bluuebunny/crossref_metadata_2025 huggingface dataset:
A double‐blind placebo controlled study of terfenadine in the treatment of chronic idiopathic urticaria.
Authors: Salisbury J , Bor S , Blair C
Published: April 2023

A double‐blind randomised cross‐over comparison of terfenadine and placebo in the treatment of idiopathic urticaria is reported. Nineteen patients aged 12 years or more were admitted to the study after investigation had failed to reveal any precipitating causes for their urticaria. They were treated with terfenadine 60 mg bd or placebo bd for seven days, followed by a seven day wash‐out period and a further seven days of the opposite treatment. Patients kept daily diary cards recording degree of itch, number of wheals and size of wheals. Results show that terfenadine treatment relieved the symptoms of urticaria to a much greater degree than placebo, and that this was statistically of high significance. Patients were asked whether they preferred the first or second treatment method, and of the 12 who expressed a preference, 11 selected active treatment.

It is concluded that terfenadine is an effective treatment for chronic idiopathic urticaria.
Is oral cefuroxime axetil suitable for the treatment of unidentified bacterial infection of skin and soft tissue?
Authors: Gudgeon A C , Vandenburg M J , Wight L J , Griffiths G K , Kelsey M
Published: April 2023

Patients presenting to the general practitioner with a variety of skin and soft tissue infections thought to be bacterial in origin, were entered into a study to assess the safety and efficacy of a seven‐day course of oral cefuroxime axetil 250 mg bd for these conditions. Ninety‐seven patients entered the study, the majority of whom had cellulitis (31 per cent), abscesses (12 per cent) and wound infections (11 per cent).

All parameters improved during the study. The number of patients with local discharge decreased from 46 per cent to 16 per cent, the number with oedema from 80 per cent to 25 per cent, the number with pain from 92 per cent to 18 per cent and with ulceration from 21 per cent to 12 per cent. An overall clinical improvement occurred in 95 per cent of patients, independent of the condition being treated. Eleven patients had 22 adverse events, mild or moderate in severity. Eighty‐six per cent of patients were satisfied with the medication. It was concluded that cefuroxime axetil produced a very acceptable response in patients with skin and soft tissue infection.
Prevention of pressure sores. A comparison of new and old pressure sore treatments
Authors: Van Der Cammen Tjm , O'Callaghan U , Whitefield M
Published: April 2023

A new lotion, Prevasore™, was found to be effective in helping to reduce the incidence of pressure sores and was cosmetically acceptable to both patients and the nursing staff.
Hyperventilation with coincidental cardiac arrhythmias: a diagnostic pitfall in patients with presyncope
Authors: Wilkes N P , Chambers J B , Jackson G , Jewitt D E
Published: April 2023

Five patients with presyncope had cardiac arrhythmias which were at first assumed to be causative. Symptoms persisted despite antiarrhythmic therapy, including insertion of a permanent pacemaker system in one case. A further interview in each patient revealed symptoms suggesting hyperventilation. Monitoring of end‐tidal pCO2 confirmed unequivocal hypocapnia preceding a typical attack and not associated with rhythm change.

The symptoms of hyperventilation should be part of the routine history in any patient with presyncope.
Interparietal hernias: analysis of six cases with literature review
Authors: Etawo U S , Elechi E N
Published: April 2023

Six cases of interparietal hernia in five females and one male, age range 48–70 years, average 52 years, are presented together with a review of the literature.

Two of the cases had emergency surgical repair for strangulated hernia with one postoperative death. There were no deaths in the four patients who had elective hernia repairs.

The incidence of interparietal hernia in this study is 2.5 per cent with the interstitial variety accounting for 83 per cent of the cases. Each interparietal hernia resulted from a direct inguinal hernia. The differential strengths of the various layers of the anterior abdominal wall, the strongest being the aponeurosis of the external oblique muscle, are believed to be a factor causing the interstitial burrowing of these hernias.
Malnutrition in cirrhotic patients: anthropometric measurements as a method of assessing nutritional status
Authors: Loguercio C , Sava E , Marmo R , Blanco C Del Vecchio , Coltorti M
Published: April 2023

This study was undertaken to evaluate by anthropmetric measurements the nutritional status of cirrhotic patients at different stages of the disease and to establish intra‐ and inter‐observer variability in the determination of these parameters.

In 60 healthy controls and 108 cirrhotics (63 ‘well compensated’ and 45 ‘decompensated’; groups A and B+C on the Child‐Pugh classification respectively) two independent experienced observers measured biceps, triceps, subscapular and overiliac skinfold thicknesses and arm circumference three times. Each observer was unaware of the results obtained by the other.

No significant intra‐ or inter‐observer variability was found.

The study indicates that skinfold thickness measurements are a reliable and reproducible method of assessing the nutritional status of cirrhotics. It was found that more than 50 per cent of the decompensated patients were malnourished, with skinfold values significantly lower than those of the controls.

