bluuebunny/crossref_metadata_2025 huggingface dataset:
Communication Patterns in Classes for Deaf Students
Authors: Craig William N. , Collins James L.
Published: February 2018

In order to describe more objectively the classroom communication of deaf children, an instrument for making systematic observations of this communication was developed and tested. This technique, based on the Flanders category interaction analysis system, was adapted specifically for use with the deaf and included notations both for communication purposes and communication modes. When applied to 12 selected classes of deaf children (94 subjects) the instrument proved sensitive to differences in classroom interaction and provided a systematic record of these communicative exchanges between the teacher and student and among students within classes.
Tumor Immunology and Immunotherapy for Head and Neck Squamous Cell Carcinoma
Authors: Moskovitz J.M. , Ferris R.L.
Published: February 2018

The immune system plays an important role in the evolution of malignancy and has become an important target for novel antineoplastic agents. This review article focuses on key features of tumor immunology, including the role of immunotherapy in general and as it pertains to head and neck squamous cell carcinoma. Side effects, resistance mechanisms, and therapeutic monitoring strategies pertaining to immunotherapy are discussed.
An Explanation for How FGFs Predict Species-Specific Tooth Cusp Patterns
Authors: Li L. , Tang Q. , Kwon H.-J.E. , Wu Z. , Kim E.-J. , Jung H.-S.
Published: February 2018

Species-specific cusp patterns result from the iterative formation of enamel knots, the epithelial signaling centers, at the future cusp positions. The expressions of fibroblast growth factors (FGFs), especially Fgf4, in the secondary enamel knots in the areas of the future cusp tips are generally used to manifest the appearance of species-specific tooth shapes. However, the mechanism underlying the predictive role of FGFs in species-specific cusp patterns remains obscure. Here, we demonstrated that gerbils, which have a lophodont pattern, exhibit a striped expression pattern of Fgf4, whereas mice, which have a bunodont pattern, have a spotted expression pattern, and these observations verify the predictive role of Fgf4 in species-specific cusp patterns. By manipulating FGFs’ signaling in the inner dental epithelium of gerbils, we provide evidence for the intracellular participation of FGF signaling, specifically FGF4 and FGF20, in Rac1- and RhoA-regulated cellular geometry remolding during the determination of different cusp patterns. Our study presents a novel explanation of how different FGF expression patterns produce different cusp patterns and implies that a conserved intracellular FGF-GTPase signaling module might represent an underlying developmental basis for evolutionary changes in cusp patterns.
Interaction With Educational Games in Hybrid Virtual Worlds
Authors: Christopoulos Athanasios , Conrad Marc , Shukla Mitul
Published: February 2018

This research links learner engagement with interactions when Hybrid Virtual Learning models are used. Various aspects have been considered, such as learners’ prior experiences related to virtual worlds, their preconceptions regarding their use as a learning tool, and the impact that instructional designers’ choices have on enhancing the opportunities for interactions. In this article, the impact that educational and leisure games have on university students’ engagement is examined. The findings suggest that the use of game-like content can contribute positively to students’ engagement, without, however, having a spectacular impact on the learning process.
Exploring How ICTs and Administration Are Entwined: The Promise of Information Ecosystems
Authors: Cortada James W.
Published: February 2018

This essay discusses the interrelationship among administrative practices, use of information and computing technologies (ICTs) in public and private organizations, and the role of information. This provides a historical overview of trends in all three areas, arguing that they were entwined, largely in the post–World War II era. The essay suggests how information exists in organizations, posing historical research questions undertaken by historians and makes recommendations on themes and methods for future studies. It argues that the use of information is the fundamental subject most in need of research as it was the basis for administrative activities and for the use of ICTs.
Client Group Influence in Economic Development Organizations: Evidence From North Carolina, Nevada, and Oregon
Authors: Jansa Joshua M.
Published: February 2018

States have empowered economic development organizations (EDOs) to administer incentive programs. But EDOs are fundamentally oriented toward client service, which can lead to client group dominance. Client group dominance can undermine the legitimacy, accountability, and efficacy of incentives. Case studies of economic development administration in North Carolina, Nevada, and Oregon demonstrate that EDOs were more likely to solicit and prioritize client group input, and that they established practices that barred competing group input. The article provides theoretical and practical implications, including potential reforms to bring EDOs closer to established good governance principles.
Screening for Occult Gastrointestinal Bleeding in Hospital Patients
Authors: Barrison I G , Littlewood E R , Primavesi J , Sharpies A , Gilmore I T , Parkins R A
Published: February 2018

Stools have been tested for occult gastrointestinal bleeding in 278 outpatients and 170 hospital inpatients using the Haemoccult and Haemastix methods. Seventeen outpatients (6.1%) and 42 inpatients (24.7%) were positive with the Haemoccult technique. Thirty-three outpatients (11.9%) and 93 inpatients (54.7%) were positive with the Haemastix test. Following investigation of the Haemoccult-positive patients, only 2 cases (3.4%) were considered false positives. However, the false positive rate with Haemastix was 22.9% which is unacceptable in a screening test. Haemoccult may be useful as a screening test for asymptomatic general practice patients, but a test of greater sensitivity is needed for hospital patients.
Single-Layer Anastomosis in the Large Bowel: Ten Years' Experience
Authors: Matheson N A , Valerio D , Farquharson A , Thomson H
Published: February 2018

