bluuebunny/crossref_metadata_2025 huggingface dataset:
Menorrhagia: clinical investigation
Authors: Critchley Hilary O D
Published: October 2023

Disorders of menstruation are the commonest indication for women to seek medical attention. Up to 20 per cent of healthy menstruating women report an excessively heavy monthly blood loss (Jacobs and Butler 1965; Hallberg et al. 1966; van Eijkeren et al. 1989). Menstruation itself has been defined as the ‘shedding of the superficial layers of the endometrium following the withdrawal of ovarian steroids. The process is associated with a variable degree of blood loss and usually lasts for up to six days’ (Cameron et al. 1996). The increase in dissatisfaction with menstrual aberrations may be a reflection of the fact that women experience more menstrual cycles than they did at the turn of the century. The average woman nowadays experiences in the order of 400 menstrual cycles during her reproductive years, in contrast to the 40 or so cycles she would have been exposed to over 50 years ago (Short 1984; Rees and Turnbull 1989). The increased numbers of menstrual cycles are due to the fewer pregnancies and reduced lactation periods chosen by women in the latter half of this century.
The medical management of menorrhagia
Authors: Rees Margaret C P
Published: October 2023

Menorrhagia is one of the most common reasons for women to consult their general practitioners and be referred to gynaecologists. This is not surprising since on average Westem women will experience about 400 menstruations between the menarche and the menopause. In a national community survey where 1069 women were interviewed in their own homes, 31 per cent reported heavy periods and 38 per cent painful periods (Corrado 1990). Of these, one third had consulted a doctor within the past four months. It has been estimated that 5 per cent of women aged 30-49 consult their general practitioners for complaints of excessive menstrual bleeding in one year in the UK (Coulter et al. 1995a).
The pathophysiology of dysmenorrhoea
Authors: Åkerlund Mats
Published: October 2023

Painful menstruation is a common gynaecological problem. Different Scandinavian studies have shown that about 50 per cent of nulliparous women suffer from menstrual pain and that 10-20 per cent have to be absent from work 1–2 days each or every second menstruation (Bergsjö et al. 1975; Andersch and Milsom 1982). Although dysmenorrhoea tends to disappear after the first birth, a Norwegian study showed that more than 30 per cent of 30–40 year old women still had menstrual pain (Bergsjö et al. 1975).
The clinical treatment of dysmenorrhoea
Authors: Lumsden Mary Ann
Published: October 2023

Dysmenorrhoea is a significant clinical problem. Twenty-one per cent of women referred to gynaecological outpatient clinics with menstrual complaints have severe dysmenorrhoea without associated menorrhagia and in many of the remainder the complaint is associated with heavy menstrual blood loss (Warner 1995). Since women now experience up to 400 menstrual bleeds during their reproductive life the significance of the problem cannot be overstated and knowledge of the effective treatments available is essential.
Endometriosis and its influence on dysmenorrhoea and menstrual disturbances
Authors: Stones R William , Thomas Eric J
Published: October 2023

Endometriosis is defined as the presence of endometrium-like glands and stroma outside the uterine cavity and myometrium. Adenomyosis, where such tissue is present within the myometrium, is reviewed in Chapter 24. Current opinion regarding the pathogenesis of endometriosis favours the concept of implantation of endometrial tissue shed during menstruation and passed via the Fallopian tubes into the peritoneal cavity, in contrast to the alternative hypothesis of coelomic metaplasia. The retrograde menstruation theory is consistent with the epidemiology of the condition, which is essentially more common in women who have experienced more episodes of menstruation. Interest presently centres on genetic, environmental, or local factors which might render endometrial tissue more likely to adhere to and invade the pelvic peritoneum and deeper tissues.
Psychosomatic and other influences on complaints of menstrual bleeding and pain
Authors: Warner Pamela
Published: October 2023

For many health complaints there has been a relatively recent realization of the potential importance of psychosomatic aetiology. However, in women’s health, particularly menstrual complaints, there is a history of ready attribution to psychological factors. It might be expected that this would have resulted in psychologically focused research, an enhanced understanding of the aetiology of menstrual complaints, and to the development of psychologically based treatment strategies. Regrettably this is not the case, as may be seen in current major reviews (Effective Health Care Bulletin 1995).
Disturbances of bleeding with intrauterine contraceptive devices and hormonal intrauterine systems
Authors: Odlind Viveca
Published: October 2023

Menstrual bleeding disturbance is often reported as a side-effect in users of intrauterine devices (IUDs) for contraception and it is the most common reason for discontinuation of IUD use. Around 40-50 per cent of all terminations in IUD users occur as a consequence of perceived bleeding problems (Table 30.1). Termination rates for bleeding problems vary between studies and between centres, probably, in part, reflecting variations in attitudes and counselling among service providers (Table 30.2). The rates are similar for inert and copper IUDs and hormone releasing systems but the nature of the bleeding problems reported by the women is very different in users of inert or copper IUDs as compared with that in users of hormonal intrauterine contraception. The most common complaints with copper IUDs are increased menstrual blood loss, prolonged menstrual bleeding periods, and intermenstrual bleeding. The most common complaints with hormone-releasing intrauterine systems are intermenstrual bleeding, irregular bleeding, and amenorrhoea.
Hormone replacement therapy and disturbances of bleeding: mechanisms and management
Authors: Archer David F
Published: October 2023