In comparison with skinfold thickness and arm circumference, parameters such as body weight and lean body mass are unreliable, and other indices such as muscle and/or fat arm area do not add any significant information to the evaluation of the nutritional status of cirrhotics.
Diphtheritic polyneuritis in an elderly woman: clinical and neurophysiological follow‐up
Authors: Roche S , Stone S , Allen CMC , Lange L S
Published: April 2023

A 71‐year‐old English lady initially presented with a bulbar paralysis and, six weeks later, developed a generalised sensori‐motor neuropathy. Corynebacterium diphtheriae mitis was cultured from her throat swab. Despite a good clinical recovery at one month, nerve conduction velocity was at its lowest. As far as the authors are aware, this is one of the few cases of neurophysiological and clinical follow‐up in a British subject with diphtheritic peripheral neuropathy. This case emphasises the importance of giving antitoxin early.
Haemophilus aphrophilus endocarditis
Authors: Webb C H , Hogg G M
Published: April 2023

We report a case of Haemophilus aphrophilus endocarditis involving mitral and tricupsid valves in a boy with congenital heart disease. He had received dental treatment without antibiotic cover. Prolonged high‐dose ampicillin with gentamicin was necessary for cure. Short courses of ampicillin alone may not successfully treat H. aphrophilus.
Granular cell tumour (myoblastoma): two cases and a review of the literature
Authors: Payne‐James J J , Watkins R M
Published: April 2023

Granular cell tumour is a rare neoplasm consisting of nests or ribbons of polyhedral cells with granular eosinophilic cytoplasm and small, dense nuclei. It may occur at various sites throughout the body. Two cases, one of the tongue and one of the rectum, are reported and the pathology and management of this uncommon neoplasm are discussed.
Acute appendicitis secondary to metastatic carcinoma of the breast
Authors: Maddox P R
Published: April 2023

A patient developing acute appendicitis and intestinal obstruction secondary to metastatic breast carcinoma is described. This rare occurrence may become more common with improved survival in cases of advanced breast malignancy.

The intrinsic nature of malignant metastases in the appendix, with or without concurrent immunosuppressive chemotherapy, leads to a late presentation of appendicitis with a high incidence of perforation, associated with an increased mortality and morbidity.

It is suggested that appendicectomy should be undertaken as a routine in patients with carcinoma of the breast when oophorectomy or laparotomy is to be performed.
HELICOBACTER PYLORI PREVALENCE IN A ROUTINE UPPER GASTROINTESTINAL ENDOSCOPY POPULATION
Authors: Sandikci M U , Doran F , Koksal F , Sandikci S , Uluhan R , Varinli S , Akan E
Published: April 2023

SUMMARY The presence of Helicobacter pylori (HP) in gastric biopsy specimens of 500 patients referred for routine upper gastrointestinal endoscopy for various abdominal complaints was investigated histologically and microbiologically. HP was detected in 429 of the 500 patients (86%). Antral biopsy specimens revealed gastritis in 457 out of 500 cases (91.4%). In the 43 patients who had normal histological findings, only 3 had HP infection (7%). The prevalence of HP in the patients with gastric and duodenal ulcers was 91%. In 95.6% of the ulcer patients, biopsy specimens showed gastritis. There was a statistically significant rise in the prevalence of HP with age. The correlation between histologic and microbiologic diagnostic methods was good. This study shows that HP positivity and gastritis are common in a routine endoscopy population and that there is a strong association between H. pylori, gastritis and peptic ulcer disease.
THYMOPENTIN PROPHYLACTIC TREATMENT IN PATIENTS WITH RECURRENT RESPIRATORY INFECTIONS
Authors: Sundal E
Published: April 2023

SUMMARY Present immunological methods do not regularly detect abnormalities in patients with chronic bronchitis, and no single parameter appears to be closely associated with the clinical findings. Of the many tests performed in the cited studies, the Merieux multitest procedure seems to offer the best findings in further studies, followed by determination of the OKT4/OKT8 ratio.The theoretical background for the use of an immunologic approach to prevent frequent recurrences of infections is discussed in depth, with particular emphasis on the pharmacologic efficacy profile of thymopentin. The safety of this drug is remarkably unproblematic.

The present survey of 11 clinical studies shows that thymopentin treatment reduces the incidence of recurrent respiratory tract infections. The most frequently used dosing regimen is 50 mg SC three times a week for 6 weeks, which may be repeated after 3–6 months. The clinical effect appears long‐lasting, ie, 3–4 months after discontinuation of treatment.
SURGICAL PRESENTATION OF TOXIC SHOCK SYNDROME
Authors: Goh D W , Drake D P , Cant A J
Published: April 2023

SUMMARY Three infants with clinical features of sepsis, hypovolaemia and an acute abdomen were referred to a paediatric surgical unit. Subsequent clinical signs of diffuse macular erythema followed by desquamation and isolation of Staphylococcus aureus from nasal or umbilical swabs led to a diagnosis of staphylococcal toxic shock syndrome. Surgical intervention was not indicated
PROBLEMS IN DIAGNOSIS AND MANAGEMENT OF HYPOVOLAEMIA IN SPINAL INJURY
Authors: Wilson R H , Whiteside M C R , Moorehead R J
Published: April 2023

SUMMARY Thoracic spinal cord injury can result in hypotension from loss of peripheral vascular tone. There may be problems in both diagnosis and management when this is combined with hypovolaemia from haemorrhage. A case is reported that illustrates these difficulties.
THE DIAGNOSTIC POTENTIAL OF SOME ROUTINE LABORATORY TESTS
Authors: Bjørnestad E , Lie RT , Janssen CW
Published: April 2023

SUMMARY The potential was tested of white blood cell count (WBC), haemoglobin concentration (Hb) and erythrocyte volume fraction (EVF) to differentiate between patients with acute mesenteric ischaemia (AMI), perforation of colon, perforation of peptic ulcer, and intestinal obstruction. The WBC in patients with AMI (18.95 ±6.88 103mr−3) was significantly above the normal range (upper cut‐off 11.0103ml−3; P<0.0001). Other variables in the patient groups did not differ from those of healthy individuals. All variables were, however, different between patients with AMI and non‐AMI (P<0.001). Receiver operator characteristic (ROC) curves were constructed to define the optimal cut‐off for each variable. Sensitivity and specificity of the variables were between 62% and 75%. Discriminant analysis of the variables classified 80% of the patients correctly into AMI and non‐AMI groups.
AUDIT OF PATIENTS' EXPERIENCES AFTER ENDOSCOPY OF THE UPPER ALIMENTARY TRACT
Authors: Meredith P , Quine A , Burridge SM , Bell GD
Published: April 2023