Satisfactory experience with single-layer colorectal anastomosis during 1969–74 led to an analysis of the results of single-layer large bowel anastomosis during the subsequent years 1975–79. This technique has continued to be associated with a low incidence of anastomotic failure, but anastomotic integrity also depends on rigorous attitudes to bowel preparation, to bacterial contamination and to the avoidance of anastomosis when the risk of anastomotic failure is high.
N-Nitrosomethylurea-Induced Rat Mammary Tumours as Models of Human Breast cancer
Authors: Gusterson B A , Williams J C
Published: February 2018

A histopathological study is reported of the autopsy findings in two strains of rats treated with N-methyl-N-nitrosourea (MNU). The induced mammary tumours were histologically indistinguishable from those produced by dimethylbenz(a)anthracene (DMBA). A number of other primary tumours were found and there was no evidence of metastases.
Ménière's Disease
Authors: Morrison Andrew W
Published: February 2018

The otological practice at The London Hospital provides very large numbers of patients with Ménière's disease from a busy department. This clinical material has been utilized as much as possible, without research assistants or funds, to examine some clinical and pathological aspects of the disease which might have a bearing on aetiology. The investigation procedures which are likely to lead to an earlier and more certain diagnosis are outlined and prognostic indicators are mentioned. It would appear that there may be an hereditary predisposition to progressive idiopathic endolymphatic hydrops. Potential sufferers tend to have migraine, a family history of migraine, minor degrees of basilar impression associated with an abnormally located endolymphatic duct and sac, a more emotional personality, and possibly an association with blood group A.

The experimental and clinicopathological evidence supports the view that the endolymphatic duct and sac have an important role in the pathogenesis of both idiopathic and secondary hydrops. Ultrastructural examination is continuing and may shed more light on the pathology at a cellular level.

There is, as yet, no cure for Ménière's disease and sufferers will be incapacitated in varying degrees, often severely, for the rest of their days.
Sleep Apnoea in Diabetic Patients with Autonomic Neuropathy
Authors: Rees P J , Prior J G , Cochrane G M , Clark T J H
Published: February 2018

Breathing during sleep was monitored in 8 diabetic patients with objective evidence of autonomic neuropathy and in 8 diabetic patients without neuropathy. Thirty or more periods of apnoea lasting 10 seconds or longer during one night's sleep were demonstrated in 3 of the diabetic patients with autonomic neuropathy. Such apnoeic periods may be related to the high incidence of cardiorespiratory arrests reported in such patients, particularly in association with anaesthesia or pneumonia.
Laparotomy
Authors: Pollock A V
Published: February 2018

In a consecutive series of 1207 major laparotomies, the incidence of wound infections, wound failures and chest complications was prospectively recorded; this allowed certain predisposing factors to be identified, both avoidable and unavoidable. Among the former were operative bacterial contamination, haemorrhagic and septic shock and the use of nasogastric tubes; the most important of the latter were male sex and pre-existing bronchitis.
Oxygen Tension Measurement Using an Automatic Blood Gas Analyser
Authors: Becket J , Chakrabarti M K , Gillies I D S , Orchard C , Hall G M , Bourdillon P J
Published: February 2018

Two different methods of assessing the reliability of the oxygen electrode of one model of an automatic blood gas analyser (BGA) have been studied. In the first, a single automatic BGA was assessed by using outdated bank blood which was pumped around a small extracorporeal circuit into which known gas mixtures were passed. Oxygen tension was varied between 2 and 16 kPa. In the second, fresh heparinized blood was tonometered with calibrated gases and submitted to the automatic BGA used in the first part of the study and also to three other identical machines. Each of the machines was between 3 and 4 years old.

Eighteen different units of blood were used in the first part of the study. The correlation coefficient between the automatic BGA and the Po2 in the extracorporeal circuit varied between 0.29 and 0.99. 31% of the total of 209 measurements made by the automatic BGA were more than 1.2 kPa from the reference value, 25% of them being between 1.2 and 4.0 kPa from the reference value. In the second part of the study, the correlation coefficient between this automatic BGA and the tonometered blood was 0.96. The correlation coefficients for the 3 other identical BGAs were 0.84, 0.97 and 0.88, indicating that the BGA used in the first part of the study was no worse than any of the others.

It is suggested that although clinicians are likely to ignore readings of an automatic BGA that are more than 4.0 kPa from the true value and are likely to repeat the investigation, readings between 1.2 and 4.0 kPa from the true value may adversely affect patient management.
Essential Design Considerations for Microporous Implants: Preliminary Communication
Authors: Cameron Hugh U
Published: February 2018

The introduction of microporous metallic implants into which bone can grow to stabilize the implant has necessitated considerable work prior to clinical studies. Ten years of bench and animal testing have resulted in a clinically available prosthesis with a multilayer porous coating with a pore size of 50–300 μ. Initial clinical trials with a 50–100 μ hip prosthesis indicated the necessity to increase the pore size to 300 μ and clinical studies of such prostheses are at present underway.
Effects of Referral to a Specialist for Headache
Authors: Fitzpatrick Ray M , Hopkins Anthony P
Published: February 2018

