bluuebunny/crossref_metadata_2025 huggingface dataset:
Dying in the dark: sunshine, gender and outcomes in myocardial infarction
Authors: Beauchemin Kathleen M , Hays Peter
Published: May 2017

We report a natural experiment that took place in a cardiac intensive care unit (CICU). We had been alerted to the possibility that sunny rooms would be conducive to better outcomes by our findings in the psychiatric unit, and by reports that depressed cardiac patients did less well than those in normal mood. The 628 subjects were patients admitted directly to the CICU with a first attack of myocardial infarction (MI). Outcomes of those treated in sunny rooms and those treated in dull rooms were retrospectively compared for fatal outcomes and for length of stay in the CICU.

Patients stayed a shorter time in the sunny rooms, but the significant difference was confined to women (2.3 days in sunny rooms, 3.3 days in dull rooms). Mortality in both sexes was consistently higher in dull rooms (39/335 dull, 21/293 sunny). We conclude that illumination may be relevant to outcome in MI, and that this natural experiment merits replication.
Neck and other muscle pains in autonomic failure: their association with orthostatic hypotension
Authors: Bleasdale-Barr K M , Mathias C J
Published: May 2017

Neck pain in the suboccipital and paracervical region (‘coathanger' configuration) is often reported by patients with autonomic failure and orthostatic hypotension. The frequency of this pain, along with pains in the buttock and calf regions, was determined by questionnaire in two major groups with primary chronic autonomic failure—pure autonomic failure (PAF) and multiple system atrophy (MSA). Comparisons were made with Parkinson's disease, cerebellar degeneration and other disorders in which neurological symptoms overlap but in which there was neither autonomic failure nor orthostatic hypotension.

Neck pain was present in 93% of patients with PAF, 51% of patients with MSA and 38–47% of the non-autonomic groups. Buttock pain was present in smaller but similar proportions (8–19%) of each group, like calf pain (23–37%). Neck pain in PAF and MSA differed from that in the other groups in being relieved by sitting or lying flat and in being associated with factors that lower blood pressure in these patients. Buttock pain was posturally related in PAF and MSA; for calf pain there was no difference between groups. Neck pain was related to the degree of orthostatic hypotension; in PAF patients, whose postural blood-pressure fall was greater than that in MSA, there was a greater frequency of neck pain.
Targeting of dornase alpha therapy in adult cystic fibrosis
Authors: Ledson M J , Wahbi Z , Convery R P , Cowperthwaite C , Heaf D P , Walshaw M J
Published: May 2017

Although dornase alpha (recombinant human DNase) can thin the viscid pulmonary secretions of cystic fibrosis (CF), clinical trials in groups of unselected patients have shown only modest average improvements in pulmonary function. The product is very expensive, so in conjunction with purchasers we designed selection criteria and a protocol for a 2-week trial to target CF individuals who might gain most benefit. Treatment was to be continued in those showing ≥10% improvement in pulmonary function. Those who had a trial of dornase alpha were followed up for 2 years.

Of 25 patients who had a 2-week trial of dornase alpha, 17 met the criteria for continuation (average gain in forced expiratory volume 37%). The 11 of these who were still alive at 2 years had a greater initial average FEV1 improvement than those who had died (45% versus 22%), and still had an average improvement of 31% at 2 years. The 8 patients who did not meet the criteria for continuation were older and had required fewer intravenous antibiotic courses. All these were alive at 2 years with unchanged clinical indices.

This method of selection for dornase alpha treatment allows targeting to those who gain most benefit without disadvantaging the remaining patients. Furthermore, production of such guidelines in conjunction with purchasers obviates funding difficulties and allows rational prescribing.
Do doctors read forms? A one-year audit of medical certificates submitted to a crematorium
Authors: Horner J Stuart , Horner Jonathan W
Published: May 2017

To determine the thoroughness and accuracy with which medical certificates for cremation are completed, a record was made, during normal processing of the documents, of the number of questions that were not answered or answered wrongly, or in which clarification was required.

Of 835 sets of forms only 346 (41 %) were completed sufficiently accurately for the cremation to proceed without further enquiry. Junior doctors contributed the most errors but general practitioners and consultants also contributed large numbers of errors.

Doctors ought to be far more accurate and thorough in completing cremation certificates than were those audited here. The results cast doubt on the reliability of information supplied on other forms. In view of the high frequency of poorly completed forms, review by a medical referee remains essential.
Triage of back pain by physiotherapists in orthopaedic clinics
Authors: Weatherley C R , Hourigan P G
Published: May 2017

In 1994 we described a system whereby certain patients with back pain, on referral to an orthopaedic clinic, were seen first by a physiotherapist who referred on only the problem cases and those in need of surgery (‘triage’). This practice has grown rapidly but there have been difficulties. To clarify these we have carried out a postal questionnaire.

The results reveal similar practices in most centres but some discrepancies that are cause for concern. These relate to the workload of the physiotherapist, informed consent, supervision and accountability, the type of cases seen and not least the stresses on the physiotherapist.

