bluuebunny/crossref_metadata_2025 huggingface dataset:
Thyroid Function Screening of Psychiatric Inpatient Admissions: A Worthwhile Procedure?
Authors: Bannister P , Mortimer A , Shapiro L , Simms A C P
Published: March 2018

A thyroid function screening programme of admissions to a general psychiatric service was established. Over a 22-week period 588 patients were admitted and thyroid function tests were performed on 336, a screening rate of 57.1%. Initial investigation showed that 21.3% had a total thyroxine outside the range 75–130 nmol/l. On further investigation only 9 patients (1 thyrotoxic, 8 hypothyroid) had confirmed thyroid disease. In 7 of the 9 patients the disease had been clinically suspected. Thus the screening programme identified only 2 unsuspected cases of thyroid dysfunction and we conclude that this level of detection does not warrant a formal screening programme.
Management of Acute Lower Gastrointestinal Haemorrhage in a Surgical Unit Over a 4-Year Period
Authors: Farrands P A , Taylor I
Published: March 2018

Over a 4-year period 107 patients, 5% of all emergency admissions, were admitted to one surgical unit with significant lower gastrointestinal haemorrhage (requiring more than a 2-unit transfusion of blood). Twenty-three individuals required more than 3 units of blood, and 7 life-saving surgery. All subjects undergoing surgery required more than 3 units of blood in the first 24 hours of admission. Arteriography was diagnostic in 5 of the 9 subjects in whom it was performed. Arteriography was positive if performed in the first 24 hours of admission. A flow chart of the management of patients with lower gastrointestinal haemorrhage is presented.
Practical Appraisal of a New Rating Scale (MRSS) for Rehabilitation
Authors: Khoosal D I , Oswald A G , Smith R J
Published: March 2018

Rating scales are available to assess patients undergoing rehabilitation for chronic psychiatric disorders. Few are universally acceptable because of pitfalls in their structure or administration. This study examines the recently printed Morningside Rehabilitation Status Scale in one rehabilitation network. The MRSS was found to be suitable in discriminating between severely and moderately disabled groups but not between mildly and moderately disabled groups.
Effectiveness of Amantadine in Reducing Relapses in Multiple Sclerosis
Authors: Plaut G S
Published: March 2018

Fifty-three patients with multiple sclerosis were assessed in a double-blind multicentre study for the effect of amantadine. The patients were observed in general practices for up to four years. Relapses occurred in 5 of the 24 patients treated with amantadine and in 14 of the 29 placebo-treated patients. Neurological deterioration was not significantly different in the two groups.
Changing Ethnic and Social Characteristics of Patients Admitted for Self-Poisoning in West London during 1971/2 and 1983/4
Authors: Lockhart S P , Baron J H
Published: March 2018

The characteristics of adult patients admitted for self-poisoning to an inner London district general hospital were examined during 1971/72 and 1983/84. The incidence of self-poisoning halved over the 12 years, from 326 to 178 per 100 000. Although no West Indians were admitted in the first period, they comprised 7% of such admissions 12 years later. The West Indian population in the catchment area remained constant at around 6%. Amongst all patients admitted for self-poisoning, there was a fall in the number of patients diagnosed as depressed, having a personality disorder or admitting to prior psychiatric care, but an increase in alcoholism. Paracetamol became more common as a drug used in self-poisoning and barbiturates were taken less often. Only one patient died in the series. These results should stimulate more soundly based epidemiological studies on ethnic variation in self-poisoning, and on self-injury in inner-city areas.
Maintenance Therapy with Unprocessed Bran in the Prevention of Acute Anal Fissure Recurrence
Authors: Jensen S L
Published: March 2018

The effect of unprocessed bran in a dose of 5 g three times daily and a dose of 2.5 g three times daily for one year on the recurrence rate of anal fissures was studied in a double-blind, placebo-controlled trial in 90 patients with recently healed acute posterior anal fissures. Fifteen patients (16.6%) were withdrawn before the code was broken due to failure to follow the trial protocol for various reasons. Significantly fewer recurrences occurred in patients receiving bran 5 g throe times daily (recurrence rate 16%, 95% confidence limits, 4.54 to 36.08) when compared with patients receiving bran 2.5 g three times daily (60%; 38.67 to 78.87) ( P<0.01) and with patients receiving placebo three times daily (68%; 46.50 to 85.05) ( P<0.01). No significant difference in recurrences was found between patients on bran 2.5 g and those on placebo.
Outpatient Fibreoptic Nasolaryngoscopy and Videostroboscopy
Authors: Weir Neil , Bassett Isobel
Published: March 2018

A description of the uses and advantages of fibreoptic nasolaryngoscopy is given together with the applications of videostroboscopy.
Building or Extending a Hospital Department: Radiology a Path through the Planning Minefield (5)
Authors: Roebuck E J , Manton D J , Fordham G L
Published: March 2018

This is the fifth of a series of articles on the planning and building of a new radiology department or the extension of an old one. While the series focuses on a radiology department, it will be of interest to anyone who is planning any part of a hospital, particularly in the detailed information about the planning process and the part to be played by hospital staff during the subsequent building and commissioning.
Tunnel Vision Presenting as Reading Disability
Authors: Leary P M , Van Selm J L
Published: March 2018

