bluuebunny/crossref_metadata_2025 huggingface dataset:
Altered Immune-Related Gene Expressions Indicate Oral Cancer Nodal Disease
Authors: Liu K.Y.P. , Lu X.J.D. , Zhu Y. , Yip S. , Poh C.F.
Published: February 2018

Lymph nodal disease (LN+) is the most significant prognostic factor of oral squamous cell carcinoma (OSCC). Current risk indicator(s) for guiding elective neck dissection (END) is insufficient for clinically node-negative (cN0) patients, resulting in under- or overtreatment. While the role of immunological events in tumorigenesis and metastasis is evident, the prognostic implication in OSCC remains unclear. The study objective was to investigate large-scale immune-related gene expression and determine its prognostic value on node-free survival (NFS). We analyzed patients who received intent-to-cure surgery with at least 3 y of follow-up and known outcome of LN through a pan-Canadian surgical trial. Total RNA was extracted from surgical tissues with >70% tumor content and analyzed on a 730-gene panel (NanoString nCounter® PanCancer Immune Panel). We first profiled gene expression in a fresh-frozen (FF) discovery set to identify differentially expressed (DE) genes, which were then used in unsupervised clustering analysis to identify patient subgroups. The prognostic value of the identified DE genes was then validated on formalin-fixed, paraffin-embedded (FFPE) samples. A total of 177 RNA samples were derived from 89 FF and 88 FFPE surgical tissues, of which 45 (51%) and 40 (45%), respectively, were from patients who developed LN+. We identified 6 DE genes overexpressed in LN+ tumors (false discovery rate <0.001; log2 fold change >1). Clustering analysis separated the patients into 2 subgroups (CM1, CM2), with CM2 exhibiting significantly increased expression and worse 5-y NFS rate (28%; P < 0.001). The prognostic value of these 6 candidate genes was validated on FFPE samples, which were also separated into 2 distinct prognostic groups, confirming the association between increased gene expression and poor 5-y NFS (CM1, 70.3%; CM2, 43.3%; P = 0.01). This is the first study identifying a panel of immune-related genes associated with NFS that can potentially be used clinically stratifying the risk of LN+ at the time of OSCC diagnosis.
Grit is Associated with Lower Depression via Meaning in Life among Filipino High School Students
Authors: Datu Jesus Alfonso D. , King Ronnel B. , Valdez Jana Patricia M. , Eala Maria Socorro M.
Published: February 2018

Grit—passion and perseverance for long-term goals—has been linked to a wide array of positive academic and psychological outcomes. However, limited research has been conducted to explore the association of grit with different indicators of well-being and psychological health. The primary objective of this study was to assess the associations among grit, meaning in life, and depression. There were 447 Filipino high school students who participated in the study. Results of structural equation modeling showed that grit was linked to higher levels of meaning in life dimensions (i.e., presence of meaning and search for meaning in life) and presence of meaning was associated with lower depression. Bias-corrected bootstrapping revealed that grit had an indirect negative influence on depression through the intermediate variable—presence of meaning in life. Theoretical and practical implications are elucidated.
Social Psychological Aspects of the Judeo-Christian Stance toward Homosexuality
Authors: Cameron Paul , Ross Kenneth P.
Published: February 2018

The American Psychiatric and Psychological Associations have taken a strong liberalization stand on the treatment of homosexuality which contrasts with the Judeo-Christian background of our society. To test the possible validity of the Judeo-Christian charge that homosexuality, and the support of granting equivalence to homosexuality, tends toward lethality (evil) and away from social cohesion and respect for human life (the good), 2, 251 participants from a series of area samples and 40 “out-of-closet” homosexuals were administered a questionnaire regarding social policy recommendations, practices that involve the endangerment of self, practices that might involve the endangerment of others, and the number and quality of intimates in their life-space. Results suggest that: (a) a Judeo-Christian bias is one of the more powerful wellsprings of discrimination against homosexuality, (b) the incidence of exclusive homosexuality approximates 1% of the population for both men and women, (c) support of equating homosexuality and heterosexuality is associated with both self- and other-endangerment, (d) a less than exclusively heterosexual orientation is associated with both self- and other-endangerment, and (e) a less than exclusively heterosexual orientation is associated with lower levels of social cohesion. It is argued that there may well be more merit in the Judeo-Christian appraisal of homosexuality than has been generally acknowledged.
Developmental and Ethical Issues in Homosexuality: Pastoral Implications
Authors: Martin Enos D. , Martin Ruth Keener
Published: February 2018

The contemporary church has been challenged to legitimize homosexuality and even to ordain homosexual persons. Yet scriptural concepts lead the church to approve sexual expression only within the framework of heterosexual marriage. By exploring concepts of sexual development and examining the church's ethical stance on homosexuality, the authors show how homosexual orientation can be approached within a supportive Christian ministry while adhering to the church's traditional values. Specific pastoral guidelines on the issue of homosexuality are offered.
Our Father Which Art in Heaven: Parataxic Distortions in the Image of God
Authors: Heinrichs Daniel J.
Published: February 2018

