bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemispherotomy in children: A retrospective analysis of 152 surgeries at a single center and predictors for long‐term seizure outcome
Authors: Kalbhenn Thilo , Cloppenborg Thomas , Woermann Friedrich G. , Hagemann Anne , Polster Tilman , Coras Roland , Blümcke Ingmar , Bien Christian G. , Simon Matthias
Published: April 2023

Objective

Completeness as a predictor of seizure freedom is broadly accepted in epilepsy surgery. We focused on the requirements for a complete hemispherotomy and hypothesized that the disconnection of the insula contributes to a favorable postoperative seizure outcome. We analyzed surgical and nonsurgical predictors influencing long‐term seizure outcome before and after a modification of our hemispherotomy technique.

Methods

We retrospectively studied surgical procedures, electroclinical parameters, magnetic resonance imaging (MRI) results, and follow‐up data in all children who had undergone hemispherotomy between 2001 and 2018 at our institution. We used logistic regression models to analyze the influence of different factors on seizure outcome.

Results

A total of 152 patients were eligible for seizure outcome analysis only. Of these, 140 cases had complete follow‐up data for ≥24 months and provide the basis for the following results. The median age at surgery was 4.3 years (range = .3–17.9 years). Complete disconnection (including the insular tissue) was achieved in 63.6% (89/140). At 2‐year follow‐up, seizure freedom (Engel class IA) was observed in 34.8% (8/23) with incomplete insular disconnection, whereas this was achieved in 88.8% (79/89) with complete surgical disconnection (p < .001, odds ratio [OR] = 10.41). In the latter group (n = 89), a potentially epileptogenic contralateral MRI lesion was the strongest predictor for postoperative seizure recurrence (OR = 22.20).

Significance

Complete surgical disconnection is the most important predictor of seizure freedom following hemispherotomy and requires disconnection of the insular tissue at the basal ganglia level. Even if the hemispherotomy is performed surgically completely, a potentially epileptogenic contralateral lesion on preoperative MRI significantly reduces the chances of postoperative seizure freedom.
Long‐term epilepsy outcome dynamics revealed by natural language processing of clinic notes
Authors: Xie Kevin , Gallagher Ryan S. , Shinohara Russell T. , Xie Sharon X. , Hill Chloe E. , Conrad Erin C. , Davis Kathryn A. , Roth Dan , Litt Brian , Ellis Colin A.
Published: April 2023

Objective

Electronic medical records allow for retrospective clinical research with large patient cohorts. However, epilepsy outcomes are often contained in free text notes that are difficult to mine. We recently developed and validated novel natural language processing (NLP) algorithms to automatically extract key epilepsy outcome measures from clinic notes. In this study, we assessed the feasibility of extracting these measures to study the natural history of epilepsy at our center.

Methods

We applied our previously validated NLP algorithms to extract seizure freedom, seizure frequency, and date of most recent seizure from outpatient visits at our epilepsy center from 2010 to 2022. We examined the dynamics of seizure outcomes over time using Markov model‐based probability and Kaplan–Meier analyses.

Results

Performance of our algorithms on classifying seizure freedom was comparable to that of human reviewers (algorithm F1 = .88 vs. human annotator = .86). We extracted seizure outcome data from 55 630 clinic notes from 9510 unique patients written by 53 unique authors. Of these, 30% were classified as seizure‐free since the last visit, 48% of non‐seizure‐free visits contained a quantifiable seizure frequency, and 47% of all visits contained the date of most recent seizure occurrence. Among patients with at least five visits, the probabilities of seizure freedom at the next visit ranged from 12% to 80% in patients having seizures or seizure‐free at the prior three visits, respectively. Only 25% of patients who were seizure‐free for 6 months remained seizure‐free after 10 years.

Significance

Our findings demonstrate that epilepsy outcome measures can be extracted accurately from unstructured clinical note text using NLP. At our tertiary center, the disease course often followed a remitting and relapsing pattern. This method represents a powerful new tool for clinical research with many potential uses and extensions to other clinical questions.
Context‐dependent responses of terrestrial invertebrates to anthropogenic nitrogen enrichment: A meta‐analysis
Authors: Gallego‐Zamorano Juan , de Jonge Melinda M. J. , Runge Katharina , Huls Steven H. , Wang Jiaqi , Huijbregts Mark A. J. , Schipper Aafke M.
Published: April 2023

Anthropogenic increases in nitrogen (N) concentrations in the environment are affecting plant diversity and ecosystems worldwide, but relatively little is known about N impacts on terrestrial invertebrate communities. Here, we performed an exploratory meta‐analysis of 4365 observations from 126 publications reporting on the richness (number of taxa) or abundance (number of individuals per taxon) of terrestrial arthropods or nematodes in relation to N addition. We found that the response of invertebrates to N enrichment is highly dependent on both species' traits and local climate. The abundance of arthropods with incomplete metamorphosis, including agricultural pest species, increased in response to N enrichment. In contrast, arthropods exhibiting complete or no metamorphosis, including pollinators and detritivores, showed a declining abundance trend with increasing N enrichment, particularly in warmer climates. These contrasting and context‐dependent responses may explain why we detected no overall response of arthropod richness. For nematodes, the abundance response to N enrichment was dependent on mean annual precipitation and varied between feeding guilds. We found a declining trend in abundance with N enrichment in dry areas and an increasing trend in wet areas, with slopes differing between feeding guilds. For example, at mean levels of precipitation, bacterivore abundance showed a positive trend in response to N addition while fungivore abundance declined. We further observed an overall decline in nematode richness with N addition. These N‐induced changes in invertebrate communities could have negative consequences for various ecosystem functions and services, including those contributing to human food production.
METAPHYSICS IN HISTORY: NOTES ON THE ORIGINS OF AUTHORITARIANISM AND POPULISM
Authors: Sor Federico
Published: April 2023