Concentric contraction of visual fields is an unusual finding in paediatric practice, and is most commonly psychogenic in origin1. We report 2 cases in which a reading problem was the presenting feature.
Passive Smoking, Potential Atopy and Asthma in the First Five Years
Authors: Kershaw C R
Published: March 2018

Evidence of prolonged exposure to cigarette smoke was sought in a group of 86 children aged five years and under with moderately severe asthma, and in 1199 infants from a mixed background population of Armed Service and civilian families. Asthmatics with a normal serum IgE (less than +1 s.d. for age) made up almost half of the cases and, compared with those with an elevated serum IgE (+1 s.d. for age or more), a greater proportion were male, had experienced prolonged exposure to cigarette smoke, were from Service families and already had fixed chest deformity. It is suggested that, in addition to facilitating the expression of asthma in young potential atopics, passive smoking may be an important contributory cause of the more severe disease reported in the socalled ‘intrinsic’ group. Perhaps the burden of illness and the extent of exposure noted in this survey will prompt renewed efforts to be made to discourage smoking in families, particularly two years before and for at least five years after the birth of a child.
Survival from Cardiac Arrest in the Accident and Emergency Department
Authors: Cope A R , Quinton D N , Dove A F , Sloan J P , Dave S H
Published: March 2018

One hundred consecutive patients who were treated in an Accident and Emergency Department for ‘cardiac arrest’ were studied prospectively. Of these 30% had arrested within the community, 21% in transit and 49% in hospital. The immediate outcome was that 40 left the A&E Department alive; of these, 13 left hospital alive. The ‘survivors’ included 3 cases of documented asystole. Patients who were over the age of 65, who arrested out of hospital and at night, were found to have a poor prognosis. The time between arrest and arrival of the ambulance was found to affect outcome. Patients with ventricular fibrillation had the best prognosis and those with electromechanical dissociation the worst.
Familial Dysalbuminaemic Hyperthyroxinaemia and Other Causes of Euthyroid Hyperthyroxinaemia
Authors: Farror C , Wellby M L , Beng C
Published: March 2018

Clinical and biochemical studies on a family in which 3 members have familial dysalbuminaemic hyperthyroxinaemia (FDH) are presented. They were clinically euthyroid with elevated serum thyroxine (T4) and free T4 indices but normal free T4 by equilibrium dialysis and normal serum triiodothyronine (total and free). All thyroid function tests on the remaining family members were normal. The inheritance is consistent with autosomal dominance. Also presented are data on 4 unrelated patients with FDH and two patients with T4 autoantibodies.

The methods for detecting FDH, T4 antibodies and other causes of euthyroid hyperthyroxinaemia are now freely available. Since these anomalies may be more common than previously supposed, clinical awareness of the conditions is necessary to protect patients from the consequences of incorrect diagnosis of thyrotoxicosis.
How does Bladder Function Change in the Early Period after Surgical Alteration in Outflow Resistance?: Preliminary Communication
Authors: Coptcoat M J , Shah P J R , Cumming J , Charig C , Worth P H L
Published: March 2018

A decrease in voiding pressures because of decreased outflow resistance has been demonstrated in 8 males, and conversely an increase in voiding pressures because of increased outflow resistance has been demonstrated in 7 females undergoing surgery. These changes occur in the early postoperative period.
The Treatment of Overuse Syndrome in Musicians. Results in 175 Patients
Authors: Fry H J H
Published: March 2018

Overuse syndrome, a condition of pain and loss of function in muscle groups and ligaments through excessive use, is common in musicians. In this series, the less serious cases of the disorder have been successfully treated by a modification of physical activity while allowing the musician to continue to play. The more serious cases were treated by a radical rest programme, first described last century, usually up to 12 months, until the patient is pain free and the muscles and ligaments are no longer tender. Performance is then very gradually resumed. The criterion for total success is a return to music performance free of pain with sustainable practice habits.
Modulating the Oxygen Tension in Tumours by Hypothermia and Hyperbaric Oxygen
Authors: Nias A H W , Perry P M , Photiou A R
Published: March 2018

Hypothermia is associated with reduced metabolism of tissues and especially reduced oxygen consumption by tumours. If the blood supply to a hypothermic tumour can be maintained then the hypoxic fraction of cells should be reduced and the radiation response increased. This hypothesis has been tested with radiation under hyperbaric oxygen and increased tumour response has been demonstrated.
Primary Non-Hodgkin's Lymphoma of the Orbit
Authors: Makepeace A R , Fermont D C , Bennett M H
Published: March 2018

Between 1954 and 1980, 9 patients with non-Hodgkin's lymphoma of the orbit were treated at the Regional Radiotherapy Centre, Mount Vernon Hospital. Following radiotherapy complete local regression of the tumour was seen in every case. Three patients subsequently developed recurrent disease which proved fatal in two cases. The overall 5 year survival was 89%.
Neuro-Otological Findings in Normal Children
Authors: Kenyon G S
Published: March 2018

The findings of a neuro-otological evaluation of 100 normal school children and 21 adults are presented. The results show changes in the vestibulo-ocular reflex with age which are of importance in the interpretation of future tests. They also give a fascinating insight into the maturation processes taking place in the growing child.
Postviral Syndrome-How can a Diagnosis be Made? A Study of Patients Undergoing a Monospot Test
Authors: Bowman S J , Brostoff J , Newman S , Mowbray J F
Published: March 2018