We believe the triage system has many benefits, but if it is not to be derailed the issues of concern must be addressed and the posts properly structured.
A rude awakening: post-take ward round in the department of medicine for the elderly
Authors: Coni Nicholas
Published: May 2017

This paper describes the post-take ward round of a department of medicine for the elderly (DME), to portray the nature of the medical admissions and their immediate management. The data concern the patients seen by one consultant in 28 such ward rounds during the last four months of 1997, in a teaching hospital where the DME is separate from the department of general internal medicine.

254 patients were seen, 107 men and 147 women, with an average age of 82.4 years (range 73–102). The decisions taken included diagnosis, further investigations, treatment, referral, discharge, and resuscitation status. Very few admissions were judged inappropriate, particularly among the majority referred by general practitioners. 101 patients were thought suitable for transfer to the department of general internal medicine, 109 definitely unsuitable.

These findings support the view that, if medical beds are to be freed, the initiative must come from facilitating discharge rather than curtailing admission. Generalists are needed to sort and manage these patients. In the UK, these will often be general internal medicine consultant geriatricians, while the younger patients are seen by consultants practising general internal medicine in addition to one of the specialties. Sizeable numbers of these consultants are needed if the post-take ward round is to be efficient and not conflict with their fixed commitments.
The one-stop dyspepsia clinic—an alternative to open-access endoscopy for patients with dyspepsia
Authors: Rutter M D , Michie A F , Trewby P N
Published: May 2017

The most sensitive investigative tool for the upper gastrointestinal tract is endoscopy, and many gastroenterologists offer an open-access endoscopy service to general practitioners. However, for patients with dyspepsia, endoscopy is not always the most appropriate initial investigation, and the one-stop dyspepsia clinic allows for different approaches. We have audited, over one year, the management and outcomes of patients attending a one-stop dyspepsia clinic. All patients seen in the clinic were included, and for those not endoscoped the notes were reviewed one year after the end of the study to check for reattendances and diagnoses originally missed. Patients' and general practitioners' views of the service were assessed by questionnaire.

485 patients were seen, of whom 301 (62%) were endoscoped at first attendance. In 66 patients (14%), endoscopy was deemed inappropriate and only one of these returned subsequently for endoscopy. 118 patients (24%) were symptom-free when seen in the clinic and were asked to telephone for an appointment if and when symptoms recurred; half of these returned and were endoscoped. Oesophagitis and duodenal ulcer were significantly more common in this ‘telephone endoscopy' group than in those endoscoped straight from the clinic. Overall, 25% of patients referred were not endoscoped. Important additional diagnoses were made from the clinic consultation. General practitioners and patients valued the system, in particular the telephone endoscopy service. 84% of general practitioners said they would prefer the one-stop dyspepsia clinic to open-access endoscopy.
Knee pain and the infrapatellar branch of the saphenous nerve
Authors: Tennent T D , Birch N C , Holmes M J , Birch R , Goddard N J
Published: May 2017

Pain over the front of the knee is common after surgery or trauma but often a definite diagnosis is difficult to make. Over the past year we have seen five cases in which the pain could be ascribed to damage to a branch of the infrapatellar branch of the saphenous nerve. Two were subsequent to trauma and three to surgical procedures. In all five cases surgical exploration gave symptomatic relief. Eight cadaveric knees were prosected to explore further the anatomy of this nerve in relation to the injuries. Injury to one of these branches should be considered in cases of persistent anterior, anteromedial or anterolateral knee pain or neurological symptoms following surgery or trauma.
Management and morbidity of cellulitis of the leg
Authors: Cox Neil H , Colver Graham B , Paterson William D
Published: May 2017

Ascending cellulitis of the leg is a common emergency. An audit was conducted in two district general hospitals to determine how it is managed and the long-term morbidity, and to formulate a treatment strategy. Case notes were reviewed for 92 patients admitted to hospital under adult specialties.

Mean duration of inpatient therapy was 10 days. A likely portal of entry was identified in 51/92 cases, of which the commonest were minor injuries and tinea pedis. Pathogens were rarely identified, group G streptococci being the single most frequent organism. Benzylpenicillin was administered in only 43 cases. Long-term morbidity, identified in 8 of 70 patients with over six months' follow-up, included persistent oedema (6) and leg ulceration (2); an additional 19 patients had either suffered previous episodes or experienced a further episode subsequently.

Ascending cellulitis of the leg has substantial short-term and long-term morbidity. Important but often neglected therapeutic suggestions are the inclusion of benzylpenicillin in all cases without a contraindication, assessment and treatment of tinea pedis, use of support hosiery, and serological testing for streptococci to confirm the diagnosis in retrospect. The high frequency of recurrent episodes suggests that longer courses of penicillin, or penicillin prophylaxis, might be useful.
Emergency small-bowel resection in a district general hospital
Authors: Wegstapel H , Hoque H M R , Hoile R W
Published: May 2017