SUMMARY This study comprises an audit of the experiences of upper alimentary endoscopy by 400 patients examined in 15 hospitals. The patients were asked to complete a 19‐section questionnaire regarding their experience of the endoscopy before, during and after the procedure. The audit was carried out in order to evaluate the patients' understanding of the investigation and to determine the impact of the findings on the patients' level of anxiety. Of the 400 patients, 304 (76.0%) returned the questionnaire; overall satisfaction was revealed with the decision to proceed with endoscopy and with the procedure itself, as well as the reassurance provided by the investigation. The study thus supports the role of open‐access endoscopy.
RECENT ADVANCES IN THE UNDERSTANDING OF THE IMMUNOLOGICAL BASIS OF PERIPHERAL NEUROPATHIES
Authors: Larner AJ
Published: April 2023

SUMMARY This article briefly reviews some recent advances in the understanding of the immunological basis of peripheral neuropathies. Peripheral neuropathies associated with paraproteinaemia, though rare, have proven paradigmatic, some of the insights gained being applicable to the more common Guillain‐Barré syndrome.
COMPUTED TOMOGRAPHY IN CREPITANT MYONECROSIS
Authors: Goodman R , Fowlie S , Rodgers C , Hands L
Published: April 2023

SUMMARY We report an unusual case of non‐traumatic myonecrosis presenting as hip pain. Computed tomography helped to define the extent of the infection and its origin in the presacral space. The use of CT in diagnosis and management of gas‐forming soft tissue infection is reviewed.
MASSIVE LOWER GASTROINTESTINAL HAEMORRHAGE SECONDARY TO METASTATIC SQUAMOUS CELL CARCINOMA OF THE LUNG
Authors: Gateley CA , Lewis WG , Sturdy DE
Published: April 2023

SUMMARY Clinically significant symptoms due to gastrointestinal metastases from primary lung cancers is rare. A case of life‐threatening lower gastrointestinal haemorrhage secondary to metastatic squamous cell carcinoma of the lung is reported. Previous reports of such metastases are reviewed, with reference to management and prognosis. After resection of colonic metastases from squamous cell lung cancer, survival is similar to that for primary disease. It is suggested that patients with known or suspected squamous cell lung cancer presenting with lower gastrointestinal symptoms be managed as aggressively as those with no previous history of disease.
FOURNIER'S GANGRENE
Authors: Chow LWC , Ong CL , Png DJC , Loh TKS , Rajagopalan R
Published: April 2023

SUMMARY Fournier's gangrene was traditionally thought to arise spontaneously. More recently, cases with urological, perianal or systemic predisposing causes have been reported. This report describes four cases of Fournier's gangrene, all associated with a predisposing cause: two with diabetes mellitus, two secondary to urinary tract pathologies, and one secondary to an infected wound after an inguinal herniorrhaphy.
DECISIONS ON RESUSCITATION STATUS OF THE ELDERLY
Authors: Smith EM
Published: April 2023

SUMMARY This study investigated whether consultants and junior staff in geriatric medicine would make similar decisions when presented with simulated patient case histories.
SLE‐ASSOCIATED THROMBOCYTOPENIA IN PREGNANCY: SUCCESSFUL OUTCOME WITH COMBINED IgG INFUSION AND PLATELET TRANSFUSION
Authors: Li EK , Li CY , Cohen MG
Published: April 2023

SUMMARY Autoimmune thrombocytopenia presents special problems during pregnancy because of the limited therapeutic options and the risks posed by even moderate degrees of thrombocytopenia. Although corticosteroids and intravenous immunoglobulin G (IV IgG) have been shown to be useful and relatively safe therapies, they are not always effective. We describe a patient with systemic lupus erythematosus (SLE) who developed severe thrombocytopenia unresponsive to prednisone and IV IgG. The combination of IV IgG and platelet transfusion immediately before delivery resulted in a rapid rise in platelet count and allowed a lower segment caesarean section to be undertaken without perioperative complication.
ACUTE ENCEPHALOPATHY DUE TO COEXISTENT NICOTINIC ACID AND THIAMINE DEFICIENCY
Authors: Teare JP , Hyams G , Pollock S
Published: April 2023

SUMMARY We report the case of an alcoholic woman with confusion, catatonia and extrapyramidal signs, who developed features of the Wernicke‐Korsakoff syndrome after treatment with intravenous high potency vitamins. We emphasise that this should arouse the suspicion of nicotinic acid deficiency even in the absence of gastrointestinal symptoms or skin lesions.
PATIENT ACCIDENTS IN HOSPITAL: INCIDENCE, DOCUMENTATION AND SIGNIFICANCE
Authors: Sutton JC , Standen PJ , Wallace WA
Published: April 2023

SUMMARY Many previous studies of reported patient accidents in hospital used the accident report forms as the only data source, without questioning their reliability and despite 80% of the accidents being unwitnessed. This paper reports on three studies using data from patient interviews, staff questionnaires, medical and nursing notes and the accident report forms. The studies confirm that falls amongst elderly patients are the most common type of patient accident. However, patients' and staff's versions of the event often differed widely. Accident reports are stated to be required for legal purposes, but they were often incomplete and unreliable. Patient accidents and safety are too important to remain marginalised to mere compliance with out‐of‐date regulations. A new, ‘slim‐line‘, more accurate but less time‐consuming patient accident reporting system should be developed, for which improvement in patient safety is the main aim and legal considerations the secondary aim.
CRUSH SYNDROME: A HAZARD OF PROLONGED BUS JOURNEYS
Authors: Asante DK , Dangas S
Published: April 2023

