bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evidence for Progression of Brain Structural Abnormalities in Schizophrenia: Beyond the Neurodevelopmental Model
Authors: Velakoulis Dennis , Wood Stephen J. , McGorry Patrick D. , Pantelis Christos 
Published: March 2018

ObjectiveClinical, neuroimaging, neuropathological and neuropsychological evidence suggests that, in schizophrenia, there is structural and functional disturbance of the hippocampus. The purpose of this paper is to present published findings concerning the nature, timing and course of these putative disturbances of hippocampal function and the pathophysiological mechanisms involved, and to explore whether schizophrenia is a disorder of neurodevelopment, neurodegeneration or a combination of both processes.MethodThe available cross-sectional and longitudinal evidence for hippocampal involvement in schizophrenia is reviewed and a model of hippocampal involvement in this disorder, which derives from our own cross-sectional and longitudinal hippocampal imaging data, is described.ResultsWe propose a three-hit model in which an early neurodevelopmental lesion renders the hippocampus vulnerable to further insult later in life during the transition phase to active illness. The available evidence suggests that the left hippocampus is particularly vulnerable during these early stages, while further insult involving the hippocampus bilaterally occurs in those who develop a chronic form of the illness.ConclusionsIntervention strategies should target the most vulnerable stages of the illness, in particular the transition phase to psychosis, when novel treatments may prevent the illness or ameliorate its effects.
Case Ascertainment: The Composite International Diagnostic Interview
Authors: Andrews Gavin 
Published: March 2018

Objective To outline the utility of the Composite International Diagnostic Interview (CIDI) in the diagnosis of psychosis. Method Report current situation. Results The CIDI was designed as a fully structured interview to be used by lay interviewers. It generates false positive diagnoses in community surveys and false negative diagnoses in psychiatric settings. A new psychosis module has been developed to reduce these problems. Conclusions The diagnosis of psychosis by fully structured diagnostic interviews is difficult.
Presymptomatic Screening for Schizophrenia: A Geneticist's Perspective
Authors: Turner Gillian 
Published: March 2018

Objective To examine whether the experience gained in offering various genetic tests may be of help in the planning for screening in schools for a personality profile that may identify those destined to develop schizophrenia. Method To examine the outcomes in offering genetic testing: (i) to individuals at risk of developing Huntington's disease; (ii) to school pupils for carrier status for cystic fibrosis; and (iii) to the intellectually handicapped in schools to identify those with the fragile X syndrome. Results All programs however carefully planned, encounter the unexpected and unforeseen. Conclusions It is essential to know the specificity and sensitivity of your screening test; to ensure that all have adequate knowledge before consenting to the testing; to ensure the confidentiality of the test results to the individual being tested and their families; and to ensure that funding is adequate and ongoing to provide continuing support and therapy to the families identified when research converts to service.
Detection of Disease at the Carotid Bifurcation Using Ultrasound – Including an Imaging System1
Authors: Lewis R R , Beasley M G , Gosling R G 
Published: March 2018

A two-stage approach is described for the detection of occlusive arterial disease at the carotid bifurcation using continuous wave Doppler-shift ultrasound with spectral analysis of backscattered signals from erythrocytes. The first stage involves analysis of Doppler-shift signals from the supraorbital and common carotid arteries. Abnormal signals from these arteries are frequently caused by the presence of atheroma at the carotid bifurcation and are used to indicate the necessity for imaging the bifurcation. This latter technique produces a physiological image of the arteries, as it depends on detecting erythrocyte velocities beneath a transducer which is guided over the surface of the neck. The investigation has advantages over arteriography in that it is noninvasive, has no attendant risk and may be repeated as often as required. In order to evaluate the accuracy of these methods the results have been compared with x-ray findings in patients undergoing carotid arteriography. In 20 comparisons there were no false positives and one false negative in which the arteriogram showed a small lesion. These results indicate that the two noninvasive methods may be used in sequence to demonstrate operable disease around the carotid junction.
Provision of Induced Abortion in Wessex Health Region: Unmet Need and Feasibility of Compensatory Day Care
Authors: Ashton John R 
Published: March 2018