One's God-concept, herein referred to as the “image of God,” is a major determinant of the quality of one's personal relationship with God. In addition, the image of God one maintains may be observed to correlate with one's capacity for relational experiences with significant others. In this article object relations theory is applied to perceptions of God. The development of object relatedness in the child is discussed and the concept of parataxic distortions in the image of God is considered within the context of biblical history and childhood development. Parataxic distortions as found in the psychotherapeutic relationship are also briefly addressed, as is the psychotherapeutic resolution of distorted God-percepts.
Risk Shift: An Institutional Logics Perspective
Authors: Nath Saheli
Published: February 2018

This study uses the concept of institutional logics and the framing processes emanating from these guiding logics to understand how risk is shifted through public policies. The study concludes that Hacker’s argument that public policies have reconstructed markets to aid the privileged by shifting risk onto the less privileged may have underestimated some of the complexities driving the phenomenon, particularly those stemming from actors having to cope with conflicting logics and ambiguity concerning policy solutions to seemingly intractable challenges. Risk shift does not necessarily involve unilateral transfer of risk from policy makers to risk bearers. Risk shift can emerge out of the complex microinteractions among relevant actors and the framing processes guided by competing logics or belief systems in which the collaborating actors are embedded.
Colorectal Anastomosis: Factors Influencing Success
Authors: Tagart R E B
Published: February 2018

Preservation of the anal sphincters is now consistent with adequate extirpation of the majority of rectal neoplasms. However, there is still a troublesome incidence of leakage through colorectal anastomoses. A number of different factors, working in combination, are responsible for this. Although most problems have been solved, and the mortality is low, the anastomotic leak rate described in the present series, and in the hands of most surgeons, remains high. Efficient suturing without tension, adequate filling and drainage of the presacral space, and antimicrobial prophylaxis effective enough to abolish abdominal wound sepsis, have been applied. The large vessel arterial blood supply to the suture line is good but the microcirculation of the left colon and rectum, upon which suture line healing ultimately depends, is suspect. Reduction of blood viscosity by deliberate lowering of the haemoglobin level before operation has been practised in the hope of improving the microcirculatory flow. The results so far are encouraging and suggest that the method is worth a continued trial.
Naloxone in the Treatment of Anorexia Nervosa: Effect on Weight Gain and Lipolysis
Authors: Moore Ray , Mills Ivor H , Forster Alison
Published: February 2018

The effects of a constant intravenous infusion of naloxone in doses ranging from 3.2 to 6.4 mg/day were studied in a group of patients with anorexia nervosa. Patients showed a significantly greater weight gain during the infusion compared with the periods before and after naloxone. Plasma fJ-hydroxybutyrate and non-esterified fatty acid levels fell during the infusion. It is suggested that, in man, naloxone has an antilipolytic effect in vivo.
Is Micropapular Sarcoidosis Tuberculosis?
Authors: Ridgway Hilary A , Ryan Terence J
Published: February 2018

Three cases of micropapular sarcoidosis are reported. Two of the cases have a history of tuberculosis and all three cases have atypical patterns of Kveim and Mantoux reactivity. The similarities between this form of sarcoidosis and lichen scrofulosorum or lichenoid tuberculid are observed and the evidence is presented for a tuberculoid aetiology in certain forms of sarcoidosis.
Are Patients Shocked by ECT?
Authors: Hughes Jennifer , Barraclough B M , Reeve W
Published: February 2018

Seventy-two consecutive patients treated with electroconvulsive therapy (ECT) for severe mental illness were asked their opinions about ECT: 83% considered they had improved as a result of the treatment and 81% would have it again. Most found the experience neutral or pleasant and 54% thought the dentist more distressing. Claims in newspapers, magazines, television and elsewhere that ECT is cruel and frightening receive little support from the results of this study.
Prospective Study of Liver Function following Repeat Halothane and Enflurane
Authors: Dundee J W , McIlroy PDA , Fee J P H , Black G W
Published: February 2018

In a prospective study of liver function following repeat anaesthesia, patients who received repeat halothane had a higher frequency of abnormal liver enzyme results than a similar group who received repeat enflurane. Obesity and short intervals between administrations increased the likelihood of abnormal liver enzyme activity in the halothane group. Enflurane would seem to be the volatile agent of choice for repeat anaesthesia in such circumstances.
Dietary Allergy and Specific IgE in Ulcerative Colitis
Authors: Jones D B , Kerr G D , Parker J H , Wilson R S E
Published: February 2018

Previous authors have considered that allergy to certain foodstuffs may play an important role in the aetiology of ulcerative colitis, but immunological evidence for dietary allergy in ulcerative colitis is inconclusive. A study is reported of 22 patients with ulcerative colitis, with matched controls, in whom total serum IgE and specific IgE to certain foodstuffs have been estimated by the Phadebas PRIST and RAST (Pharmacia) techniques. Allergens tested were egg-white, milk, wheat, rye, oat, fish (cod) and peanut. There was no significant difference in the total serum IgE levels and the food specific IgE activity between the two groups.
Captopril for Refractory Hypertension in Patients with Chronic Renal Failure and Renal Transplantation
Authors: Hamilton D V , Evans D B , Maidment G , Pryor J S
Published: February 2018