Menopause has recently become a significant issue as the life expectancy of the female population increases. The average age of menopause in the United States is 52 years, with an average life expectancy to age 82. The majority of women in the world do not receive hormone replacement therapy following menopause. In fact, hormone replacement therapy as a treatment for post-menopausal women has only come into vogue in the developed world since the middle of the 1960s.
The midwife’s potential - from ritual to radical
Authors: Duerden Jean
Published: October 2023

This chapter will look at developments in midwifery, especially within the community setting, and suggest where the community midwifery service should be going in light of primary care development. It is important to remember that maternity services across the country vary tremendously and there can be no set pattern of care as the differing populations and geographic settings determine contrasting systems.
Educating the carers
Authors: Smith Lindsay , Alexander Jo
Published: October 2023

The education and training of midwives and doctors (whether obstetricians or GPs) providing maternity care must ensure that they are competent to provide women with continuity and choice (Taylor 1986; Flint et al. 1989; Ford et al. 1991; House of Commons 1992; Department of Health 1993; Campbell and Macfarlane 1994). This includes choice of care, carer, and of place of delivery. Such knowledge, attitudes, and skills which are required to achieve competence (Newble 1992) may be acquired as an undergraduate and/or during postgraduate education and training. The acquisition of appropriate knowledge and skills is not sufficient. It is also vital for both groups to believe that they have important complementary roles in maternity care.
Reproductive information and advice in primary care
Authors: Modell Michael , Modell Bernadette
Published: October 2023

The objective of providing reproductive information if possible for couples rather than women alone, is to increase the chance of the birth of a healthy baby. The list below summarizes the areas to be covered in this chapter:
Care of the mother after birth
Authors: Garcia Jo , Marchant Sally
Published: October 2023

This comment, from a mother who took part in a study of postnatal care (Garcia and Marchant 1992), was chosen to illustrate two things: first, that care is given in the wider context of family support and the woman’s varied responsibilities; and second, that women’s physical health and mental well being are closely related. The first section of this chapter describes current patterns of postnatal care in this country. Next is a section about women’s health in the period after a birth. We then explore what the purposes of postnatal care might be and look at evidence about interventions in the postnatal period.
Community-based maternity care in the new millennium
Authors: Marsh Geoffrey N , Renfrew Mary J
Published: October 2023

Working on this book has been a major learning exercise for us. As we read the chapters that our contributors sent, we found that we learned much that was new to us about developments in community-based maternity care. We have also benefited from our discussions and work with each other. The combination of perspectives of an experienced GP who has cared for nearly 2000 child-bearing women with an academic midwife who believes in the key role of midwifery in the community as well as the fundamental importance of evidence-based care was not always straightforward, but it was always valuable. We knew when we started out that this book would be for other people - principally midwives, GPs, and obstetricians. It became, also, a mind-expanding exercise for us.
Anatomy
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Knowledge of some basic anatomy of the hand is essential. It will help in the diagnosis of injuries and also in communication when referring the patient.
Rupture of the ulnar collateral ligament of the MP joint of the thumb (gamekeeper’s thumb)
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

You may not be able to elicit laxity in fresh injuries because of pain. Refer for senior opinion for tender¬ ness over UCL following a relevant injury.
Ring avulsion Injury
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Ring may be buried under skin flap and not visible. Will show up on X-ray. Beware of not assessing the blood supply properly and sending the patient home. The next day the finger may be dead.
Chemical burns including hydrofluoric acid
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Seek specific antidote from place of work, if available. Alkalis can seem innocuous initially, but they keep burning and may produce a full-thickness burn. They need prolonged washing with water.
Skin loss
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Small areas of skin loss on the fingertip are treated by the application of a semipermeable film dressing (e.g. Opsite). (See also fingertip injuries, burns.) Is there really skin loss, or is it just elastic retraction of the skin edges? What structures are beneath the wound? Is there any underlying injury? There is usually an obvious history of cutting, crushing, or avulsion of tissue.
Foreign body in fingertip
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

If the patient feels that there is a FB present, then there usually is. Beware the incomplete removal of foreign body by the patient or doctor. Cut the barb off a fishing hook or remove it antegradely (forward).
Nerve injuries
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

If you do not think that the nerve is injured, and there are no other injuries, it is very acceptable to close the wound (suture or tapes) and review the patient at 48 hours. If a nerve division is confirmed at this time, a delayed primary suture can be performed.
Scaphoid fracture
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