SUMMARY Compartment syndrome is a devastating condition, with a high morbidity if it goes unrecognised. We describe a case that progressed to muscle ischaemia and crush syndrome in a man undergoing a prolonged bus journey while under the influence of alcohol — an unusual presentation whose outcome is dependent on early recognition.
PSYCHIATRIC AND BEHAVIOURAL MANIFESTATIONS OF NORMAL‐PRESSURE HYDROCEPHALUS
Authors: Nagaratnam N , Verma S , Nagaratnam K , Sahasrabudde R , Koumoukeus H
Published: April 2023

SUMMARY Seven patients with psychiatric and behavioural manifestations of normal‐pressure hydrocephalus are described. There is little disagreement about the classical triad of symptoms. However, it requires a high index of suspicion when a patient presents with non‐specific psychiatric and behavioural symptoms. Clinicians must be alert to the possibility when positive findings point to the diagnosis of normal‐pressure hydrocephalus, namely gait disturbance, incontinence, soft neurological signs, history of hypertension and no previous psychiatric history.
YOHIMBINE IN THE TREATMENT OF ERECTILE DISORDER
Authors: Riley AJ
Published: April 2023

SUMMARY Yohimbine is an alkaloid derived mainly from the bark of the African tree, Pausinystalia yohimbe. Although many pharmacological properties of yohimbine have been described, at the plasma concentration attained at recommended dosages in man the predominant activity is antagonism of α2‐adrenoceptors. For more than 70 years yohimbine has been used as a treatment for male and female sexual difficulties. It has enjoyed a reputation as an aphrodisiac although no effect on sexual drive in humans has been adequately demonstrated. Yohimbine has been evaluated in the management of erectile disorder by means of placebo‐controlled but often poorly designed trials. It does appear to have a modest therapeutic benefit over placebo, particularly in essentially psychogenic erectile disorder, and is generally well tolerated. Yohimbine is not licensed in the UK.
THE CURRENT MANAGEMENT OF PARACETAMOL OVERDOSAGE
Authors: Makin A , Williams R
Published: April 2023

SUMMARY Paracetamol overdosage is a common problem, but severe poisoning occurs in only a small percentage of cases. A patient who has suffered paracetamol overdosage should be monitored carefully to ensure that a specialist liver unit can be contacted at the earliest signs of severe poisoning for optimal management and transfer. Paracetamol overdosage remains the most common cause of fulminant hepatic failure in the UK, with a mortality rate of 90%, but survival rates can be improved dramatically by specialist intensive care management, and with the advent of transplantation a previously untreatable group of patients can be treated successfully. However, a patient who is inadequately monitored and treated in the early stages after an overdose may deteriorate to an extent that renders them unsalvable by the time they arrive at the specialist centre.
NEURILEMMOMA OF THE LARYNX
Authors: Dekker PJ , Haidar A
Published: April 2023

SUMMARY Neurogenous tumours of the larynx are extremely uncommon. We describe a case of a neurilemmoma which presented clinically as a discrete nodule on the vocal cord. Simple endoscopic removal under direct vision was performed.
BREAST HAEMATOMAS: SAME APPEARANCE, DIFFERENT DIAGNOSIS
Authors: Shrotria S , Ghilchik MW
Published: April 2023

SUMMARY We report two cases of patients presenting as breast haematomas but with uncommon underlying pathology. One patient had a bilateral breast augmentation by a peculiar method of inserting shredded cellophane packing. A haematoma developed after a fall and subsequently became infected. The second patient was on long‐term anticoagulant therapy and developed a haematoma through bleeding from an occult malignant lesion. Both cases demonstrate the need to obtain histology — especially in the elderly, where history and clinical examination may confound diagnosis.
POSTERIOR VOCAL CORD ADHESION: AN UNUSUAL COMPLICATION OF ENDOTRACHEAL INTUBATION
Authors: Nicol JW , Yardley MPJ , Bull PD
Published: April 2023

SUMMARY A case is presented of a patient who required endotracheal intubation followed by tracheostomy and who consequently developed an adhesion between the vocal processes, which was identified and divided at direct laryngoscopy.
BUPRENORPHINE AND HEPATIC PRURITUS
Authors: Juby LD , Wong VS , Losowsky
Published: April 2023

SUMMARY Pruritus in cholestatic liver disease can be difficult to treat. It may be related to impaired excretion of large opioid peptides. Buprenorphine, a drug with partial opiate antagonist properties, was used in a double‐blind trial of five patients with uncontrollable itching. One patient improved clinically, one patient had good relief from pruritus and three had intolerable side‐effects. Buprenorphine may be of limited use in intractable pruritus.
AUDIT OF THE RELATIONSHIP BETWEEN EPISIOTOMY AND RISK OF MAJOR PERINEAL LACERATION DURING CHILDBIRTH
Authors: Fernando B , Leeves L , Greenacre J , Roberts G
Published: April 2023

SUMMARY The beneficial effect of mediolateral episiotomy in reducing major perineal lacerations during childbirth has been questioned. In a test of the hypothesis of no association between episiotomy and the incidence of major perineal lacerations, the incidence of major perineal laceration was determined in three cohort groups in one maternity unit between 1984 and 1991. Among those undergoing non‐instrumental delivery, no reduction in the incidence of major lacerations could be demonstrated following episiotomy. Among those undergoing episiotomy, the incidence of major lacerations was significantly higher following instrumental delivery.
SELECTING PATIENTS FOR HRT: POSITIVE INDICATIONS
Authors: Ross D , Whitehead MI
Published: April 2023