Small-bowel resection has been identified as a core surgical skill that all general surgical trainees must acquire. Most of these resections are performed by the unsupervised higher surgical trainee on call. Reviewing 51 small-bowel resections performed over a five-year period in a district general hospital we found that, although the operation carried a high mortality rate (18%) and a high morbidity rate (21%), these had less to do with the operative technique than with the nature of the underlying disease and the hazards of emergency surgery in general. We conclude that small-bowel resection per se is relatively safe and remains a good training procedure.
Church service: President's address
Authors: Paine Christopher
Published: May 2017

After medical school at Oxford and St Bartholomew's Hospital, Sir Christopher Paine was Consultant in Radiotherapy and Oncology at Oxford from 1970–1995. From 1982–1985 he was Director of Clinical Studies of the Oxford University Medical School and District General Manager of Oxfordshire Health Authority from 1984–1988. Sir Christopher was then President of The Royal College of Radiologist from 1992–1995, and Vice Chairman of the Conference of Medical Royal Colleges for the year 1994/1995. From July 1996 until July 1998 he was the President of The Royal Society of Medicine. His present post is Medical Director of the Advisory Committee on Distinction Awards. In 1995, he was knighted in the New Year Honours.
The past: ‘the good old days’
Authors: Innes Williams David
Published: May 2017

Sir David Innes Williams was educated at Cambridge and University College Hospital, he qualified in 1942 and took resident posts at UCH before joining the Army. In 1944 he gained FRCS and served in India as a surgical specialist (Major RAMC). Returning to London he chose a specialist career and, after junior experience at St Peter's Hospital and the Hospital for Sick Children Great Ormond Street, was appointed urological surgeon at both those hospitals. He soon concentrated on paediatric urology and children's work gradually excluded adult practice. He was elected President of the British Association of Urological Surgeons in 1976. Two years later he resigned from his hospitals to become Director of the British Postgraduate Medical Federation, and later Pro-Vice-Chancellor of the University of London. He served on the GMC, was Vice President of the Royal College of Surgeons, Chairman of the Imperial Cancer Research Fund, President of the BMA 1988–1989 and of The Royal Society of Medicine, 1990–1992.
Research and development in the NHS
Authors: Swales John
Published: May 2017

J D Swales is Professor of Medicine, University of Leicester from 1974 to present. He is on secondment as Director of Research & Development (1996 to present) Department of Health.

Professor Swales' main research interest is in the processes which cause high blood pressure and methods of treatment. In his present post he is responsible for research and development within the NHS. He has written and edited several books including Platt versus Pickering (1985), Textbook of Hypertension (1994) and Manual of Hypertension (1995).

He is an ex-President of the British Hypertension Society and has been Editor of Clinical Science, The Journal of Hypertension and The Journal of the Royal Society of Medicine. He has been Bradshaw, Croonian and Harveian Lecturer of the Royal College of Physicians.
Seasonal variations in sexual activity and their implications for sexual health promotion
Authors: Wellings K , Macdowall W , Catchpole M , Goodrich J
Published: May 2017

Although seasonal variations in births are observed in all human populations, the links between calendar events and sexual activity have received little attention in relation to health promotion and service provision. We have plotted various relevant data—routinely collected data for births within and outside of marriage, abortions, sexually transmitted infections, human immunodeficiency virus tests and condom sales figures—by calendar period.

The trends point consistently to an increase in sexual activity and unsafe sex occurring at or around the Christmas period, and a longer but less pronounced subsidiary period of increased sexual activity and unsafe sex coinciding with the summer vacation.

We conclude that seasonal patterns of sexual activity have implications for provision of sexual health services and for the timing and targeting of sexual health promotional interventions.
Misuse of correlation and regression in three medical journals
Authors: Porter Alan M W
Published: May 2017

Errors relating to the use of the correlation coefficient and bivariate linear regression are often to be found in medical publications. This paper reports a literature search to define the problems. All the papers and letters published in the British Medical Journal, The Lancet and the New England Journal of Medicine during 1997 were screened for examples. Fifteen categories of errors were identified of which eight were important or common. These included: failure to define clearly the relevant sample number; the display of potentially misleading scatterplots; attachment of unwarranted importance to significance levels; and the omission of confidence intervals for correlation coefficients and around regression lines.
Lateral internal sphincterotomy is not redundant in the era of glyceryl trinitrate therapy for chronic anal fissure
Authors: Jonas M , Lobo D N , Gudgeon A M
Published: May 2017

Lateral internal sphincterotomy has been the standard treatment for chronic anal fissure, but fissure healing rates of up to 80% with topical glyceryl trinitrate (GTN) treatment have suggested that this operation may become redundant. We evaluated the results of topical treatment of chronic anal fissures with 0.2% GTN for 6 weeks in the outpatient clinical setting, outside the confines of a randomized clinical trial. The role of lateral internal sphincterotomy in the GTN era was also assessed.

GTN induced fissure healing in 21 of 49 consecutive patients. Fissures healed spontaneously in 2 patients who discontinued GTN because of headache. Lateral internal sphincterotomy was performed in 26 patients who had persistent symptoms after 6 weeks of GTN therapy. At the 6-week post-sphincterotomy review, all fissures had healed and there were no complications.