This article contains an analysis of metaphysics in historical narrative, especially as it pertains to the study of authoritarianism and populism, and a brief exploration of the political implications of metaphysical narratives. The article engages closely with twentieth‐century accounts of the origins of authoritarianism and populism and related topics insofar as they are relevant today. Some present‐day authors continue to adopt some of the tropes of twentieth‐century accounts, though they do so without acknowledging the uncertainties and doubts expressed by twentieth‐century historians and social scientists with regard to their own paradigms. The analysis proceeds through an immanent critique, examining the internal contradictions of complex notions. The focus is on teleology and transcendentalism. Teleology occludes short‐term causality, contexts, and conjunctures. It entails anachronism, or the retrospective attribution of meaning, and ontological fatalism, which renders historical explanation irrelevant. Eschewing fatalism means allowing for the causal efficiency of intervening conditions, which contradicts the premises of the teleological approach. The reification of stages (or eras) in teleological successions leads to asynchronies, or the coexistence of elements belonging to different totalities. The formulation of origins as predispositions and potentialities entails a transcendental approach. Immanently, there are no potentialities but actual existents immersed in their historical context; these can only be potentialities with respect to a transcendental being or essence. But this approach leads to irresoluble contradictions and an alienated form of history in which human agency and actors themselves are only manifestations of a beyond. The neglect of social antagonisms as immediate causes of authoritarianism entails a specific political position. The postulation of populism as transcendentally equivalent to authoritarianism carries a negative valuation of challenges to liberal democracy. With a less deterministic approach to history, analytical and normative assessments become less predetermined.
The effect of incisional negative pressure wound therapy on the improvement of postoperative cosmetic suture wounds and scar hyperplasia
Authors: Liu Yanjun , Xu Mingze , Wang Zheng , Zhu Xiaoshu , Xu Jianguo
Published: April 2023

This study aimed to explore the effects of early incisional negative pressure wound therapy (INPWT) on cosmetic suture wounds and postoperative scar hyperplasia. We retrospectively evaluated 120 patients who underwent abdominoperineal resection at the Changhai Hospital between February 2018 and October 2021 and divided them into two groups according to their treatment: the INPWT group (n = 60) and the control group (n = 60). The quality of post‐surgical wound healing in the two groups was evaluated. The Patient Scar Assessment Scale (PSAS), the Vancouver Scar Scale (VSS), and the visual analogue scale (VAS) were used to evaluate the surgical incision scar at 1‐year follow‐up. At this follow‐up visit, 115 patients underwent reexamination; five patients were lost to follow‐up, including two patients in the INPWT group and three patients in the control group. The INPWT group showed better wound healing than the control group (P < .05). The proportion of patients who received INPWT was significantly higher in the non‐surgical site infection (SSI) group than in the SSI group (P < .05). The PSAS, VSS and VAS scores were significantly improved in the INPWT group compared with those in the control group (P < .05). Our results show that INPWT improved the quality of cosmetic suture wounds and reduced the degree of postoperative scar hyperplasia.
Punctured surgical gloves and bacterial re‐colonisation of hands during open heart surgery: Implications for prosthetic valve replacement.
Authors: Berg G A , Kirk A J B , Bain W H
Published: April 2023

The frequency and distribution of accidentally Punctured surgical gloves were studied during 40 consecutive open heart operations. The efficacy of pre‐operative skin scrubbing and the amount of skin re‐colonisation under gloves were also assessed. Punctures were common, occurring in over 40 per cent of gloves examined but were infrequently recognised at the time of trauma. Pre‐operative hand scrubbing was effective in initially eliminating bacteria but 50 per cent of hands had significant amounts of skin re‐colonisation at the end of each operation. The majority of bacteria cultured were those that most commonly cause early prosthetic valve endocarditis. Greater awareness is needed that glove penetration occurs frequently during open heart surgery and has the potential to contaminate implanted prosthetic valves with bacteria.
Genito‐urinary approach to the management of colposcopic abnormalities of the cervix
Authors: Mohanty K C , Rand R J
Published: April 2023

One hundred and fifty nine patients with abnormal cervical cytology were studied by colposcopy and histologically. Fifty six were attending the Department of Genito‐Urinary Medicine, 103 were referred from elsewhere. The STD clinic patients were younger (73 per cent under the age of 29 years) and 89 per cent had a satisfactory colposcopy. The incidence of cervical intra‐epithelial neoplasia (C1N) for both groups was 87 per cent. This was associated with human papilloma virus in 35 per cent of cases. Treatment by laser vaporisation for CIN with koilocytic change was 100 per cent successful, probably due to the screening and treatment of sexual partners. A distinct genitourinary approach to these patients is suggested. Patients with an unsatisfactory colposcopy (with evidence of CIN) should be referred to the gynaecologist for cone biopsy and treatment without any further investigations such as colposcopic cervical biopsies in the STD clinic. Patients with a satisfactory colposcopy may be investigated, treated and followed‐up in the STD clinic.
Acute intussusception: referral in relation to presentation and aetiology
Authors: Jain S K , Sharma M , Singla S K , Pathania O P
Published: April 2023

A study of 42 consecutive children with acute intussusception was undertaken. The emphasis was on the time taken for surgical referral in relation to the presenting symptom. Operative findings and outcome revealed late referral (>72 h) in cases presenting with diarrhoea and bleeding per rectum. A higher incidence of gangrenous gut and irreducibility of intussusception was found in the ileoileal variety of intussusception.

