Aspergillus flavus is a ubiquitous soil saprophyte in the Sudan and is responsible for many cases originating from this area. The literature is reviewed and treatment options discussed.
Successful Outcome of Severe Unilateral Pulmonary Interstitial Emphysema after Bi-Lobectomy in a Very Low Birthweight Infant
Authors: Ahluwalia J S , Rennie J M , Wells F C
Published: March 2018

Extubation of ventilated infants with severe unilateral pulmonary interstitial emphysema is difficult because the function of normal lung tissue is impaired. Continued positive pressure ventilation worsens hyperinflation on the side with interstitial emphysema, leading to cardiorespiratory compromise. Resection of affected single lobes is well described, but there are no reported cases of multiple lobectomies in very low birthweight infants. We describe a case where resection of both right upper and middle lobes was successful, allowing extubation within a few days of surgery. Computed tomography (CT) of the chest was helpful in making the decision to treat this infant by surgery.
Tracheostomy in Children
Authors: Shinkwin C A , Gibbin K P
Published: March 2018

Tracheostomy is more hazardous in children than in adults, and carries special risks in the very young. The past 20 years have seen a large shift in the age distribution of tracheostomy. Whereas formerly the operation was done largely for management of epiglottitis and laryngotracheobronchitis, today the prime indication is subglottic stenosis in infants consequent upon intubation for respiratory distress syndrome and prematurity. We have reviewed experience with 57 tracheostomies in 56 children under 12 years old managed from a university hospital.

All operations were done as elective procedures, in standard fashion, by otolaryngologists. Forty (70%) were in children under 1 year old, the indications being upper airways obstruction (41), failed extubation (11), and long-term assisted ventilation (5). Subglottic stenosis was the commonest cause of obstruction (21 operations). In 91.4 accumulated years with a tracheostomy there were 11 complications related to tracheostomy, one of which (a blocked tube) was fatal. Thirty-nine children were decannulated, the mean duration of cannulation being 21 months.

In this series we suggest that the low morbidity and mortality rates were due to management by otolaryngologists; to postoperative intensive care; and, for the majority cared for at home, to careful education of parents and visits by specialist nurses.
Smoking and Menstrual Problems in 16-Year-Olds
Authors: Charlton Anne , While David
Published: March 2018

The British Birth Cohort Study (BCS70) is a cohort study which follows all the people born in England, Scotland and Wales in the week of 5–11 April 1970. The data described here were from the postal questionnaires returned by 2181 young women aged between 16 and 16½ in 1986.

Thirty-nine per cent of the respondents had never smoked, 39% had smoked at some time and 22% were regular smokers. Most of the respondents indicated that they had one or more of the following symptoms associated with menstruation: pain, depression, irritability, headaches, cramps. Analysis of the data showed that regular smokers were significantly more likely than those who had never smoked to have all these symptoms. Whilst the percentage of ‘sometime smokers’ experiencing pain, depression and headaches fell between smokers and ‘never-smokers’, the percentage experiencing unpleasant symptoms in general, irritability and cramps was the same as for regular smokers.

If causality could be demonstrated, messages about immediate health problems such as these might be more powerful health education to young women than information about long-term risks.
Personal Child Health Record and Advice Booklet Programme in Tuzla, Bosnia Herzegovina
Authors: McMaster P , McMaster H J , Southall D P
Published: March 2018

Personal child health records, held by the parents, have potential advantages in times of civil disorder. Via health and community workers, 939 booklets (incorporating health records and health advice) were distributed to displaced and other families near Tuzla. Subsequently mothers were invited to bring their children for examination.

Five hundred and seventy-one children with their booklets returned to the clinics. The survey revealed high rates of dental caries (305 cases), anaemia (36), and scabies (20). The war had not affected the duration of breast feeding, and the children's nutrition was generally satisfactory. Immunization status was generally good, though rates were unacceptably low in children from certain areas, reflecting not only deficient provision in their place of origin but also failings in the programme for displaced persons. An informal survey indicated that parents and older children appreciated the health-information content of the booklet.