The converting-enzyme inhibitor, Captopril, was given to ten patients with refractory severe hypertension of renal origin: 6 patients had chronic renal failure, 3 patients had hypertension following renal transplantation, and one patient had hypertension and congestive cardiac failure. Control of blood pressure was achieved with doses from 75 to 400 mg/day. Severe hyperkalemia occurred in one patient, ageusia (dose dependent) in another, and one patient withdrew from treatment because of nausea.
Colonoscopy: A Survey of its Value in a Teaching Hospital Surgical Unit1
Authors: Jourdan Martin , Rendall Max , McColl Ian
Published: February 2018

A survey has been undertaken of the diagnostic, therapeutic and economic value of colonoscopy in a teaching hospital surgical unit. Provided it is undertaken in conjunction with a good clinical history and double contrast barium enema, colonoscopy provides a high yield of information bearing upon the patient's subsequent management. Therapeutic polypectomy was undertaken in 21% of examinations. Its value in acute colonic disease is discussed, and the importance of training colonoscopists for the future is emphasized.
Carcinoma of the Rectum in Male Homosexuals
Authors: Leach R D , Ellis H
Published: February 2018

Two male homosexuals with carcinomata of the rectum with transitional cell changes are reported, and the possible aetiology of these lesions is discussed.
Familial Jejunal Atresia with ‘Apple-Peel’ Variant1
Authors: Al-Awadi S A , Naguib K , Farag T I , Cuschieri A , Issa M
Published: February 2018

We report two siblings who had jejunal atresia which we believe to be familial. The parents of these siblings were first cousins. The first child had jejunal atresia with mesenteric agenesis and ‘apple-peel’ configuration; the second child had jejunal atresia with a V-shaped mesenteric defect. Other reported cases of familial atresia of the small intestine are reviewed.
Haemoglobin, Smoking and Peripheral Vascular Disease
Authors: Castleden W M , Faulkner Kingsley , House A K , Watt Alan
Published: February 2018

One hundred and four patients with peripheral vascular disease requiring operation were reviewed retrospectively with respect to age, sex, preoperative haemoglobin, smoking habits and diabetic status. The preoperative haemoglobin levels and smoking status in 63 non-diabetic male patients with peripheral vascular disease were compared with a matched group of individuals treated for inguinal hernia. For all patients there was a significant correlation between smoking habits, preoperative haemoglobin level and the presence of peripheral vascular disease. The mechanisms by which smoking may damage the vascular tree are reviewed.
Multiple Primary Maligant Neoplasia in three Members of a Family
Authors: Kenyon G S
Published: February 2018

Three members of a family have presented in adult life with a succession of invasive malignancies. No known premalignant condition has been apparent in this group, and a limited study of immune competence has failed to reveal any abnormality. In spite of this there is strong evidence to suggest a so far undetected immunogenetic abnormality as the basis of this phenomenon.
Tranylcypromine Isomers and Parkinson's Disease: New Aspects of an Old Drug
Authors: Reynolds G P , Riederer P , Sandler M
Published: February 2018

The tranylcypromine stereoisomers have been investigated in a series of comparative trials in Parkinson's disease and the results indicate that doses below 3 mg/day, of the (+)-isomer in particular, are effective as adjuvant antiparkinsonian therapy. Biochemical results, monitoring platelet monoamine oxidase (MAO) activity and plasma concentrations of drugs and phenylethylamine, an MAO substrate, showed such low doses of the (+)-isomer to inhibit MAO without inducing the hypertensive reaction sometimes observed at higher dosage. These findings, along with the observation of substantial pharmacokinetic differences between the two isomers are discussed, particularly in relation to reports on their efficacy in depressive illness.
Single Photon Emission Tomography of the Pituitary: Preliminary Communication
Authors: Britton Keith , Shapiro Brahm
Published: February 2018

A specific application of single photon emission tomography to the relative quantitation of the pituitary region is described together with the results obtained in 19 patients with pituitary adenoma proven by air encephalography. These are compared with those obtained by X-ray computer tomography and conventional brain imaging and a superiority of single photon emission tomography is demonstrated in this small series.
Glucose Concentrations in Parotid Fluid and Venous Blood of Patients Attending a Diabetic Clinic1
Authors: Forbat L N , Collins R E , Maskell G K , Sönksen P H
Published: February 2018

Measurements of the glucose concentration in venous blood and parotid saliva taken from 31 diabetics attending a diabetic clinic showed values ranging respectively from 3.9 to 19.1 mmol/l and 0.06 to 0.83 mmol/l (means 9.6 mmol/l and 0.32 mmol/l respectively). Linear regression of salivary glucose on blood glucose gave a simple correlation coefficient of 0.18 (NS). Since salivary glucose levels did not reflect blood glucose levels, the possibility of diabetics regulating their metabolic control by the noninvasive technique of monitoring salivary glucose concentrations is not possible.
Some Aspects of the Fractured Scaphoid
Authors: Thomas Tudor L
Published: February 2018

Ninety-three patients who presented at a district general hospital in one year with a suspected or actual scaphoid fracture were studied. Certain changes in the accepted management of scaphoid fractures, particularly the radiology of these fractures, are suggested. These changes could result in significant savings of time and money. A new investigation is described which may prove helpful in the long-term prognostic assessment of patients who have suffered a scaphoid fracture.
Cryoanalgesia for Intractable Perineal Pain1
Authors: Evans P J D , Lloyd J W , Jack T M
Published: February 2018