Some interesting facts about the aetiology have also been noted. Rupture of intussuscipiens was also encountered.
Influenza vaccine and anticoagulation control in patients receiving warfarin
Authors: Arnold Wsg , Mehta M K , Roberts J St Clair
Published: April 2023

The effects of a trivalent split virion influenza vaccine on anticoagulation control were prospectively evaluated in a sample of well‐controlled warfarin recipients. Vaccine‐induced changes in prothrombin time ratios were not detected during one month of follow‐up after immunisation. The results are supported by the findings of other studies conducted in this country and the USA, which have all refuted the conclusions of early reports that suggested a possible interaction between warfarin and influenza vaccine.
Complications of cholecystectomy in district general hospitals
Authors: Habib N A , Foo C L , El‐Masry R , Gouli O , Cox S , Salem R , Todd B , Benjamin I S
Published: April 2023

The aim of this retrospective study was to determine the incidence of the complications in one thousand consecutive cholecystectomies performed in three district general hospitals.

Major post‐operative complications occurred in 63 patients (6.3 per cent) and were responsible for 12 deaths (1.2 per cent operative mortality) and 31 reoperations.

The incidence of retained stones was 5.8 per cent (10 patients) for those who underwent exploratory choledochotomy, and 10.9 per cent in those who were managed by common bile duct exploration and stone extraction.

There were four cases of iatrogenic biliary trauma (0.4 per cent), all in cases operated by junior registrars. All (except one) occurred during elective ‘non‐complicated’ cholecystectomy.
False aneurysm of the brachial artery: an unusual complication following accidental puncture by a patient on home haemodialysis
Authors: Coen L D , Johnson B F , Moorhead P J , Raftery A T
Published: April 2023

A case is reported of false aneurysm of the brachial artery following accidental puncture during attempted cannulation of the median cubital vein for routine haemodialysis at home. The merits of early diagnosis and prompt surgical repair are discussed.
Pharmacokinetic study of controlled‐release choline theophyllinate in elderly patients
Authors: Mondal B K , Beck PR , Gregory J , Le Cotonnec J‐Y , Clarke I
Published: April 2023

Controlled‐release choline theophyllinate tablets (Sabidal SR 270, Zyma) were administered to 17 elderly patients aged between 68 and 86 years (mean 76 ± 7 years) until steady state was obtained. The dosage form was one tablet every 12 hours for four days.

Plasma theophylline concentrations were measured by high‐performance liquid chromatography after the first dose and during the fourth day for a 12‐hour period. The tablets showed evidence of controlled‐release properties: the maximum plasma concentration (10.8 ± 2.5 mg/1) was obtained after 3.4 ±1.6 hours. The mean trough level was 6.6 ±1.5 mg/1 and the difference between the peak and trough levels was 4.1 ± 1.2 mg/1. The mean steady‐state plasma theophylline concentration was 8.5 ± 2.2 mg/1. The mean elimination half‐life was 14 ± 7 hours. The mean volume of distribution was 0.8 ± 0.4 l/kg. The mean total body clearance was 0.05 ± 1/h/kg. All values, the half‐life excepted, were found to be within the ranges for the patients reported in the literature. The values show the usual interindividual variation.
Effect of using alcoholic and non‐alcoholic skin cleansing swabs when sampling blood for alcohol estimation using gas chromatography
Authors: McIvor R A , Cosbey S H
Published: April 2023

A study was carried out using 20 volunteers in whom venepuncture through the skin soaked in either ethyl or isopropyl alcohol was performed. A non‐alcoholic cetrimide/chlorhexidine swab was used as a control. All subjects were initially alcohol free.

Ethyl alcohol was detected in only one blood sample and the level was found to be only 0.4 mg% (roughly the limit of detection of the assay). A slightly higher level of isopropyl alcohol (3 mg%) was found in one of the blood samples.

Alcohol estimation was carried out by headspace gas chromatography using a pair of instruments each fitted with a column exhibiting different retention characteristics. The system was similar to that used by other UK Forensic Science Laboratories where accurate, definitive results are a necessity.

It was concluded that under very testing conditions only minute ethanol interference is produced by using alcohol‐based skin cleansing swabs. This minimal interference is unlikely to affect clinical sample results, and even in a forensic situation the inadvertent use of alcohol‐based swabs is unlikely to lead to a miscarriage of justice.
Femoral hernia in children
Authors: Nayeem N
Published: April 2023

Femoral hernia is rare in children. Unfamiliarity with the occurrence of this condition may lead to incorrect diagnosis and delayed treatment. This mistake can be obviated by careful clinical examination.
Comparison of oral erythromycin ethylsuccinate and ciprofloxacin in the treatment of acute respiratory tract infections
Authors: Feld M S , Carnegie Christina , MacKlin Jeffery , Coles Stephen
Published: April 2023

A total of 619 patients with acute upper or lower respiratory tract infection were randomised to receive either erythromycin ethylsuccinate tablets at a dose of 1 g twice daily, or ciprofloxacin tablets 500 mg twice daily in a singleblind, multicentre study. The efficacy of each antibacterial was similar, with close to 90% of patients on each treatment being reported as either cured or improved. Gastrointestinal symptoms were the most commonly reported side‐effects, being similar in overall incidence for both agents. Nausea, vomiting, dizziness and headache occurred more frequently in the ciprofloxacin group, while abdominal pain and diarrhoea occurred more frequently in the erythromycin ethylsuccinate group. In each group, the number of patients failing to complete treatment was similar and the main reasons cited for discontinuation were gastrointestinal symptoms. This study indicates that both erythromycin ethylsuccinate and ciprofloxacin are well tolerated and are equally effective for routine empirical treatment of acute respiratory tract infections.
AN OPEN, RANDOMISED, PARALLEL GROUP STUDY OF LACTULOSE VERSUS ISPAGHULA IN THE TREATMENT OF CHRONIC CONSTIPATION IN ADULTS
Authors: Rouse M , Chapman N , Mahapatra M , Grillage M , Atkinson S N , Prescott P
Published: April 2023

