bluuebunny/crossref_metadata_2025 huggingface dataset:
ACUTE EFFECTS OF HORMONE REPLACEMENT WITH TIBOLONE ON MYOCARDIAL ISCHAEMIA IN WOMEN WITH ANGINA
Authors: Lloyd GWL , Patel NR , McGing EA , Cooper AF , Kamalvand K , Jackson G
Published: April 2023

This study was designed to evaluate whether hormone replacement therapy with tibolone demonstrated similar effects to those observed with oestrogen on myocardial ischaemia and angina. Ten postmenopausal women with documented coronary artery disease were evaluated by treadmill exercise electrocardiograms before and 24 hours after the oral administration of tibolone 2.5 mg. Onset of myocardial ischaemia, as defined by ST segment depression, increased by a median 102 seconds (p=0.022). Time to onset of angina increased by 31 seconds (p=0.038), while total exercise time was not significantly affected (p=0.24). Haemodynamic variables in the form of heart rate, systolic blood pressure and their product were unaffected by tibolone administration. We conclude that tibolone appears to show similar anti‐ischaemic properties to oestrogen.
CHARACTERISTICS OF CHILDREN UNDER 5 REFERRED TO HOSPITAL WITH CONSTIPATION: A ONE‐YEAR PROSPECTIVE STUDY
Authors: Gallagher B , West D , Puntis JWL , Stringer MD
Published: April 2023

Constipation in the pre‐school child can cause considerable distress to the individual and to the family. Most cases are idiopathic and with early diagnosis and effective treatment prognosis is good. In a teaching hospital paediatric unit, a year‐long prospective study identified 42 new referrals for constipation in children under 5. Before referral for a specialist opinion there appeared to be considerable variation in both duration of symptoms and treatment given. Psychological factors in the family, as well as advice regarding simple behaviour modification and management of common secondary behavioural problems, seemed largely overlooked. Guidelines for treating constipation in the community could help standardise and improve care. For children with refractory constipation referred to a specialist centre, we recommend a multidisciplinary assessment including paediatrician, paediatric surgeon, and member of the child mental health team.
PURE AGRAPHIA FOLLOWING PERI ENDARTERECTOMY STROKE
Authors: Nagaratnam N , Plew J , Cooper S
Published: April 2023

We report on a patient with pure agraphia due to perioperative stroke following left carotid endarterectomy. Her writing was illegible, slow and laborious, with impaired copying. Her oral spelling skills were normal. There was no limb apraxia. The CT brain scan revealed two hypodense areas – one anterior, the other posterior – at the level of the left centrum semi‐ovale.
FATAL SEPTICAEMIA IN A PREVIOUSLY HEALTHY MAN FOLLOWING A DOG BITE
Authors: Saab M , Corcoran JP , Southworth SA , Randall PE
Published: April 2023

A rare case of fatal septicaemia after a dog bite in a previously healthy individual is presented and discussed. Capnocytophaga canimorsus (DF‐2 bacterium) was isolated from blood cultures. Our case shows the importance of immediate antibiotic treatment for all dog and cat bites, regardless of severity.
A COMPARISON OF NISOLDIPINE COAT‐CORE AND FELODIPINE IN THE TREATMENT OF MILD‐TO‐MODERATE HYPERTENSION
Authors: Hoglund C , Hutchinson HG
Published: April 2023

The efficacy and safety of nisoldipine CC and felodipine were compared in a multicentre, randomised, double‐blind, trial in patients with mild‐to‐moderate hypertension (n=229). Following a two‐week placebo run‐in period, patients were randomised to 16 weeks' active treatment with nisoldipine coat core (CC) 20‐40 rng or felodipine 5‐10 mg once daily. At week 16, a higher proportion of patients in the nisoldipine CC group were on low‐dose therapy (51% vs 36%, p=0.07). The proportion of treatment responders was 77.8% with nisoldipine CC and 66.5% with felodipine. The mean change from baseline in systolic/diastolic blood pressure was ‐18.8/‐13.6 mmHg with nisoldipine CC and ‐17.4/‐11.3 mmHg with felodipine. The most common adverse events included peripheral oedema and headache; neither treatment affected heart rate. Thus, nisoldipine CC and felodipine provide comparable antihypertensive efficacy. The adverse effects of both drugs are related to their vasodilator properties and are common to the class.
PYRUVATE KINASE DEFICIENCY: AN UNUSUAL CAUSE OF PUERPERAL JAUNDICE
Authors: Esen UI , Olajide F
Published: April 2023

We present one of the rarer causes of pregnancy‐associated jaundice in the immediate puerperium. A 30‐year‐old multipara with pyruvate kinase deficiency became jaundiced within a few hours of delivery, following an uneventful pregnancy and labour at term. She responded to conservative management, the jaundice clearing and the altered liver function showing a steady return to normal. Pyruvate kinase deficiency may cause pregnancy‐associated jaundice. A thorough investigation is still necessary to exclude other causes of jaundice in pregnancy and the puerperium.
A CASE OF PICA AND IRON DEFICIENCY ANAEMIA IN NOTTINGHAM
Authors: Parry SD , Perkins AC , Hawkey CJ
Published: April 2023

Pica is the persistent eating of a non‐nutritional substance (as defined by the American Psychiatric Association) and is often associated with iron deficiency. Current literature leaves uncertain whether pica causes iron deficiency via its proposed effect on iron absorption or, conversely, whether iron deficiency causes pica. We report the case of a young girl from Nottingham who we believe developed pica secondary to her iron deficiency anaemia. To determine that her pica was not affecting gastrointestinal iron absorption we carried out iron absorption studies first under pica and then under normal dietary conditions.
FIRST‐DOSE RESPONSE TO ANGIOTENSIN‐CONVERTING ENZYME INHIBITION IN CONGESTIVE CARDIAC FAILURE: A MALAYSIAN EXPERIENCE
Authors: Navookarasu NT , Rahman ARA , Abdullah I
Published: April 2023