Cryoanalgesia, the local application of extreme cold to nerves to produce analgesia, has been used to treat patients with intractable perineal pain. The cryoprobe was inserted percutaneously through the sacral hiatus into the sacral canal to produce anaesthesia of the lower sacral nerve roots. Forty patients received a total of 70 treatments: 31 patients (78%) were helped by the procedure and the median duration of improvement was 30 days. The treatment was more successful in relieving symptoms in patients suffering from pelvic cancer and coccydynia. The best results were obtained in those patients who received numerous freeze applications or prolonged freezing.
Detection and Natural Progression of Early Oesophageal Carcinoma: Preliminary Communication1
Authors: Yanjin Miao , Guangyi Li , Xianzhi Gu , Wenheng Chen
Published: February 2018

Twenty-three cases of untreated early carcinoma of the oesophagus are described. The detection and observation on the natural progression of these early carcinomas were performed by means of abrasive cytology, barium oesophagography, and/or fibreoptic oesophagoscopy. Eleven cases had developed late carcinoma in a mean of 55.5 ± 29.0 months after the initial detection of the disease, while in the remaining 12 cases the disease had maintained its early stage of progression for 74.4 ± 27.3 months without developing into late carcinoma. Further, of the 23 patients, 18 had lived beyond 5 years, making a natural 5-year survival rate of 78.3%. The relatively long period of dormancy at the early stage of oesophageal carcinoma might thus influence the 5-year survival rate of this disease currently treated by surgery.
Observations in Micturating Cystourethrography
Authors: Rose D H , Eaton A C
Published: February 2018

Combined studies of micturating cystourethrography (MCU), bladder pressure and urinary flow rate measurements (urodynamic studies) have been analysed in 1584 adult patients of both sexes. The combined study is called a videocystometrogram (VCM). The simple MCU is satisfactory for demonstrating vesicoureteric reflux, but in the investigation of other problems of the lower urinary tract in adults, conclusions based on the MCU alone can be misleading. It is recommended that if the MCU is performed at all in the investigation of adult incontinence and suspected urinary outflow obstruction, it should be combined with a urodynamic study. This increases the examination time by about 50% but greatly improves the diagnostic accuracy, especially in establishing whether surgery is indicated or inappropriate.
Iatrogenic Neuromuscular Disorders: A Review
Authors: Swash Michael , Schwartz Martin S
Published: February 2018

The frequency of iatrogenic neuromuscular disorders has only recently been appreciated. Pressure palsies, especially common peroneal nerve palsies following bed rest or surgical procedures, are well recognized and easily preventable disorders. Mononeuropathies may also result from direct injuries to nerves, especially from venepuncture or attempted arterial cannulation in the axilla (O'Keefe 1980) or antecubital fossa, when the median nerve is particularly at risk. Stretch injuries to the lower cervical roots or to the lower cords of the brachial plexus may complicate sternal thoracotomy (Winer & Harrison 1982). However, most iatrogenic disorders of nerve and muscle are due to the unwanted effects of drugs used in therapeutic dosage. They are thus difficult to prevent. However, early detection is possible and this may prevent the development of severe disabilities.
Pseudo-Obstruction of the Large Bowel
Authors: Addison N V
Published: February 2018

Thirty patients with acute pseudo-obstruction of the large bowel are presented, and the aetiology and diagnosis of this recognized clinical entity are described. Emergency barium enema examination is recommended in patients with symptoms and signs of large bowel obstruction. When no mechanical blockage is found a diagnosis of pseudo-obstruction can be made. The management of pseudo-obstruction is conservative, with nasogastic suction, intravenous fluids and the treatment of any associated condition such as cardiac failure and inflammatory conditions. The indications for surgery in pseudo-obstruction are discussed.
Radiological Management of Abdominal Abscess
Authors: Mac Erlean D P , Gibney R G
Published: February 2018

Forty-two abdominal and retroperitoneal abscesses were drained percutaneously under ultrasound guidance. A success rate of 85.7% was achieved. Subsequent surgery was required in only 5 patients. Postoperative and spontaneous abscesses did equally well. Most intra-abdominal and retroperitoneal abscesses are amenable to this form of percutaneous drainage. The procedure requires only local anaesthesia and is well tolerated. Surgical management should probably now be reserved for those cases which are considered unsuitable for percutaneous drainage or which fail to resolve following this procedure.
Fibre Endoscopic Insertion of Palliative Oesophageal Tubes with the Nottingham Introducer1
Authors: Rose J D R , Smith P M
Published: February 2018

Using the Nottingham introducer and diazepam sedation, 93 of 100 patients with oesophagogastric malignancy have been successfully intubated, 67 with Celestin tubes and 26 with Atkinson tubes. Their mean age was 72 years (range 36–91). Six of the failures were in patients with fundal adenocarcinoma. Sixty-nine patients were discharged from hospital after initial intubation (74%). Nine patients developed a perforation, 6 died and there were 5 deaths from aspiration. Nine patients are alive up to 11 months later. The mean survival after discharge was four months with a maximum of 18 months. Later 11 tubes obstructed and 12 Celestin tubes displaced upward.