Eighty-nine of 150 patients having a Monospot test filled out a questionnaire about their illness, and the General Health Questionnaire. They completed a follow-up questionnaire 6 months later. Twelve (8%) had a positive Monospot. Twenty-eight of 83 serum samples tested (34%) were positive for VP1 enteroviral antigen. Forty of the patients had a self limiting illness, 13 had a definite diagnosis (excepting glandular fever), 14 had a possible postviral syndrome, 10 had recurrent sore throats/flu, and 12 had a chronic non-specific illness. Patients with a specific diagnosis were less likely to complain of aching muscles/joints, sore throat, tiredness or loss of concentration. Their GHQ scores were lower, although this just failed to reach significance (P=0.08), and they scored significantly lower on the somatic symptoms subscale (P=0.022). Overall 72% scored above the GHQ threshold for ‘psychological caseness’ which is higher than in other studies. Sixty-five per cent of the sample questioned at 6 months felt that their illness started with a viral infection. The methodological problems involved in making a diagnosis of postviral syndrome are discussed.
Metabolic Effects of Prostatectomy
Authors: Hamilton Stewart P A , Barlow I M
Published: March 2018

Transurethral resection syndrome (TURS), complicating transurethral resection of the prostate (TURP) has been ascribed to hyponatraemia but reports have indicated that hyperammonaemia following metabolism of glycine can be the main cause.

Prospective data has been collected on 96 prostatectomy patients (82 TURP and 14 retropubic). The retropubic group showed no significant postoperative change in the serum sodium or plasma ammonia. Of the TURP group, no TURS occurred although hyponatraemia was noted in 32 patients. The weight of prostate resected, the volume of glycine used, the time taken and the plasma ammonia levels were not significantly different in the normonatraemic or hyponatraemic groups.

In severely hyponatraemic patients (13 out of 32 with a 10mmol/l, or greater, decrease in serum sodium) there was a significant rise (P≤0.05) in plasma ammonia, 1 or 4 h post TURP, which had decreased by 24 h.

There was a highly significant increase in serum glycine level in the hyponatraemic compared with the normonatraemic group (P≤0.001).

There was no correlation between serum glycine and plasma ammonia levels in the normonatraemic or hyponatraemic group.

There were nine patients with post TURP plasma ammonia levels ≥ 100 μmol/l (mean 254) who experienced no mental confusion: six of these patients were hyponatraemic. The weight of prostrate resected (mean 26 g), volume of glycine used (mean 181) and operation time (mean 39 min) were all relatively low.

Subsequently, TURS has occurred in a patient, with severe hyponatraemia and hyperglycinaemia but no hyperammonaemia. This study shows that hyperammonaemia does not always correlate with hyponatraemia or hyperglycinaemia, and high plasma ammonia levels can occur in the absence of TURS.
Significance of Buerger's Test in the Assessment of Lower Limb Ischaemia
Authors: Insall R L , Davies R J , Prout W G
Published: March 2018

In claudicante with arteriosclerosis obliterans admitted for vascular surgery, Buerger's test was compared with other indicators of lower limb ischaemia. Rest pain, gangrene, trophic changes, and chronic erythro-melia were significantly commoner and more distal pulses were absent in Buerger positive limbs. Doppler and transcutaneous oxygen pressures and indices were significantly lower in Buerger positive legs. Significantly more occlusions were noted on arteriography in arteries distal to the adductor hiatus in the Buerger positive group.

Buerger's test is a useful adjunct to routine peripheral vascular assessment and, if positive, suggests more severe ischaemia with distal limb artery involvement.
Problems of Adolescents Sexuality
Authors: Whatley J , Thin N , Reynolds B , Blackwell A
Published: March 2018

Recent discussions highlighted adolescents’ sexual behaviour, but published studies concentrate on specific problems or subgroups of patients without addressing factors related to sexuality. To obtain a broad picture we studied two groups of adolescents attending genito-urinary medicine/sexually transmitted disease (STD) clinics in contrasting areas of Britain, inner London and Swansea. These were evaluated for referral pattern, sexual partner, contraception, obstetric history, sexually transmitted disease, and cervical cytology findings.

Over half the adolescents referred themselves but few doctors other than general practitioners referred patients. Sexual partners were regarded by males as casual but by females as regular. Only 66% (81) of females practised contraception. Adolescents had more STD's than the total clinic population except for genital herpes simplex infection, and a high prevalence of genital warts in females has important future implications.

The main conclusions were that there is a need for sexually related education targetted at adolescents and their health care providers, especially doctors.
Acceptability of Day Care Surgery
Authors: Senapati A , Young A E
Published: March 2018

Although day case surgery is recommended, its widespread feasibility in an urban environment is unclear. We studied 100 consecutive unselected patients admitted for surgical procedures considered to be suitable for day case surgery. Their age, fitness and social details were recorded and they were asked both before surgery and after discharge by a postal questionnaire, whether they would have preferred treatment as an outpatient.