SUMMARY The efficacy, tolerance and acceptability of lactulose (Duphalac) and ispaghula (Fybogel Orange) were assessed in the treatment of chronic constipation in adults. In an open, prospectively randomised, parallel group study, 124 patients with a history of constipation for more than three weeks were treated with either 15 ml bd of lactulose (increasing to 60 ml daily if necessary) or one sachet bd of ispaghula. Over the four‐week treatment period both treatments were shown to be effective, and numbers of concurrent effects were similar between the two groups. Differences were demonstrated with regard to acceptability in favour of lactulose.
A COMPARISON OF INTERPRETATION OF SCREENING MAMMOGRAMS BY A RADIOGRAPHER, A DOCTOR AND A RADIOLOGIST: RESULTS AND IMPLICATIONS
Authors: Haiart D C , Henderson J
Published: April 2023

SUMMARY In 1986, a project began to assess the feasibility of mobile breast screening, using oblique view mammography, in rural areas near Edinburgh. One of the aims of the project was to determine the feasibility, in terms of accuracy and cost, of non‐radiologist prescreeners. The sensitivity and specificity of each reader was calculated (using 12‐month interval cancer rates). Sensitivities of 80%, 80% and 83% were found for a radiographer, a non‐radiologist doctor and a radiologist respectively, with corresponding specificities of 78%, 84% and 86%.

When each reader was costed, prescreening was no cheaper than the radiologist reading all the films himself (£79.10 for the radiologist reading 1,000 pairs of films alone, against £84.97 with the radiographer prescreening and £163.93 with the non‐radiologist doctor prescreening). We were unable to demonstrate any advantages of prescreening, but found that double reading of the films, though costly, would have increased the sensitivity of the programme.
COMPLICATED PEPTIC ULCER DISEASE IN CHILDHOOD: AN OVERLOOKED DIAGNOSIS
Authors: Lewis D C , Hodinott C
Published: April 2023

SUMMARY Primary peptic ulceration is no longer regarded as a rare disease of childhood, but its exact incidence and pathogenesis remain debatable. We report the case of an 11 ‐year‐old boy, who presented with a perforated primary gastric ulcer, a rare complication in this age group.
A MULTICENTRE STUDY OF THE SAFETY AND EFFICACY OF AMLODIPINE IN MILD TO MODERATE HYPERTENSION
Authors: Cross BW , Kirby MG , Miller S , Shah SH , Sheldon DM , Sweeney MT
Published: April 2023

SUMMARY An open, non‐comparative study of 10 weeks' duration was conducted in general practice to assess the safety of amlodipine in patients with mild to moderate hypertension. Of the 5352 patients entering the study, 5135 received amlodipine; 4621 patients (90%) with a mean age of 58.2 years completed the study. Normalisation of blood pressure was achieved in over 80% of patients with a mean reduction of 21/15 mmHg. The mean final dose of amlodipine was 6.8 mg/day. Adverse experiences possibly related to amlodipine were reported by 19.3% of patients, and overall adverse events led to withdrawal in 6.7% of patients. The most common reported side‐effect was oedema. The frequency of headache was almost identical in older and younger patients and oedema, flushing and dizziness were seen only slightly more often in elderly patients. Ninety per cent of patients were considered by their GP to have shown excellent or good toleration of therapy. Over 85% of patients elected to continue on amlodipine therapy after completion of the study.
MANAGEMENT OF NSAIDs‐RELATED DYSPEPSIA IN THE COMMUNITY
Authors: Hardo PG , Chalmers DM , Jakeways M , Wright V , Axon ATR
Published: April 2023

SUMMARYLittle is known about how non‐steroidal anti‐inflammatory drugs (NSAIDs)‐related dyspepsia is managed in general practice. A survey was conducted to ascertain the preferred methods of investigation and management of NSAIDs‐related dyspepsia by GPs in the Leeds district in the summer of 1992. A total of 261/300 (87%) replied to the questionnaire. Most (87%) GPs discontinued NSAIDs, and 12% changed the drug. Only 42 (16%) suggested endoscopy.
CONGENITAL FISTULATION OF A MECKEL'S DIVERTICULUM TO THE SURFACE OF AN EXOMPHALOS SAC
Authors: Hale PC , Agrawal M
Published: April 2023

SUMMARY Exomphalos and vitellointestinal duct remnants are well‐known entities. This report details the presentation of congenital fistulation of a Meckel's diverticulum to the surface of an exomphalos minor.
SODIUM CROMOGLYCATE: A REMEDY FOR ACE INHIBITOR‐INDUCED COUGH
Authors: Hargreaves M
Published: April 2023

SUMMARY The beneficial effects of angiotensin converting enzyme (ACE) inhibitors may be limited by cough, for which the only consistently effective treatment is withdrawal of therapy. The effect of inhaled sodium cromoglycate (20 mg, 4 times daily) was examined in five patients who experienced cough following the introduction of an ACE inhibitor. In three patients inhaled cromoglycate suppressed the cough. Inhaled sodium cromoglycate may thus be of value in a proportion of patients with ACE inhibitor‐induced cough.
SCIENTIFIC BASIS OF TESTICULAR DESCENT AND MANAGEMENT IMPLICATIONS FOR CRYPTORCHIDISM
Authors: Kiely EA
Published: April 2023