Patients consulting neurological outpatient clinics for headaches that were found not to be due to a serious structural lesion were followed up one year afterwards. Considerable improvement in symptoms was found in the sample. This was only partly attributable to any medical treatment received at the clinics or subsecquently from a general practitioner. Improvement was associated with previously expressed satisfaction with the clinic consultation, and a nonspecific ‘placebo’ response is postulated.
Effects of using a Charnley-Howorth Enclosure in a District General Hospital
Authors: Bintcliffe I W L
Published: February 2018

A high rate of infection was found to occur when total hip replacements were performed in an operating theatre used by a variety of surgical specialities. Because of this, a downward displacement laminar flow enclosure was installed to provide ultraclean air operating conditions. Retrospective examination of 419 total hip replacements, carried out over a six-year period during which the enclosure was installed, showed a reduction in the infection rate from 3.2% to 0.4% ( P=0.05) when using the enclosure. The infections were associated with a postoperative wound discharge and with revision surgery but were less frequent when the enclosure was used. Prosthetic loosening was found to be common when metal-to-metal prostheses were used. Working in an enclosure with side panels, wearing body exhaust units, was generally considered to be so noisy as to restrict communication.
Detection of Isolated Mammary Carcinoma Cells in Marrow of Patients with Primary Breast Cancer
Authors: Dearnaley D P , Sloane J P , Imrie S , Coombes R C , Ormerod M G , Lumley H , Jones M , Neville A M
Published: February 2018

Single cells from mammary carcinoma infiltrating bone marrow can be detected in marrow aspirates using immunocytochemical stains for epithelial membrane antigen (EMA). This technique has been used to examine marrow aspirates taken from multiple sites from 24 patients at surgery for breast cancer. Ten of these patients had EMA-positive cells in their marrow, while 32 marrow samples from patients who did not have carcinoma were negative. These results have been combined with those obtained by taking aspirates from single sites from 47 breast patients without known skeletal deposits. Follow up showed that the patients with EMA-positive cells in their marrow developed bone metastases at a significantly faster rate.
Relationship between Protein Binding and Extravascular drug Concentrations of a Water-soluble Drug, Cytosine Arabinoside
Authors: Johnston A , Piall E M , Turner P , Slevin M L , Woollard R C , Lister T A
Published: February 2018

The degree of binding of a drug to plasma proteins has a marked effect on its distribution, elimination, and pharmacological effect. Since only the unbound fraction is available for distribution into extravascular space, the ratio of drug in cerebrospinal fluid (CSF) or saliva to that in plasma is often regarded as a physiological measure of the free fraction of a drug. CSF: plasma and saliva: plasma ratios of cytosine arabinoside (araC) have been measured in patients with acute leukaemia and found to be 0.1–0.28, implying a binding of 72–90%.

The protein binding of araC was measured by equilibrium dialysis in the plasma of patients with acute leukaemia at presentation. The mean binding ratio was 2.3 ± 6.8, implying that there was little or no protein binding. There was no correlation between alpha — 1 acid glycoprotein (AAG) levels and protein binding.

The low CSF and saliva: plasma araC ratios found, suggest that drugs such as araC which have low lipid solubility do not pass freely into extravascular space. Thus the CSF or saliva: plasma ratio cannot be considered a good physiological measure of protein binding for drugs with poor lipid solubility.
Intravenous Glycopyrrolate and Atropine at Induction of Anaesthesia: A Comparison1
Authors: Dewar M , Greenan J , Jones C J
Published: February 2018

In unpremedicated patients presenting for general anaesthesia for electroconvulsive therapy (ECT), the use of atropine combined with methohexitone as an intravenous induction agent was found to produce a significantly greater increase in heart rate than glycopyrrolate in similar combination. There was no difference in the antisialogogue effect of the two drugs at the doses used, and both drugs provided similar protection against the effects of suxamethonium and ECT on heart rate.
Family Exhibiting Cerebellar-Like Ataxia, Photosensitivity and Shortness of Stature - a New Inborn Error of Tryptophan Metabolism
Authors: Fenton David A , Wilkinson John D , Toseland Patrick A
Published: February 2018

Two cases in a brother and sister of a previously undescribed hereditary syndrome are reported. The features, which include shortness of stature, photosensitivity and cerebellar-like ataxia, are attributed to a new inborn error of tryptophan metabolism.
Role of Ultrasound in the Management of Ovarian Carcinoma
Authors: Khan O , Wiltshaw E , McCready V R , Cosgrove D O , Bland C
Published: February 2018

The ultrasound findings of the pelvis, upper abdomen and peritoneal cavity were correlated with second-look laparotomy in 85 patients with Stage III or Stage IV ovarian carcinoma. High values of accuracy were obtained for the pelvis (90%) and liver (91%) but ultrasound was insensitive to peritoneal disease unless ascites was present.
Serious Eye Injury from Windscreen Contact
Authors: Keightley S J
Published: February 2018