An easy fracture to miss. Delayed treatment may cause delayed union or nonunion. Beware an associated dislocation of the lunate, scapholunate dissociation, and other injuries to the carpus.
Fractured neck of fifth metacarpal
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Ask patient specifically if a punch on a tooth occurred. At follow-up check extension lag, i.e. loss of full extension of the little finger, and encourage extension exercises.
Paronychia
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

May spread, if neglected, to infect the pulp space (pulp abscess) or flexor tendon sheath (purulent tenosynovitis). Chronic resistant paronychia is often due to fungal infection. Treat by removal of part or all of nail plate, send specimen for culture and prescribe an antifungal cream.
Purulent tenosynovitis
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Pain on passive stretching of the tendon is virtually pathognomonic of purulent tenosynovitis. Refer to hand surgeon on suspicion. At an early stage IV antibiotics may settle the infection, but it needs constant review as an in-patient.
Palmar space infections
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Do not just treat with antibiotics and review. Needs immediate assessment by a hand surgeon as delayed or inadequate treatment may lead to a useless hand. There are potential spaces in the hand where infection can occur. The mid-palmar space is deep to the flexor tendons. The thenar space lies radial to the third metacarpal. The hypothenar space overlies the hypothenar muscles (Fig. 45.1).
Family violence: the general practice context
Authors: Heath Iona , Amiel Stephen
Published: October 2023

The discipline of general practice is founded in the long-term relationship between doctor and patient, which nurtures mutual respect and trust. Within this relationship, each has their own field of expertise. The patient has intimate knowledge of their own life situation and of the experience of illness or disease that brings them to the doctor; the doctor has expert knowledge of the science of disease.. . . however pressed he may be for time, each patient should be made to feel that his illness is of real concern to the doctor. The general practitioner needs a deeply imaginative sympathy which enables him to understand his patient’s fears, anxieties, pain and discomfort.
The context
Authors: Hanmer Jalna
Published: October 2023

Violence against women from men they know and with whom they often live is common. In the past two decades, social knowledge of this widespread behaviour has increased, but not for the first time. Historically, public awareness of violence against women is associated with agitation for women’s rights. In our times the special events that created a climate where violence against women began to become socially visible once again arose when the Women’s Liberation Movement took up this issue in the early 1970s. After a long period of neglect women began to provide advice, counselling and accommodation services for other women who turned to the movement for assistance with problems of violence from known men.
The future
Authors: Heath Iona
Published: October 2023

The pioneering work of Women’s Aid over the past 25 years has gradually but profoundly shifted attitudes to domestic violence within society. The 1989 Report from the Home Office Research and Planning Unit led directly to the Home Office circular which was issued to police in 1990. This made clear the responsibility of the police to treat violence perpetrated against women in their own homes as seriously as violence occurring in a public place.
The future
Authors: Jenkins Ginny
Published: October 2023

Agreeing that elder abuse exists may seem straightforward. However, acceptance that it is more than granny battering or bashing and that its causes are complex has been slow. In 1993, only months after the publication of the national prevalence study by Ogg and Bennett, Virginia Bottomely, then Secretary of State for Health, said that she did not think that elder abuse was a problem.
Perplexed? You should be
Authors: Greaves Mel
Published: October 2023

Allow me to start with the bad news will you? Statistics. Around one in three of us will at some time have an unwelcomed diagnosis of cancer, providing common ground between presidents, movie stars, bishops, athletes, Nobel prize winners, Jew and gentile, black and white, wealthy and destitute. Every day, around 1500 Americans die of the disease and, needless to say, vastly more non-Americans. Worldwide, over eight million new cancer diagnoses are delivered each year. It’s geographically and ethnically ubiquitous, and it’s a big problem. Something of an acute problem in Western societies relishing wealth, health, and longevity, anticipating the quick fix and perplexed by the lack of it. In the developed world, with the eradication of infection and malnutrition as major causes of mortality, cancer has, largely by default, become more prominent as a life-threatening illness in children, although its frequency in the young remains very low.
Pundit’S Progress
Authors: Greaves Mel
Published: October 2023

The ancient Greeks and Romans recognized several types of cancers but many of their vague and erroneous ideas persisted unchallenged for 1500 years and more. For almost two millennia, cancer, as a medical problem, lay almost exclusively within the domain of surgeons and pathologists. This explains why societies prohibiting or eschewing these disciplines in medical training, such as the Chinese and most of Europe during the Dark Ages, made little or no progress in identifying and treating cancer. In medieval Europe, medical acumen with regard to cancer lay with Islamic surgeons and physicians practising throughout the Mediterranean region from Baghdad to Cordoba.
The Way We Are: Risks and Restraints
Authors: Greaves Mel
Published: October 2023