A study of routinely collected data showed that in 1975 only 42% of Wessex abortion patients obtained a National Health Service operation in their own region. Within this average the range for own district National Health Service operations was from 8.7% (Central Hampshire) to 68% (South West Hampshire) when known paybed operations had been excluded. Most of the remaining patients obtained private operations outside the region and of these about 50% obtained an operation at the British Pregnancy Advisory Service Clinic (BPAS) at Brighton. A survey of Wessex women obtaining induced abortions at BPAS, Brighton, found that 85% of a sample of patients interviewed would have been willing to have a National Health Service operation locally but it had not been available. Only 24% of these women had been referred by way of a formal and accepted path, and had obtained their operation before ten weeks gestation, a suggested maximum for day-care provision. If this proportion is representative of Wessex patients obtaining operations outside the region, the numbers of patients involved in 1975 would have been 643 and the feasibility of a day surgical unit specially providing for this number would be questionable. It is suggested that by reducing delays in the referral process and accepting patients by non-traditional referral paths at least a further 21% of the patients would have qualified for day care. On the basis of this estimate a Regional Day Abortion Unit is probably a practicable proposition.
Psychiatric disorders among elderly patients admitted to hospital medical wards
Authors: Cooper Brian 
Published: March 2018

A psychiatric investigation was carried out on patients aged 65–80 years who were admitted to the medical wards of six general hospitals in an industrial urban area of West Germany. In all, 626 patients were screened for cognitive and affective disorder using a short standardized interview, and at the second stage all those with abnormal responses, as well as a subsample of the apparently normal patients, were examined in greater detail. After correction for inaccuracies of screening, the frequency of psychiatric illness in this patient population was estimated as 30.2%, made up of 9.1% with organic brain syndromes and 21.1% with functional mental disorders. Comparison with field-study data for the same background population showed that the hospital patients were at increased risk for mental disturbance. At follow up after one year, outcome in terms of mortality, admission to long-term care and dependency on others was worst for patients with organic mental disorder, even after matching for age and initial severity of physical impairment. Functional mental illness was also associated with a relatively poor outcome in terms of dependency. The mental status of elderly medical patients appears to be important for the prognosis.
Familial Dysalbuminaemic Hyperthyroxinaemia and Other Causes of Euthyroid Hyperthyroxinaemia
Authors: Farror C , Wellby M L , Beng C 
Published: March 2018

Clinical and biochemical studies on a family in which 3 members have familial dysalbuminaemic hyperthyroxinaemia (FDH) are presented. They were clinically euthyroid with elevated serum thyroxine (T4) and free T4 indices but normal free T4 by equilibrium dialysis and normal serum triiodothyronine (total and free). All thyroid function tests on the remaining family members were normal. The inheritance is consistent with autosomal dominance. Also presented are data on 4 unrelated patients with FDH and two patients with T4 autoantibodies. The methods for detecting FDH, T4 antibodies and other causes of euthyroid hyperthyroxinaemia are now freely available. Since these anomalies may be more common than previously supposed, clinical awareness of the conditions is necessary to protect patients from the consequences of incorrect diagnosis of thyrotoxicosis.
Metabolic Effects of Prostatectomy
Authors: Hamilton Stewart P A , Barlow I M 
Published: March 2018

Transurethral resection syndrome (TURS), complicating transurethral resection of the prostate (TURP) has been ascribed to hyponatraemia but reports have indicated that hyperammonaemia following metabolism of glycine can be the main cause. Prospective data has been collected on 96 prostatectomy patients (82 TURP and 14 retropubic). The retropubic group showed no significant postoperative change in the serum sodium or plasma ammonia. Of the TURP group, no TURS occurred although hyponatraemia was noted in 32 patients. The weight of prostate resected, the volume of glycine used, the time taken and the plasma ammonia levels were not significantly different in the normonatraemic or hyponatraemic groups. In severely hyponatraemic patients (13 out of 32 with a 10mmol/l, or greater, decrease in serum sodium) there was a significant rise (P≤0.05) in plasma ammonia, 1 or 4 h post TURP, which had decreased by 24 h. There was a highly significant increase in serum glycine level in the hyponatraemic compared with the normonatraemic group (P≤0.001). There was no correlation between serum glycine and plasma ammonia levels in the normonatraemic or hyponatraemic group. There were nine patients with post TURP plasma ammonia levels ≥ 100 μmol/l (mean 254) who experienced no mental confusion: six of these patients were hyponatraemic. The weight of prostrate resected (mean 26 g), volume of glycine used (mean 181) and operation time (mean 39 min) were all relatively low. Subsequently, TURS has occurred in a patient, with severe hyponatraemia and hyperglycinaemia but no hyperammonaemia. This study shows that hyperammonaemia does not always correlate with hyponatraemia or hyperglycinaemia, and high plasma ammonia levels can occur in the absence of TURS.
Significance of Buerger's Test in the Assessment of Lower Limb Ischaemia
Authors: Insall R L , Davies R J , Prout W G 
Published: March 2018