Despite their proven value in reducing morbidity and mortality in different grades of heart failure, angiotensin converting enzyme (ACE) inhibitors continue to be underused. One reason for this is clinicians' apprehension of first‐dose hypotension. We conducted a double‐blind, randomised, placebo‐controlled parallel group study to investigate the effect of various ACE inhibitors on first‐dose hypotension. Eighty unselected patients were randomised into five treatment groups: placebo, captopril 6.25 mg, enalapril 2.5 mg, perindopril 2 mg and lisinopril 2.5 mg. Blood pressure was measured at baseline, half hourly for two hours and hourly for three hours after drug treatment. The maximum drops in mean arterial pressure (in mmHg ± SD) were placebo 5.89 ± 2.65, perindopril 5.29 ± 2.49, enalapril 13.28 ± 3.31, lisinopril 15.04 ± 5.74 and captopril 16.76 ± 5.74 (all p< 0.05 vs placebo except for perindopril). Perindopril, unlike the other ACE inhibitors studied, did not produce first‐dose hypotension following its initiation in patients with congestive heart failure.
IMPROVED BLOOD PRESSURE CONTROL BY MONITORING COMPLIANCE WITH ANTIHYPERTENSIVE THERAPY
Authors: Waeber B , Vetter W , Dariolp R , Keller U , Brunner HR
Published: April 2023

Compliance with antihypertensive therapy was monitored for three months using an electronic medication dispenser in 35 patients remaining hypertensive despite the once‐daily administration of a blood pressure lowering drug (either as monotherapy or as fixed‐dose combination therapy). During the monitoring of compliance, the treatment was unchanged but blood pressure decreased significantly (p<0.001) from 167.9/100.4 ± 16.3/7.2 mmHg (mean ± SD) to 152.5/90.9 ± 20.9/11.5 mmHg. The percentage of days with one opening per day was 80.8 ± 20.5. Thus, discussing with the patient about compliance with the prescribed drug regimen and monitoring compliance for a few months allows better control of blood pressure. This most likely reflects increased compliance with antihypertensive drug therapy.
THE ANTIPHOSPHOLIPID OR HUGHES' SYNDROME: AN UNDERDIAGNOSED CAUSE OF THROMBOSIS
Authors: Williams FMK , Hunt BJ
Published: April 2023

The antiphospholipid or Hughes' syndrome is the association between antiphospholipid antibodies, recurrent venous and arterial thromboses and recurrent fetal loss. There are many clinical manifestations arising from this acquired thrombophilia and these are described in the article. The pathogenic mechanism by which the antibodies cause thrombosis is the subject of much debate, and current theories are described. The diagnosis and management of patients with the syndrome are also discussed.
MANAGEMENT OF NIDDM BY FAMILY DOCTORS IN HONG KONG: A QUESTIONNAIRE SURVEY
Authors: Lam TP , Chan TYK
Published: April 2023

The management approach to non‐insulin‐dependent diabetes mellitus among family doctors in Hong Kong was studied using two case histories. In 1996, all 804 fellows, members and associate members of the Hong Kong College of Family Physicians were sent a letter and a questionnaire. Of the 512 who responded, 405 were male and 95 were female (12 were discarded) with ages ranging from 24 to 77 years (median 40). For the 48‐year‐old obese man who showed improvements in blood glucose and symptoms after diet for 6 weeks (Case 1), most respondents suggested adding a sulphonylurea (39.0%) or metformin (21.1%), or continuing diet (35.2%). Younger and more junior doctors tended to use metformin plus diet. Of 192 respondents who wanted to use a sulphonylurea, gliclazide (45.8%) and glibenclamide (42.7%) were chosen most often. For the 76‐year‐old overweight woman with symptomatic diabetes despite diet therapy (Case 2), most respondents suggested adding a sulphonylurea (41.9%), metformin (25.6%) or both (19.2%). Younger and more junior doctors tended to use metformin plus diet, whereas older doctors tended to use insulin plus diet. Older and more experienced doctors tended to use diet plus metformin and sulphonylurea. Of 208 respondents who wanted to use a sulphonylurea, gliclazide (47.8%) and glibenclamide (30.1%) were chosen most often. The management approach to NIDDM varied with the age and experience of the doctor.
SCREENING FOR ACUTE MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH COLLAPSE, CONFUSION AND FALLS
Authors: Phillips JRN , Carroll J , Ehsanullah M
Published: April 2023

Falls, collapse and confusion are frequent causes of admission to hospital in the elderly, and myocardial infarction (Ml) can present atypically. The study was designed to assess the incidence of Ml in this group of patients and provide information on the value of screening methods. A total of 142 elderly patients with a mean age of 83 years (range 76‐99) were admitted with unexplained collapse, confusion or falls. Serial ECGs and cardiac enzymes were performed. Eighty‐two patients (59%) had normal ECGs; of these, 80 (98%) had normal or non‐significantly elevated cardiac enzymes; 72/108 patients without chest pain had normal ECGs compared with 10/32 who had chest pain (p<0.01). Cardiac enzymes were elevated in 5/108 without chest pain and 10/32 with chest pain (p<0.01). Thirty‐two (23%) had chest pain, 14 (10%) had an acute Ml. In those presenting with chest pain, 32% had an Ml, compared with only 1.9% of those without chest pain (p<0.01); 18% of patients with an initially abnormal ECG had an Ml compared with only 5% of those with a normal ECG (p=0.02). None of the patients with a normal ECG who were free of chest pain were subsequently proven to have an Ml. Cardiac enzymes are often non‐specifically elevated in this group of patients due to muscle injury. The incidence of Ml is low in patients without chest pain and we would not advocate routine screening with serial cardiac enzymes, unless there is chest pain or an abnormal 12‐lead ECG on admission.
THE INCIDENCE OF COUGH: A COMPARISON OF LISINOPRIL, PLACEBO AND TELMISARTAN, A NOVEL ANGIOTENSIN II ANTAGONIST
Authors: Lacourciere Y ,   the Telmisartan Cough Study Group
Published: April 2023