In the antique but thriving world of unicellular life forms such as bacteria and many protozoa, as well as viruses, success is a transparent process of self-perpetuation - a numbers game. The evolution of multicellular organisms some 700 million years ago was a critical transition point engendering more sophisticated survival and reproductive strategies involving specialization of cells and tissues, coupled with interdependence of cells and subservience of the parts to the whole. But this co-operative form of life does not eliminate the capacity of constituent cells to proliferate as clones and, under some circumstances, to migrate across tissue boundaries, or to behave, at least temporarily, like unicellular organisms or cancer cells. Indeed, these are critical functions for embryo development, in tissue renewal, inflammation, wound healing, immunity, and, in mammals, pregnancy. Evolution has therefore favoured conservation and elaboration of genes for these basic functions. But there then must be an inherent, genetic risk of clonal escape. In these circumstances, the potency of natural selection might be a real liability.
Green-Eyed Mutations?
Authors: Greaves Mel
Published: October 2023

Up until now, I’ve talked somewhat glibly about mutant genes in cancer cells as if identifying them and understanding their function in enabling clonal evolution has been a straightforward task. In fact it has taken little less than a technological revolution and intellectual tour de force by the biomedical research community to reach this point. Much of this progress has been skilfully chronicled elsewhere by the pilgrims involved. Identifying individual mutant genes has important implications, not only for unravelling the evolutionary process of cancer clone development but for sensitive and differential diagnosis, prognostication, monitoring of residual or cryptic disease, and possibly treatment. You don’t need here a catalogue of the hundreds of genes involved but a little insight into the nature of these mutations will help reinforce the evolutionary thread of this story and hopefully convince you that molecules indicted as culprits at one critical level in the causal pathway for cancer have been well and truly fingered.
The Great Glut
Authors: Greaves Mel
Published: October 2023

Patterns of food intake and culinary virtuosity vary dramatically between human societies and are part of their richness. The way we eat and what we eat has also changed many times during history, both in recent times and during our evolutionary trajectory from Africa. Along with our great ape cousins, we are derived from herbivorous primate predecessors. But climates change, food sources decline, and we move on. Over millennia, dental and intestinal anatomies will change also, reflecting our nutritional dialogue with nature and the potent selective force that is thus engaged. It is likely that prior to our emergence as erectile species, we shared with other great apes the predilection for plant foods with energy-rich, ripe fruits as haute cuisine.
Dying for a Living
Authors: Greaves Mel
Published: October 2023

Some argue that bacteria or insects are planet Earth’s most successful lifeforms. In terms of persistence, sheer numbers of individuals or species, and extraordinary environmental adaptations, they may well be. Mosquitoes usually get the better of me. But even a cursory observer from another planet would surely single out Homo sapiens as rather special. We are an extraordinarily dextrous and inventive species. We are enterprising at making things; superb at construction and destruction - and on a massive scale. In so doing we have drastically altered our habitat and can generate quite novel environments - no more so than where we work. Working for a living, as everyone knows, can seriously damage your health. Workers down the ages have been burnt, poisoned, drowned, or squashed, or have died of sheer exhaustion.
Finale: Cause, Complexity, and the Evolutionary Rub
Authors: Greaves Mel
Published: October 2023

The composite and probabilistic nature of risk for cancer, plus its extended time frame of evolutionary development, poses the major intellectual obstacle in understanding causation for the public and professionals alike. The ingredients and pattern of the composite are different for each type of cancer and, even for a single type of cancer, risk factors can vary in weight or importance. This is not intuitively easy to grasp given past false presumptions about disease causality. There is often a tacit assumption that not only can and should causation in cancer be formally and indisputably provable but that singular causes must exist and that these are both necessary and sufficient for the disease. This is simplistic and it is wrong.
Treatment: The Blindfolded Marksman
Authors: Greaves Mel
Published: October 2023

The long history of cancer in human society is replete with exotic or bizarre treatments, quackery, and gallant failure. Radical intervention by the surgeon’s knife has for centuries vied with the herbalist’s less harrowing, if ineffective, remedies and when all else fails, there has been no shortage of the surreal: An example of a woman who had cancer of the breast, which was already so severe that eight holes had been eaten into it, and who recovered through the following expedient: She took eight frogs applied to the breast in a muslin bag, which attached themselves instantly thereto as firmly as leeches. When they had sucked to repletion, they dropped off in violent convulsions without the sucking causing pain. This was repeated until 20 frogs were used, which all from time to time, sucked until they died. And the breast was not only cured, but returned again to its normal size absolutely.
Hormone synthesis, storage, release, and transport (Physiology)
Authors: Laycock John , Wise Peter
Published: October 2023

are molecules released by endocrine gland cells into the extracellular fluid to act on specific target cells are either proteins, polypeptides, or steroids are released from specific nerve endings in the hypothalamus can act on target cells near to their point of release, in which case they have a paracrine function include energy substrates such as glucose
Female reproductive endocrinology
Authors: Laycock John , Wise Peter
Published: October 2023

coincides with adrenarche (the time when adrenal androgen production is increased) is associated with the beginning of menstrual cyclicity usually occurs approximately two years earlier than in boys is initiated by the increasing quantities of circulating gonadal steroids e is retarded when blindness has been present from birth the testes have normally descended into the scrotum at birth
Is psychotherapy an act of goodness?
Authors: Lomas Peter
Published: October 2023