Endoscopic insertion of oesophageal prosthetic tubes provides satisfactory palliation for inoperable oesophagogastric malignancy. The development of the Atkinson tube with a distal flange has eliminated tube displacement upwards.
Effect of Different Corticosteroid Regimens on Hypothalamic-pituitary-adrenal Axis and Growth in Juvenile Chronic Arthritis
Authors: Byron M A , Jackson J , Ansell B M
Published: February 2018

Linear growth was recorded in 36 children with juvenile chronic arthritis. In 20, the hypothalamic-pituitary-adrenal axis (HPA axis) was assessed by insulin-induced hypoglycaemia, the results of which correlated well with resting Cortisol levels. Three groups were identified according to type of corticosteroid regimen administered. Group 1 (6 children), receiving daily corticosteroid therapy, were clearly suppressed and failing to grow. Group 2 (13 children) had received an alternate-day regimen from the initiation of corticosteroid therapy; they were not suppressed and growth was satisfactory in 11. Group 3 (17 children) were receiving alternate-day therapy, but had had daily corticosteroid in the past; they showed no clear pattern of suppression or growth. Factors influencing the recovery of the HPA axis and resumption of growth were assessed. No difference was found in the individual growth of 7 children who commenced alternate-day therapy before the age of 5, compared with matched controls.

It is suggested that daily divided doses of corticosteroid should not be used. Ideally, a single morning dose (up to 2 mg/kg) alternate-day regimen should be employed, as this regimen has minimal effects on HPA function and growth, even in young children. For very severe systemic features, it may be necessary to add a small single dose on the alternate day.
Double-ended Pigtail Polyethylene Stents in Management of Benign and Malignant Ureteric Obstruction
Authors: Jones Peter A , Moxon R A , Pittam M R , Edwards L
Published: February 2018

Surgical urinary diversion for incurable pelvic malignancy has a high morbidity and mortality, and external drainage provides less than ideal palliation. Six patients with ureteric obstruction caused by cancer have been managed by operative or endoscopic insertion of self-retaining polyethylene tubes. These techniques also have applications in non-malignant disease, and the treatment of two patients with benign ureteric stricture is described.
Chemotherapy of Chemically-induced Colorectal Tumours
Authors: Gilbert J M , Slavin G , Thompson E M , Kark A E
Published: February 2018

Benign and malignant tumours were induced in the large bowel of rats by the carcinogen 1,2-dimethylhydrazine (DMH). Benign tumours appeared from week 20 onwards and malignant tumours from week 30. 5-Fluorouracil was administered intraperitoneally in maximally tolerated doses from week 26 onwards and failed to influence significantly the development of either benign or malignant tumours. Tumours induced by DMH are a close model of human colorectal cancer and suitable for testing anticancer drugs. Agents with greater activity against colorectal cancer are required.
Use of Hypnosis in Criminology: Discussion Paper
Authors: Waxman David
Published: February 2018

Memories of events which are unremarkable may pass unrecorded or may fade with the passage of time. In any situation of stress, anxiety may cloud the memory of the incident and in the case of some intensely frightening or humiliating experience such material may not be subject to voluntary conscious recall and may be repressed.

A technique for uncovering certain ‘forgotten’ or repressed memories with the use of hypnosis is described. A similar method has been used in order to retrieve such memories in the investigation of witnesses and victims of serious crime. Nevertheless, various aspects of the overall validity of such a procedure have been called into question and for this reason the results of numerous experiments and the conclusions arrived at in many papers are discussed. It is emphasized that a rigid code of conduct be followed if hypnosis is to be used as an investigatory tool.
Use of Ender's Nails in Unstable Trochanteric Femoral Fractures
Authors: Marsh C H
Published: February 2018

Eighty consecutive patients with unstable trochanteric femoral fractures treated by the Ender technique have been studied. Early fixation failure was seen in 18% of patients. Leg shortening and external rotation deformities due to uncontrolled fragmentary collapse were found in almost 80% of the 57 surviving patients at 3 months, and caused severe disability. The continued use of the Ender technique in unstable fractures is questioned.
Ligature Applicator and Tier
Authors: Fraser Ian
Published: February 2018

A new instrument is described which holds, carries and ties ligatures in areas where access is limited or vision obscured during traditional hand tying. It has been used during deep pelvic surgery, for cholecystectomy, in highly selective vagotomy and may be useful in peraxillary transthoracic cervical sympathectomy.
Extraurinary Manifestations of Chronic Pyonephrosis
Authors: Roberts J B M , Gingell J C , Kirk D , Feneley R C L , Smith P J B
Published: February 2018

Twenty-five patients who underwent nephrectomy for chronic pyonephrosis were studied retrospectively. Such patients may present with a wide range of symptoms. Marked haematological and biochemical abnormalities are found, the most striking being a gross elevation of plasma viscosity (or ESR) and a raised alkaline phosphatase. The resulting picture often suggests extrarenal disease, and diagnostic confusion occurred in a number of patients.
Diagnosis of Coronary Embolism: A Review1
Authors: Charles R G , Epstein E J
Published: February 2018