In this study topical GTN for treatment of chronic anal fissure in the outpatient setting was not as effective as demonstrated in controlled clinical trials. Lateral internal sphincterotomy is still a good therapeutic option, especially in patients not responding to GTN.
No association of Chlamydia with abortion
Authors: Feist A , Sydler T , Gebbers J-J O , Pospischil A , Guscetti F
Published: May 2017

Case reports and serological work have raised the possibility that chlamydias can infect the placenta and thus harm the fetus. We investigated the involvement of Chlamydia in a series of 195 unselected cases of spontaneous abortion or miscarriage. Formalin-fixed placental tissues from all cases were examined immunohistochemically, for the presence of chlamydial lipopolysaccharide, as well as histopathologically. A serum sample was collected from 187 of the patients for detection of anti-chlamydial antibodies by microimmunofluorescence.

All placental sections were negative for chlamydial antigen. Serological findings indicated that 8 patients had been in contact with C. trachomatis, 15 patients with C. pneumoniae, and none with C. psittaci. A few cases of perivillitis or intervillitis were detected, but none exhibited the intracytoplasmic inclusions typical of C. psittaci.

Although these results are negative a search for Chlamydia in abortion materials should be encouraged.
Orthopaedic management in four cases of mucolipidosis type III
Authors: Hetherington C , Harris N J , Smith T W D
Published: May 2017

Four patients with mucolipidosis type III, three of them brothers, were seen initially in the first two decades of life. Their main symptoms were carpal tunnel syndrome, trigger fingers and generalized joint stiffness. Radiographs showed spinal deformities and hip dysplasia, but these were not causing pain. Carpal tunnel syndrome was treated surgically but joint stiffness and hip and knee contractures were managed by physiotherapy. Up to the age of 24 none of these patients has had pelvic osteotomy for hip dysplasia; this operation, not yet reported in mucolipidosis type III, may eventually be necessary.
Non-communication between ophthalmologists and optometrists
Authors: Whittaker Karl W , Ikram Khalid , Anderson David F , Kiel Andrew W , Luff Andrew J
Published: May 2017

Many patients seen in the British hospital eye service are referred by high-street optometrists; and, if the optometrist is to receive feedback from the ophthalmologist, the patient should consent to disclosure of medical information. On the referral form (revised GOS 18) there is a space for this purpose. We investigated the level of communication by asking optometrists in our hospital catchment area about their use of the GOS 18 form and by examining the medical records of all new patients seen in the eye outpatient department in one month.

79 optometrists (55%) returned the questionnaire. 54 routinely used the GOS 18; and, of these, 10 said they obtained patient consent always, 23 sometimes and 21 never. 158 of 555 sets of medical notes contained an optometrist's referral, 107 of them on the revised GOS 18; and patient consent had been recorded on 17 of these forms. Ophthalmologists responded to the optometrist in 2/17 (12%) cases where consent had been obtained and 15/90 (17%) where it had not.

Ophthalmologists could provide much better feedback to optometrists. The GOS 18 form could be used more effectively; and there is no reason why patient consent to disclosure of medical information should not be obtained by ophthalmologists as well as by optometrists.
Coeliac Disease in Adults: Variations on a Theme
Authors: Bhattacharyya A , Patel M K , Tymms D J
Published: May 2017

In childhood, coeliac disease (gluten enteropathy) tends to show itself with failure to thrive and growth retardation; in adult life with malabsorption syndromes. We report six cases in adults who presented atypically, with features including clotting disorder, hypoglycaemia, weight loss, anaemia and angina pectoris, all of which responded to gluten withdrawal.
Consent to Treatment and the Mentally Incapacitated Adult
Authors: Turner N J , Brown A R , Baxter K F
Published: May 2017

Doctors are sometimes faced with adult patients who lack the mental capacity to consent to treatment. In a questionnaire, 120 doctors in a district general hospital were asked what action they would take if such a patient had a clear need for elective treatment. Of the 89 who replied, 57 said they would seek consent from relatives or others; 11 of these, nevertheless, stated that treatment could proceed without such consent. These results, and inquiries about other options, pointed to widespread misunderstanding of the law. In English law, no one can give legally valid consent on behalf of another adult. When an individual is unable to give consent, common law allows a doctor to protect a patient's best interests by treating him or her in accordance with a responsible body of medical opinion.
The Struck-off Mystery
Authors: Buntwal Neena , Hare Jonathan , King Michael
Published: May 2017

Observations on ward rounds suggested that psychiatric patients might be at special risk of removal from their general practitioner's list. Little has been published on why patients are struck off and our first attempt at investigation was by direct appeals for patients. This drew a small and unsatisfactory sample. We then asked two family health services authorities to distribute questionnaires to struck-off patients. One agreed, but later withdrew cooperation. There is a danger that struck-off patients will become an underclass excluded from primary care. We propose anonymous collection of information by health authorities, so that policy can be reviewed if necessary.
Management of acute bursitis: outcome study of a structured approach
Authors: Stell Ian M
Published: May 2017

In patients with septic bursitis the indications for admission and surgical intervention remain unclear, and practice has varied widely. The effectiveness of a conservative outpatient based approach was assessed by an outcome study in a prospective case series. Consecutive patients attending an emergency department with acute swelling of the olecranon or prepatellar bursa were managed according to a structured approach, subjective and objective outcomes being assessed after two to three days, and subsequently as required until clinical discharge. Long-term outcomes were assessed by telephone follow-up for up to eighteen months. 47 patients were included in the study: 22 had septic bursitis, 15 of the olecranon bursa and 7 of the prepatellar bursa.