It is clear that the therapist does not do her work simply out of love; if this were so she would not claim a fee. The numerous motives, conscious and unconscious, for adopting the profession include curiosity, a wish for status, a sense of moral worth, the assuaging of loneliness, the pleasure of being an object of love, voyeurism, the possibilities for creative thought, and the enjoyment of vicarious identification. The therapist is perhaps rather like the heroine in Peter Hoeg’s novel Miss Smilla ‘s feeling for snow, who says:
Goodness, shame, and autonomy
Authors: Lomas Peter
Published: October 2023

A middle-aged man, John, was recalling his wedding many years ago. The reception was going well, speeches were made, photographs taken, and everyone was congratulatory, as he moved around among the guests. When he approached a group of four or five people, one of them, a tough, bluff, outspoken man said, ‘Why’ve you come here? We don’t want to talk to you.’ Although spoken dead pan it was presumably said as a joke. But John was devastated and had no response. Suddenly the whole occasion seemed a sham. He felt that he had merely been performing and, although the others had taken him at his face value, this man had seen him as the
Fragmentation, Psychotherapy, and Society
Authors: Lomas Peter
Published: October 2023

The loss of vitality and the distortion of truth which occurs when morality is excluded from a dialogue about human experience has been noted by so many thinkers in the past that any selection is bound to be arbitrary. In the field of literature Wordsworth and Coleridge are pre-eminent. In an essay on Wordsworth, Matthew Arnold writes of the ‘noble and profound’ application of ideas to life and the application of those ideas under the conditions fixed for us by the laws of poetic beauty or poetic truth: If it is said that to call these ideas moral ideas is to introduce a strong and injurious limitation, I answer that it is to do nothing of the kind because moral ideas are really so main a part of human life. The question, how to live, is itself a moral idea; and it is the question which most interests every man, and with which, in some way or other, he is perpetually occupied. A large sense is of course to be given to the term moral. Whatever bears upon the question, “how to live”, comes under it.
Psychological support
Authors: Skevington Suzanne M
Published: October 2023

Melzack and Wall’s (1965) classic paper on the Gate Control theory of pain is a prime example of how brilliant theoretical insights can lead to a plethora of therapeutic interventions. Without it, we would not have discovered transcutaneous electrical nerve stimulation (TENS), understood how distraction works as a coping strategy, or made serious strides in the pharmacological targeting of analgesics. It is also exciting because, for the first time, the central psychological mechanisms that contribute to the experience and reporting of pain were made explicit within a theory of pain rather than being seen as incidental.
Physiotherapy
Authors: O’gorman Betty , Elfred Ann
Published: October 2023

Traditionally in palliative care and oncology pharmacology has played the major role in the management of cancer pain (Baines 1989), but this approach may be insufficient to achieve optimal pain relief. Many units have included physiotherapy since their inception; in one modern hospice unit this is longer than 30 years. Expertise has developed from this small base as a speciality of physiotherapy in oncology and palliative care. Physiotherapy practice covers many modalities which may be of use in the alleviation of pain in cancer patients. Many patients have co-existing conditions that may contribute to their overall pain picture. Multiple pathologies of both malignant and non-malignant origin are common.
Percutaneous cordotomy
Authors: Wells J C D
Published: October 2023

It is logical to assume that targeted destruction of pain pathways will relieve pain. Unfortunately most neuronal pathways have mixed fibres, and destruction of the painfibres involves destruction of useful function such as motor and sensory nerve tissue. The most logical way of interrupting painfibres therefore is to destroy them in the anterolateral quadrant of the spinal cord, where they lie as a distinct pathway. If this area can be targeted and interrupted accurately significant relief of pain can be achieved. Thus the complication of interruption of sensory and motor pathways is avoided. There still remains the difficulty of the dysaesthetic sensation that can occur in a pain denervated area.
Treatment planning
Authors: McDonald F , Ireland A J
Published: October 2023

Treatment planning is the stage of orthodontics at which, in many cases, science is replaced by art. Operators determine what can be achieved, generally based on their own previous experience, with some individuals being able to produce treatment results that others are incapable of producing with precisely the same facilities. To this end, many controversies exist in orthodontics which can only be alluded to in a text of this nature. It is important, however, to be aware that many debates as to the effectiveness of a particular mode of treatment often have little or no basis in scientific fact.
Obstetrics and Gynaecology
Authors: Leung Wai-Ching
Published: October 2023

5 .1 The following parameters are recorded in the Bishop score in the assessment of readiness for induction of laboura dilatation of the cervix b viscosity of the cervical mucus c consistency of the cervix d position of the cervix e fundal height.
Paediatrics
Authors: Leung Wai-Ching
Published: October 2023