Dry cough is a troublesome side‐effect associated with certain antihypertensive agents that act by modulating aspects of the renin‐angiotensin‐aldosterone system. The incidence of dry cough associated with two of these therapies, the novel All receptor antagonist telmisartan and the ACE inhibitor lisinopril, was assessed in a multicentre, randomised, parallel‐group, double‐blind, placebo‐controlled, 8‐week study of 88 patients with mild to moderate hypertension who previously demonstrated ACE inhibitor‐related cough. Patients received either telmisartan 80 mg, lisinopril 20 mg, or placebo once daily. Cough incidence, measured at each visit by a self‐administered symptom assessment questionnaire, was significantly higher with lisinopril (60%) than with telmisartan (15.6%) or placebo (9.7%). A visual analogue scale demonstrated a similar trend for cough frequency. Thus the incidence of cough with telmisartan 80 mg is significantly less than that seen with lisinopril 20 mg and is comparable to placebo.
DRAWING UP CLINICAL GUIDELINES
Authors: McGovern MC , Stewart MC
Published: April 2023

This report describes the processes involved in compiling a set of guidelines, locally developed by informal consensus, for the management of common paediatric medical problems in a teaching hospital.
PULMONARY ARTERIOVENOUS MALFORMATION AS A CAUSE OF SEVERE EXERTIONAL DYSPNOEA
Authors: Bain DJ , Webb KA , O'Donnell DE
Published: April 2023

A 48‐year‐old woman presented to the respiratory clinic with progressive exertional dyspnoea and an abnormal chest radiograph. Examination revealed mucosal telangiectasia and pulmonary angiography confirmed the presence of two pulmonary arterial venous malformations (PAVM). After therapeutic coil embolisation, dyspnoea was markedly improved, and exercise tolerance increased. Comparison of exercise test responses before and after this therapeutic intervention provides new insights into the physiological mechanisms of exertional dyspnoea in this condition.
BRONCHOGENIC CARCINOMA PRESENTING AS ABRONCHOPERICARDIAL FISTULA
Authors: George LD , David N , Omrani A , Davies R
Published: April 2023

A case is reported in which an undiagnosed bronchogenic carcinoma presented clinically with sudden onset shortness of breath and cardiac failure due to the development of an acute bronchopericardial fistula.
THE EFFECT OF SUPPLEMENTATION WITH MILK FERMENTED BY LACTOBACILLUS CASEI (STRAIN DN‐114 001) ON ACUTE DIARRHOEA IN CHILDREN ATTENDING DAY CARE CENTRES
Authors: Pedone CA , Bernabeu AO , Postaire ER , Bouley CF , Reinert P
Published: April 2023

The objective of this study was to determine if supplementation with milk fermented by yogurt cultures and Lactobacillus casei (strain DN‐114 001) could lessen acute diarrhoea in healthy children. The study was conducted over six months, with 287 children aged 18.9 (SD 6.0) months, comprising three periods of one month supplementation, each month being followed by one month without supplementation. Subjects were supplemented daily with either 125 g or 250 g (according to age) of one of three tested dairy products: standard yogurt, milk fermented by yogurt cultures and Lactobacillus casei (108 cfu/ml), or a jellied milk (control product). A daily record was kept of the number and type of stools. Although the incidence of diarrhoea was not shown to be different between the groups, the severity of diarrhoea over the six‐month study was significantly decreased (4.3 days) with the supplementation of L. casei fermented milk compared with the jellied milk (8.0 days) (p=0.009).
ACUTE PULMONARY OEDEMA COMPLICATING ADENOTONSILLECTOMY FOR OBSTRUCTIVE SLEEP APNOEA
Authors: Motamed M , Djazaeri B , Marks R
Published: April 2023

Acute pulmonary oedema can sometimes complicate adenotonsillectomy carried out for obstructive sleep apnoea. Early recognition and adequate oxygenation are the key to management. We report such a case; the pathophysiology and management of this rare complication of a common procedure are discussed.
A CASE OF SEVERE REVERSIBLE LUNG DISEASE CAUSED BY SULPHASALAZINE
Authors: Manchanda S , Rees PJ
Published: April 2023

Various lung problems have been reported in patients with inflammatory bowel disease. Some of these can be drug related. We report an unusual case of upper lobe infiltration which appeared to be caused by sulphasalazine.
A NATIONAL SURVEY OF THORACIC SURGICAL PRACTICE IN THE UK
Authors: Khan IH , Vaughan R
Published: April 2023

We conducted a survey of thoracic surgery in the UK today. Questionnaires were sent to 75 cardiothoracic surgeons, known to perform thoracic surgery regularly; we had a 100% response. The commonest preoperative investigations for carcinoma of the oesophagus were serum alkaline phosphatase (90%), GGT (69%), contrast swallow (80%), ultrasound of abdomen (71%) and CT scan of chest and abdomen (60%). After oesophagectomy, 84% of the surgeons inserted nasogastric tubes and 31% sent their patients to the intensive care unit. Oral fluids were started on days 3‐5 in 81% of cases, and 58% of the surgeons requested a postoperative contrast swallow, usually between the seventh and tenth postoperative days, after oral fluids had been started. Most of the surgeons nearly always used staplers for a given procedure or else completely avoided them for that part of the operation. The commonest use of staplers was for bronchial closure in pneumonectomy (67%) and lobectomy (48%) and in constructing an oesophageal anastomosis (25%). Twenty per cent of the surgeons did not insert a chest drain after pneumonectomy, while 65% observed the protocol of chest drain insertion with short intermittent unclamping, usually every hour, followed by removal of the drain, usually the next morning. Thoracic surgeons vary widely in their surgical practices. In a well structured training programme, trainees should rotate between several units so they are exposed to different techniques and ideas and acquire a broad based training.
EFFICACY OF TWICE‐DAILY AMOXYCILLIN/CLAVULANATE IN LOWER RESPIRATORY TRACT INFECTIONS
Authors: Balgos AA , Rodriguez‐Gomez G , Nasnas R , Mahasur AA , Margono BP , Tinoco‐Favila JC , Sansores‐Martinez RH , Hassan M , Beppo O , Wongsa A , Cukier A , Vargas F
Published: April 2023