A retrospective survey was carried out of serious eye injury caused by windscreen contact in road traffic accidents over a 6–year period. All 15 patients had contacted toughened windscreens, and all but one did not wear seat belts. The cost in terms of pounds sterling paid out by the National Health Service, and also the cost in terms of visual handicap were assessed. It was found that of the 15 patients admitted during this time, the treatment of the large majority cost at least twice as much as that for patients undergoing routine cataract surgery. This was primarily due to the longer hospitalization necessary. Only 2 patients retained a visual acuity of 6/6.
Prescribing Habits for Theophylline Preparations
Authors: Wiffen J K , Jackson S H D
Published: February 2018

Information concerning the prescriptions for theophylline preparations for a group of 80 inpatients and 55 outpatients were examined. Slow-release preparations were overwhelmingly preferred. The majority of patients were receiving low daily doses of theophylline or equivalent, and serum drug level monitoring was almost non-existent.
Comparison of Static and Dynamic Repairs for Ligamentous Instability of the Knee
Authors: Rawlins Richard
Published: February 2018

Twenty-three patients who have had a Macintosh type of fasciodesis for anterolateral rotary instability of the knee have been studied. Overall 73% were improved by this procedure; of those whose only instability was when turning on the run, 90% improved. These results have been compared with a series of 51 patients who had a pes anserinus transfer for anteromedial instability (D'Arcy 1978). It is suggested that both static and dynamic reconstructions have a place in the management of knee instability resulting from anterior cruciate injury.
Reoperative Surgery for Early Complications following Abdominal and Abdominothoracic Operations
Authors: Kirk R M
Published: February 2018

In-hospital mortality was 9.6% in 3000 abdominal and abdominothoracic operations carried out by me or under my care. Intra-abdominal complications developing during the recovery period required reoperation in 141 patients. The decision to reoperate was a clinical one in 97.8%, although investigations were often helpful in localizing the site of the complicating lesion: the mortality in this group was 42.5%. Technical failure at the first operation could be indicted in 46%. Leaks and bleeding were most frequent and carried a high mortality. Patient selection and preparation, and selection of the simplest effective procedure, are not yet capable of being fully assessed in an individual patient.
Survival of Lung Cancer in East London: A Prospective Survey
Authors: Festenstein F , Weatherstone R M , Rehahn M
Published: February 2018

Five hundred men and 76 women all under the care of one physician at the London Chest Hospital were diagnosed as having bronchogenic carcinoma and admitted to a prospective survey between May 1966 and April 1978. The survey was completed in December 1984 when all but 19 of the 500 men had died. None was lost to follow up. The longest period of surveillance was 18 years 7 months, the shortest 6 years 8 months. The five-year survival of the group of 500 men was 7.6% (38), and 22% (32) for the 145 patients who had had resections. Of the 78 patients (63 men, 15 women) who had small cell carcinoma, only one survived 3 years; the others died in under 2 years, giving a median survival of 5 months. The median survival of the 21 untreated cases in this group of small cell carcinoma was 2 months.
Perforated Duodenal Ulcer and Cigarette Smoking
Authors: Smedley F , Hickish T , Taube M , Yale C , Leach R , Wastell C
Published: February 2018

Whilst the association between smoking and peptic ulceration has been reported previously, the relationship between smoking and the complications of ulcers, such as perforation, bleeding or acute painful exacerbation, has not been examined. In a retrospective study comparing 275 emergency admissions for peptic ulcer with 275 controls, cigarette smoking was significantly more common only in those with a perforated duodenal ulcer. Of 128 patients with perforated duodenal ulcers, 110 (86%) were cigarette smokers compared with 65 (51%) of the 128 matched controls (χ2, P<0.01). Cigarette smoking in patients with bleeding or acutely exacerbated ulcers was not significantly more common than in controls. These findings strongly suggest a particular association between smoking and perforated duodenal ulcer.
Which Patients with Arm Oedema are Helped by Intermittent External Pneumatic Compression Therapy
Authors: Newman G
Published: February 2018

Twenty-two breast cancer patients with arm oedema answered a questionnaire to assess the efficacy of intermittent pneumatic compression therapy. Ten patients found the treatment useful, 12 were disappointed. A number of factors were analysed to find out whether it is possible to predict the outcome of treatment.
The use of Bladder Neck Electric Conductance (Bnec) in the Investigation and Management of Sensory Urge Incontinence in the Female
Authors: Peattie A B , Plevnik S , Stanton S L
Published: February 2018

Measurement of urethral electric conductance can be used to detect the movement of urine along the urethra by registering a change in conductivity reading. This technique has been employed in patients complaining of urge incontinence and has shown movements at the bladder neck when urgency is appreciated. Patients with sensory urgency have been successfully managed by learning to control the movements at the bladder neck during a conductivity recording.
A Preliminary Report on the Role of Lay Counselling amongst Patients with Inflammatory Bowel Disease
Authors: Godber D , Mayberry J F
Published: February 2018