In a disaster of this sort, the personal child health record and advice booklet serves the combined purpose of yielding essential epidemiological data, providing a permanent health record, and meeting a need for health education material.
Randomized Comparison of Oral and Intravenous Fluid Regimens after Gallbladder Surgery
Authors: Cassell O C S , Oakley N , Forrest A R W , Thomas W E G , Dennison A R
Published: March 2018

Numerous studies of post-operative fluid status have utilized sophisticated measurements of electrolyte distribution and fluid shift without relating results to clinical practice. The aim of this prospective randomized study was to investigate the response of patients undergoing abdominal surgery of moderate severity to conservative postoperative fluid administration. Forty-five patients undergoing open cholecystectomy were randomized to receive 2.51 of fluid (11 normal saline and 1.51 5% dextrose), 11 of normal saline, or free oral fluids (groups 1, 2, 3, respectively). Serum and urine osmolality and electrolytes were measured pre-operatively and at 24 and 48h post-operatively. Patients remained in the study irrespective of the urine output. Plasma electrolytes and osmolality remained within normal limits in all three groups despite significant changes in urine electrolyte and osmolality in groups 2 and 3. This confirms that a conservative approach to fluid administration has no detrimental effect on hydration in fit patients with uncomplicated surgery.
Recognizing Syncope: Pitfalls and Surprises
Authors: Lempert T
Published: March 2018

Loss of consciousness and falling are the key features of syncope. Common accompaniments include tonic and myoclonic muscle activity, eye deviations, automatisms, vocalizations and hallucinations which may render the distinction from epileptic seizures difficult. Differential diagnosis is based on the specific features and not the mere presence of these phenomena. Recognition of syncope depends also on accurate information about precipitants, premonitory symptoms and postictal events: the absence of postictal confusion has been identified as the single most powerful factor discriminating syncope from epileptic seizures whereas incontinence and head injury are common in both conditions. Investigations such as electroencephalogram, tilt testing and postictal prolactin or creatine kinase levels may be helpful but are never diagnostic in isolation. Exceptionally, hypoxic and epileptic mechanisms interact within a single attack.
Adhesion Molecules in Melanoma—More than Just Superglue?
Authors: Mason MD , Allman R , Quibell M
Published: March 2018

Malignant melanoma is increasing in incidence, and, though early lesions are readily treatable, systemic therapy for metastatic disease remains disappointing. Integrins are a family of cell-surface molecules that mediate adhesion between the cell and the extracellular matrix. One member of the integrin family, the αvβ3 integrin, is associated with progression of melanomas, in that the most malignant cells express the highest levels of αvβ3. Like many members of the integrin family, αvβ3 recognizes the sequence Arg-Gly-Asp (RGD) in its ligands, and other molecules that contain this sequence will compete with the natural ligands (such as vitronectin) for binding. There is growing evidence that integrins function as receptors for signal transduction, and that integrin-mediated signalling can affect cell behaviour and even cell survival. Under certain circumstances, loss of integrin-mediated signalling will induce apoptosis, or programmed cell death, and we have demonstrated that melanoma cells treated with a cyclic peptide with high affinity for the αvβ3 integrin will undergo apoptosis within three days. This mechanism might be exploited therapeutically.
The Hairy Family of Burma: A Four Generation Pedigree of Congenital Hypertrichosis Lanuginosa
Authors: Bondeson J , Miles A E W
Published: March 2018

A Burmese family with congenital hypertrichosis lanuginosa had an eventful history in the nineteenth century. The earlier members of this family were employed at the court of Ava, but the later ones spent their lives in show business, being widely exhibited for money in the 1880s. Their extraordinary hairiness attracted much curiosity, and they were photographed several times. The hairy Burmese are the only example of a four-generation pedigree of congenital hypertrichosis lanuginosa, which is consistent with an autosomal dominant mode of inheritance. There is good evidence that, when the members of this family were hairy, their dentition was also deficient.
Bone Mineral Density Measurements: Are they Worth While?
Authors: Torgerson D J , Donaldson C , Reid D M
Published: March 2018