There were 47 men and 53 women with a mean age of 42.5 years. Ninety-six were considered to be medically fit for day case surgery but 10 patients lived alone, seven had no suitable companion, 22 had too many stairs to climb, 13 lived too far from the hospital and two could not provide a lift home. Thus 58 of the patients were unsuitable for day case surgery. Seventy-eight of the patients replied to the postal questionnaire. Before the operation 51 patients preferred the idea of day care but only 14 felt the same way afterwards. The single postoperative complication was one case of acute retention after a hernia repair.

In our experience, over half the patients initially deemed suitable for day case surgery would be unsuitable.
Preliminary observations on clotting under three hydrocolloid dressings
Authors: Mulder G D , Walker A
Published: March 2018

Four patients with five wounds were randomly assigned to treatment with three occlusive dressings: DuoDERM®, Restore® and Comfeel Ulcus®; the dressings were left intact for 24-48 h.

When the dressings were removed, it was found that wounds that had been covered with Restore and Comfeel contained coagulated sanguinous material. Two wounds that had been covered with Comfeel and Restore, respectively, were then covered with DuoDERM, while one wound previously covered with DuoDERM was covered with Restore. Either no clotting occurred under DuoDERM or clots may have resolved.

Although these preliminary data suggest that DuoDERM gel may have fibrinolytic properties, more extensive and controlled studies are needed to assess the characteristics of this dressing.
Effect of Perilesional Injection of α-interferon on Cervical Intraepithelial Neoplasia and Associated Human Papillomavirus Infection
Authors: Dunham A M , McCartney J C , McCance D J , Taylor R W
Published: March 2018

In this controlled prospective study, 14 patients with cervical intraepithelial neoplasia (CIN) were observed for one month to exclude spontaneous regression, and then seven patients were treated twice-weekly with perilesional injections of α-interferon. Both groups were monitored colposcopically, and advised to use the contraceptive sheath. Cervical smears and biopsies for histology and viral studies were taken before and after the study.

There was an improvement of six out of seven of the study group, with two complete cures. Koilocytosis disappeared if it had been present initially, as did human papillomavirus (HPV) 16. By contrast, three control cases showed improvement, but there were no cures, and one case deteriorated; Koilocytosis (2 cases) did not change; HPV 16 disappeared in two controls and appeared in one.

A new focus of dysplasia appeared in a part of the transformation zone not being treated with α-interferon in one of the study cases, illustrating the advisability of treating the whole transformation zone in CIN.
Anorexia Nervosa Associated with Acromegaloid Features, Onset of Acrocyanosis and Raynaud's Phenomenon and Worsening of Chilblains
Authors: Rustin M H A , Foreman J C , Dowd P M
Published: March 2018

Patients with anorexia nervosa may develop many physical and endocrinological complications. We wish to report two patients who developed soft tissue swelling of their hands and worsening of their peripheral vascular disease, evidenced by the appearance of acrocyanosis and Raynaud's phenomenon and more severe perniosis, following the onset of their anorexia nervosa.
The Economics of Cardiac Failure
Authors: Kleber F X
Published: March 2018

Quality assurance and inclusion of prospective evaluation of costs of treatment in phase 3 and 4 pharmaceutical trials are becoming increasingly important. Not only high technology applications have to be investigated, but also relatively cheap but very common strategies for diagnostic work up and therapy. This may yield major savings. We are at the beginning of an era in which waste of resources may be reduced by scientific analysis with improvement in patient care and teaching achieved as a result.
The Earliest known Case of a Lithopaedion
Authors: Bondeson Jan
Published: March 2018

A lithopaedion, or stone-child, is a dead fetus, usually the result of a primary or secondary abdominal pregnancy, that has been retained by the mother and subsequently calcified. This paper describes the earliest known case of this phenomenon. It was discovered in 1582, at the autopsy of a 68-year-old woman in the French city of Sens, and described in a thesis by the physician Jean d'Ailleboust. The woman had carried her lithopaedion for 28 years. In this historical vignette, the lithopaedion of Sens is compared to later instances of this phenomenon. The ultimate fate of the lithopaedion specimen, which was widely traded throughout Europe in the 1600s before finally ending up in Copenhagen, is traced.
Bladder Exstrophy from Childhood into Adult Life
Authors: Ben-Chaim Jacob , Docimo Steven G , Jeffs Robert D , Gearhart John P
Published: March 2018

Exstrophy of the bladder is rare and the incidence of bladder exstrophy is calculated to be from 1 per 30 000 to 50 000 live births with male to female ratio ranging from 1.5-5 to 1 1-4 It was found that persistence or overgrowth of the cloacal membrane on the lower anterior abdominal area, prevents normal mesenchymal ingrowth. This causes divergence of the lower abdominal muscular structures and forces the genital ridges to fuse caudal to the cloacal membrane. The stage of ingrowth of the urorectal septum at the time of rupture determines whether one will produce an exstrophic urinary tract alone (classic bladder exstrophy or epispadias) or cloacal exstrophy with the hindgut interposed between the hemibladders5,6.
Notes for Contributors
Authors: Swales J D
Published: March 2018

The Journal of the Royal Society of Medicine, which offers a large international circulation, invites original reports and reviews relevant to any field of medicine. It publishes laboratory and clinical studies, papers on public health issues, epidemiology, health economics, medical history and ethics. All such submissions are subjected to peer review and revision may be required before acceptance.
Aggression against Doctors: A Review
Authors: Hobbs F D Richard , Keane Ursula M
Published: March 2018