SUMMARY Cryptorchidism occurs in about 1% of boys, but has a raised incidence in those with deficiencies of androgen function. Greater knowledge of fetal‐maternal endocrinology and related experimental work has provided evidence that fetal testicular endocrine function is vital in descent of the gonad. The therapeutic use of hCG has, however, been disappointing, and its role is confined to helping to distinguish the retractile from the undescended testis. Cryptorchidism is commonly associated with congenital pathological defects such as ductal abnormalities, and others (including interstitial fibrosis and a reduction in germ cells) develop after 1‐2 years, while later these patients are at greater risk of carcinoma in situ and germ cell cancer. The demonstration of the early pathological changes has recently dictated much earlier surgical correction, but long‐term follow‐up is needed to prove clinical benefit from this practice.
A COMPARATIVE STUDY OF THE EFFICACY AND TOXICITY OF ETODOLAC AND NAPROXEN IN THE TREATMENT OF OSTEOARTHRITIS
Authors: Chikanza IC , Clarke B , Hopkins R , Macfarlane DG , Bird H , Grahame R
Published: April 2023

SUMMARY In a two‐period, double‐blind, crossover study, patients with osteoarthritis of the knee and/or hip received etodolac 300 mg twice daily for 4 weeks and naproxen 500 mg twice daily for 4 weeks in random order. The assessment of efficacy showed that naproxen and etodolac were equally effective in the management of pain and stiffness in osteoarthritis. However, a significantly higher proportion of patients preferred naproxen to etodolac for the relief of pain intensity. The incidence of adverse events caused by either drug was the same.
HYPERTHYROIDISM ASSOCIATED WITH HYPEREMESIS GRAVIDARUM
Authors: Krentz AJ , Redman H , Taylor KG
Published: April 2023

SUMMARY Hyperemesis gravidarum is an uncommon presentation of hyperthyroidism in pregnancy which is usually attributable to autoimmune (Graves') disease. While this condition necessitates treatment with antithyroid drugs, a syndrome of transient hyperthyroidism associated with hyperemesis gravidarum that resolves spontaneously is also recognised. Differentiation between these two conditions may prove problematic in practice. We report two cases of hyperthyroidism associated with severe hyperemesis gravidarum. Intractable hyperemesis continued in one patient despite normalisation of circulating free thyroid hormone concentrations with carbimazole. Neither patient exhibited clinical or immunological features of autoimmune thyroid disease, suggesting in retrospect that they had the syndrome of transient hyperthyroxinaemia associated with hyperemesis gravidarum rather than Graves' disease. The role of antithyroid drugs in the treatment of self‐limiting transient hyperthyroidism associated with hyperemesis gravidarum requires clarification.
UNUSUAL PRESENTATION OF A NASAL (ANTROCHOANAL) POLYP
Authors: Rashid A‐MH , Soosay G , Morgan D
Published: April 2023

SUMMARY A case is described of expulsion of an autoamputated antrochoanal nasal polyp per mouth in a young patient. This rare complication of a nasal polyp is potentially dangerous.
PLEXIFORM NEUROFIBROMA: AN UNUSUAL CAUSE OF NECK LUMP IN A CHILD
Authors: Nicol JW , Yardley MPJ , Parker AJ
Published: April 2023

SUMMARY Although relatively rare, neurofibromas have been described in many different sites. We present the unusual case of an 8‐year‐old girl with a plexiform neurofibroma situated deep to the sternomastoid muscle, and review the current literature with particular regard to the pathology and site of neurofibromas.
THE NEW FACE OF ATHEROSCLEROSIS
Authors: Mitchinson MJ
Published: April 2023

SUMMARY Findings in cell cultures, experimental animals, human lesions and human populations have, over the past decade, provided a new perspective of atherogenesis. Some of the more important findings are reviewed here. They permit the conclusion that atherosclerosis is a chronic inflammatory disease in which the activities of macrophages are responsible for the development of the lesion. The death of macrophages may be the cause of progression to advanced plaque. Only the advanced plaque causes the stenosis, thrombosis and ischaemia that are responsible for the fatal complications of the disease. There is evidence, as yet persuasive rather than conclusive, that lipid oxidation is an important mechanism in atherogenesis. If so, dietary supplementation with antioxidants such as vitamin E might be effective in postponing the development of the complications.
SQUAMOUS CELL CARCINOMA IN A CHRONIC PILONIDAL SINUS
Authors: Jeddy TA , Vowles RH , Southam JA
Published: April 2023

SUMMARY A case is reported of squamous cell carcinoma arising in a chronic pilonidal sinus.
LORAZEPAM IN STUPOR
Authors: Ungvari GS , Leung CM , Chiu HM
Published: April 2023

SUMMARY The use of lorazepam in relieving catatonic symptoms is illustrated by the dramatic response in a stuporous patient. The treatment allows further investigations and management. It is recommended that clinicians familiarise themselves with this simple pharmacological intervention.
THE PHARMACOKINETICS, PHARMACODYNAMICS AND COMPARATIVE EFFICACY OF FLURBIPROFEN LAT
Authors: Bolten W
Published: April 2023

SUMMARY After topical application, concentrations of flurbiprofen in serum, synovium and other deeper tissues are low in comparison with oral application and in comparison with concentrations in skin. Undesired systemic effects are therefore rare. In localised soft‐tissue rheumatism and osteoarthrosis of the knee joint, flurbiprofen LAT has been shown to be at least as efficacious as indomethacin ointment and comparable in efficacy to flurbiprofen 40 mg three times daily and ibuprofen 200 mg three times daily. The mechanisms of action of external topical applications have not been sufficiently elucidated.
CALCITONINS AND OSTEOPOROSIS
Authors: Gennari C , Agnusdei D
Published: April 2023