A team of lay counsellors was trained by the Nottingham Counselling Centre to provide advice to members of the East Midlands branch of the National Association for Colitis and Crohn's Disease. Initial contact was by telephone and the results of the first 25 client/counsellor discussions are presented. Twenty enquiries were made directly by the patient and 5 by a relative of the patient. AU but two of the patients were women. The median age of the patients was 52 years with a median duration of symptoms of 3 years. A failure of communication between the patient and other people underlay most of the problems discussed. Eighteen people welcomed the opportunity simply to talk; in 10 cases there was little rapport with their own doctor and in 8 cases people felt too embarrassed to discuss their problems with friends or relatives. This sense of isolation had been anticipated by counsellors from their own experience and may be a substantial, but as yet unrecognized problem amongst many patients with inflammatory bowel disease.
Assaults in South East London
Authors: Hocking M A
Published: February 2018

A survey was performed of 425 consecutive patients attending Lewisham Hospital as a result of deliberate physical violence. Eighty-two per cent attended ‘out of hours’, and in at least 50% alcohol was a contributing factor. Less than half the incidents were reported to the police. Fifteen per cent of the attacks were due to knives and accounted for 47% of the admissions and 90% of the serious injuries. The results support the view that it is becoming common for youths to be armed. Assault victims, particularly those with knife wounds place a considerable burden on hospital resources. Accident and Emergency departments are ideal places to monitor the epidemiology of assaults.
Early Diagnosis and Surgical Management of Acoustic Neuroma: Is it Cost Effective?
Authors: Moffat D A , Hardy D G
Published: February 2018

Audiological and radiological advances and refinement of microsurgical techniques have facilitated the diagnosis and excision of very small acoustic nerve tumours with a low morbidity and mortality. Is this cost effective?

In an attempt to answer this question, an analysis of 66 cases of surgically treated acoustic neuromas is presented. This represents a part of a series of otoneurosurgical procedures carried out at Addenbrooke's Hospital over the last five years. By studying the relative morbidity of early and late surgical intervention in these cases, and by costing the exercise, the justification for early diagnosis and treatment is presented both in financial and human terms.
Tissue Oxygenation, Venous Ulcers and Fibrin Cuffs
Authors: Mani R , White J E , Barrett D F , Weaver P W
Published: February 2018

Skin oxygen tension (TcPo2) was measured at 43°C on patients (n=27) with venous ulcers. Measurements were made at ulcer edge and, proximally on the same limb for control. Similar measurements were also made on healthy volunteers (n=14) in the medial aspects of the distal third of the legs. TcPo2 at ulcer edge was significantly lower (P=0.001) than control values which in turn were lower than that measured on healthy volunteers. TcPo2 reflects skin nutrition. While low TcPo2 at ulcer edges might be the result of pericapillary barriers to oxygen transport, the control values measured on apparently normal skin suggest the need for further studies.
Major Abdominal Surgery in the Over-Eighties
Authors: Palmer C A , Reece-Smith H , Taylor I
Published: February 2018

We report a prospective controlled trial looking at the outcome of major abdominal surgery judged on the ability of patients to return to their preoperative activity level. Eighty patients were included in the study. Forty of these were over 80 years old and the remainder in the age group 40–65 years. Fifty-four per cent of the over 80s demonstrated an increased level of dependance six months after surgery compared to 18% of the 40–65 year olds. The mortality rate at six months was 42% for the over 80 group. The poor prognosis of elderly surgical patients not only in their increased mortality rate but also in their dependency should be considered before they are subjected to major abdominal surgery.
Detection of Ocular Malignancies
Authors: Lyons C J , Hungerford J
Published: February 2018

The case notes of new patients attending the oncology clinic at Moorfields Eye Hospital during the first 5 months of 1988 were analysed retrospectively with regard to the origin of the primary referral, the presence of symptoms, the diagnosis and management. Sixty-eight of 94 new patients were diagnosed as having malignant ocular lesions. Of these 68, 47% were first seen and referred by an optician. Half of these patients were asymptomatic at the time of detection.
Mobility of the Young Adult Physically Handicapped Patient following Lower Limb Surgery in Childhood
Authors: Spencer J D
Published: February 2018

Fifty-six cases seen consecutively in a young adult physically handicapped clinic were assessed with regard to their mobility. In addition an attempt was made to review the long term outcome of lower limb orthopaedic operations in these patients with physical handicap. The patients were subdivided into four groups and it was found that in three of the groups, patients who could only walk with a walking aid or who were wheelchair bound had had more surgical procedures than those who walked independently in adulthood. As problems in the young adult physically handicapped patients are defined so further work will be required to determine the best way they should be treated.
Blood Ordering Habits for Elective Surgery: Time for Change
Authors: Juma T , Baraka A , Abu-Lisan M , Asfar S K
Published: February 2018

A prospective study was carried out for 6 months to determine the efficacy of blood ordering routines for elective surgery. It was found that only 23% of procedures needed preoperative crossmatching of blood (transfusion index ‘IT’ >0.5). There was an excessive over-ordering of blood for 77% of the operations (crossmatch/transfusion ratio >2.5). In addition, the transfusion index for the latter group showed that there was no need to prepare blood preoperatively (TI <0.5).