In this double‐blind, double‐dummy study, 324 patients with clinical evidence of community‐acquired pneumonia (CAP) or an acute exacerbation of chronic bronchitis were randomly assigned to receive 10 days' treatment with either amoxycillin/clavulanate 875/125 mg twice daily or amoxycillin/clavulanate 500/125 mg three times daily. At the end of therapy, clinical success rates were 92.4% for the twice daily regimen and 94.2% for the three times daily regimen. There was no statistically significant difference between treatments (p=0.647) and the 95% confidence interval around the treatment difference indicated that the two treatments were equivalent. Treatment equivalence was also confirmed at follow‐up, four weeks after the end of treatment. Both regimens were well tolerated. In conclusion, amoxycillin/clavulanate 875/125 mg twice daily is as effective as amoxycillin/clavulanate 500/125 mg three times daily for the treatment of community‐acquired lower respiratory tract infections and could improve patient compliance.
RISK FACTOR MODIFICATION EXTENDS THE BENEFIT OF CORONARY ARTERY REVASCULARISATION PROCEDURES
Authors: Shepherd J
Published: April 2023

The management of coronary artery disease has undergone major changes in the past three decades. Early medical preventive strategies rapidly gave way to surgical intervention by the end of the 1960s; 10 years later this was supplemented by the introduction of angioplasty. Both of these approaches offered rapid symptomatic relief but were dogged by a predisposition to restenosis. While technical improvements have helped reduce this problem, there is a growing perception that the imbalance between the enthusiastic adoption of surgical intervention and the jaundiced neglect of secondary medical prevention needs to be redressed. This can be achieved without stepping back in time, for, since the 1960s, agents far more effective in the struggle against ischaemic vascular disease have proven their worth in the clinical arena. Graft protection following bypass surgery is vital, but equally important is the need to target the metabolic derangement which caused the occlusion in the first place. This article reviews medical strategies designed to add life to coronary artery revascularisation procedures.
THERAPEUTIC APPROACHES TO THE MANAGEMENT OF COMMON BALDNESS
Authors: Sommer S , Wilson C
Published: April 2023

Common baldness or androgenetic alopecia is a universal problem, having affected both sexes of all races to different extents for as long as mankind has existed. The progressive androgen dependent hair loss follows specific patterns and is a physiological process, which may take on disease quality due to psychosocial compontents. These should be taken into consideration when discussing the several treatment options available, particularly as a cure cannot be offered. Cosmetic measures range from back‐combing over perms to hairpieces and wigs. Medical therapies include systemic antiandrogens and topical minoxidil; surgical options comprise follicular transplantation, scalp reduction and rotation. Before starting treatment, however, careful consideration should be given to the differential diagnosis which includes drug‐induced hair thinning, anagen effluvium, diffuse alopecia areata, metabolic disturbances, nutritional deficiencies and acute as well as chronic telogen effluvium.
UNUSUAL PRESENTATION OF DISSECTING AORTIC ANEURYSM
Authors: Ismil ML , Hussien M
Published: April 2023

Dissecting aneurysms generally cause radiating back pain, chest pain, or symptoms caused by aortic insufficiency. Presentation solely with abdominal pain is rare. We report on a patient with dissecting thoracic aortic aneurysm who presented solely with abdominal pain. The possibility of intrathoracic disease must be considered in every patient with abdominal pain, especially if the pain is in the upper part of the abdomen.
AN ASSESSMENT OF THE EFFICACY OF ATORVASTATIN IN ACHIEVING LDL CHOLESTEROL TARGET LEVELS IN PATIENTS WITH CORONARY HEART DISEASE: A GENERAL PRACTICE STUDY
Authors: Neil HAW , Fowler G , Patel H , Eminton Z , Maton S
Published: April 2023

Adherence to evidence‐based guidelines for the secondary prevention of coronary heart disease (CHD) has been shown to be poor in a number of surveys. In this open‐label, non‐comparative 17‐week trial, 399 patients with existing CHD and LDL cholesterol concentration >3.4 mmol/l (130 mg/dl) were treated with atorvastatin 10 mg daily. After 5 weeks, the dose of atorvastatin was adjusted according to a patient's LDL cholesterol level. Of the 379 patients remaining in the study after five weeks of treatment, dose titration was not required for 355 patients (94%) who had reached the target LDL cholesterol of ≤3.4 mmol/l. Of the 23 patients titrated to higher doses, 11 achieved the target LDL cholesterol after treatment for 17 weeks. Atorvastatin was well tolerated during the course of the study. Achieving LDL cholesterol targets without the need for dose titration simplifies clinical management and should encourage better adherence to evidence‐based recommendations for secondary prevention of CHD.
NEW VARIANT CREUTZFELDT‐JAKOB DISEASE
Authors: Gordon N
Published: April 2023