Coronary embolism is an uncommon but distinct clinical entity. It can be diagnosed clinically, and should be suspected when acute myocardial infarction occurs in association with an underlying condition which predisposes to embolism. The most common are valvular heart disease, a prosthetic heart valve, infective endocarditis, cardiomyopathy with mural thrombus and arrhythmia. The diagnosis may be obscured by atypical symptoms and transient ECG changes. The diagnosis is supported by the demonstration of normal coronary arteries by selective coronary arteriography. Treatment with long-term anticoagulants may prevent further emboli. Additional antiplatelet drugs are also necessary in patients with prosthetic heart valves.
Clinical Analysis of Laryngeal Trauma Secondary to Intubation
Authors: Gleeson M J , Fourcin A J
Published: February 2018

A study was undertaken to analyse the effect of short-term intubation on the voice. Children were examined laryngographically both pre- and postoperatively. Changes in larynx frequency distribution following intubation were documented using the technique of electrolaryngography; the resolution of these changes was similarly recorded. The results, in comparison with the frequency distributions associated with other disease states, give insight into the nature of the damage and its effect on vocal fold vibratory patterns. The technique therefore enables objective evidence of minor degrees of laryngeal trauma to be demonstrated and differentiated.
Use of Ultrasound Localization to Improve Results of Fine Needle Aspiration Cytology of Breast Masses
Authors: Patel J J , Gartell P C , Guyer P B , Herbert A , Taylor I
Published: February 2018

A prospective randomized controlled trial of 116 patients with breast masses was conducted to compare the accuracy of ‘blind’ aspiration cytology performed in the clinic with aspiration cytology using ultrasound localization. The unsatisfactory aspiration cytology rate was significantly reduced by ultrasound localization (P=0.028). This was mainly due to an improvement in the unsatisfactory rate for tumours less than 3 cm in diameter (P=0.036). The results were influenced by the number of needle manoeuvres performed, < 10 needle manoeuvres being associated with a 54% unsatisfactory aspiration rate compared with 25% when > 10 manoeuvres were performed (P= <0.02). One experienced aspirator in the clinic had results comparable to those achieved with ultrasound localization.

It is concluded that experience and technique are the most important factors in obtaining a satisfactory aspirate from breast masses. Routine ultrasound localization prior to aspiration confers some benefit. Consideration should be given to the use of the ultrasound-assisted technique following a previous unsatisfactory aspiration, particularly if the tumour is less than 3 cm in diameter.
Recent Respiratory and Enteric Adenovirus Infection in Children in the Manchester Area
Authors: Richmond S J , Wood D J , Bailey A S
Published: February 2018

Seventy-three group B adenoviruses (29 type 3 and 44 type 7) identified in a recent community outbreak were analysed with restriction endonucleases. Considerable genetic heterogeneity was identified, particularly amongst the type 3 isolates, but this genome variation could not be correlated with either clinical or epidemiological findings. Group F adenoviruses were found in 132 (4.1%) of 3202 stool specimens from children with gastroenteritis and, after rotaviruses, they were the most common viruses identified. Unlike rotaviruses, these enteric adenoviruses were endemic throughout the 3–year study period and the greatest proportion of infections (47.6%) were found in babies under 6 months old.
Anaesthetic Considerations in Facial Reconstruction for Down'S Syndrome
Authors: Beilin B , Kadari A , Shapira Y , Shulman D , Davidson J T
Published: February 2018

Sixty-three patients with Down's syndrome underwent facial reconstructive surgery under general anaesthesia in order to improve their acceptability and potential for functioning effectively in society. Preoperatively, one-third of the patients had respiratory illnesses, 11 (17.5%) had cardiac anomalies, and 5 (7.9%) had endocrinological abnormalities. Anaesthesia was based on spontaneous ventilation of halothane and N2O in oxygen via an endotracheal tube with appropriate monitoring. Only one patient had an intraoperative complication, an episode of ventricular dysrhythmia, but postoperatively 9 patients required nasopharyngeal airways or endotracheal intubation in order to maintain a patent upper airway. The anaesthetic considerations for facial reconstructive surgery in Down's syndrome are discussed.
Screening for Cervical Cancer: Review of Administrative Arrangements
Authors: Pye M J
Published: February 2018

In 1980 a working party was established in Cambridge Health District to review the administrative arrangements for cervical cytology recall using the National Health Service Central Register at Southport. As a result of a number of surveys and ad hoc enquiries it was decided not to continue with the central recall scheme (which was subsequently withdrawn).and not to replace it with any formal centralized local scheme. The decision was based on the apparent failure of the central scheme, the effectiveness of informal systems already in operation locally, and the need to place cervical cancer amongst competing priorities for prevention.
Smoking-a Major Cause of Polycythaemia
Authors: Aitchison R , Russell N
Published: February 2018

The importance of smoking in the aetiology of polycythaemia has been assessed in a group of patients referred to a general haematology clinic. All patients with true and relative polycythaemia (excluding those with polycythaemia rubra vera) were studied. Of the 21 such patients evaluated, 14 were smokers and had raised carboxyhaemoglobin levels and had no other demonstrable cause for their polycythaemia. The commonest physiological abnormality in these patients was a raised red cell mass combined with a low plasma volume. Six of the 14 patients were able to reduce their smoking with subsequent improvement in their haematocrits. These results suggest that smoking is a major cause of polycythaemia in an unselected series of referrals to a general haematology clinic. The early identification of these patients may be useful in planning therapy.
Neonatal Septal Deviations
Authors: Kent S E , Reid A P , Nairn E R , Brain D J
Published: February 2018

In a review of 1000 consecutive neonates of all races, nasal septal deformity was identified in 29, an incident of 2.9%; significantly fewer cases were found in negroid babies (0.1>P > 0.05). Ten cases (35%) underwent manipulation of the deviated septum. Six-monthly review revealed that symptoms associated with the septal deformity are rare. In 7 (44%) of the 16 cases not manipulated, the septum straightened spontaneously during the first few months of life.