The average 9 month old baby cana walk alone unaided b pass an object from one hand to the other c put two words together d sit without support e scribble.
Pharmacology of local anaesthetics Key points in pharmacology of local anaesthetics
Authors: Illingworth Karen A , Simpson Karen H , Swales Sue
Published: October 2023

Bupivacaine provides more prolonged anaesthesia and analgesia than lignocaine. Transdermal local anaesthetics such as EMLA cream or amethocaine gel can be useful, especially in paediatric anaesthesia. Adrenaline may be used with some local anaesthetics to reduce systemic absorption and bleeding and prolong anaesthesia. Adrenaline must never be used near endarteries, such as fingers, toes, ear, nose, and penis. All local anaesthetics have a similar chemical structure, a lipophilic aromatic ring linked to a hydrophilic amino moiety by a carbon chain.
Fine Wines & Fish Oil
Authors: Ewin Jeannette
Published: October 2023

The British scientist, Hugh Macdonald Sinclair (1910-1990), is best remembered for his belief that diets deficient in essential fatty acids are the cause of most degenerative illnesses, including coronary heart disease. Sinclair's forceful arguments on this matter preceded firm scientific evidence and were met with ridicule. Nonetheless, convinced he was right, Sinclair raged against the scientific establishment, and thereby cast himself into a professional wilderness. He emerged as a hero when research by others proved him right. Fine Wines and Fish Oil explores the facts behind Sinclair's rise and fall, and finds a complex story involving family life, personal ambition, and the schism between the academic pursuit of knowledge and the use of information for the public good. Much of the story is set against the events of the Second World War, and the struggle to feed people on limited rations as a means of sustaining both human health and the defence of the nation. The study of human nutrition during the twentieth century provides the thread that binds these events together.
Manners makyth man
Authors: Ewin Jeannette
Published: October 2023

The Colonel’s death cast a pall over Hugh’s life. Some of his ghosts were laid to rest when, shortly after breakfast on an Out Day in March 1925, he borrowed a bicycle too small for his long body and headed away from School towards Longmoor Camp. He cycled hard over unpaved roads, crossing two fords and one flooded lane. Wet and uncomfortable, with his knees rising above the handlebars and bumping as he peddled, he lost his bearings repeatedly, making the journey longer than planned. At last a familiar house came into view. The outlines of the training camp where his father had drilled and readied the railwaymen for war began to unfold. Hugh had returned to the place where the King once walked with the Colonel among his men.
Robert McCarrison and other influences
Authors: Ewin Jeannette
Published: October 2023

Complaining of its small size and lack of amenities, Hugh rarely visited Gransden, and entertained friends in his rooms at college rather than inviting them home. In more than miles, Kent had become distant from his life in Oxford. John was in Transjordan pursuing an increasingly successful military career: a career that his mother enjoyed describing at length to Hugh. Rosalie and Catherine were immersed in their own interests, and Hugh felt they spent too little time appreciating his academic work. Communication at home was increasingly conducted through letters, left on fireplaces or under doors, as this permitted each to have his or her full say without the fear of interruptions. As for Salie, she seemed to make a point of vexing Hugh; clever and good at sport, she had always outshone her younger brother more than he liked. During the last weeks of 1932, Hugh had written a letter to his mother about his own success and his efforts as a son.
The foundations of Social Medicine
Authors: Ewin Jeannette
Published: October 2023

Intended to lower British morale, the Luftwaffe ‘Baedeker’ raids struck at the cultural heart of the country. Using a guidebook by Karl Baedeker describing the finest architectural sites in the country, the bombers dropped their loads at night on treasured cathedrals, towns, and cities. In Oxford, in the darkness, one could hear German bombers throb overhead on their way to the Midlands and beyond; but still, the City of Oxford was not targeted.

Largely due to the effective action of the Royal Air Force, by early 1942, Britain had withstood the worst of the Luftwaffe attacks, and government officials began looking ahead to rebuilding the nation. Two years earlier, Ernest Bevin, the Minister of Labour, had appointed William Henry Beveridge, an economist and social reformer, to conduct a rapid survey of peace-time manpower requirements. In 1941, however, Beveridge’s mission was changed, and he was appointed Chairman of a committee on social insurance. The work was comprehensive and included a number of social surveys. Added to all the other surveys under way, members of the public complained that every time one ate, or coughed, or failed to attend work, there was another person measuring, timing, and counting what had occurred.
Reports on the Western Netherlands and dietary fat
Authors: Ewin Jeannette
Published: October 2023