The mean visual analogue pain scores of those with septic bursitis improved from 4.8 at presentation to 1.7 at first follow-up for olecranon bursitis, and from 3.8 to 2.7 for prepatellar bursitis. Symptoms improved more slowly for patients with non-septic bursitis. No patients were admitted initially, but 2 were admitted (two days each) after the first follow-up appointment. One patient had incision and drainage on the third attendance, and 3 patients developed discharging sinuses, which all healed spontaneously. All patients made a good long-term symptomatic recovery and all could lean on the elbow or kneel by the end of the follow-up period.

The management protocol, with specific criteria for admission and surgical intervention, thus produced good results with little need for operation or admission.
Family support in general practice
Authors: Goodhart Clare , Sarah Layzell , Cook Alice , Graffy Jonathan
Published: May 2017

At a time when social services are overburdened in Britain, family support in general practice offers one way to fill the gap. In the WellFamily Project, a ‘family support coordinator’ worked within a general practice in Hackney, London. In the first eighteen months she saw 113 clients. Evaluation was by semistructured interviews with a sample of these clients and with professional workers.

Comments from those interviewed indicate that the family support was valued. The general practice base was convenient and non-stigmatizing. By adopting a proactive approach, the project was able to work with clients who had previously ‘slipped through the net’. Some of the professionals interviewed would have liked to provide the same help, but were unable to do so because of time and other constraints.

Family support provided through general practice was well received by vulnerable families. Although there was overlap with the remit of health visitors and social workers, the protected time and the independence of the coordinator enabled clients to obtain the help they wanted. The replicability of this strategy now needs to be assessed.
Imprecision in medical communication: study of a doctor talking to patients with serious illness
Authors: Skelton J R , Murray J , Hobbs F D R
Published: May 2017

Uncertainty is believed to be a central feature in illness experiences. Conversations between a consultant haematologist and 61 seriously ill patients were transcribed, entered on a database and scrutinized for patterns of language uncertainty by linguistic concordancing analysis. Transcripts were then discussed in detail with the haematologist, and techniques of protocol analysis were used to gain insight into his thought processes during consultations. The main findings were that the doctor used many more expressions of uncertainty than did patients: that evaluative terms were widely used to reassure rather than to worry patients; and that patients and doctor together used certain key terms ambiguously, in a manner which allowed the doctor to feel that facts were not misrepresented while perhaps permitting the patient to feel reassured.
Robust H∞ control of stochastic linear systems with input delay by predictor feedback
Authors: Javadi Ali , Jahed-Motlagh Mohammad Reza , Jalali Ali Akbar
Published: May 2017

This study investigates the prediction-based (dynamic) stabilization of linear systems with input delay in the presence of external disturbances and multiplicative noise modelled as Itô type stochastic differential equations. Conventional memory-less (static) controllers are widely used for the stabilization of both deterministic and stochastic delayed systems. However, using these methods the upper bound for delay is strongly restricted. Motivated by acceptable performances of dynamic controllers for deterministic delayed systems, the extension of these methods for stochastic delayed systems is considered in this paper. The structure of the dynamic controller for stabilization of stochastic delayed systems is firstly derived utilizing the prediction vector. Then two sufficient conditions are given in the form of linear matrix inequalities that in the case of feasibility provide the stabilizing gain of the controller. Finally, simulation results are given to illustrate the effectiveness of the proposed method.
On the Relation Between the (Censored) Shifted Wald and the Wiener Distribution as Measurement Models for Choice Response Times
Authors: Miller Robert , Scherbaum Stefan , Heck Daniel W. , Goschke Thomas , Enge Sören
Published: May 2017

Inferring processes or constructs from performance data is a major hallmark of cognitive psychometrics. Particularly, diffusion modeling of response times (RTs) from correct and erroneous responses using the Wiener distribution has become a popular measurement tool because it provides a set of psychologically interpretable parameters. However, an important precondition to identify all of these parameters is a sufficient number of RTs from erroneous responses. In the present article, we show by simulation that the parameters of the Wiener distribution can be recovered from tasks yielding very high or even perfect response accuracies using the shifted Wald distribution. Specifically, we argue that error RTs can be modeled as correct RTs that have undergone censoring by using techniques from parametric survival analysis. We illustrate our reasoning by fitting the Wiener and (censored) shifted Wald distribution to RTs from six participants who completed a Go/No-go task. In accordance with our simulations, diffusion modeling using the Wiener and the shifted Wald distribution yielded identical parameter estimates when the number of erroneous responses was predicted to be low. Moreover, the modeling of error RTs as censored correct RTs substantially improved the recovery of these diffusion parameters when premature trial timeout was introduced to increase the number of omission errors. Thus, the censored shifted Wald distribution provides a suitable means for diffusion modeling in situations when the Wiener distribution cannot be fitted without parametric constraints.
Congenital Vascular Malformations: General Treatment Principles
Authors: Lee B B , Laredo J , Kim Y W , Neville R
Published: May 2017