The appearance of the deviation is not of a dislocation of the caudal edge of the cartilage but a smooth concavity. In vitro compression of the neonatal nasal cavity reproduced this C-shaped deformity, but only temporarily. Histological serial sections of 6 postmortem nasal cavities showed that the high laminae of the vomer prevent any caudal dislocation of the septal cartilage.
Treatment of Urethral Stricture Disease by Internal Urethrotomy followed by Intermittent ‘Low-Friction’ Self-Catheterization: Preliminary Communication
Authors: Lawrence W T , MacDonagh R P
Published: February 2018

The aim of this study was to determine whether the natural course of urethral stricture disease could be modified following urethrotomy by teaching patients intermittent self-catheterization. Preliminary results in 42 patients show that postoperative urine flow rates can be maintained if this method of ‘low-friction’ catheterization is adopted. The technique has been well received by an elderly group of patients and can be recommended for wider use.
Sliding Hip Screws and Medial Displacement Osteotomy
Authors: Nunn D
Published: February 2018

The case notes and radiographs of 108 patients who had undergone compression screw fixation of trochanteric fractures of the femur were reviewed. Forty-seven patients had unstable comminuted fractures, and 20 of these had medial displacement osteotomies performed. In 40% of this group the operation was not a success in terms of extrusion of the screw through the femoral head, compared with 20% for the whole series of 108 patients. A number of parameters were studied in the search for a cause for the failure, and there was a correlation with a superior position of the screw initially, and a low serum albumin. Although the proximal fragment abutted the plate at the time of operation, the medial cortices of the proximal and distal fragments were often not in apposition, allowing the fracture to collapse into varus with resultant extrusion. Unless a stable configuration is achieved at the time of operation, reliance on the sliding component of these implants to allow for collapse at the fracture site will not necessarily produce this stability, and failure will ensue.
Place of Abdominoperineal Excision in Rectal Cancer
Authors: Christiansen J
Published: February 2018

In an attempt to elucidate if and when there is a place for abdominoperineal excision in rectal cancer, we have evaluated survival, risk of local recurrence and functional results of alternative procedures. There seems to be no difference in survival rate after intended curative surgery for rectal cancer between rectal excision and sphincter-saving resection. This is also true with respect to risk of local recurrence, except in patients with poorly differentiated Dukes’ C tumours, where the risk of significant distal intramural spread is increased.

Functional results are satisfactory after low anterior resection with colorectal anastomosis, whereas coloanal anastomosis is followed by less satisfactory results especially in elderly patients. In these patients rectal excision with a permanent colostomy is probably preferable.
Say Yes to Life: A Pilot Study
Authors: Wood Clive , Keen Allison
Published: February 2018

In an attempt to assess whether there are any characteristics which a majority of ordinary people regard as life-affirming or life-denying, a questionnaire was given to a pilot group of 167 respondents, representing three different age and social categories. Five life-affirming and five life-denying characteristics were mentioned by more than 10% of respondents. Of the former, Drive, Sociability, Happiness and Optimism were endorsed by 15–20%. Of the latter, Unsociability and Poor Coping were mentioned by 22%, making them distinctly more frequent than the following categories of Pessimism, Lack of Drive and Unhappiness (11–14%). It is suggested that a number of these subjectively determined characteristics, which the general public perceive as being life-affirming or denying, do indeed influence physical or mental health, illness or illness behaviour. It may therefore be of value to utilize this set of public perceptions in future programmes of health education.
Evaluation of Ileorectal Anastomosis for the Treatment of Ulcerative Proctocolitis
Authors: Backer O , Hjortrup A , Kjærgaard J
Published: February 2018

Of 327 patients treated for ulcerative proctocolitis, 165 underwent surgery and an ileorectal anastomosis was performed in 59: 19 of these patients were operated upon in one stage and 40 in two stages. In 13 cases the anastomoses had to be converted, 5 during the initial hospitalization and 8 during a later admission. Three patients developed carcinoma of the rectal stump. The median follow-up period was 15 years. It is concluded that ileorectal anastomosis has a place in the treatment of inflammatory bowel disease, but requires careful follow up of the patients.
Managing the Dyspeptic Patient: Experience of a Single-Visit Dyspepsia Clinic
Authors: Lobo A , Dickinson R
Published: February 2018

During a one-year period, 206 of 245 patients referred directly to a single-visit dyspepsia clinic underwent gastroscopy after clinical consultation. Endoscopic findings enabled diagnosis in the majority and no complications occurred. In 12 patients with positive endoscopies there was an unrelated clinical diagnosis, and 23 with normal endoscopies had organic disease. Such a clinic has advantages both for patients in providing single-visit diagnosis and management for the majority, and for the hospital in reducing the load on outpatient services. Prior consultation may prevent both unwarranted use of endoscopy facilities and inappropriate diagnosis.
Unacceptable Variation in the Core Diameters of Some ao Type Cancellous Screws
Authors: Radford W J P , Pozo J L , Muirhead-Allwood W F G
Published: February 2018