SUMMARY Calcitonin, a polypeptide hormone secreted by the parafollicular C cells of the thyroid gland, lowers serum calcium by decreasing bone resorption and tubular calcium reabsorption. An analgesic action, possibly mediated via β‐endorphins, is also evident. Parenteral calcitonin has been shown to stabilise and increase indices of cortical and trabecular bone mass and total body calcium when administered to patients with established osteoporosis. The routine use of this route of administration has been limited by poor patient compliance and tolerability. An intranasal preparation of calcitonin provided a more convenient means of administration. Several clinical trials have shown that intranasal calcitonin is effective and well tolerated both in prevention of postmenopausal bone loss and in established osteoporosis. Calcitonin therapy is particularly indicated for patients with high‐turnover osteoporosis where results show a net gain of bone mineral in the axial skeleton and a slowing of bone loss in the appendicular bones. Due to receptor downregulation a resistance to the hormone may occur after 12‐18 months of continuous treatment. This resistance can be avoided and delayed by the cyclical or discontinued administration of the hormone. Further research is needed to confirm longer‐term efficacy and effects on fracture rate.
REPAIR OF ABDOMINAL AORTIC ANEURYSM AFTER RENAL TRANSPLANTATION WITHOUT RENAL PROTECTION
Authors: Hakim NS , Koffman G , Taylor P
Published: April 2023

SUMMARY The successful resection is reported of an abdominal aortic aneurysm after renal transplantation without the use of bypass or cooling procedure to preserve the kidney.
PHYSICIAN DECISION‐MAKING IN ANTIRETROVIRAL USE
Authors: Valian R , Moyle G , Reddy D
Published: April 2023

SUMMARY The results of a survey of physicians treating HIV are reported. The survey aimed to determine physicians' attitudes to and practices in antiretroviral prescribing and to assess the factors they use for decision‐making regarding initiation and change of therapy.
HAVE WE IDENTIFIED THE FACTORS AFFECTING PROGNOSIS FOLLOWING CORONARY ARTERY BYPASS SURGERY?
Authors: Lip GYH , Metcalfe MJ
Published: April 2023

SUMMARY Although coronary artery bypass graft (CABG) surgery has been an established therapeutic alternative for more than 20 years in the palliation of symptoms of ischaemic heart disease, the associated risk factors for subsequent mortality and morbidity in these patients remain unclear. This is pertinent, as CABG surgery does not affect the underlying pathological process and different factors affect the early and late postoperative outcomes. As one objective of CABG surgery is to provide symptomatic relief of angina, it is desirable to identify (and perhaps modify) the factors affecting prognosis and outcome. An awareness of these factors will allow better patient selection and the development of better screening and therapeutic interventions.
ARE THEOPHYLLINES BEING PRESCRIBED EFFECTIVELY AND SAFELY IN GENERAL PRACTICE?
Authors: Johnston IDA , Jenkinson D
Published: April 2023

SUMMARY To investigate the attitudes and practices of GPs towards the use and monitoring of theophyllines, a questionnaire was mailed to all 479 GP principals in Nottinghamshire with one reminder to non‐responders. Valid responses were obtained from 49% (236). Theophyllines were regarded as first‐line or frequent second‐line bronchodilators by 40% (94 of 234) of GPs in chronic bronchitis, 24% (56 of 234) in nocturnal asthma, and by 6% (15 of 234) in chronic stable asthma, although only 1% (2 of 234) of GPs regarded theophylline as strictly first‐line therapy in chronic stable asthma. Theophylline levels were never checked by 76% (172 of 225) of practitioners at the start of therapy, or by 48% (110 of 231) during long‐term therapy; half (110 of 217) could identify only up to 50% of a series of common factors affecting theophylline levels. There was no relationship between a score of theophylline knowledge and prescribing habits in chronic bronchitis, but doctors who checked levels scored significantly higher. Although theophyllines are being used in general practice for broadly sensible indications, this survey highlights aspects of prescribing that may be compromising both safety and effectiveness. Patients are likely to benefit if the need to check levels and the factors affecting levels become better known.
TONSILLOPHARYNGITIS: EVALUATION OF SHORT‐TERM TREATMENT WITH CEFUROXIME AXETIL VERSUS STANDARD 10‐DAY PENICILLIN V THERAPY
Authors: Gehanno P , Chiche D
Published: April 2023

SUMMARY Recent resurgence in serious streptococcal infections and rising failure rates with the standard 10‐day course of therapy with penicillin V for group A β‐haemolytic streptococcus (GABHS)‐associated tonsillopharyngitis (pharyngitis and/or tonsillitis) have heightened interest in alternative treatments for this infection. Reasons for failure of the standard therapy include penicillin tolerance, increased virulence of GABHS strains, inactivation by β‐lactamase, and poor compliance. Short, 4‐5‐day courses with oral cephalosporins, such as cefuroxime axetil, have recently proven to be effective alternatives. Cefuroxime axetil provides resolution of clinical symptoms and fever within 2.5 days of onset of therapy, and its short course of treatment may improve compliance.
ARTERIAL THROMBOSIS AFTER CHEMOTHERAPY WITH CISPLATIN, VINBLASTINE AND METHOTREXATE
Authors: Molloy RG , Welch GC , Drury JK , Abel BJ
Published: April 2023