The era where surgical excision alone was the sole treatment of venous malformation (VM) is now over. A multidisciplinary approach that utilizes both traditional surgical therapy and endovascular therapy is now the standard of care. Endovascular therapy utilizing primarily both embolization therapy and sclerotherapy is the treatment of choice for surgically ‘inaccessible' VM lesions. Surgical therapy of VM lesions has been shown to be more effective when combined with supplemental endovascular therapy.
Endovascular Management of Venous Malformations
Authors: Rosenblatt M
Published: May 2017

Venous malformations are the most common vascular anomalies. When they are superficial and large, they are easily recognized. However, when the malformation is deep or involves normally occurring veins, the diagnosis can be challenging. Extremity varicosities may be the only visible signs of the problem. Unfortunately, varicosities are often presumed to be the result of superficial venous insufficiency and the underlying venous malformation is overlooked. The phlebologist must be cognizant of the possibility that a venous malformation may be the cause of the patient's symptoms and varicosities. Ultrasound and magnetic resonance imaging can help to confirm the correct diagnosis. Treatment involves image-guided endovenous occlusion of the malformation, most commonly with potent liquid sclerosing agents. Some of these agents can cause severe complications. A thorough knowledge of the sclerosing solutions and the endovascular techniques to properly deliver them to the malformation is essential. This article will review the basic principle surrounding endovascular management of venous malformations.
Surgical Management of Venous Malformations
Authors: Loose D A
Published: May 2017

Objectives

Among vascular malformations, the predominantly venous malformations represent the majority of cases. They form a clinical entity and therefore need clear concepts concerning diagnosis and treatment. This paper presents an overview of contemporary classification as well as tactics and techniques of treatment. According to the Hamburg Classification, predominantly venous malformations are categorized into truncular and extratruncular forms, with truncular forms distinguished as obstructions and dilations, and extratruncular forms as limited or infiltrating.

Methods

The tactics of treatment represent surgical and non-surgical methods or combined techniques. Surgical approaches utilize different tactics and techniques that are adopted based on the pathologic form and type of the malformation: (I) operation to reduce the haemodynamic activity of the malformation; (II) operation to eliminate the malformation; and (III) reconstructive operation. As for (I), a type of a tactic is the operation to derive the venous flow. In (II), the total or partial removal of the venous malformation is demonstrated subdivided into three different techniques. In this way, the infiltrating as well as the limited forms can be treated. An additional technique is dedicated to the treatment of a marginal vein. Approach (III) involves the treatment of venous aneurysms, where a variety of techniques have been successful.

Results

Long-term follow-up demonstrates positive results in 91 % of the cases.

Conclusion

Congenital predominantly venous malformations should be treated according to the principles developed during the past decades in vascular surgery, interventional treatment and multidisciplinary treatment. The days of predominantly conservative treatment should be relegated to the past. Special skills and experiences are necessary to carry out appropriate surgical strategy, and the required operative techniques should be dictated by the location and type of malformation and associated findings.
Management of the Marginal Vein: Current Issues
Authors: Mattassi R , Vaghi M
Published: May 2017

The marginal vein, an abnormal superficial vein of the lateral lower limb, is a remnant of primitive embryonic vessels that have failed to regress. According to the extent, topography and sites of connection with the deep veins, five types have been distinguished by Weber. The marginal vein is valveless and may create venous stasis. Limb–length discrepancy and nevus may coexist. Diagnosis is made by duplex scan examination and phlebography; angio computerized tomography or magnetic resonance effectively demonstrates the vein but yield less haemodynamic data. The best treatment is complete surgical resection of the vein. Resection should be avoided in the rare cases when aplasia of the deep veins exists. A careful skeletonization can be performed if arterio-venous fistulas converge into the vein.
Vascular Bone Syndrome – Angio-Osteodystrophy: Current Concepts
Authors: Mattassi R , Vaghi M
Published: May 2017

Congenital vascular bone syndrome (CVBS) is an abnormal enhancement or reduction of growth in long bones due to pathologic circulation during childhood. Several authors have described these clinical pictures with limb lengthening; well known are Klippel and Trenaunay and Parkes-Weber. Later, Servelle and Martorell also described cases of limb length difference, but with shortening of the pathologic limb. The mechanism of limb overgrowth is probably due to the effect of A-V shunts, while shortening occurs due to mechanical compression on bones by dysplastic vessels or flow reduction. Some molecules, like vascular endothelial growth factor and others, probably affect bone growth through a poorly understood mechanism. Diagnostically, one should try to demonstrate A-V shunts around or inside the bone or low flow vascular mass. Correction of length differences can occur spontaneously if the cause of CVBS is treated in childhood. In adults, limb length differences may be corrected by orthopaedic techniques.
Foam Sclerotherapy of Venous Malformations
Authors: Bergan J , Cheng V
Published: May 2017

Venous malformations may occur either as localized or segmental lesions. Radiologic imaging defines the extent of involvement but magnetic resonance imaging is the best modality: it gives a bright hypersignal on T2-weighted spin-echo sequences.