SUMMARY As our understanding of the nature of modern postmenopausal hormone replacement therapy (HRT) has improved, the number of true contraindications to its use has declined. As a result, the question of whether or not to take HRT has become determined more by patient choice and less by medical factors, a trend that is likely to continue. Thus, women (as well as their doctors) need to be told of the indications for HRT so that they can make an informed choice.
PSEUDOTUMOUR OF THE ORBIT: BILATERAL METACHRONOUS PRESENTATION
Authors: Anwar S , Davies KG , Tejura B , White AET , Neal JW , Lane C
Published: April 2023

SUMMARY A case is presented of a pseudotumour that developed in the left orbit 4 years after surgery and histological confirmation of a pseudotumour in the right orbit. There was no evidence of any thyroid pathology.
ADULT DENGUE HAEMORRHAGIC FEVER AT KUALA LUMPUR HOSPITAL: RETROSPECTIVE STUDY OF 102 CASES
Authors: Ibrahim NM , Cheong IZHAM
Published: April 2023

SUMMARY A retrospective study involving 102 adults with dengue haemorrhagic fever (DHF) was conducted to investigate the demographic aspect, clinical presenting features, laboratory investigations, complications, and mortality associated with the disease. The clinical diagnosis of DHF was in accordance with WHO recommendations. Epistaxis, gingivitis, haematemesis and gastritis were among the common complications. Platelet levels tended to decline from a higher value on admisssion (mean 67 000/mm3) to lower levels on subsequent days, with the lowest (mean 61 000/mm3) being on day 6 of the fever. Hyponatraemia (46.8%) was commonly observed. Morbidity of DHF was significant (29.4%) but the case fatality rate remained low (2.0%) in our adults, suggesting that adults are less likely than children to suffer from shock syndrome.
AIDS‐RELATED BEHAVIOUR IN ADOLESCENTS: INTERVENTION PROGRAMME WITH INTERNATIONAL APPLICATION
Authors: Nikolopoulos TP , Gamatsi IE , Lioumi DE , Apostolopoulos NJ
Published: April 2023

SUMMARY Adolescents and young adults comprise one of the fastest‐growing categories of AIDS cases. The results of an opinion survey taken of 3242 adolescents raise serious doubts about the prevalent view that high‐risk behaviour is attributable to insufficient information and education on AIDS: female adolescents are found to be at risk despite having the proper knowledge. Five chief factors affected the knowledge and behaviour of adolescents: age, gender, origin, family profession, and parental education. Each of the subpopulations (females, younger adolescents, children in rural areas) has its own characteristics and needs. We describe a permanent and long‐term intervention programme, which might be applied in any country.
IMAGING AND STAGING OF SMALL‐CELL LUNG CANCER: IS THERE A FUTURE ROLE FOR OCTREOTIDE SCINTIGRAPHY?
Authors: Stokkel MPM , Kwa BH , Pauwels EKJ
Published: April 2023

SUMMARY In small‐cell lung cancer (SCLC), CT scan remains the most accurate imaging modality for evaluating local extension and specific sites of metastatic disease. The role of nuclear medicine in the work‐up of SCLC is still limited to the detection of bone metastases. Recently, a new potential diagnostic tool has been introduced based on the presence of somatostatin receptors in SCLC. With the use of radiolabelled somatostatin analogues it is hoped that an equally effective but simpler staging system has been found that gives a better separation of prognostic subgroups. This article reviews the role of nuclear medicine in general and somatostatin receptor scintigraphy in particular in the imaging and staging of SCLC. Clinical value in terms of sensitivity and specificity is discussed in relation with other imaging and staging modalities.
DEEP VEIN THROMBOSIS
Authors: Tyrrell  , Birtle AJ , Taylor PR
Published: April 2023

SUMMARYDeep vein thrombosis (DVT) is a common condition. Most cases arise as complications during the perioperative period. This can largely be prevented by adequate prophylaxis, principally using low‐dose subcutaneous heparin. Only a minority of DVTs produce serious complications, but it is not currently possible to predict the clinical behaviour of any DVT, once formed. For this reason, any identified DVT should be vigorously treated. The mainstay of treatment remains systemic anticoagulation with heparin and then warfarin. Warfarin should be continued for 1 month in postoperative cases and 3 months in spontaneous cases, provided there is no ongoing predisposing factor. Recurrent spontaneous DVT formation is an indication for lifelong anticoagulation. Recent evidence suggests that the subcutaneous route of administration of heparin has advantage over traditional intravenous infusion. Some large DVTs require thrombolysis, and it is now possible to treat the underlying anatomical defects with angioplasty and endovascular stenting, although the long‐term outcome of these procedures has not yet been established. For patients with contraindications to the use of anticoagulants, a variety of (temporary and permanent) percutaneously inserted vena caval filters are now available. The principal complications of DVT are pulmonary embolism, which may be fatal, and the development of a postphlebitic leg. The avoidance of these depends on adequate prophylaxis and vigorous treatment of the primary DVT.
POSTSTROKE PSYCHOSIS
Authors: Chin HFK
Published: April 2023

SUMMARY A patient with poststroke psychosis is reported. This is rare but is readily amenable to treatment. Heightened awareness is necessary for early detection and intervention.
DEATHS ASSOCIATED WITH WARFARIN IN ELDERLY PATIENTS
Authors: Reardon M , Burns B , Brewer B , O'Sullivan JP
Published: April 2023

SUMMARY The four cases presented illustrate fatal errors in the management of elderly patients at different stages in the chain of their anticoagulation treatment. As indications for anticoagulation increase in the elderly, more care needs to be taken.
MEDICAL PREGNANCY TERMINATION IN THE PRESENCE OF A MASSIVE UTERINE FIBROID
Authors: Fenwick DKF , Divers MJ
Published: April 2023