In the post-war climate of political idealism, the British Government sought to heal the social woes of the country. The National Health Service, initiated in 1948, was the greatest legacy of this time, setting out to provide medical care to all, from the cradle to the grave, free at the point of delivery. To meet changing demands, medical education at Oxford accelerated its transformation, and Hugh Sinclair was asked to participate. In February 1949, Leslie John Witts, the Nuffield Professor of Clinical Medicine at the Radcliffe Infirmary, and a supporter of Sinclair’s, had an idea for remodelling the medical lectures, devoting the first term to dietetic, metabolic, and renal disease. He wrote to Sinclair, asking him to comment on the plan.
Conducting trials
Authors: Girling David J , Parmar Mahesh K B , Stenning Sally P , Stephens Richard J , Stewart Lesley A
Published: October 2023

In this chapter, we describe the launching and conduct of a trial. For a trial to succeed, all those involved should promote and publicize it and do everything they can to maintain impetus and enthusiasm. We consider all aspects of conducting the trial on a day-to-day basis, paying particular attention to the membership, roles and methods of functioning of the committees responsible for independent data monitoring and supervision, and raise issues concerning computing and information technology, data protection, and the prevention of research misconduct.
Reporting and interpreting results
Authors: Girling David J , Parmar Mahesh K B , Stenning Sally P , Stephens Richard J , Stewart Lesley A
Published: October 2023

When reporting the results of a randomized trial, one should keep two goals in mind. Firstly, the onus is on the authors to show that the trial has been designed, conducted and analysed to appropriate standards – or if it has not, to explain why and discuss the possible impact of any limitations on the interpretation of the results. As other chapters demonstrate, the fact that a trial is referred to as randomized is not sufficient to confirm true randomization with adequate concealment; further, the use of proper randomization does not imply that all other aspects of the trial design will render it free from bias; and even the conduct of a well designed, properly randomized trial does not preclude the possibility of bias being introduced in the analysis. The first goal should therefore be to report the results in a structured way, which includes all the information necessary for a reader to judge whether these standards have been reached. For randomized trials, many aspects of structure have been formalized in the ‘CONSORT’ statement, which is discussed in detail later.
Benefits of an established trials centre and research group
Authors: Girling David J , Parmar Mahesh K B , Stenning Sally P , Stephens Richard J , Stewart Lesley A
Published: October 2023

In this book, we have described the conduct of cancer clinical trials, systematic reviews and meta-analyses. Some trials will be conducted by a single centre or small group of collaborating hospitals with a separate grant for each study, others as part of a long-term programme of research by an established trials centre and research group with some core funding. In this final chapter, we describe the advantages of such an established group. These include the strategic planning of coherent programmes of clinical studies and meta-analyses; undertaking large multi-centre and multi-group trials nationally and internationally; having a team of well-trained and experienced core staff thoroughly familiar with locally developed and well tested procedures, who have built up a group of centres conversant with the practicalities of collaborating in trials over many years; developing long-term collaboration with patient-advocacy groups; training and teaching; fulfilling advisory and consultative roles, and conducting a programme of trials-associated and methodological research.
Taxanes
Authors: McLeod Howard L
Published: October 2023

The taxanes paclitaxel (Taxol®) and docetaxel (Taxotere®) represent a novel class of antineoplastic drugs. They have very high activity in a spectrum of solid tumours that matches the combined spectrum of anthracyclines and platinating agents.The discovery of the prototypic taxane (paclitaxel) dates back to 1960, when the drug was identified in a large screening programme of plant products evaluated for anticancer activity by the US National Cancer Institute. Paclitaxel was initially extracted from the bark of the Pacific yew (Taxus brevifolia). The procedure was laborious, gave a low yield of final product, and had deleterious long-term environmental consequences.
Topoisomerase I targeting agents
Authors: Rowinsky Eric K , Baker Sharyn D
Published: October 2023

An extensive National Cancer Institute programme to screen natural products during the 1950s led to the isolation of an extract of the Chinese tree Camptotheca acuminata which had cytotoxic activity against a wide variety of leukaemia and solid tumours, including drug-refractory malignancies. Subsequent studies by Wall et al. in 1966 demonstrated that camptothecin (CPT) (Fig.12.1) was the active constituent of the extract, and initial studies of the mechanism of action of this compound suggested that cytotoxicity might be due to inhibitory effects on both DNA and RNA synthesis.
Neurochemical pathology in degenerative dementias
Authors: Perry Elaine , Goodchild Rose , Piggott Margaret
Published: October 2023

The focus of this chapter on transmitter abnormalities in dementia is: how transmitter deficits contribute to cognitive and non-cognitive/neuropsychiatric clinical features; how these can be targeted by specific pharmacotherapies; and, if such therapies are of clinical value, whether diagnostic markers of relevant transmitter disturbances (such as in vivo neuroimaging) can be developed to facilitate disease management. Chemical messengers involved in CNS signalling can be divided into two groups. There are neurotransmitters, released at synapses that operate via ionotropic receptors, designed to rapidly and accurately mediate the transfer of information between neurons—the so-called ‘executive’ transmitters such as glutamate (GLU, excitatory) and GABA (inhibitory). In contrast, a large number of neuromodulatory transmitter systems exist whose predominant action is to alter the responsiveness of a neuron to this fast neurotransmission. These include noradrenergic, serotonergic, dopaminergic, cholinergic, and histaminergic together with the neuropeptide systems.
Inflammatory and Infective Disorders
Authors: Wilson Heather C , Scolding Neil
Published: October 2023