Bone mineral density measurements have been criticized on the grounds that they are not a worth-while screening tool. In this paper we argue that bone mineral measurements can be an efficient diagnostic tool even if they are not of proven value for screening. There is complex relationship between the costs of a measurement, the intervention and the predictive value of the test all of which must be accounted for when assessing the value of a bone density measurement. For bone density measurements to be used for screening, a wider evaluation needs to be undertaken compared with that for their use as a diagnostic tool. We address some common objections, for example, that low compliance with screening would undermine efficiency, and show that these are not relevant. Evaluations of screening need to address issues that are likely to affect efficiency.
Carcinoma of the Tongue: Pathological Considerations in Management of the Neck
Authors: Woolgar Julia A
Published: March 2018

In a series of 76 patients with carcinoma of the tongue the occurrence of metastasis was related to the size and histological features of the primary tumour. 64% of patients with metastasis and 10% of patients with clinically negative neck showed spread beyond the node capsule. Fast tracks (long lymphatic pathways uninterrupted by nodes) seemed to be involved in the spread of metastatic cancer in at least 20% of patients with metastasis. With surgery and adjuvant radiotherapy based on the pathological stage, metastases confined to lymph nodes did not appear to affect short-term outcome.
Self-Administered Disposable Micro-Enemas before Outpatient Sigmoidoscopy
Authors: Marsh S K , Huddy S P J
Published: March 2018

Many colorectal carcinomas can be diagnosed by rigid sigmoidoscopy. One important limiting factor in the usefulness of this investigation is the presence of faeces; another is inability to negotiate the recto-sigmoid bend. 101 patients (47 men) were sent a Microlax enema with instruction to use it before their first attendance in the outpatient department. The grade of preparation [on a scale of 0 (empty rectum) to 3, with grades 0 and 1 providing an adequate view], height achieved with the sigmoidoscope and whether or not the extent of the examination was limited by faeces were recorded. These data were compared with results in 78 patients (38 men) who did not receive any special preparation.

There were no serious difficulties with self-administration. An adequate view was obtained in 89 (88%) of those who had received an enema and in 41 (53%) of those who were unprepared (P< 0.001, χ2 test). The height achieved and the percentage of patients in whom the sigmoidoscopy was not limited by faeces were also significantly increased.

The mailing of micro-enemas to patients who are likely to need sigmoidoscopy is a cheap measure that increases diagnostic yield and saves reattendances.
Aristophanes’ Wealth: Ancient Alternative Medicine and its Modern Survival
Authors: Koutouvidis N , Papamichael E , Fotiadou A
Published: March 2018

The miraculous cure of the blind god Plutos (‘Wealth’) in Aristophanes’ play illuminates some of the reasons why people have sought help in alternative medicine over the ages. Apart from limitations of conventional medicine these factors can be social, political, religious, psychological, and scientific. Alternative medicine may function in a complementary way to the conventional. Nevertheless, an overestimation of its therapeutic potentials by the public can lead to the domination of irrationalism, all in the name of liberation from the shackles of a mechanistic rationalism.
Educating Psychiatric Patients about their Treatment: Do Fact Sheets Work?
Authors: Evans Mark , Macpherson Rob , Thompson Emma , Babiker Isam
Published: March 2018

Psychiatric patients are sometimes given fact sheets about their treatment but the benefits of these are uncertain. We tested three strategies in three cohorts of psychiatric inpatients—fact sheets alone, fact sheets and subsequent discussion, and control. Knowledge of medication was assessed by questionnaire.