SUMMARY Surgical termination of pregnancy in the presence of uterine fibroids may be technically difficult resulting in reduced efficacy of the termination procedure. We describe the first documented use of RU486 and gemeprost in the successful medical termination of a pregnancy in a uterus grossly enlarged by fibroids.
METHICILLIN‐RESISTANT STAPHYLOCOCCUS AUREUS BACTERAEMIA AT A TERTIARY TEACHING HOSPITAL
Authors: Cheong I , Samsudin LM , Law GH
Published: April 2023

SUMMARY Between July and December 1994, 25 patients with MRSA bacteraemia were treated at the Hospital Kuala Lumpur, a tertiary hospital in Malaysia with 3000 beds. The patients included 15 males and 10 females whose mean age was 46.7 years (range 13‐75). The sources of their MRSA were: Urology/Nephrology, 11; General ICU, six; Orthopaedic, four; Medicine, three; Surgery, one. Their underlying diseases were: end‐stage and chronic renal failure, 11; burns, three; acute necrotising pancreatitis, two; haematological malignancies, two; and one each of fracture of the neck of the femur, pustular psoriasis, alcoholic cirrhosis, liver abscess, peptic ulcer (antrectomy), choledochol cyst, and abdominal aneurysm with gangrene of the legs. Six patients were also diabetic. A total of 19 infections were considered nosocomial. The duration of hospital stay ranged from one to 60 days, mean 16 days. On the day of blood culture, 20 patients (80%) were febrile and 15 (60%) had leucocytosis. A total of 14 patients were considered to have received prolonged broad‐spectrum antibiotics before the bacteraemia; of these, 11 had had either a third‐generation cephalosporin and/or a quinolone. The primary foci of infection were: vascular access dialysis catheters, six; infected AV fistulae, three; non‐surgical wounds, five; orthopaedic pin, one; multiple venous lines and catheters, nine; unknown, one. The sensitivities to anti‐MRSA antibiotics were: vancomycin, 100%; fusidic acid, 96%; rifampicin, 96%; ciprofloxacin and perfloxacin 28% each. In all, 13 patients (52%) eventually died; nine of these deaths were directly attributed to MRSA bacteraemia. The microbiological eradication rate was 88%. Mortality was significantly associated with duration of hospital stay and failure to remove the infected catheters/peripheral lines after the development of MRSA bacteraemia.
AMOXYCILLIN‐INDUCED HALLUCINATIONS — A VARIANT OF HOIGNE'S SYNDROME?
Authors: Stell IM , Ojo OA
Published: April 2023

SUMMARY A case report of amoxycillin‐induced hallucinations is presented.
BACTERIAL VAGINOSIS
Authors: Priestley CJF , Kinghorn GR
Published: April 2023

SUMMARY Bacterial vaginosis (BV) is an alteration of the vaginal flora, where the normally predominant lactobacilli are replaced by a cocktail of organisms including Gardnerella vaginalis and anaerobes. It presents with a grey, homogenous, offensive vaginal discharge that has a raised pH. However, around half the women with this condition are asymptomatic. Diagnosis is best made by microscopic examination of a Gram‐stained smear of vaginal secretions. Treatment is with metronidazole or clindamycin. The indications for treatment of asymptomatic BV are not clear, but women should probably be treated before any invasive gynaecological procedure, including intrauterine contraceptive device (IUCD) insertion. BV during pregnancy is associated with preterm labour, although a causal effect is not proven; studies are in progress to determine whether treatment of BV will improve the outcome of these pregnancies.
FOCAL LYMPHOID HYPERPLASIA OF THE TERMINAL ILEUM MIMICKING CROHN'S DISEASE
Authors: Ganly I , Shouler PJ
Published: April 2023

SUMMARY Focal lymphoid hyperplasia of the terminal ileum is a rare cause of terminal ileitis.1 We describe the case of a 13‐year‐old boy with a stricture of the terminal ileum that was diagnosed as Crohn's disease on barium meal and follow through. This failed to resolve on steroid therapy and the boy eventually required resection of his terminal ileum. Pathology of the terminal ileum showed focal lymphoid hyperplasia and not Crohn's disease.
VARIATIONS OF INVASIVE SALMONELLA INFECTION IN ELDERLY PEOPLE
Authors: Bruce‐Jones PNE , Allen SC
Published: April 2023

SUMMARY Four cases of elderly people with differing forms of invasive salmonella infection are presented. Vulnerability factors and patterns of presentation are discussed.
PROGRESSIVE SUPRANUCLEAR PALSY PRESENTING WITH PSYCHIATRIC FEATURES
Authors: Chiu HFK , Li SW
Published: April 2023

SUMMARY A patient with progressive supranuclear palsy who presented with psychiatric features is reported. His case illustrates the difficulty of early diagnosis of this condition. Associated psychiatric symptoms are common and may precede the occurrence of gaze palsy. Our patient's behavioural problems responded to fluoxetine.
BLOOD COAGULATION AND FIBRINOLYTIC ACTIVITY IN HYPOTHYROIDISM
Authors: Erem C , Kavgaci H , Ersöuz HÖ , Hacihasanoglu A , Ukinç K , Karti SS , Deger O , Telatari M
Published: April 2023