The range and breadth of diseases of the nervous system caused by immunological, infective, or inflammatory disturbances is very large. It includes ‘primary’ or idiopathic neuroimmune disor- ders, which may affect any part of the neuraxis (e.g. multiple sclerosis, Guillain-Barré syn- drome), and which are very familiar to neurologists. ‘Secondary’ disorders, where the neurological disturbance reflects involvement of the nervous system in a systemic inflammatory disease, are no less common than idiopathic immune disorders, but most neurologists are rather less familiar and comfortable with them. In this account we can necessarily provide only a brief overview; and our aim is not to be encyclopaedically inclusive, but to rather to follow William Morris’s advice, and aim to ‘have nothing in … that [we] do not know to be useful or believe to be beautiful’; we therefore offer a summary of those diseases which are either reasonably common, or which illustrate principles of particular interest and relevance. Prion-related disor- ders are covered elsewhere; Chapters 16 and 18. Where possible, we will point out particular fea- tures which might direct the physician (or psychiatrist) towards specific diseases, and approaches to diagnosis. The management of these rare and often life-threatening disorders is beyond the scope of this chapter (see Scolding 1999).
Introduction
Authors: Syrigos Konstantinos N
Published: October 2023

In the rapidly growing field of oncology the burden of information can sometimes be overwhelming. Perhaps no disease reflects this better, than bladder cancer. Over the past decade, advances in our knowledge of the pathophysiology, diagnosis, and management of bladder cancer have been rapid. During this time the causal relationship with tobacco has been established, molecular biology has exponentially increased our knowledge, and inspired research from several centres has given us great insight into the mechanisms of bladder cancer pathogenesis, invasion, and metastasis. This has been accompanied by the development of new methods of investigation in both the experimental and clinical field. Clinical diagnostic practice has changed, while new staining techniques and interpretation have improved morphological diagnosis. Finally, novel therapeutic strategies and new approaches to palliation have been introduced.
Animal Models For The Study Of Bladder Cancer
Authors: Russell Pamela J , Kingsley Elizabeth A
Published: October 2023

Bladder cancer is a heterogeneous disease which occurs mostly in elderly patients. It may occur singly, but is often multifocal and presents different clinical and histopathological appearances. Over 90% of tumours are transitional cell carcinomas (TCCs), with less than 5% squamous cell carcinomas (SCCs) and 1% adenocarcinomas, but mixed tumours may also occur. Most cancers present as superficial disease (80%) and these generally respond well to treatment, while invasive disease is more difficult to treat. Currently, no markers absolutely predict the clinical outcome of individual patients, and studies of models of bladder cancer are therefore helpful for dissecting out pathways of carcinogenesis and progression as well as for treatment. Because of the paucity of well¬ preserved human clinical specimens for study, several such models have been developed, and these to varying extents mimic the clinical spectrum of disease in humans. Bladder tumours in animals, together with human bladder cancer cell lines, provide a basis for experimental studies of the molecular basis of processes involved in tumour formation, progression, and therapy (1-3). Available animal models include spontaneous or induced animal tumours, the growth of rodent or human bladder cancer in tissue culture, and the growth of xenografted human tumour in immunodeficient hosts. These in vivo systems provide the appropriate cellular milieu allowing for epithelial cell-stromal cell interactions which are crucial to the behaviour of bladder cancer cells. This chapter provides a critical appraisal of the use of the models for studies of the biological progression of bladder cancer, and highlights some recent uses of the models for testing new therapeutic strategies.
The Role Of Adhesion Molecules In The Biology Of Bladder Cancer
Authors: Syrigos K N , Harrington K J , Pignatelli M
Published: October 2023

It is now widely recognized that shedding and subsequent reimplantation of neoplastic cells within the bladder may, at least in part, be responsible for the high recurrence rates of bladder cancer. There is a growing body of evidence suggesting that alterations in the adhesion properties of neoplastic cells may play a pivotal role in the development and progression of the malignant phenotype in a range of tumour types including bladder cancer. Adhesion molecules are intimately involved in the control of such processes as morphological differentiation, cellular proliferation, and invasion and colonization of distant organs (1). Reduced cell-matrix adhesion allows neoplastic cells to circumvent the control of differentiation induced by the normal extracellular environment, while loss of the intercellular adhesion allows malignant cells to escape from their site of origin, degrade the extracellular matrix, acquire a more motile and invasive phenotype, and finally invade and metastasize (2). In bladder cancer in particular desquamation of single cells or whole sheets from the underlying lamina propria requires interruption of tight junctions between neighbouring cells and reorganization of intermediate filaments (3).