During a 30-month period, 1427 patients were investigated for venous disorders and 1% were found to have venous angiomata (9 women and 5 men). The age range was 15 to 76 years (mean 30.8 ± 18.6 years). Foam was produced by the Tessari technique using 1% or 2% concentration of polidocanol. The duplex Doppler was used for ultrasound guidance to insure intravenous flow of foam and to monitor effects of treatment.

A goal of pain-free healing of ulcers or cosmetic improvement was set for each patient. The mean number of treatments was 3.6 ± 2.8 (range 1–10). Pain-free healing was achieved in patients with non-healing ulcerations and cosmetically, all of the patients were improved. Sclerosant foam is useful in treating low-flow venous malformations.
Mapping the collaterome for precision cerebrovascular health: Theranostics in the continuum of stroke and dementia
Authors: Liebeskind David S
Published: May 2017

Precision cerebrovascular health or individualized long-term preservation of the brain and associated blood vessels, is predicated on understanding, diagnosing, and tailoring therapies for people at risk of ischemic injury associated with stroke and vascular dementia. The associated imaging patterns are sculpted by the protective effect of the collaterome, the innate compensatory ability of the brain and vasculature to offset hypoperfusion when antegrade or normal arterial inflow pathways are compromised. Theranostics or rational and synchronous use of diagnostic studies in tandem with specific therapies to optimally guide patient outcomes in ischemic brain disorders may capitalize on the pivotal role of the collaterome. Understanding the functional impact of the collaterome across populations of individuals would advance translational science on the brain, while questions with immediate clinical implications may be prioritized. Big data and systematic analyses are necessary to develop normative standards, multimodal imaging atlases, and delineation of specific patterns to guide clinical management. Large-scale, systematic imaging analyses of the collaterome provide a platform for translational work on cerebral collateral circulation and hemodynamics and a theranostic framework with direct clinical implications. This article frames incipient research objectives to guide precision stroke medicine in coming years, building upon the collaterome concept in brain health.
Between striated and smooth space: Exploring the topology of transnational student mobility
Authors: Lysgård Hans Kjetil , Rye Ståle Angen
Published: May 2017

In this paper, we raise a question regarding how transnational students develop their spaces as mobile, temporary, and at times stable and territorially fixed. We argue that approaching transnational student migration and its relations to place as a Deleuzian assemblage is a fruitful way of highlighting this issue, and we propose the axes of the expressive/material and territorialisation/de-territorialisation as analytical tools for understanding aspects of the temporal and spatial dimensions of transnational student mobility. Our theoretical discussion is informed by the migration experiences of transnational students studying at a Norwegian university. Our core argument is that transnational student mobility should be approached as a complex process in which links to places in the student’s past, present and future dissolve the linear notion of causality and in which new notions of the relations between proximity and distance challenge ideas regarding the power relations embedded in a geometrical space.
Functional interactions between transient receptor potential M8 and transient receptor potential V1 in the trigeminal system: Relevance to migraine pathophysiology
Authors: Kayama Yohei , Shibata Mamoru , Takizawa Tsubasa , Ibata Keiji , Shimizu Toshihiko , Ebine Taeko , Toriumi Haruki , Yuzaki Michisuke , Suzuki Norihiro
Published: May 2017

Background

Recent genome-wide association studies have identified transient receptor potential M8 ( TRPM8) as a migraine susceptibility gene. TRPM8 is a nonselective cation channel that mediates cool perception. However, its precise role in migraine pathophysiology is elusive. Transient receptor potential V1 (TRPV1) is a nonselective cation channel activated by noxious heat. Both TRPM8 and TRPV1 are expressed in trigeminal ganglion (TG) neurons.

Methods

We investigated the functional roles of TRPM8 and TRPV1 in a meningeal inflammation-based migraine model by measuring the effects of facial TRPM8 activation on thermal allodynia and assessing receptor coexpression changes in TG neurons. We performed retrograde tracer labeling to identify TG neurons innervating the face and dura.

Results

We found that pharmacological TRPM8 activation reversed the meningeal inflammation-induced lowering of the facial heat pain threshold, an effect abolished by genetic ablation of TRPM8. No significant changes in the heat pain threshold were seen in sham-operated animals. Meningeal inflammation caused dynamic alterations in TRPM8/TRPV1 coexpression patterns in TG neurons, and colocalization was most pronounced when the ameliorating effect of TRPM8 activation on thermal allodynia was maximal. Our tracer assay disclosed the presence of dura-innervating TG neurons sending collaterals to the face. Approximately half of them were TRPV1-positive. We also demonstrated functional inhibition of TRPV1 by TRPM8 in a cell-based assay using c-Jun N-terminal kinase phosphorylation as a surrogate marker.