The influence of hypothyroidism on haemostasis is controversial; both hypocoagulable and hypercoagulable states have been reported. Hypothyroidism has been associated with atherosclerosis; a hypercoagulable state in addition might represent a risk factor for thromboembolic disease. The aim of the present study was to investigate the markers of endogenous coagulation and vascular endothelial cell function and to evaluate the relationship between serum lipid profile, thyroid hormones and haemostatic parameters in hypothyroid patients. We investigated various haemostatic parameters in 20 patients with hypothyroidism and compared them with 20 euthyroid controls. The relationship between serum thyroid hormones and the haemostatic parameters was examined. The plasma levels of fibrinogen, AT III and PAI‐1 were significantly increased in hypothyroid patients compared with the control group, whereas factors VIII and X activity was decreased. We showed that free T3 levels correlated with factor IX activity. Free T4, FT3 and TSH did not correlate with fibrinogen, vWF, AT III, t‐PA, or PAI‐1. aPTT correlated inversely with t‐PA activity and positively with protein C activity Anti‐Tg correlated inversely with FV. There was a positive correlation between triglycerides and protein C. Protein S correlated inversely with high density lipoprotein cholesterol. We found a hypofibrinolytic state in patients with hypothyroidism. Our results suggest that the risk of developing thrombosis and ultimately myocardial infarction via high PAI‐1 levels may be increased in patients with hypothyroidism, a result in line with recent epidemiological data. However, thyroid hormones may play a role at different levels of the complex haemostatic system.
NON‐VASCULAR CLAUDICATION: A CLINICAL CONUNDRUM
Authors: Fasih T , Pickin M , Cuschieri RJ
Published: April 2023

This is a prospective study of patients referred to our department with symptoms of claudication unlikely to be of vascular origin. After clinical assessment these patients were referred to an orthopaedic physician. Of 1070 patients referred, 33 patients were diagnosed with a non‐vascular problem. Of these, 21 were cases of spinal stenosis with or without nerve root irritation, seven had a combination of spinal pathology and peripheral vascular disease, and five were diagnosed with intervertebral disc prolapse (n=3), diabetic neuropathy (n=1) and chronic fatigue syndrome (n=1). The prognosis for patients with non‐vascular claudication in respect of the development of premature vascular events is likely to be different from vascular claudicants and they should be counselled appropriately Furthermore, the potentially less favourable outcome following reconstruction must be clearly explained to patients with a non‐vascular contribution to their symptoms before any therapeutic vascular intervention. Failure to do this is likely to have significant medicolegal implications.
THE RETURN OF THE LEECH
Authors: Abdelgabar AM , Bhowmick BK
Published: April 2023

Medicinal leeches (Hirudo medicinalis) have been used in medicine for thousands of years to treat a wide range of ailments. Nowadays, leeches are used successfully for only a few conditions, notably in the field of reconstructive or microsurgery, to salvage tissue flaps and skin grafts whose viability is threatened by venous congestion. The anticoagulant properties of hirudin, contained in leech saliva, may lead to wider therapeutic applications in the prevention and treatment of thromboembolic disease. Optimal care is needed when applying leeches, because their use can be complicated by serious bacterial infections.
REVIEW OF CLINICAL EXPERIENCE WITH ATOSIBAN AND THE TRACTOCILE EFFICACY ASSESSMENT SURVEY IN EUROPE (TREASURE) STUDY PROTOCOL
Authors: Husslein P , Quartarolo JP
Published: April 2023

A phase IV multinational, multicentre study has been designed – the Tractocile Efficacy Assessment Survey in Europe (TREASURE). The aim is to assess atosiban in the clinical setting, which is associated with fewer restrictions than in phase III trials. Atosiban is to be compared with ‘usual care’ in women eligible for treatment, and will also be evaluated as deferred or immediate treatment in women who have not yet fulfilled the diagnostic criteria for pre‐term labour. Exploring the use of atosiban beyond the normal indications may allow the identification of additional subpopulations of women who will benefit from early treatment. TREASURE will offer data on new diagnostic tools, investigate respiratory distress syndrome according to severity and record the use of antenatal steroids. It is hoped that additional information concerning the subtle differences in clinical practice will broaden our understanding of how to manage pre‐term labour and offer the chance to revise treatment guidelines. (Int J Clin Pract 2003; 57(2): 121–127)
ACUTE DISSEMINATED ENCEPHALOMYELITIS: A RIDDLE WRAPPED IN A MYSTERY INSIDE AN ENIGMA
Authors: John L , Khaleeli AA , Larner AJ
Published: April 2023

The difficulties in establishing a diagnosis of acute disseminated encephalomyelitis (ADEM) are illustrated in this case report, which attempts to raise awareness of the condition among general physicians, since they are the practitioners most likely to see such acute neurological presentations. Clinical and investigative features which raise the index of suspicion for the diagnosis of ADEM are outlined.
COX‐LOX INHIBITION: CURRENT EVIDENCE FOR AN EMERGING NEW THERAPY
Authors: Smelly MM , Hawkey CJ
Published: April 2023

Safe and effective drug treatment is an important objective of all doctors. In the treatment of arthritis, non‐steroidal anti‐inflammatory drugs offer effective treatment but safety is significantly limited, largely due to gastrointestinal toxicity. Attention has recently focused on exploiting increased knowledge of metabolism of arachidonic acid to allow the development of safer anti‐inflammatory drugs. Dual inhibitors of cyclo‐oxygenase and lipoxygenase are planned. These drugs may inhibit formation of both prostaglandins and leukotrienes. This review outlines the salient features of cyclo‐oxygenase and lipoxygenase metabolism of arachidonic acid. The role of the eicosanoids in mediating inflammation and gastrointestinal integrity is delineated. Evidence is presented regarding action of licofelone, one COX/LOX inhibitor that is currently in advanced stages of clinical trials. This review examines the hypothesis that licofelone is an effective anti‐inflammatory agent that does not cause peptic damage.
RELAPAROTOMY: A FIVE‐YEAR REVIEW OF INDICATIONS AND OUTCOME
Authors: Ching SS , Muralikrishnan VP , Whiteley GSW
Published: April 2023