Although the number of doctors abused is comparatively small, the perceived risk of violence presents a major issue for the whole profession since the consequences extend to all doctors through the intimidation reports in the medical press and newspapers engender.
Characteristics of Referrals to an Inpatient Hospice and a Survey of General Practitioner Perceptions of Palliative Care
Authors: Seamark David A , Lawrence Clive , Gilbert James
Published: March 2018

In order to determine symptoms, drug prescribing and physical problems of patients referred to an inpatient hospice, case notes from 130 consecutive first admissions (95 general practitioner (GP) referrals, 35 consultant referrals) were analysed. GP referrals were more likely to be constipated, require care and be discharged to home. Consultant referrals were more gravely ill, dependent and more likely to die in the hospice. On admission 76 (58%) patients were receiving opiates with co-prescription of opiate and laxative occurring in 41 % (31/76) of the cases. The prescription of laxatives with the symptoms of constipation occurred in 62% (26/42) of the cases on admission. A telephone survey of 79 referring GPs revealed that 37% had attended neither a course nor a lecture relevant to palliative care in the past 3 years. GPs experienced difficulties frequently or always in: (a) managing pain (8/79); (b) managing other symptoms (25/79); (c) helping patients and relatives cope with their emotional distress (18/79); and (d) coping with their own emotional responses to death and dying (5/79).

In conclusion, the differences demonstrated between the GP and consultant referrals have implications for purchasers. The high incidence of possible opiate-induced side-effects and the difficulties with symptom control expressed by some GPs indicate a continuing need for effective educational input.
Ought Low Alcohol Intake to be Promoted for Health Reasons?
Authors: Holman C D J , English D R
Published: March 2018

There is increasingly widespread acceptance that alcohol taken in moderation by the population aged 35 years or older reduces the risks of ischaemic heart disease and all-cause mortality. Ten causal criteria are used to evaluate the scientific evidence for a protective effect of low alcohol intake on ischaemic heart disease. Inferences for public policy are then assessed using the principles of beneficence, non-maleficence, justice and autonomy to support a framework of nine ethical considerations: intervention versus causation; effect modification by gender, smoking, biogenetic and other factors; inappropriate adoption of recommendations; competing hazards between atherosclerotic disease and cancer; opportunity cost; equity of access; the value system used to judge outcomes; the degree of social influence warranted; and consent and responsibility. We conclude that in the absence of more adequate scientific knowledge and informed community debate it is unethical to promote low alcohol intake as a preventive health measure.
Three Simple Methods of Detecting Malnutrition on Medical Wards
Authors: Nightingale J M D , Walsh N , Bullock M E , Wicks A C
Published: March 2018

Malnutrition in hospital is often unrecognized. A nutrition team aims to teach simple methods of detecting malnutrition. On a single day all medical in-patients underwent a nutritional assessment. Eighty-four patients (43 men), median age 71 years (range 28–97), were assessed. The most common diagnoses were cardiac disease (26), stroke/dementia (12), non-malignant lung disease (9) and malignancy (6). A weight loss of more than 10% (%WL) was found in 17/65 (26%) and a body mass index (BMI) of less than 19kg/m2 in 13/69 (19%). A mid-arm muscle circumference (MAMC) less than the fifth percentile occurred in 16/83 (19%) patients. Percentage weight loss alone detected seven patients of whom four were overweight (BMI > 25 kg/m2), BMI alone detected three patients, and MAMC alone eight patients of whom three could not be weighed and three had fluid retention. There was fluid retention in 35/84 (42%) patients of whom nine were malnourished (six detected by BMI and/or %WL, and three by MAMC alone). All three measurements were made in 64 patients, six (9%) of whom were detected as malnourished by all three methods.

Combining the three measurements 29/84 (35%) of patients were malnourished and only 28% of these patients had been assessed by a dietitian. BMI and %WL detect most patients but fluid retention may limit their accuracy. MAMC is useful in those who cannot be weighed or who have fluid retention.
Antenatal Diagnosis of Renal Tract Anomalies: Has it Increased the Sum of Human Happiness?
Authors: Malone P S J
Published: March 2018

When used as a screening procedure, ultrasound examination of the fetal urinary tract seldom leads to beneficial interventions. There is also a cost in terms of parental anxiety and unnecessary investigation and treatment. A formal screening programme would therefore be unjustified. However, screening of women for obstetric purposes will continue to reveal fetal abnormalities, and a strategy for dealing with these is needed. Antenatal treatments remain experimental; for most of the common conditions postnatal treatment has no urgency; and, in cases of minor abnormality detected by ultrasound, the best course may be to do nothing.
Uretric Obstruction in Gardener's Syndrome
Authors: Batstone R , Sharma S , Bickerstaff H , Persad R , Doyle P
Published: March 2018

Desmoid tumours in Gardener's syndrome are a rare cause of ureteric obstruction. We report two cases of ureteric obstruction caused by desmoids, in a mother and daughter.
Munchausen's Syndrome—Masquerading as Necrotizing Fasciitis
Authors: Park A J , Scerri G V
Published: March 2018

We would like to present a novel form of Munchausen's syndrome which presented us with a difficult problem in the midst of the recent media hysteria regarding flesh eating bacteria. This condition, first described by Richard Asher in 19511, is often very difficult to diagnose and it is not, therefore, surprising that the victims have been through several epsiodes of treatment before the suspicions of staff are raised. It owes its name to a fictitious character, Baron Karl Friedrich Hieronymus Freihess von Munchausen, who recounted extraordinary and wildly exaggerated exploits of adventure and daring, not unlike patients who present with this condition.