A transfusion tariff is worked out which abandons crossmatching for the majority of procedures (cholecystectomy, thyroidectomy and surgery for duodenal ulcer excluding gastrectomy). Instead a ‘group and screen’ policy is suggested.
Long-Term Parenteral Nutrition: Problems with Venous Access
Authors: McIntyre A S , Gertner D J , Wood S , Phillips R K S , Lennard-Jones J E
Published: February 2018

Long-term parenteral nutrition requires central venous access, often difficult in patients who have had several central venous catheterizations. Therapy may be complicated by thrombosis and sepsis which may further compromise central access. We report five cases illustrating such difficulties and suggest that these patients be referred early to specialist centres where experienced catheter insertion and management results in a greatly reduced incidence of complications.
Policing a Violent Society
Authors: Imbert Peter
Published: February 2018

This is an abridged version of a lecture given to the Section of Clinical Forensic Medicine on 15 October 1988.
Impact of Conventional and Three-Dimensional Thallium-Technetium Scans on Surgery for Primary Hyperparathyroidism
Authors: Jenkins B J , Newell M S , Goode A W , Boucher B J , Monson J P , Brown C L
Published: February 2018

Twenty-nine patients with primary hyperparathyroidism underwent double-tracer subtraction scanning after injection of 201T1 as thallous chloride for thyroid and parathyroid images followed by 99mtechnetium as sodium pertechnetate for thyroid images prior to surgical exploration of the neck. The operative findings were correlated with the scans. All 23 adenomas (100%) and 13 of 18 (72%) hyperplastic glands were correctly localized. The ability of the scan to identify abnormal parathyroids was determined by the gland mass rather than whether the tissue was adenomatous or hyperplastic as all 32 (100%) abnormal glands weighing more than 180 mg were successfully localized in contrast to four of nine (44%) glands weighing less than 180 mg.

An additional technique, in which emission tomography was carried out after subtraction scintigraphy, was used on 11 patients in the series. In all 11, the site of a single abnormal gland was predicted by the conventional subtraction scan: in nine of these patients, emission tomography provided additional localization of the gland in the anteroposterior plane.
Day-Case Surgery: Enhanced Recovery with Flumazenil
Authors: Birch B R P , Anson K M , Clifford E , Miller R A
Published: February 2018

In an open, randomized, parallel group study of 84 adult patients undergoing elective day-case urological surgery the specific benzodiazepine antagonist flumazenil was shown to reverse effectively subjective postoperative sedation due to midazolam and enabled 83% of patients to recover and be ready for potential discharge within 15 min of surgery (control group 24% p<0.001). The significantly shorter recovery time has benefits in terms of increased patient cooperation and reduced demands on postoperative nursing care. The implications of these findings for day-case surgery are discussed.
Ethics in Clinical Development
Authors: Keen Peter J
Published: February 2018

The meeting was convened to provide a forum for the discussion of those aspects of medical ethics which concerned clinical research, particularly the clinical studies which the pharmaceutical industry is required to carry out to satisfy regulatory authorities for them to issue licences for the introduction of new medicines. While the speakers did not confine themselves to this topic, they did raise many issue which impinge on clinical research with medicines, It is unfortunate that the meeting coincided with a server storm which undoubtedly restricted the audience and, therefore, the discussion which was intended. However, those who attended were fortunate to hear three excellent speakers give their personal views on an important subject which tends to be the Cinderella topic among clinical researchers and the pharmaceutical industry. However, all three speakers made the audience aware of the significance of ethics in all research on humans and the need for more education of both the profession and the public on this subject.
Dysphagia in the Elderly: What Does it Mean to the Endoscopist?
Authors: Bannister P , Stanners A J , Mountford R A
Published: February 2018

The role of fibreoptic endoscopy in the investigation of dysphagia in an elderly population was investigated. Three hundred and sixty-five subjects were studied. Two hundred and sixty subjects had abnormalities with extra oesophageal disease accounting for symptoms in a substantial minority. Endoscopy was safe, offered the advantage of immediate therapy and was well tolerated. Sub-group analysis showed it to be preferable to radiological investigation in diagnosing both benign and malignant mucosal lesions.
The Uvulopalatopharyngoplasty Operation: The Edinburgh Experience
Authors: Sharp J F , Jalaludin M , Murray JAM , Maran A G D
Published: February 2018

The experience of the uvulopalatopharyngoplasty operation, performed on 24 patients for the relief of loud or heroic snoring, is presented. The operation successfully reduced the severity of snoring in 96% of patients. Postoperative complications were uncommon but included nasal regurgitation and intrapharyngeal adhesions in one patient. The role of the uvulopalatopharyngoplasty operation in the treatment of obstructive sleep apnoea is undecided but the authors do not perform this operation on such patients.
Asherman's syndrome: A review of the literature, and a husband and wife's 20-year world-wide experience
Authors: Chapman Kenneth , Chapman Roxana
Published: February 2018

Asherman's syndrome is reviewed, and 27 cases treated by us in Iran, England, New Zealand and Australia over a 20-year period are analysed. Aetiological factors and treatment are discussed. In view of the high incidence of complications in subsequent pregnancies, the need for prevention is stressed. Although more common in some countries, it is, nevertheless, of world-wide distribution and, unless looked for, will be missed.
Communicating Information to Patients
Authors: Dooley M
Published: February 2018

Preference is given to letters commenting on contributions published recently in the JRSM. They should not exceed 300 words and should be typed double-spaced.
Double J Stents in the Treatment of Gynaecological Injury to the Ureter
Authors: Turner W H , Cranston D W , Davies A H , Fellows G J , Smith J C
Published: February 2018

Ureteric injury is a recognized complication of hysterectomy and may present with obstruction or fistula.