For various reasons, only 33 of the 77 patients were included in the study or analysis. Of the patients who had been given fact sheets, 87% independently read them and reported finding them helpful whilst all asked for more information. Receiving a fact sheet alone had no significant effect, whereas having discussed it with a health care professional was associated with a significant increase in knowledge about medication. Patients receiving fact sheets selectively learned more about side-effects than about drug action or precautions.

This strategy for patient education could be used by ward nurses and deserves further evaluation.
Trolling ourselves to death? Social media and post-truth politics
Authors: Hannan Jason
Published: March 2018

There are at least two ways of framing the problem of post-truth politics. One is to focus on the media, or journalism. A second is to focus on media, or technologies of communication. Between the two, which can be said to be the driver of our post-truth world? This paper follows the second framework, locating the problem of post-truth politics in social media. It further suggests that trolling has gone mainstream, shaping politics and even legislation. Adding a twist to Neil Postman’s (1985) classic thesis, I argue that we are not so much amusing, as trolling ourselves to death.
Venous stent patency may be affected by collateral vein lumen size
Authors: van Vuuren Timme MAJ , Doganci Suat , Toonder Irwin M , Graaf Rick De , Wittens Cees HA
Published: March 2018

Purpose

Deep venous thrombosis causes blood flow deviation. It is hypothesized that with stent placement, developed collateral veins become redundant. This article evaluates the relation between the surface area of the collaterals and stent patency.

Methods

The azygos and hemiazygos veins were identified and the largest surface area was measured at thoracic level. Patency rates of stented tracts were evaluated and related to collateral vein lumen size.

Results

The vena cava occlusion and the azygos and hemiazygos vein surface area measurements were positive and statistically significant related (OR 1.01, 95% CI 1.003−1.019, p = 0.004) respectively (and OR 1.007, 95% CI 1.001−1.013, p = 0.004). An azygos surface area measurement of 23 (p<0.001) and hemiazygos surface area measurement of 40 (p = 0.008) was shown as cut-off point related to higher occlusion rates.

Conclusions

The surface area of major venous collateral pathways seems to be related to stent occlusion in deep venous interventions.
Dec-MCTS: Decentralized planning for multi-robot active perception
Authors: Best Graeme , Cliff Oliver M , Patten Timothy , Mettu Ramgopal R , Fitch Robert
Published: March 2018

We propose a decentralized variant of Monte Carlo tree search (MCTS) that is suitable for a variety of tasks in multi-robot active perception. Our algorithm allows each robot to optimize its own actions by maintaining a probability distribution over plans in the joint-action space. Robots periodically communicate a compressed form of their search trees, which are used to update the joint distribution using a distributed optimization approach inspired by variational methods. Our method admits any objective function defined over robot action sequences, assumes intermittent communication, is anytime, and is suitable for online replanning. Our algorithm features a new MCTS tree expansion policy that is designed for our planning scenario. We extend the theoretical analysis of standard MCTS to provide guarantees for convergence rates to the optimal payoff sequence. We evaluate the performance of our method for generalized team orienteering and online active object recognition using real data, and show that it compares favorably to centralized MCTS even with severely degraded communication. These examples demonstrate the suitability of our algorithm for real-world active perception with multiple robots.
Clinical features predicting group A streptococcal pharyngitis in a Japanese paediatric primary emergency medical centre
Authors: Nishiyama Masahiro , Morioka Ichiro , Taniguchi-Ikeda Mariko , Mori Takeshi , Tomioka Kazumi , Nakanishi Keita , Fujimura Junya , Nishimura Noriyuki , Nozu Kandai , Nagase Hiroaki , Ishibashi Kazuto , Ishida Akihito , Iijima Kazumoto
Published: March 2018

Objectives

To identify clinical features that predict Group A streptococcal (GAS) pharyngitis in a Japanese paediatric primary emergency medical centre.

Methods

The prevalence of GAS pharyngitis according to age and body temperature (BT) was calculated among 3098 paediatric patients with pharyngitis. The numbers of GAS-positive and -negative patients for each clinical parameter, and each point increase in the McIsaac score were compared and likelihood ratios (LRs) were calculated.