This study assesses the variability in core diameter of a series of cancellous screws and its effect on torque strength. Analysis of a series of 107 cancellous screws revealed a wide variation of the core diameters in our sample. Tests to evaluate the effect of this variation showed that torsional strength is directly proportional to the cube of the radius of the core; a 30% reduction in radius resulting in a 70% loss in torsional strength. Conclusions drawn from this experimental data indicate that variability in core dimensions below the recommended specifications is unacceptable in clinical practice.
Patients’ Alcohol Drinking Habits in General Practice: Prevention and Education
Authors: Shute P A
Published: February 2018

A survey of alcohol drinking habits using a questionnaire was conducted in a practice with 2 GPs and 4500 patients. Six hundred and thirty-two questionnaires were completed by all patients aged 15 and over attending the surgery during a three month period. Forty-five patients drinking in excess of 20 units of alcohol per week were identified, 22 of whom submitted to formal interview, examination, haematology, serum biochemistry and an education plan. When 20 of these were followed up after 3 months, 9 claimed to have significantly reduced their alcohol consumption and 10 remembered half or more of the ‘education plan’. As a result of the survey, drinking habits were recorded in the notes of 15% of the practice list and many associated medical problems were recognized for the first time.
P6 Acupressure Reduces Morning Sickness
Authors: Dundee J W , Sourial F B R , Ghaly R G , Bell P F
Published: February 2018

A prospective study was designed to test the efficacy of pressure at the P6 (Neiguan) acupuncture point, in preventing morning sickness. Three groups of patients in early pregnancy recorded the severity and frequency of sickness over a period of 4 consecutive days following daily pressure at P6 point, pressure at a point near the right elbow and with no treatment. Troublesome sickness was significantly less in both the genuine (23/119) and dummy (41/112) pressure groups as compared with the control series (67/119). When the data are adversely ‘weighted’ to compensate for the lower incidence of fully completed returns in the active treatment groups, only the P6 group show a significant reduction in sickness. No side effects occurred in either group and while anticipation of benefit may offer a partial explanation for the findings, pressure at the Neiguan point appears to have a specific therapeutic effect.
Quantitative Exfoliative Cytology of Abnormal Oral Mucosal Smears
Authors: Cowpe J G , Longmore R B , Green M W
Published: February 2018

In this study quantitative techniques have been applied to smears collected from the buccal mucosa and floor of the mouth. The results display an encouraging success rate for identifying premalignant and malignant lesions. ‘Intrapatient’ normal smears provide a satisfactory control for comparison with pathological smears. Early results indicate that quantitative cytology could be of great value for monitoring and follow-up of suspicious lesions and provide an excellent additional diagnostic test for detecting early oral malignancy.
Corticosteroid Replacement Therapy: Twice Or Thrice Daily?
Authors: Groves R W , Toms G C , Houghton B J , Monson J P
Published: February 2018

Although glucocorticoid replacement is conventionally administered twice daily, the pharmacokinetics of hydrocortisone would predict very low levels of plasma Cortisol by mid-afternoon. This study compared plasma Cortisol day profiles in 7 hypoadrenal patients while on twice daily and thrice daily hydrocortisone replacement. The twice daily regimen was associated with very low levels of Cortisol at 16.00 and 18.00 h. This was eliminated by administering the same total dose in a thrice daily regimen. Furthermore, estimates of ‘well-being’ by visual analogue scale correlated significantly with simultaneous plasma Cortisol levels and 5 of the patients expressed a preference for the thrice daily regimen. The findings suggest that thrice daily glucocorticoid replacement therapy should be adopted routinely.
AIDS: Neurological Opportunist Infections in Central London
Authors: Guiloff R J
Published: February 2018

Twenty six (41%) of 64 central London cases of AIDS with nervous system involvement during the course of the illness had neurological opportunist infection. Cytomegalovirus and Toxoplasma gondii were the commonest agents in 22 cases with central nervous system (CNS) infection. Eight cases had herpes zoster radiculopathy. Other infections included those caused by Cryptococcus neoformans, Mycobacterium tuberculosis and papova JC virus. Prognosis was generally poor, irrespective of whether the opportunist infection was treatable.
Septicaemia in Patients with Temporary and Permanent Endocardial Pacemakers
Authors: Smyth E G , Pallister D
Published: February 2018

Twenty-four patients with staphylococcal septicaemia due to permanent (14) and temporary (10) endocardial pacemakers were reviewed. With permanent pacemakers local inflammation was usually present and the onset of septicaemia rapid. If patients were treated with high dose intravenous flucloxacillin combined with removal, recovery was usual. In patients with retained endocardial tips (6) we eradicated infection with medical treatment alone in four cases.

We would advocate antistaphylococcal prophylaxis for patients undergoing revision in the presence of local inflammation and high dose intravenous flucloxacillin plus a second anti-staphylococcal antibiotic (e.g. gentamicin) in patients with septicaemia and a pacemaker in situ.