It is now recognised that new variant Creutzfeldt‐Jakob disease (CJD) can present during adolescence, so it may be within the experience of any paediatrician. Some observations on prion proteins are made, and some of the features of classical CJD are reviewed. Reports of patients with new variant CJD are given. The possible links between this condition and bovine spongiform encephalopathy (BSE) are considered, especially the finding that certain people who are homozygous for methionine at codon 129 of the prion protein may be particularly susceptible to this infection. The diagnosis of new variant CJD can be difficult. Early sensory and psychiatric symptoms can be suggestive, so can the initial signs of ataxia and involuntary movements. The EEG does not help in this variety. Although not specific, some serum and CSF tests may give diagnostic support. It has been claimed that tonsillar biopsy may confirm the diagnosis, but this often necessitates brain biopsy; or the diagnosis may only be made at autopsy. Beliefs about the way infections spread will have to be modified, and more must be learnt about the nature of prions, how they enter the body, and how they spread in the brain.
TUBERCULOUS PERFORATIONS OF THE SMALL INTESTINE
Authors: Talwar S , Talwar R , Prasad P
Published: April 2023

The hospital records of 58 patients operated on for tuberculous perforations of the small intestines at our hospital between 1987 and 1996 were reviewed. Clinical features were non‐specific in the majority of the patients. Pneumoperitoneum on abdominal radiographs was present in only 28 (48.3%) patients. Forty‐five (77.6%) were operated on within 36 hours of perforation. Surgical management consisted of resection and end‐to‐end anastomosis (n=45); oval excision of the perforation and transverse anastomosis reinforced with an omental patch (n=7); ileo‐transverse colostomy (n=5); and peritoneal drainage only (n=1). There were 17 deaths (29.3%). Adverse prognostic factors were operation beyond 36 hours (p<0.01), multiple perforations (p<0.001), and faecal fistula formation (p<0.01). Mortality was least with early resection and end‐to‐end anastomosis of the perforated bowel segment. We conclude that a high index of suspicion is essential for early diagnosis and optimal treatment of patients with tuberculous intestinal perforations.
ATTENTION DEFICIT HYPERACTIVITY DISORDER: POSSIBLE CAUSES AND TREATMENT
Authors: Gordon N
Published: April 2023

The possible causes of attention deficit hyperactivity disorder are considered, and the drugs that may be of benefit in treating it. Accurate diagnosis is essential for effective management. This includes the syndrome itself and associated conditions. Theories of causation are discussed. These involve the anatomical substrate but, equally importantly, the role of neurotransmitters; and the use of tests such as positron emission tomography will undoubtedly increase understanding. Genetic factors also play a part. Options for treatment are considered. Evidence supports the effectiveness of stimulant drugs, such as methylphenidate. Among the justifications for such treatment are the excessive strains placed on family relationships by the condition, and the disruption of the child's schooling. It must be carefully planned, and a constant watch kept for adverse effects. These can include difficulty in sleeping, poor appetite, loss of weight and tics. Drugs alone, however, are unlikely to help, and attention must first be given to the situation at home and at school, and how this can be improved. Treatment is often successful, and it can be a rewarding condition to treat.
FEVER, RASH AND WORSENING OF ASTHMA IN RESPONSE TO INTRAVENOUS HYDROCORTISONE
Authors: Vaghjimal A , Rosenstreich D , Hudes G
Published: April 2023

We describe a case of a hypersensitivity reaction to intravenous hydrocortisone in a 64‐year‐old female with asthma, and briefly review other cases.
PULSE OXIMETRY: EVOLUTION AND DIRECTIONS
Authors: Middleton PM , Henry JA
Published: April 2023

Pulse oximetry monitoring is a relatively recent technique that has been embraced enthusiastically by medical, nursing and paramedical personnel in many clinical situations. Few people, however, have any idea of how it provides the reading of arterial blood saturation. This review performs several functions: it discusses the haemoglobin molecular structure and explains its relation to spectrophotometry, describes the history and principles of pulse oximetry and the nature of the equipment used, and reviews its common uses. It also explores the principles and proposed uses of its lesser known corollary, photoplethysmography.
CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME PRESENTING AS DILATED CARDIOMYOPATHY WITH BILATERAL BRANCH RETINAL ARTERY THROMBOSIS
Authors: Mandal B , Rathore S , Douglas AF
Published: April 2023

Cardiac manifestation of antiphospholipid syndrome (APS) is mainly in the form of left‐sided valvular insufficiency, intra‐cardiac thrombi or coronary artery occlusion. Dilated cardiomyopathy is a rare but important cardiac manifestation of APS, and responds well to adequate anticoagulation and steroids. We describe a case in which APS presented with dilated cardiomyopathy and bilateral retinal artery thrombosis.
MULTICENTRIC STUDY OF THE EFFECT OF MILK FERMENTED BY LACTOBACILLUS CASEI ON THE INCIDENCE OF DIARRHOEA
Authors: Pedone CA , Arnaud CC , Postaire ER , Bouley CF , Reinert P
Published: April 2023

The aim of this study was to determine if supplementation of healthy children with milk fermented by yogurt cultures and Lactobacillus casei strain DN‐114 001 could affect the incidence of acute diarrhoea when compared with traditional yogurt. The study was a multicentre, randomised, double‐blind trial, conducted over four months, on 928 children aged, at inclusion, 6–24 months. The study consisted of two periods: supplementation and observation. Subjects were supplemented daily with 100 g of one of the two dairy products being tested: standard yogurt and milk fermented by yogurt cultures and Lactobacillus casei (108 cfu/ml). Frequency or duration of any diarrhoea episode was evaluated. As far as frequency was concerned there was a statistically significant difference between the groups, the incidence of diarrhoea being significantly reduced by supplementation with L. casei fermented milk (15.9%) compared with yogurt (22%) (p=0.03). These results suggest an additional benefit of L. casei in acute diarrhoea in children compared with standard yogurt.
PROSTATE‐SPECIFIC ANTIGEN AND PROSTATE CANCER
Authors: Rosalki SB , Rutherford FJ
Published: April 2023