Conclusions

Our findings provide a plausible mechanism to explain how facial TRPM8 activation can relieve migraine by suppressing TRPV1 activity. Facial TRPM8 appears to be a promising therapeutic target for migraine.
Return to Play After Shoulder Instability Surgery in National Collegiate Athletic Association Division I Intercollegiate Football Athletes
Authors: Robins R. Judd , Daruwalla Jimmy H. , Gamradt Seth C. , McCarty Eric C. , Dragoo Jason L. , Hancock Robert E. , Guy Jeffrey A. , Cotsonis George A. , Xerogeanes John W. ,   ASP Collaborative Group, Tuman Jeffrey M. , Tibone James E. , Javernick Matthew A. , Yochem Eric M. , Boden Stephanie A. , Pilato Alexis , Miley Jennifer H. , Greis Patrick E.
Published: May 2017

Background:

Recent attention has focused on the optimal surgical treatment for recurrent shoulder instability in young athletes. Collision athletes are at a higher risk for recurrent instability after surgery.

Purpose:

To evaluate variables affecting return-to-play (RTP) rates in Division I intercollegiate football athletes after shoulder instability surgery.

Study Design:

Case series; Level of evidence, 4.

Methods:

Invitations to participate were made to select sports medicine programs that care for athletes in Division I football conferences (Pac-12 Conference, Southeastern Conference [SEC], Atlantic Coast Conference [ACC]). After gaining institutional review board approval, 7 programs qualified and participated. Data on direction of instability, type of surgery, time to resume participation, and quality and level of play before and after surgery were collected.

Results:

There were 168 of 177 procedures that were arthroscopic surgery, with a mean 3.3-year follow-up. Overall, 85.4% of players who underwent arthroscopic surgery without concomitant procedures returned to play. Moreover, 15.6% of athletes who returned to play sustained subsequent shoulder injuries, and 10.3% sustained recurrent instability, resulting in reduction/revision surgery. No differences were noted in RTP rates in athletes who underwent anterior labral repair (82.4%), posterior labral repair (92.9%), combined anterior-posterior repair (84.8%; P = .2945), or open repair (88.9%; P = .9362). Also, 93.3% of starters, 95.4% of utilized players, and 75.7% of rarely used players returned to play. The percentage of games played before the injury was 49.9% and rose to 71.5% after surgery ( P < .0001). Athletes who played in a higher percentage of games before the injury were more likely to return to play; 91% of athletes who were starters before the injury returned as starters after surgery. Scholarship status significantly correlated with RTP after surgery ( P = .0003).

Conclusion:

The majority of surgical interventions were isolated arthroscopic stabilization procedures, with no statistically significant difference in RTP rates when concomitant arthroscopic procedures or open stabilization procedures were performed. Athletes who returned to play often played in a higher percentage of games after surgery than before the injury, and many played at the same or a higher level after surgery.
Enzymatic Analysis of the Gingival Crevicular Fluid in Hypoxia of High Altitude (Everest)
Authors: Trentini P. , Ferrante M. , Dolci M. , Ciavarelli L. , Tondi A. , Spoto G.
Published: May 2017

The aim of this study is to determine the qualitative and quantitative changes of alkaline phosphatase (ALP) that occur in the Gingival Crevicular Fluid (GCF) in hypobaric-hypoxic conditions (high altitude). Hypoxia affects systemic adaptation responses in different organs. We examined 17 Caucasians subjects, of whom 13 were mountain climbers (1 female and 12 males), and 4 Tibetans (2 females and 2 males) following exposure to the hypoxia environment of high altitude. The study was conducted at different altitudes (0 m control, 1000 m, 5200 m above sea level) on Mount Everest. The protocol consisted of withdrawing crevicular fluid through the use of cones made of endodontic paper size 30 sectioned to 15 mm from the apex, inserted for 30 seconds in the gingival sulcus (about 2 mm). The analyzed sites were the mesial and distal, buccal and palatal of tooth 1.1 and 2.1. Blood exams were performed on the subjects using I-Stat, furnishing analysis in real time (about 2 mins). In agreement with other results reported in literature, in all the subjects we found an increase in the hematocrit and hemoglobin with a large range of values between them, and with significant differences, as analysed with the Fisher, Scheffe and Bonferroni/Dunn statistical methods. The enzymatic analysis of the GFC showed an increase of the levels of ALP at each altitude studied. With this preliminary study we show that hypoxic environment determines not only the well known cardiovascular systemic responses, but also crevicular fluid adaptation.
Multiple Chemical Sensitivity: Current Concepts
Authors: Rossi G. , Nucera E. , Patriarca G. , Manicone P.F. , Raffaelli L. , Pescolla A. , Berardp D. , Perfetti G.
Published: May 2017

Multiple Chemical Sensitivity (MS) is characterized by a wide range of symptoms when affected patients come into contact with several chemical products. Very little is known of either the diagnosis or the suitable treatment. In this study we report the case of a 38-year-old woman, previously diagnosed as suffering from MCS, who was referred for an oral health evaluation. After removing all the existing restorations and extracting the diseased teeth, a removable partial denture without metal structure was made after testing her hypersensitivity to these materials. The one year follow-up of the patient did not show any remarkable reaction, confirming the reduction of a large number of MCS symptoms and the increase in her quality of life.