SUMMARY A case of acute arterial thrombosis of the branches of the internal iliac, femoral and popliteal arteries is reported in a 38‐year‐old man receiving intravenous cisplatin‐vinblastine‐methotrexate therapy for carcinoma of the urethra. The patient had no angiographic evidence of atheromatous disease or tumour invasion of the occluded arteries and no source of emboli. Although cisplatin and vinblastine are known to cause a variety of vaso‐occlusive complications, acute large‐vessel arterial occlusion has not previously been reported with this combination of agents.
GIANT KERATOACANTHOMA OF THE NASAL VESTIBULE
Authors: Salam MA , Bickerton RC
Published: April 2023

SUMMARY A case is reported of a large keratoacanthoma of the nasal vestibule, which was treated by surgical excision and reconstruction using a partial‐thickness postauricular skin graft.
DO CLINICIANS PRESCRIBE HRT FOR HYPERTENSIVE POSTMENOPAUSAL WOMEN?
Authors: Lip GYH , Beevers M , Churchill D , Beevers DG
Published: April 2023

SUMMARY Despite the benefits of hormone replacement therapy (HRT) in relieving menopausal symptoms, there continues to be anxiety about its use in women who also have hypertension. To examine clinical practice in relation to HRT, especially in patients with hypertension, and to canvass opinions on potential or perceived side‐effects, the authors conducted a postal survey of HRT prescribing habits among 285 GPs, physicians and obstetricians in the West Midlands. The overall response rate to the questionnaire was 191 (66.3%): 61 clinicians reported that they would not prescribe HRT in women whose hypertension was difficult to control, but only 3 would withhold treatment if blood pressure was well controlled; 9% of physicians and 13% of gynaecologists did not routinely measure blood pressure before starting HRT or monitor BP at follow‐up (24% and 10% respectively). A proportion of GPs (20%), physicians (21%) and gynaecologists (9%) reported that in their opinion HRT raised blood pressure, and a minority in each group considered that HRT increased the risk of venous thrombosis, stroke and myocardial infarction. This study demonstrates differences among GPs, physicians and gynaecologists in the use of HRT in menopausal women with hypertension, the authors suggest that, in view of data from studies of the effects of HRT on blood pressure and the possible reduction of cardiovascular disease, these clinicians can be reassured and hypertensive women need not be denied the benefits of HRT, as long as there is careful monitoring.
TRAINING AND SUPERVISION OF TEMPORARY TRANSVENOUS PACEMAKER INSERTION
Authors: Murphy JJ , Frain JPJ , Stephenson CJ
Published: April 2023

SUMMARY To assess the current training and practice of central venous cannulation and temporary transvenous pacemaker insertion, a telephone survey of senior house officers (n=60) and registrars (n=20) was carried out in 80 acute hospitals in England and Wales. A median of one central line and two pacings were performed under supervision before the respondents were left unsupervised. The procedures were almost invariably taught at the bedside and usually by a fellow SHO or registrar. Virtually all the doctors surveyed were familiar with subclavian puncture, but experience with other routes was limited; 39/80 doctors questioned were unhappy about the training they had received, and 47 felt that formal training, such as tutorials or videos, would have helped. Training in central vein cannulation and temporary pacing needs to be more structured. This could be done by the use of videos or mannequins, and should include the use of routes other than the subclavian.
HOLISTIC APPROACH TO THE MANAGEMENT OF ERECTILE DISORDERS IN A MALE SEXUAL HEALTH CLINIC
Authors: Perring M , Moran J
Published: April 2023

SUMMARY A holistic view is given of the management of erectile disorders in a male sexual health clinic. Responsibility for the choice of treatment programme is shared with the patient, who makes informed consent. Involvement of the patient's partner is encouraged throughout. The increasing importance of good management for erectile dysfunction is indicated by the prevalence of the condition and the fact that, with a growing proportion of the population over the age of 65, it is age‐related.
NON‐CONVULSIVE STATUS EPILEPTICUS AS A COMPLICATION OF Mycoplasma pneumoniae INFECTION
Authors: Jeffery KJM , Ellis SJ , Fink CG
Published: April 2023

SUMMARY Described is a confirmed case of non‐convulsive status epilepticus, an unusual presentation of M. pneumoniae infection. The postulated pathological mechanisms in this infection are reviewed.
PERSISTENT ELECTROCARDIOGRAPHIC CHANGES AFTER FLECAINIDE OVERDOSE
Authors: Greig J , Groden BM
Published: April 2023

SUMMARY Flecainide acetate is a potent class 1C antiarrhythmic agent, overdosage with which is rare. An overdose is reported in a patient on long‐term therapy, resulting in life‐threatening arrhythmias and prolonged electrocardiographic abnormalities.
PAGET'S DISEASE: OCULAR COMPLICATIONS OF DISODIUM PAMIDRONATE TREATMENT
Authors: O'Donnell NP , Rao GP , Aguis‐Fernandez A
Published: April 2023

SUMMARY Three cases of uveitis associated with disodium pamidronate have been notified to the Committee for Safety of Medicines. Two new cases of bilateral anterior uveitis and episcleritis after administration of intravenous disodium pamidronate are described.
POST‐TRAUMATIC STRESS DISORDER — A SCAR FOR LIFE
Authors: D'Souza D
Published: April 2023

SUMMARY The symptoms of flashbacks, nightmares and hypervigilance may be understood by those who have shared or understand a traumatic event, but the duration of such symptoms may well outstretch all expectations. Post‐traumatic stress disorder (PTSD) is serious, and may affect the rest of a sufferer's life. Traumatic situations are ubiquitous in the modern‐day world, and can occur in both military and civilian settings. A great deal of research into the development and management of PTSD has been carried out in the past two decades; although many drug treatments and psychotherapeutic approaches have been investigated, no single method has been found to cure all the symptoms successfully.
EPIDERMOID CYST (MONODERMAL TERATOMA) OF THE TESTIS
Authors: Perkins JMT , Mitchell A
Published: April 2023