Complications from abdominal surgery may necessitate reoperation and can be associated with significant morbidity and mortality. This review aims to analyse the incidence and outcome of relaparotomy for various indications. In a retrospective review of case notes of patients who had undergone one or more relaparotomies during the same hospitalisation between 1996 and 2000, 55 patients required relaparotomy. Indications included bleeding, infection, anastomotic leakage, wound dehiscence, necrotising pancreatitis, bowel necrosis, bowel obstruction and miscellaneous indications. Relaparotomy for dehiscence and obstruction carried minimal risk; for bleeding and infection entailed moderate risks; and for anastomotic leak had the highest mortality rate. The mortality rate increased in older age groups, multiple system and organ failure and multiple relaparotomies. The overall mortality rate was 38%. Twenty‐nine per cent of patients had MRSA infection contributing to sepsis and multiple system and organ failure. Reintervention had brought to evidence technical errors, which could be corrected, and resulted in patient salvage in some cases. The mortality rate of relaparotomy has remained unchanged compared with data published previously, despite improvements in surgical techniques and critical care. Timely relaparotomy is valuable in the identification and treatment of complications following abdominal surgery.
UNUSUAL PERIANAL TUMOURS MASQUERADING AS ABSCESSES
Authors: Bracey EECL , Mathur P , Dooldeniya M , Joshp A , Dawson PM
Published: April 2023

Tumours of the perianal region and anal canal are uncommon and can present in a variety of ways. Acute anorectal sepsis is a common condition that usually presents as a painful lump close to the anal margin. Tumours in the perianal region may mimic the symptoms and signs of anorectal sepsis, thereby leading to a delay in diagnosis and management. We report three patients who presented to our department with symptoms and signs suggestive of perianal abscess but which on further investigation were discovered to be due to unusual perianal tumours. Only one of the tumours was found to be malignant – a primary perianal mucinous adenocarcinoma; the other two were benign, a leiomyoma and an aggressive angiomyxoma. A high index of clinical suspicion is required to the diagnosis of perianal tumours when assessing patients with painful perianal lumps, particularly those with a long history and those of ethnic origin. Every effort should be made to establish a preoperative diagnosis so that correct treatment can be delivered.
TESTICULAR TORSION: A TWIST TO THE TALE
Authors: Shergill IS , Gupta S , Arya M , Patel HRH
Published: April 2023

Testicular torsion is a surgical emergency that requires prompt exploration if testicular viability is to be maintained. Although rare, it is essential to be aware that it may occur despite previous fixation (orchidopexy). Testicular torsion occurring after previous orchidopexy is rare, but recognition of this possibility is essential to prevent testicular infarction and subsequent orchidectomy During scrotal exploration a wide variety of methods for orchidopexy exist. We present a case of testicular torsion despite previous fixation and discuss the merits of various techniques available for orchidopexy.
TILT‐INDUCED PSEUDOSYNCOPE
Authors: Luzza F , Pugliatti P , Di Rosa S , Calabro D , Carerj S , Oreto G
Published: April 2023

Using the head‐up tilt test (HUTT) we evaluated 986 consecutive patients affected by unexplained syncope. In 266 patients the test induced bradycardia and/or hypotension resulting in syncope or presyncope, thus allowing a diagnosis of neurally mediated syncope. In three other patients (0.3% of the entire population and 1% of the all positive tests) HUTT provoked loss of consciousness despite no significant change in heart rate and/or blood pressure. In all three cases unconsciousness was prolonged and no pathological finding was present except lack of response. This phenomenon has been defined as ‘pseudosyncope’ and related to psychiatric illness. Pseudosyncope induced by HUTT reproduced the clinical events, so the test outcome was considered a true positive response. Our experience suggests that HUTT may contribute to the recognition of psychiatric disorder in some patients affected by unexplained syncope.
HOSPITAL‐ACQUIRED URINARY TRACT INFECTION
Authors: Kalsi J , Arya M , Wilson P , Mundy A
Published: April 2023

Nosocomial urinary tract infections (UTIs) account for up to 40% of all hospital‐acquired infections. The associated morbidity and mortality are a major drain on hospital resources. Patients with indwelling urinary catheters, patients undergoing urological manipulations, long‐stay elderly male patients and patients with debilitating diseases are at high risk of developing nosocomial UTIs. The organisms responsible usually originate from patients' endogenous intestinal flora, but occasionally from a moist site in the hospital environment. Nosocomial pathogens causing UTIs tend to have a higher antibiotic resistance than simple UTIs. Infection control policies are important in limiting the number of hospital‐acquired UTIs. Other important points include catheterisation using an aseptic technique and sterile equipment and the use of closed drainage systems. UTIs should be treated only after a urine sample has been sent and the advice of a microbiologist sought. In the future catheters impregnated with antibiotics, and the use of newer materials, may lead to further reductions in the incidence of nosocomial UTIs.
THE ROLE OF CILOSTAZOL (PLETAL™) IN THE MANAGEMENT OF INTERMITTENT CLAUDICATION
Authors: Bradbury AW
Published: April 2023

Intermittent claudication affects 5% of the middle‐aged population in developed countries and is associated with a significant reduction in health‐related quality of life and cardiovascular morbidity and mortality The mainstay of treatment is best medical therapy (BMT) comprising smoking cessation, antiplatelet agents, lipid‐lowering, advice to exercise, and correction of other modifiable vascular risk factors. Although BMT is highly effective in reducing cardiovascular risk and may also improve walking distance, many patients remain unacceptably symptomatic despite it. Until recently, the only available adjuvant therapies were supervised exercise programmes, angioplasty and surgery Many patients are unable to comply with the first, and the last two are associated with limited durability and risk. The advent of cilostazol (Pletal™) adds evidence‐based pharmacotherapy to the vascular specialist's armamentarium for the first time. Here cilostazol and its role in the management of intermittent claudication are discussed.