In claudicante with arteriosclerosis obliterans admitted for vascular surgery, Buerger's test was compared with other indicators of lower limb ischaemia. Rest pain, gangrene, trophic changes, and chronic erythro-melia were significantly commoner and more distal pulses were absent in Buerger positive limbs. Doppler and transcutaneous oxygen pressures and indices were significantly lower in Buerger positive legs. Significantly more occlusions were noted on arteriography in arteries distal to the adductor hiatus in the Buerger positive group. Buerger's test is a useful adjunct to routine peripheral vascular assessment and, if positive, suggests more severe ischaemia with distal limb artery involvement.
Problems of Adolescents Sexuality
Authors: Whatley J , Thin N , Reynolds B , Blackwell A 
Published: March 2018

Recent discussions highlighted adolescents’ sexual behaviour, but published studies concentrate on specific problems or subgroups of patients without addressing factors related to sexuality. To obtain a broad picture we studied two groups of adolescents attending genito-urinary medicine/sexually transmitted disease (STD) clinics in contrasting areas of Britain, inner London and Swansea. These were evaluated for referral pattern, sexual partner, contraception, obstetric history, sexually transmitted disease, and cervical cytology findings. Over half the adolescents referred themselves but few doctors other than general practitioners referred patients. Sexual partners were regarded by males as casual but by females as regular. Only 66% (81) of females practised contraception. Adolescents had more STD's than the total clinic population except for genital herpes simplex infection, and a high prevalence of genital warts in females has important future implications. The main conclusions were that there is a need for sexually related education targetted at adolescents and their health care providers, especially doctors.
Acceptability of Day Care Surgery
Authors: Senapati A , Young A E 
Published: March 2018

Although day case surgery is recommended, its widespread feasibility in an urban environment is unclear. We studied 100 consecutive unselected patients admitted for surgical procedures considered to be suitable for day case surgery. Their age, fitness and social details were recorded and they were asked both before surgery and after discharge by a postal questionnaire, whether they would have preferred treatment as an outpatient. There were 47 men and 53 women with a mean age of 42.5 years. Ninety-six were considered to be medically fit for day case surgery but 10 patients lived alone, seven had no suitable companion, 22 had too many stairs to climb, 13 lived too far from the hospital and two could not provide a lift home. Thus 58 of the patients were unsuitable for day case surgery. Seventy-eight of the patients replied to the postal questionnaire. Before the operation 51 patients preferred the idea of day care but only 14 felt the same way afterwards. The single postoperative complication was one case of acute retention after a hernia repair. In our experience, over half the patients initially deemed suitable for day case surgery would be unsuitable.
Preliminary observations on clotting under three hydrocolloid dressings
Authors: Mulder G D , Walker A 
Published: March 2018

Four patients with five wounds were randomly assigned to treatment with three occlusive dressings: DuoDERM®, Restore® and Comfeel Ulcus®; the dressings were left intact for 24-48 h. When the dressings were removed, it was found that wounds that had been covered with Restore and Comfeel contained coagulated sanguinous material. Two wounds that had been covered with Comfeel and Restore, respectively, were then covered with DuoDERM, while one wound previously covered with DuoDERM was covered with Restore. Either no clotting occurred under DuoDERM or clots may have resolved. Although these preliminary data suggest that DuoDERM gel may have fibrinolytic properties, more extensive and controlled studies are needed to assess the characteristics of this dressing.
Effect of Perilesional Injection of α-interferon on Cervical Intraepithelial Neoplasia and Associated Human Papillomavirus Infection
Authors: Dunham A M , McCartney J C , McCance D J , Taylor R W 
Published: March 2018