Our enquiries revealed that the laid down procedure when faced with a patient with this condition is that the regional medical officer (RMO) should be contacted. It is then his responsibility to contact other RMOs, who in turn pass the information on to accident and emergency consultants in their area.
High dose Chemotherapy for Breast Cancer: The Case for Trials in Adjuvant Therapy
Authors: Leonard R C F
Published: March 2018

Adjuvant polychemotherapy reduces the annual mortality for breast cancer, the effect being seen for at least the first decade after primary treatment for stage II disease. However, the overall benefit is modest with an annual reduction in the odds of death of the order of 20%–30%. For patients at standard or low risk of recurrence this appears to be an acceptable benefit given low toxicity of treatment. However, some patients have a very much worse prognosis identifiable on the basis of the number of involved axillary nodes at surgery. Patients with more than 10 lymph nodes, for example, have a predicted survival of less than 30% at 5 years and around 10% at 10 years.

High dose chemotherapy has shown immediate benefits in terms of complete response rates in advanced breast cancer. Potential benefits of this treatment could be even higher in the adjuvant setting given the patient's fitness and the fact that micrometastatic disease represents the best clinical analogue of the successful laboratory experimental conditions. Now that the safety factors appear to be favourable with a treatment-related mortality of less than 5% it would appear that stage II poor risk disease is an appropriate setting to test high dose chemotherapy against the best conventional therapy in randomized trials.
Notes for Contributors
Authors: Fox Robin , David Tim
Published: March 2018

The Journal of the Royal Society of Medicine, which offers a large international circulation, invites original reports and reviews relevant to any field of medicine. It publishes laboratory and clinical studies, papers on public health issues, epidemiology, health economics, medical history and ethics. All such submissions are subjected to peer review and revision may be required before acceptance.
Alcohol Abuse and Stage of HIV Disease in Intravenous Drug Abusers
Authors: Lake-Bakaar Gerond , Grimson Roger
Published: March 2018

Our objective was to identify factors that might correlate with human immunodeficiency virus (HIV) disease stage in intravenous drug abusers (IVDA). Particular attention was given to alcohol abuse. We accordingly explored in a cross-sectional study the relation between stage of HIV disease and age, sex, needle sharing, ethnicity, self-reported history of alcohol consumption and CAGE scores. IVDA from a single municipal hospital were subdivided into three groups according to HIV disease status. Group 1 comprised 42 individuals with AIDS; group 2 comprised 114 who were HIV positive but without AIDS; and group 3 comprised 52 who were HIV negative. Information on alcohol consumption and CAGE responses were obtained by questionnaire and interview.

Discriminant analysis indicated that alcohol abuse, assessed either by self-reported consumption or by CAGE scores, was significantly more common in the AIDS group than in either the HIV positive or the HIV negative groups, when controlled for age, sex, and needle sharing status. The relative risk of AIDS was 3.8 times higher in the heavy drinkers than in moderate drinkers. Needle sharing was also more common in the AIDS group than in the HIV positive or HIV negative groups when the other factors were controlled for. AIDS was more common in black than white IVDA, and this increased frequency did not appear related to alcohol consumption since the distribution of heavy drinkers within each category of HIV disease did not differ within the ethnic groups.

These data indicate that a history of heavy alcohol consumption is more common in IVDA with AIDS than in IVDA at earlier stages of HIV disease.
The D2 Dopamine Receptor Gene as a Determinant of Reward Deficiency Syndrome
Authors: Blum K , Sheridan P J , Wood R C , Braverman E R , Chen T J H , phd J G Cull , Comings D E
Published: March 2018

The dopaminergic system, and in particular the dopamine D2 receptor, has been profoundly implicated in reward mechanisms in the brain. Dysfunction of the D2 dopamine receptors leads to aberrant substance seeking behaviour (alcohol, drug, tobacco, and food) and other related behaviours (pathological gambling, Tourette's syndrome, and attention deficit hyperactivity disorder). We propose that variants of the D2 dopamine receptor gene are important common genetic determinants of the ‘reward deficiency syndrome’.
Cocaine-Associated Myocardial Infarction
Authors: Hollander Judd E
Published: March 2018

Myocardial ischaemia and infarction has become a well-recognized sequelae of cocaine use. The possibility of recent cocaine use should be assessed in patients with potential myocardial ischaemia because the treatment of patients with myocardial ischaemia related to cocaine differs from that of patients with myocardial ischaemia unrelated to cocaine. Patients with cocaine-associated myocardial ischaemia should receive initial treatment with benzodiazepines to decrease central adrenergic stimulation. Aspirin should be used to reduce thrombus formation, and nitroglycerin to reverse coronary vasoconstriction. Patients with continued ischaemia can be treated with either low doses of phentolamine, or verapamil. If ischaemia continues after treatment with these agents mechanical reperfusion or thrombolytic therapy should be considered depending upon the clinical circumstances. Patients with myocardial ischaemia secondary to cocaine should not receive treatment with beta adrenergic antagonists as these agents enhance coronary vasoconstriction thereby worsening ischaemia.
Endocrine Treatment of Cancer
Authors: Gulliford Tim , Epstein Richard J
Published: March 2018