Results

The prevalence of GAS pharyngitis was extremely low in patients aged < 1 (1.2%) and 1 year (3.9%). The GAS-positive rate was significantly higher in patients with a BT < 38.0°C compared with ≥ 38.0°C (30.0% vs. 19.8%). A BT ≥ 38.0°C was not a predictive finding for GAS pharyngitis (positive LR: 0.82). Rash was the most useful individual predictor, and a McIsaac score of 4 or 5 increased the probability; however, the positive LRs were 1.74 and 1.30, respectively.

Conclusions

The prevalence of GAS pharyngitis is extremely low in patients aged < 1 and 1 year, and a BT ≥ 38.0°C is not a predictive symptom. Although a rash and McIsaac score of 4 or 5 are associated with an increased probability, they cannot be used to confirm GAS infection.
Effect of α-lipoic acid on symptoms and quality of life in patients with painful diabetic neuropathy
Authors: Agathos Evangelos , Tentolouris Anastasios , Eleftheriadou Ioanna , Katsaouni Panagiota , Nemtzas Ioannis , Petrou Alexandra , Papanikolaou Christina , Tentolouris Nikolaos
Published: March 2018

Objective

To examine the effect of α-lipoic acid on neuropathic symptoms in patients with diabetic neuropathy (DN).

Methods

Patients with painful DN were treated with 600 mg/day α-lipoic acid, orally, for 40 days. Neuropathy Symptom Score (NSS), Subjective Peripheral Neuropathy Screen Questionnaire (SPNSQ) and douleur neuropathique (DN)4 questionnaire scores were assessed at baseline and day 40. Quality-of-life treatment effects were assessed by Brief Pain Inventory (BPI), Neuropathic Pain Symptom Inventory (NPSI) and Sheehan Disability Scale (SDS). Changes in body weight, arterial blood pressure, fasting serum glucose and lipids were also assessed.

Results

Out of 72 patients included, significant reductions in neuropathic symptoms were shown by reduced NSS, SPNSQ and DN4 scores at day 40 versus baseline. BPI, NPSI, and SDS in terms of work disability, social life disability, and family life disability scores were also significantly reduced. Moreover, 50% of patients rated their health condition as ‘very much better’ or ‘much better’ following α-lipoic acid administration. Fasting triglyceride levels were reduced, but no difference was found in body weight, blood pressure, fasting glucose, or other lipids at day 40 versus baseline.

Conclusions

A-lipoic acid administration was associated with reduced neuropathic symptoms and triglycerides, and improved quality of life.
Optimizing stability in AO/OTA 31-A2 intertrochanteric fracture fixation in older patients with osteoporosis
Authors: Zhang Chi , Xu Bo , Liang Guanzhao , Zeng Xianshang , Zeng Dan , Chen Deng , Ge Zhe , Yu Weiguang , Zhang Xinchao
Published: March 2018

Objectives

To compare the functional and radiographic outcomes of InterTAN nail (IT) and proximal femoral nail anti-rotation (PFNA) for managing primary AO/OTA 31-A2 intertrochanteric hip fractures (IHFs) in older osteoporotic patients.

Methods

Patients aged 60 years or older who received surgical treatment for IHFs (AO/OTA 3.1A2.1-A2.3) with IT or PFNA were retrospectively evaluated. The primary outcome was the postoperative treatment failure rate. The secondary outcome was the Harris Hip Score (HHS).

Results

A total of 326 osteoporotic cases (326 hips: IT, n = 162; PFNA, n = 164) were assessed with a mean follow-up of 43.5 months (range, 38–48 months). For the entire cohort, the incidence of postoperative treatment failure (periprosthetic fracture and reoperation) was 29/326 (8.9%); the IT-treated cohort (7/162, 4.3%) had a significantly lower rate compared with the PFNA-treated cohort (22/165, 13.3%). The incidence of postoperative periprosthetic fractures was significantly lower in the IT-treated cohort than in the PFNA-treated cohort (2.5% vs 7.9%). The postoperative HHS at the final follow-up was not significantly different between the groups.