Between 1987 and 1989 in Oxford nine patients with 10 injured ureters underwent attempted retrograde placement of double J stents. Three patients had successful outcomes and one patient with bilateral ureteric obstruction required reimplantation of the right ureter after successful stenting of the left ureter. One patient required removal of a stent due to irritation but her fistula eventually closed. In three patients placement was unsuccessful and in one patient injury to the bladder base prevented the ureteric orifices from being seen and hence stenting was not possible. Thus five of these 10 injured ureters were managed successfully with double J stents.

We advocate the initial use of double J stents in gynaecological ureteric injury. This approach is simple and may cure the fistula. If it is unsuccessful, subsequent reimplantation is not hindered.
A Study of Scalds in Birmingham
Authors: Cason C G
Published: February 2018

The causes of serious domestic scald injuries in Birmingham were studied for one year. Seventy-eight people sustained such scalds, 11 adults and 67 children. Only 51 of the patients received satisfactory first aid. Most accidents could have been avoided and the severity of the injury would have been less if appropriate first aid had been given.
Failure of Perception of Hypocapnia: Physiological and Clinical Implications
Authors: King J C , Rosen S D , Nixon P G F
Published: February 2018

Hyperventilation causes hypocapnia and respiratory alkalosis and thereby predisposes to coronary vasoconstriction and cardiac arrhythmia. Diagnostic methods for use between episodes have not been established.

In this study of 100 patients and 25 control subjects the resting end-tidal PCO2 (Pet CO2) levels and the results of a forced hyperventilation test did not show a significant difference between the groups. However the patients hyperventilated more profoundly in response to emotional stimulation, and were less aware of inappropriate breathing and hypocapnia.

It is suggested that these differences should be accommodated in cardiac rehabilitation.
Adenocarcinoma of the Gallbladder – a 5 Year Review of Outcome in Newcastle upon Tyne
Authors: Burgess P , Murphy P D , Clague M B
Published: February 2018

Patients presenting with adenocarcinoma of the gallbladder within Newcastle upon Tyne over a 5 year period (1980–1985) were reviewed retrospectively. The mean age of patients on diagnosis was 74 years.

Of the 29 patients diagnosed, two were detected after routine cholecystectomy. Laparotomy was performed in 21 patients (72%) of which only 14 patients had a cholecystectomy performed. Mean survival after surgery was 6.6 months with only one patient alive after 5 years.

Metastatic disease was present in 72% of patients. The poor prognosis of carcinoma of the gallbladder reflects its late diagnosis and early metastasis to distant sites. Improvement in survival will depend upon early detection of in situ lesions and identification of at risk patients.
Wire-Guided Balloon Coloplasty – a New Treatment for Colorectal Strictures?
Authors: Banerjee A K , Walters T K , Wilkins R , Burke M
Published: February 2018

A new technique for dilatation of colorectal anastomotic strictures – wire-guided balloon coloplasty – is described. It is suitable for high strictures, may be performed without general anaesthetic and is repeatable. It does not require endoscopy and may be used to relieve obstructive symptoms in both benign and malignant strictures so avoiding the need for a defunctioning colostomy.
Aesthetics and the Individual in the Practice of Medical Research: Discussion Paper
Authors: Aldridge D
Published: February 2018

‘Art does not reproduce the visible, rather it makes visible. Formerly we used to represent things visible on earth, things we either liked to look at or would have liked to see. Today we reveal that reality that is behind all living things, thus expressing the belief that the visible world is merely an isolated case in relation to the universal, and there are many more latent realities’ Paul Klee1
Are our Babies Becoming Bigger?
Authors: Alberman E
Published: February 2018

I have tried to show, using a contemporary international data set, the overall consistency in shape of curves of national birthweight distributions which reflect the biological and social characteristics of the population from which they are derived, and the effects of changes in these characteristics. For several countries, including the United States and England and Wales, the trends in recent years have been such as to shift the main distribution upwards, so that the median weight has increased.

Also shown has been the close and specific relationship within each population group between infant mortality and birthweight, with sharp falls of mortality with increasing birthweight. It has been shown elsewhere that similar patterns are seen with short- and long-term morbidity, thus underlining the importance to be attached to increasing birthweight particularly in underprivileged groups. In the short term this can be done by reducing the frequency of parental smoking, where this is a problem, and in the longer term by improving maternal health and nutrition. The shift towards higher birthweights if it persists, should make an important contribution towards the improvement of the public health of the next generation.
Accident & Emergency Department's Response to Patients' Inquiries by Telephone
Authors: Singh G , Barton D , Bodiwala G G
Published: February 2018

A prospective survey of all telephone calls for medical advice to the Accident & Emergency Department of Leicester Royal Infirmary was undertaken. The objectives of the study were to quantitate the frequency and circumstances related to these inquiries. Over the study period of 10 days, details of 154 telephone calls were recorded. The results demonstrated the perception of the general public, that the A & E department was the most logical place to contact. Only 30% (46) attempted to seek advice from their general practitioner prior to calling the department.
Value of Emergency Cardiac Enzymes: Audit in a Coronary Care Unit
Authors: Lewis F , Jishi F , Sissons C E , Baker J T , Child D F
Published: February 2018