Cancer has been treated by hormonal manipulation for over 100 years. Although therapeutic progress during this period has resulted mainly from clinical observation, more rational treatment approaches are now emerging from insights into the molecular basis of hormone-responsiveness. Among these are the recognition that hormonal signalling effects are transduced via specific receptor proteins, and the possibility that tumour lysis by hormonal therapies is effected by triggering of a programmed cell death pathway. Clinical progress has already been achieved through basic advances: receptor assays, for example, now permit prediction of treatment benefit in various settings. However, much remains to be learned about the mechanism and application of hormonal anticancer treatments.
Self-Expanding Stents for Malignant Dysphagia
Authors: Clements W D B , Johnston L R , Mrcrad E Mcllwrath , Spence R A J , McGuigan J
Published: March 2018

Self-expanding metallic stents have been employed successfully for vascular, urethral, and biliary strictures. In a prospective study we examined the efficacy of the 16 mm Wallstent for palliation of malignant dysphagia.

Eight patients with severe dysphagia due to advanced primary (four) or secondary (four) oesophageal malignant disease were recruited and nine Wallstents were inserted (one patient required two). Dysphagia was reduced in all but one patient, who died after oesophageal perforation; a second patient had a self-limiting bout of haematemesis. Two patients required subsequent treatment for tumour ingrowth but five had no further palliative therapy from stent insertion to time of death.

With careful patient selection and skilful application, a 16 mm self-expanding metal endoprosthesis affords effective palliation in malignant oesophageal obstruction.
The identity and Work of the Ancient Egyptian Surgeon
Authors: Sullivan Richard
Published: March 2018

That a well-developed and hierarchical medical profession existed in Pharaonic Egypt is without doubt. What is a matter of contention is the existence of a recognizable surgical profession, or even of the practice of surgery by medically qualified personnel. Palaeoarchaeological specimens that demonstrate some form of surgical procedure are rare. Medical papyri and the treatises of the historians of antiquity provide a far more reliable source of information on surgical practice. They have indicated possible titles for surgeons, and the types of instruments used.
A Pseudo-Outbreak of Skin Disease in British Troops
Authors: Croft Ashley , Smith Harvey , Creamer Ian
Published: March 2018

When a newspaper report claimed that a serious outbreak of skin disease had occurred in British Army troops stationed at the Bočac Dam, in western Bosnia, all troops at the Bočac Dam location (n=96), followed by a matched control group of troops (n=91) at a nearby location, were examined by two investigators.

14% of the study population and 21% of the control group were found to have skin disorders. Most were complaints that are commonly encountered in general medical practice. There was a striking absence of skin infestations. The historical consultation rate for skin disorders had not increased. It was concluded that an outbreak of skin disease had not occurred in British troops guarding the dam.

This epidemiological study shows that, even under conditions of modern field hygiene, up to one in five soldiers will have skin disease. Skin infestations, however, have become progressively less common during military campaigns this century, probably because of better personal hygiene, good preventive medicine practices and better access to effective health care.
Development and Evaluation of a Novel Patient Information System
Authors: Wise Peter H , Pietroni Roger G , Bhatt Vikram B , Bond Catherine S , Hirst Stephen , Hooker Richard J
Published: March 2018

A comprehensive patient information datafile of 320 topics has been developed, subserving the domains of medicine, surgery, gynaecology and paediatrics. The system was designed as loose-leaf sheets capable of being photocopied, as well as a computer-based datafile. In a four-practice study, 73% of consecutive general practice attenders could be issued with the relevant disorder or procedure information sheet. With a questionnaire return rate of 79%, 886 patients rated the three criteria of readability, understandability and usefulness of their leaflets as very or quite easy and very or quite useful in more than 94% of instances. This system could be a valuable adjunct to patient education in both general and hospital practice settings.
Weekend versus Weekday Urine Collections in Assessment of Stone-Formers
Authors: Norman Richard W
Published: March 2018

Twenty-four-hour urine collections are an important part of the metabolic evaluation of stone-formers, but are difficult for patients at work. At weekends the results might be different. Forty-five stone-formers who worked at day jobs from Monday to Friday collected urine for 24 h on a normal working day and also on a Saturday or Sunday and the differences were evaluated. Average 24 h urine volume was higher on weekdays than at weekends. Calcium, oxalate, and uric acid excretion did not differ.

These results imply an increased risk of crystalluria at the weekend. Therefore weekend collections are most likely to show abnormalities and should be acceptable to clinicians.
The Changing Profile of Poisoning and its Management
Authors: MacNamara A F , Riyat M S , Quinton D N
Published: March 2018

To identify changes in treatment methods and types of drugs taken in overdoses over a 10-year period we conducted a retrospective study in the accident and emergency department of a large teaching hospital. The influence of a protocol to direct medical management was also studied. Results were compared with those of a 1984 survey at the same institution.

409 cases of accidental and deliberate poisoning were reviewed. In deliberate poisoning 52% of drugs taken were prescription drugs, 41.6% over-the-counter medications and the remaining 6.4% illicit drugs. Only 13% of patients had a stomach emptying procedure compared with 75.2% of patients in the previous survey. Charcoal was administered or offered in over 95% of cases.