Conclusion

IT might show a better outcome in managing osteoporotic AO/OTA 31-A2 IHFs in terms of periprosthetic fracture and reoperation compared with PFNA.
Reversed Depth in Anticorrelated Random-Dot Stereograms and the Central-Peripheral Difference in Visual Inference
Authors: Zhaoping Li , Ackermann Joëlle
Published: March 2018

In a random-dot stereogram, the percept of object surfaces in a three-dimensional scene is generated by images presented to left and right eyes that comprise interocularly corresponding random black and white dots. The spatial disparities between the corresponding dots determine the depths of object surfaces. If the dots are anticorrelated, such that a black dot in one monocular image corresponds to a white dot in the other, disparity-tuned neurons in the primary visual cortex (V1) respond as if their preferred disparities become nonpreferred and vice versa, thereby reversing the disparity signs reported to higher visual areas. Typically, when viewing anticorrelated random-dot stereograms presented in the central visual field, humans have great difficulty perceiving the reversed depth or indeed any coherent depth at all. We report that the reversed depth is more easily perceived in the peripheral visual field, supporting a recently proposed central-peripheral dichotomy in the way that feedback from higher to lower visual cortical areas implements visual inference.
Driving after an injury or disease affecting the brain: an analysis of clinical data
Authors: Samuelsson Kersti , Modig-Arding Ingalill , Wressle Ewa
Published: March 2018

Introduction

Traffic safety may be affected if a licence holder has experienced illness or injury that may have an impact on cognition. Occupational therapists are involved in assessing cognitive functions that might affect a patient’s ability to drive a car using different evaluation tools in different countries and settings. The aim of this study was to look at the predictive value of some of the assessment tools available to occupational therapists for making judgements about resuming driving after cognitive impairment due to brain trauma or disease.

Method

A retrospective study based on clinical data from 204 patients referred to a specialist department for recommendations on ability to drive after brain injury or disease. All patients underwent three assessments: stroke drivers screening assessment, useful field of view and simulated driving skill. In addition, an on-road assessment was added in 76% of the sample.

Results

Useful field of view had the highest sensitivity (78%) and, combined with the results from the simulator, the sensitivity was 87%. The specificity for the two methods was 55%.

Conclusion

The results from useful field of view and a simulator test combined best predicted the final recommendation from the multi-professional team discussion on which clients should be recommended not to resume driving.
Hip precautions after hip operation (HippityHop): Protocol for a before and after study evaluating hip precautions following total hip replacement
Authors: Lightfoot Courtney , Sehat Khosrow , Drury Gary , Brewin Catherine , Coole Carol , Drummond Avril
Published: March 2018

Introduction

Hip precautions are routinely used despite inconclusive evidence that they reduce dislocations and concern that they impede activities of daily living. This study compares a change in practice locally from implementing routine hip precautions to no routine precautions, in order to: 1. Compare patient outcomes in quality of life, functional performance, pain, sleep, mood, and satisfaction. 2. Ascertain staff and patient perceptions of the two regimes. 3. Determine the cost of precautions.

Method

Phase one patients will receive hip precautions, while phase two patients will receive no routine precautions. We propose to collect data from 342 participants at baseline, and at one week, six weeks, and three months postoperatively. Interviews will be conducted with 20 staff and 20 patients, and data collected relating to costs.

Results

Statistical analysis will be conducted to compare the two groups to determine any differences in patient outcomes. Thematic analysis will be used to identify and report themes within the interview data.

Conclusion

If there are no additional advantages to hip precautions, patients could resume everyday activities more quickly, potentially improving their quality of life. Conversely, if withdrawing hip precautions is detrimental, evidence for precautions will be provided.