Serum prostate‐specific antigen (PSA) measurement is used to investigate patients with lower urinary tract symptoms and to screen for prostatic malignancy in symptom‐free males over 50 years of age. Approximately 60% of patients with early (prostate‐confined) occult malignancy show increased serum PSA levels, as do some 20% of patients with prostatic symptoms from benign prostatic disease. When PSA is only slightly raised, serial PSA measurements, correction for prostatic volume and especially measurement of free (unbound) PSA (which is reduced in prostatic malignancy) may assist the differentiation of prostatic cancer from benign hypertrophy. Serial measurements are also of value for monitoring treatment of prostate cancer and for post‐treatment surveillance.
MANAGEMENT OF ADVANCED BREAST CANCER WITH ENDOCRINE THERAPY: THE ROLE OF THE PRIMARY HEALTHCARE TEAM
Authors: Theobald AJ
Published: April 2023

Of the 25,000 new cases of breast cancer annually in the UK, at least half will develop metastases at some time. Approximately one‐third of these will be hormone‐sensitive and thus suitable for endocrine manipulation. Such patients may live for several years. Care should be patient‐centred and evidence‐based, with primary care playing an integral part in the multidisciplinary team. Quality of life is paramount, and largely determines decisions to change endocrine therapy. Tamoxifen remains the first choice treatment, but newer agents, in particular the oral aromatase inhibitors, have successfully extended the range of therapy available. Ovarian ablation can be effectively achieved using LHRH analogues, which have the advantage of being reversible if ineffective. In future, further improvements in outcome are likely with new pure antioestrogens and the possibility of sequential or combined use of existing drugs.
SMALL BOWEL CARCINOID TUMOUR PRESENTING WITH INTESTINAL ISCHAEMIA
Authors: Ormandy SJ , Parks RW , Madhavan KK
Published: April 2023

A rare cause of intermittent intestinal ischaemia is presented to highlight the importance of thorough investigation, including the usefulness of laparoscopy, in the assessment of patients with persistent postprandial abdominal pain and hyperactive bowel sounds. (Int J Clin Pract 2000; 54(1): 42‐43)
INTERPRETATION OF THE DIRECT ANTIGLOBULIN TEST IN NEONATES WITH HAEMOLYTIC DISEASE OF THE NEWBORN
Authors: Tuladhar R , Patole SK , Whitehall JS
Published: April 2023

Neonatal blood grouping and direct antiglobulin test results need to be interpreted with caution following multiple intrauterine blood transfusions for haemolytic disease of the newborn (HDN). Except for a few reports published about 20 years ago, this fact is not well documented. We report a case emphasising the problem and its consequences. (Int J Clin Pract 2000; 54(1): 64
ACUTE PULMONARY OEDEMA FOLLOWING SMOKE INHALATION
Authors: Saab M , Majid I
Published: April 2023

A case of acute pulmonary oedema after smoke inhalation from a chip pan fire is presented. The role of bronchial and pulmonary circulation in the development of pulmonary oedema after smoke inhalation is discussed. We stress the importance not only of observation after smoke inhalation, as the manifestation of pulmonary oedema may be delayed, but also of a baseline chest X‐ray before admission for comparison. (Int J Clin Pract 2000; 54(2): 115‐116)
PERFORATION OF UTERUS BY THE GYNEFIX INTRAUTERINE CONTRACEPTIVE DEVICE
Authors: Al‐Kamil RK
Published: April 2023

A case of intrauterine perforation by a GyneFix contraceptive device in a 29‐year‐old parous woman is described. It is the first report of uterine perforation by the frameless, anchored GyneFix in the UK since its introduction here in 1997. Perforation was diagnosed 12 days after insertion and was complicated by visceral perforation and infection. (Int J Clin Pract 2000; 54(2): 128‐129)
DUODENAL OBSTRUCTION DUE TO A SWALLOWED NASOGASTRIC TUBE
Authors: Naraynsingh V , Maharaj D , Rampaul R
Published: April 2023

Nasogastric tubes are commonly used, not only in surgical practice but in all disciplines. Their use, however, is not without complications. We present the first reported case of duodenal obstruction due to a swallowed nasogastric tube, and recommend that nasogastric tubes be used in their entirety (uncut) with the splayed distal end intact. This simple procedure will prevent a rare but distressing complication that might be amenable only to laparotomy. (Int J Clin Pract 2000; 54(2): 130)
CURRENT MANAGEMENT OF MULTIPLE SCLEROSIS
Authors: Leary SM , Thompson AJ
Published: April 2023

Multiple sclerosis is a complex disease which presents a unique challenge in clinical management. This decade has seen the advent of new therapies which are partially effective in modifying the disease course. However, current therapies have no impact on existing neurological deficits and so supportive measures, symptomatic treatment and comprehensive rehabilitation remain at the core of management. Historically clinical practice has often been empirical but management should now be evidence‐based and guided by consensus opinion if improvements in care are to be made. (Int J Clin Pract 2000; 54(3): 161‐169)
DAPSONE‐INDUCED METHHAEMOGLOBINAEMIA: A SOURCE OF DIAGNOSTIC CONFUSION
Authors: Craig D , Cadden ISH , Gormley WP , Rilet  , Jones FGC , Mcmullin MF
Published: April 2023

Arterial desaturation as measured using pulse oximetry may not reflect cardiorespiratory disease; other possible causes, including certain drugs, should be sought. Within the literature, examples exist of dapsone‐induced methaemoglobinaemia causing diagnostic confusion, particularly where respiratory disease is a feature. Few cases have been reported that demonstrate the potential of relatively low levels of methaemoglobinaemia to upset pulse oximetry readings. We describe three examples of dapsone‐induced methaemoglobinaemia emphasising the potential for low‐grade methaemoglobinaemia to cause diagnostic confusion. Widespread use of the pulse oximeter indicates this problem may occur more regularly, hence there is a need for increased awareness. (Int J Clin Pract 2000; 54(3): 194‐196)
CHYLOUS ASCITES: A RARE COMPLICATION OF RADICAL GASTRECTOMY
Authors: Rajasekar A , Ravi NR , Diggory RT
Published: April 2023