Medical management of overdoses in this centre changed drastically over 10 years. A department protocol had been adhered to in the great majority of cases, and we recommend that all accident and emergency departments as well as medical and paediatric teams establish similar protocols. Over-the-counter drugs are increasingly troublesome, especially paracetamol, which accounts for 28.8% of drugs taken in deliberate overdose.
The Cholesterol-Raising Factor from Coffee Beans
Authors: Urgert R , Katan M B
Published: March 2018

Coffee beans and some types of coffee brew—not the regular types of coffee prepared with a paper filter or with soluble coffee granules—contain the diterpenes cafestol and kahweol. Cafestol and kahweol raise the serum concentration of cholesterol and triglycerides in humans, and they also appear mildly to affect the integrity of liver cells. Both effects are transient after withdrawal of the diterpenes, and it is as yet unsure whether these effects are associated. Patients at increased risk of heart disease who drink large amounts of coffee should be advised to select brews low in diterpenes.
Anticoagulation in venous Thrombosis
Authors: Schulman Sam
Published: March 2018

Major studies addressing various aspects of the treatment of deep vein thrombosis are reviewed. It has lately been demonstrated that heparin should be dosed according to body weight and is preferably given as subcutaneous injections twice daily. Alternatively, low-molecular-weight heparins may be given in a fixed dose once daily, which does not require monitoring. Oral anticoagulation should be started concomitantly with heparin and targeted at an international normalized ratio of 2.0-3.0. This treatment should continue for a longer duration than previously accepted, in many cases for 6 months. For patients with contraindications to oral anticoagulation, secondary prophylaxis with a low-molecular-weight heparin is also effective and safe.
Paediatric Rectal Prolapse in Rwanda
Authors: Chaloner EJ , Duckett J , Lewin J
Published: March 2018

During the 1994 crisis in Rwanda, a high incidence of full-thickness rectal prolapse was noted among the refugee children in the south-west of the country. The prolapses arose as a result of acute diarrhoeal illness superimposed on malnutrition and worm infestation. We used a modification of the Thiersch wire technique in 40 of these cases during two months working in a refugee camp. A catgut pursestring was tied around the anal margin under local, regional or general anaesthesia. This was effective in achieving short-term control of full-thickness prolapse until the underlying illness was corrected. Under the circumstances, no formal follow-up could be arranged; however, no complications were reported and only one patient presented with recurrence.
Evaluation of a Diabetes Prevention Program Lifestyle Intervention in Older Adults: A Randomized Controlled Study in Three Senior/Community Centers of Varying Socioeconomic Status
Authors: Kramer M. Kaye , Vanderwood Karl K. , Arena Vincent C. , Miller Rachel G. , Meehan Rebecca , Eaglehouse Yvonne L. , Schafer Gerald , Venditti Elizabeth M. , Kriska Andrea M.
Published: March 2018

Purpose

The purpose of this study is to evaluate the feasibility and effectiveness of an adapted Diabetes Prevention Program (DPP) lifestyle program, DPP Group Lifestyle Balance (GLB), delivered in 3 economically diverse senior/community centers.

Methods

The DPP-GLB was implemented in 3 senior/community centers in Allegheny County, PA. A 6-month delayed control intervention design was used. Participants were randomized to begin the DPP-GLB immediately (immediate) or after a 6-month delay (delayed). Adults (n = 134; mean age = 62.8 years) with BMI ≥24 kg/m2 and prediabetes and/or the metabolic syndrome took part. Weight, physical activity (PA), and diabetes and cardiovascular disease (CVD) risk factors were assessed at 6, 12, and 18 months from baseline.

Results

At 6 months, the immediate group demonstrated greater mean weight loss than the delayed control group as well as significantly greater improvements in PA, A1C, fasting insulin, and waist circumference. In pre-post analyses, both randomized groups showed similar success that was maintained at 18 months.

Conclusions

The DPP-GLB delivered in economically diverse community centers was effective in this group of older adults. These findings support provision of coverage for prevention programs in older adults at risk for diabetes/CVD, which is important considering the large number of individuals who will be Medicare eligible in the near future.
The nature and emotional valence of a prime influences the processing of emotional faces in adults and children
Authors: Conte Stefania , Brenna Viola , Ricciardelli Paola , Turati Chiara
Published: March 2018

A large body of research has investigated both the emotional elaboration of facial stimuli in adults and the development of children’s recognition of emotional expressions. Yet, it is still not clear whether children’s ability to recognize an emotional face may be modulated by prior exposure to a different face, and whether an emotional expression may exert an effect on the processing of subsequently encountered facial emotional expressions. We tested in three experiments the recognition of happy and angry target faces preceded by neutral faces or objects (Experiment 1) and happy or angry faces (Experiment 2A and Experiment 2B) using an affective priming task in adults and 7- and 5-year-old children. Results showed a standard prime effect for neutral faces (Experiment 1) for all participants, and for happy faces in children (Experiment 2A) and adults (Experiment 2B). Otherwise, angry faces elicited negative priming effects in all participants (Experiment 2A). Overall, our findings showed that both prior exposure to a face per se and the emotional valence of the prime face have an impact on subsequent processing of facial emotional information. Implications for emotional processing are discussed.