Medical audit in a district general hospital coronary care unit led to the introduction of an emergency cardiac enzyme service. 91.2% of patients eligible for thrombolysis therapy received treatment following this introduction compared to 73.7% before (P=.05). No patient was treated inappropriately on the basis of a raised cardiac enzyme.
Cortical Evoked Response Olfactometry
Authors: Whittet H B , Royston R
Published: February 2018

An objective for the assessment of smell based upon olfactory cortical responses is introduced and illustrated with clinical examples.
‘Hysteria’, ‘Functional' or ‘Psychogenic’? a Survey of British Neurologists’ Preferences
Authors: Mace C J , Trimble M R
Published: February 2018

The diagnostic preferences of British neurologists for patients who lack a physical explanation for their symptoms were assessed by means of a postal questionnaire. Analysis of 168 completed replies showed ‘functional’, ‘psychogenic’ and ‘hysteria’ to be the most popular terms in use. The number of different terms a clinician would use rose in line with the volume of such patients they encountered, but was unrelated to clinician factors such as the extent of their clinical experience in psychiatry. A specific enquiry into these respondents' interpretation of the term ‘functional’ revealed a clear consensus as to which syndromes it should apply to, although this consensus was not shared by a comparison group of psychiatrists.
The Changing Pattern of Thoracic Surgery in the United Kingdom 1963–1982
Authors: Paraskevopoulos J A , Gunning A J , Dennison A R
Published: February 2018

During the period 1963–1982 a total of 11 459 patients with general surgical and thoracic conditions were admitted to the Churchill and John Radcliffe Hospitals in Oxford under the care of a single thoracic surgeon. 55.1% of the admissions were for general surgical conditions whereas 44.9% were for a thoracic disorder. The total period has been studied by dividing it into three subgroups of 7, 6 and 7 years (1963–1969, 1970–1975, 1976–1982). The percentage of thoracic patients treated during the three periods was found to be 48.86%, 41.73% and 50.11% respectively. The three periods studied have been subdivided into major disease groups and the changes in these groups have been studied in detail.

During this 20-year period there has been a dramatic change in the makeup of a typical thoracic surgical practice. This is in part due to the changing pattern and prevalence of many of the diseases treated by thoracic surgeons, but is also due to a change in referral patterns, the distribution of patients between thoracic and general surgeons and also the dichotomy emerging between thoracic and cardiac surgeons.
Patients' Views on how to Run Hospital Outpatient Clinics
Authors: Bishop F , Matthews F J , Probert C S J , Billett J , Battcock T , Frisby S D , Mayberry J F
Published: February 2018

To investigate patients' views and expectations when attending outpatient clinics a questionnaire-based study was performed. The questionnaires asked about appointment systems, continuity of care, staff appearance, chaperons and medical students. Patients wanted fixed appointment times, to see the same doctor on successive visits, for the staff to be formally dressed and to have chaperons during examination. The number of medical students should be restricted especially for women patients. Staff should be sensitive to patients' needs.
Breast Liver Metastases – Incidence, Diagnosis and Outcome
Authors: Hoe A L , Royle G T , Taylor I
Published: February 2018

Breast liver metastases are uncommon and have not been well reported. We studied the clinical outcome of 47 patients who developed liver metastases out of 912 breast cancer patients treated between 1982 and 1987, an incidence of 5.2%.

The median disease free interval prior to clinical liver metastases was 20.2 months (range 4–192 months). The most frequent clinical presentations were hepatomegaly (70%) and abdominal pain (34%). The diagnosis was confirmed on ultrasound scan in 72.7% patients.

Thirty-one patients (70.5%) received specific treatment with both hormone and chemotherapy but only six showed any evidence of objective response, the majority of whom had metastases only in the liver.

The median survival of treated patients was 4 months and absence of jaundice, response to treatment and liver metastases only were associated with significantly better survival.

In conclusion breast liver metastases usually present as a manifestation of disseminated disease and have an appalling prognosis. When they occur as an initial site the prognosis is better but very few patients overall respond to conventional treatment.
Modern Social Hierarchies and the Spaces between: How Are Subjective Status Inconsistencies Linked to Mental Well-Being?
Authors: Andersson Matthew A.
Published: February 2018

Higher socioeconomic status is linked to higher mental well-being, but modern individuals inhabit multiple hierarchies and reference groups—and thus well-being may be determined between as much as within socioeconomic statuses. Drawing on proprietary national data collected by Gallup in 2017, I find that inconsistency between one’s perceived standing in society and one’s standing in more local hierarchies based in neighbors or friends is quite common. Individuals with negative status inconsistency (lower perceived status among one’s neighbors or friends relative to society) exhibit diminished mental well-being relative to those without. Relational or interpersonal mechanisms, including lower closeness to others, anomie or social disengagement, and diminished meaning in life, appear to partially or mostly explain how status inconsistencies undermine well-being. However, these relational mechanisms vary in their explanatory importance across types of inconsistencies and types of well-being. Positive and negative status inconsistencies both show links to lower-quality social relations.