Chylous ascites is the accumulation of lymphatic fluid within the peritoneal cavity, due to trauma or obstruction to the lymphatic system. Postoperative chylous ascites is a rare complication of abdominal surgery. This is frequently reported after retroperitoneal dissections, and results in high morbidity and mortality. The treatment options are varied and include total parenteral nutrition (TPN), elemental diet with medium chain triglycerides (MCT), repeated paracentesis and surgical ligation. We report a case of post‐operative chylous ascites after D2 distal gastrectomy. Treatment by fasting, TPN followed by fat‐free diet resulted in complete resolution of ascites within 3 weeks. To our knowledge this is the first report of such a complication following radical gastrectomy. We review the literature and briefly discuss the management options. (Int J Clin Pract 2000; 54(3): 201‐203)
ALTERNATIVES TO HYSTERECTOMY FOR THE TREATMENT OF EXCESSIVE UTERINE BLEEDING
Authors: Robins JC , Liu J
Published: April 2023

Abnormal uterine bleeding is a common gynaecological problem that traditionally has been treated with hysterectomy. However, there are many other conservative treatment modalities that should be considered before hysterectomy. Medical therapies are effective in most cases. Endometrial ablation may be an effective surgical alternative to hysterectomy. This article reviews and updates the diagnostic concepts and management options for the treatment of abnormal uterine bleeding. The authors present a review of the pertinent literature and describe their experience with the latest balloon device for endometrial ablation therapy. (Int J Clin Pract 2000; 54(4): 233‐237)
POTT'S PUFFY TUMOUR: A RARE CAUSE OF FOREHEAD SWELLING IN A CHILD
Authors: Hore I , Mitchell RB , Radcliffe G , De Casso Moxo C
Published: April 2023

We report a case of Pott's puffy tumour in a 12‐year‐old. Owing to the late development of the frontal sinuses, frontal sinus infection in children is rare. When present it can lead to osteomyelitis associated with forehead swelling. Early diagnosis and active treatment prevent progression to life‐threatening intracranial spread. (Int J Clin Pract 2000; 54(4): 267‐268)
THYROTOXICOSIS IN DOWN'S AND TURNER'S SYNDROMES: THE LIKELIHOOD OF HASHIMOTO'S THYROIDITIS AS THE UNDERLYING AETIOLOGY
Authors: Idris I , O'Malley BP
Published: April 2023

Biochemical thyrotoxicosis in young women is almost invariably due to Graves' disease. Its occurrence in females with Turner's and Down's syndromes, both of which are seldom associated with Graves' hyperthyroidism but are frequently allied to Hashimoto's thyroiditis, should alert physicians to the possibility of the latter. The discharge thyroiditis of Hashimoto's disease can be recurrent and protracted. A brisk response to antithyroid therapy would favour a thyroiditis and, in this circumstance, radio‐iodine uptake should be reduced. The absence of TSH receptor antibodies in such cases, while not wholly refuting the notion of active Graves' disease, lends support to the existence of Hashimoto's thyroiditis. (Int J Clin Pract 2000; 54(4): 272‐273)
MOXIFLOXACIN (AVELOX): AN 8‐METHOXYQUINOLONE ANTIBACTERIAL WITH ENHANCED POTENCY
Authors: Ball P
Published: April 2023

Moxifloxacin is a novel 8‐methoxyquinolone with enhanced potency against important Gram‐positive pathogens, notably Streptococcus pneumoniae. It retains class activity against Gram‐negative bacteria. Currently available for oral use, it has a prolonged half‐life, enabling once‐daily administration and reflecting balanced renal and hepatic elimination. Clinical trials have demonstrated an excellent safety record with minor class effects in the skin and gastrointestinal systems. Potential for phototoxicity is minimal and moxifloxacin is free of clinically significant neurological, hepatic or cardiac effects. Investigated primarily in respiratory infections, moxifloxacin has shown excellent performance in community‐acquired pneumonia (both pneumococcal and atypical), acute exacerbations of chronic bronchitis and acute maxillary sinusitis. It is available in many European countries and in the US where it is rapidly establishing clinical acceptance and formulary inclusion. (Int J Clin Pract 2000; 54(5): 329‐332)
BISOPROLOL ALONE AND IN COMBINATION WITH AMLODIPINE OR NIFEDIPINE IN THE TREATMENT OF CHRONIC STABLE ANGINA
Authors: Ferguson JD , Ormerod O , Lenox‐Smith AJ
Published: April 2023

Beta‐blockers and calcium antagonists are both effective monotherapy for stable angina. When symptoms persist, these two agents are commonly co‐prescribed in the hope that this combination has added benefit compared with monotherapy alone. We investigated the additional efficacy of the calcium antagonists amlodipine and nifedipine when added to bisoprolol in patients with stable angina. Patients were randomised in a multicentre, single‐blind study, with crossover of three treatments consisting of bisoprolol 10 mg once daily, bisoprolol plus nifedipine 20 mg twice daily, and bisoprolol plus amlodipine 5 mg once daily. Exercise tests were performed at the end of each four‐week study period and the exercise time to onset of angina was assessed. A total of 198 patients from 17 centres were recruited of whom 147 were evaluable for efficacy. There were no statistically significant differences in exercise duration to onset of angina between any of the groups. The combination of bisoprolol plus nifedipine was least well tolerated. In summary, this study suggests there is little benefit in adding a calcium antagonist to bisoprolol in treating patients with stable angina. (Int J Clin Pract 2000; 54(6): 360‐363)
ACUTE SPONTANEOUS HAEMATOMA OF THE RECTUM
Authors: Babu ED , Axisa B , Taghizadeh AK , Delicata RJ
Published: April 2023