SUMMARY Two cases of epidermoid cyst, illustrating the difficulties associated with the management of this lesion, are reported.
THE PSYCHOLOGICAL EFFECTS OF BREAST SCREENING IN TERMS OF PATIENTS' PERCEIVED HEALTH ANXIETIES
Authors: Swanson V , McIntosh IB , Power KG , Dobson H
Published: April 2023

SUMMARY This study aimed to assess and compare the impact of letter of invitation, initial breast screening mammography, and subsequent recall procedures on the level of anxiety over breast problems. The survey of females undergoing routine breast screening procedures in a primary care setting is part of the first wave of a national breast screening programme in the UK. Women aged 50‐64 registered with six general practices (n=2618) were invited by letter to attend for screening. Their self‐perceived impact of receipt of invitation letter, attendance at initial screening, and recall, in terms of anxiety and concern about breast problems, was measured by a self‐report questionnaire and the physical, emotional and social dysfunction subscales of the Psychological Consequences of Screening Mammography Questionnaire (PCQ). Overall, subjects' anxiety levels diminished between the receipt of their invitation letter and the completion of their screening examination. Subjects did not, however, respond to the letter of invitation and screening procedure in a homogeneous manner. In a sample of 1253, the letter of invitation reduced anxiety about breast problems in 39.7%, increased anxiety in 24.6%, and had no appreciable effect in 35.7%. In the 1280 who attended for breast screening, the examination procedure reduced anxiety about breast problems in 55.9%, increased anxiety in 12.8%, and had no appreciable effect in 31.3%. In a smaller sample (n=33) who completed questionnaires at recall, there were significant increases in PCQ‐measured anxiety. Throughout the study, the PCQ was sensitive to change in anxiety over breast problems. We conclude that screening procedures can either increase or reduce anxiety about breast problems, or have no appreciable effect. Subjects' perception of the impact of receiving the letter of invitation and undergoing the screening examination procedure is related to previous levels of concern over breast problems. Conclusions about the psychological effect of breast screening cannot be drawn without consideration of the time and place of the baseline assessment. Participants in breast screening programmes therefore cannot be considered a homogeneous entity. Caution should be exercised when assessing the impact of screening procedures on entire populations as this approach might mask an important diversity of response.
DOMICILIARY OXYGEN
Authors: Wilkinson J , Rees J
Published: April 2023

SUMMARY Major studies have shown that LTOT improves survival in patients with COPD, although the precise mechanism remains unclear. There are established guidelines for prescription, but these are often disregarded. This is perhaps partly because oxygen concentrators and cylinders are prescribed by general practitioners unable to carry out a full assessment of patients' suitability for oxygen therapy. Patients who are thought to be suitable for oxygen therapy should be referred to a respiratory physician with the facilities to carry out a full evaluation of their needs. It is important not to neglect other aspects of treatment when assessing a patient for domiciliary oxygen. Bronchodilator therapy should be maximised with or without inhaled steroids, and patients will often also benefit from a moderate amount of regular exercise as part of the overall pulmonary rehabilitation programme.
LIFE‐THREATENING TARDIVE DYSKINESIA
Authors: Chiu HFK , Chung DWS , Wing YK , Wong CK
Published: April 2023

SUMMARY We present the case of a patient with severe tardive dyskinesia that led to dehydration. Clinicians need to recognise that tardive dyskinesia is a potentially life‐threatening condition, and familiarise themselves with its management.
ADVANCES IN THE TREATMENT OF SCHIZOPHRENIA
Authors: Kuperberg GR , Murray R
Published: April 2023

SUMMARY We review advances in the treatment of schizophrenia. We begin with an overview of antipsychotic drug development, focusing on the in vitro and in vivo binding profiles of clozapine and a new generation of D2:5HT antagonists. We then consider the main barriers to effective treatment: non‐compliance (and side‐effects) of medication, recurrent relapse, ‘treatment resistance’, negative symptoms and neurocognitive deficits. Within this framework, we review the mechanisms of action and clinical uses of the ‘atypical’ antipsychotic drugs. We also show how a variety of psychosocial interventions, particularly those that incorporate cognitive techniques, can be used in combination with pharmacotherapy to overcome the same clinical hurdles.
CALCITONIN TREATMENT IN REFLEX SYMPATHETIC DYSTROPHY: A PRELIMINARY STUDY
Authors: Hamamci N , Dursun E , Ural C , Cakci A
Published: April 2023

SUMMARY Reflex sympathetic dystrophy is one of the important complications effecting the rehabilitation programmes of hemiplegic patients in a negative manner by causing pain and function loss. In this study, the aim was to investigate the effects of salmon calcitonin treatment in reflex sympathetic dystrophy that develops in hemiplegia. Forty‐one patients with hemiplegia resulting from cerebrovascular events and stage 1‐2 reflex sympathetic dystrophy were included in the study. Salmon calcitonin, 1×100 IU/day intramuscularly for 4 weeks, was administered to 25 of these patients (calcitonin group); to the other 16 patients physiological saline,1 ml/day intramuscularly for 4 weeks, was administered (control group). At the end of the fourth week of treatment, the pain score of the calcitonin group was significantly lower than that of the control group. Shoulder abduction and external rotation, wrist flexion and metacarpophalangeal extension of the calcitonin group were found to be significantly better than those of the control group. In the calcitonin group the significant decrease in pain and tenderness resulted in improvement of range of motion and motor functions.