Gastrointestinal haematomata occur usually in the small intestine and may be secondary to anticoagulation. Spontaneous intramural haematoma of the rectum is rare. We report such a case which presented as acute abdominal pain and which was treated by simple drainage.
EXTRAFINE BECLOMETHASONE DIPROPIONATE BREATH‐ACTUATED INHALER (400 μG/DAY) VERSUS BUDESONIDE DRY POWDER INHALER (800 μG/DAY) IN ASTHMA
Authors: Reichel W , Dahl R , Ringdal N , Zetterstrom O , Van Den Elshout EJJ , Laitinen LA
Published: April 2023

Hydrofluoroalkane‐134a beclomethasone dipropionate extrafine aerosol breath‐actuated inhaler (Qvar™ Autohaler™; BDP‐AH) provides an alternative to chlorofluorocarbon metered dose inhalers or dry powder inhalers (DPIs). The aim of this six‐week, open‐label study was to determine whether BDP‐AH demonstrates equivalent asthma control to twice the dose of budesonide (BUD)‐DPI (Pulmicort Turbuhaler®). Adults with symptomatic asthma inadequately controlled on BUD‐DPI 400 μg/day and β‐agonist were enrolled. Patients (n=193) were randomised to receive 400 μg/day BDP‐AH (n=98) (two puffs of 100 μg/actuation inhaler twice daily) or 800 μg/day BUD‐DPI (n=95) (two puffs of 200 μg/actuation inhaler twice daily). Both groups showed a statistically significant change from baseline in morning (a.m.) peak expiratory flow (PEF) at weeks 5–6 (p<0.01), indicating study treatment improved a.m. PEF over prestudy 400 μg/day BUD. Changes from baseline in a.m. PEF at weeks 5–6 were 15.9 l/min for BDP‐AH and 14.2 l/min for BUD‐DPI; the groups were statistically equivalent (90% Cl ‐7.02–10.44; p<‐0.001 [equivalence=within ± 25 l/min]). Other efficacy assessments (evening PEF, FEV1, asthma symptoms, β‐agonist use) confirmed the treatments were clinically equivalent. Thirty‐nine (40%) patients on BDP‐AH and 35 (37%) on BUD‐DPI experienced at least one adverse event (p=0.767). Four (4%) patients on BDP‐AH and 3 (3%) on BUD‐DPI reported increased asthma symptoms. BDP‐AH at half the daily dose provided equivalent asthma control to BUD‐DPI; both treatments were well tolerated.
DRUGS FOR TREATMENT OF ALZHEIMER'S DISEASE
Authors: Wilkinson D
Published: April 2023

Alzheimer's disease is already an international problem of enormous significance, with an estimated 500,000 sufferers in the UK alone. There are currently four licensed compounds available for the symptomatic treatment of mild to moderate Alzheimer's disease, yet there is still considerable debate over their effectiveness. A variety of anti‐dementia agents affecting the various aspects of the disease are in development and the debate will continue over the potential rationing of such treatments in the future. Drugs developed from the cholinergic and glutamatergic hypotheses will be discussed, and a number of other potential treatments aimed at reducing the oxidative stress and inflammatory response associated with dementia will be reviewed. The arrival of these new treatments for Alzheimer's disease has focused attention on the management of dementia in general and has provided the catalyst for the widespread development of memory clinics to enable proper assessment of patients with dementing disorders, providing hope for both patients and carers.
‘ALWAYS CHEW YOUR CHILLIES’: A REPORT OF SMALL BOWEL OBSTRUCTION WITH PERFORATION
Authors: Rajaratnam SS , Boyle N , Owen WJ
Published: April 2023

We report an unusual case of small bowel obstruction and localised ileal perforation caused by an undigested green chilli in a 43‐year‐old man presenting in accident and emergency.
MULTIPLE ANEURYSMS ASSOCIATED WITH CONGENITAL RUBELLA
Authors: Rocker MD , Bond SE , McGuinness CL , Taylor PR
Published: April 2023

We describe the case of a woman with congenital rubella who presented with backache. Plain abdominal X‐ray revealed calcification of a superior mesenteric artery aneurysm. Intra‐arterial digital subtraction angiography demonstrated multiple aneurysms of the arteries to the upper and lower limbs and the viscera. We have not found another report in the literature of the association of congenital rubella with multiple aneurysms.
COMPARISON OF CLINICAL CHARACTERISTICS AND HIGH‐RISK FACTORS IN AUSTRALIAN ABORIGINAL AND NON‐ABORIGINAL NEONATES WITH NECROTISING ENTEROCOLITIS
Authors: Kadalraja R , Patole SK , Muller R , Whitehall JS
Published: April 2023

In a five‐year retrospective data analysis, incidence of >stage II necrotising enterocolitis (NEC) was four times higher in aboriginal (18/125) than non‐aboriginal (11/306) neonates, all ≤32 weeks' gestation. Stage III NEC occurred more frequently (10/18 vs 3/11) and related mortality was higher (44.4% vs 0%) in aboriginal than non‐aboriginal neonates. Risk factors for NEC‐prolonged rupture of membranes (50% vs 9.1%, p=0.01), prematurity (median [range] gestational age: 25 (24–28.5) vs 30 [27–33]) weeks, p=0.02), birth weight (<1 kg 13 [72%] vs 2 [18%], p=0.007) and intrauterine growth retardation (50% vs 0%, p=0.01) occurred more frequently in aboriginal neonates. Though feed type and increments per day were similar, aboriginal neonates received higher volume of feeds/kg/day (median [range]: 154 [145–189] vs 106 [103–134] ml, p< 0.05). Condition at delivery and respiratory status before development of NEC were not significantly different.
AN UNUSUAL PRESENTATION OF THYROGLOSSAL DUCT CYST
Authors: Babu E Dinakara , Harrison L , Ahmed N , Ramus NI
Published: April 2023

Thyroglossal duct cyst usually presents as a painless swelling in the mid‐line of the neck. This is the first documented case of an acute presentation of hoarseness and multi‐loculated swelling. It also contrasts the limitations of ultrasonography with the accuracy of magnetic resonance imaging in such atypical swellings.