In this controlled prospective study, 14 patients with cervical intraepithelial neoplasia (CIN) were observed for one month to exclude spontaneous regression, and then seven patients were treated twice-weekly with perilesional injections of α-interferon. Both groups were monitored colposcopically, and advised to use the contraceptive sheath. Cervical smears and biopsies for histology and viral studies were taken before and after the study. There was an improvement of six out of seven of the study group, with two complete cures. Koilocytosis disappeared if it had been present initially, as did human papillomavirus (HPV) 16. By contrast, three control cases showed improvement, but there were no cures, and one case deteriorated; Koilocytosis (2 cases) did not change; HPV 16 disappeared in two controls and appeared in one. A new focus of dysplasia appeared in a part of the transformation zone not being treated with α-interferon in one of the study cases, illustrating the advisability of treating the whole transformation zone in CIN.
Characteristics of Referrals to an Inpatient Hospice and a Survey of General Practitioner Perceptions of Palliative Care
Authors: Seamark David A , Lawrence Clive , Gilbert James 
Published: March 2018

In order to determine symptoms, drug prescribing and physical problems of patients referred to an inpatient hospice, case notes from 130 consecutive first admissions (95 general practitioner (GP) referrals, 35 consultant referrals) were analysed. GP referrals were more likely to be constipated, require care and be discharged to home. Consultant referrals were more gravely ill, dependent and more likely to die in the hospice. On admission 76 (58%) patients were receiving opiates with co-prescription of opiate and laxative occurring in 41 % (31/76) of the cases. The prescription of laxatives with the symptoms of constipation occurred in 62% (26/42) of the cases on admission. A telephone survey of 79 referring GPs revealed that 37% had attended neither a course nor a lecture relevant to palliative care in the past 3 years. GPs experienced difficulties frequently or always in: (a) managing pain (8/79); (b) managing other symptoms (25/79); (c) helping patients and relatives cope with their emotional distress (18/79); and (d) coping with their own emotional responses to death and dying (5/79). In conclusion, the differences demonstrated between the GP and consultant referrals have implications for purchasers. The high incidence of possible opiate-induced side-effects and the difficulties with symptom control expressed by some GPs indicate a continuing need for effective educational input.
Three Simple Methods of Detecting Malnutrition on Medical Wards
Authors: Nightingale J M D , Walsh N , Bullock M E , Wicks A C 
Published: March 2018

Malnutrition in hospital is often unrecognized. A nutrition team aims to teach simple methods of detecting malnutrition. On a single day all medical in-patients underwent a nutritional assessment. Eighty-four patients (43 men), median age 71 years (range 28–97), were assessed. The most common diagnoses were cardiac disease (26), stroke/dementia (12), non-malignant lung disease (9) and malignancy (6). A weight loss of more than 10% (%WL) was found in 17/65 (26%) and a body mass index (BMI) of less than 19kg/m2 in 13/69 (19%). A mid-arm muscle circumference (MAMC) less than the fifth percentile occurred in 16/83 (19%) patients. Percentage weight loss alone detected seven patients of whom four were overweight (BMI > 25 kg/m2), BMI alone detected three patients, and MAMC alone eight patients of whom three could not be weighed and three had fluid retention. There was fluid retention in 35/84 (42%) patients of whom nine were malnourished (six detected by BMI and/or %WL, and three by MAMC alone). All three measurements were made in 64 patients, six (9%) of whom were detected as malnourished by all three methods. Combining the three measurements 29/84 (35%) of patients were malnourished and only 28% of these patients had been assessed by a dietitian. BMI and %WL detect most patients but fluid retention may limit their accuracy. MAMC is useful in those who cannot be weighed or who have fluid retention.
Munchausen's Syndrome—Masquerading as Necrotizing Fasciitis
Authors: Park A J , Scerri G V 
Published: March 2018

We would like to present a novel form of Munchausen's syndrome which presented us with a difficult problem in the midst of the recent media hysteria regarding flesh eating bacteria. This condition, first described by Richard Asher in 19511, is often very difficult to diagnose and it is not, therefore, surprising that the victims have been through several epsiodes of treatment before the suspicions of staff are raised. It owes its name to a fictitious character, Baron Karl Friedrich Hieronymus Freihess von Munchausen, who recounted extraordinary and wildly exaggerated exploits of adventure and daring, not unlike patients who present with this condition. Our enquiries revealed that the laid down procedure when faced with a patient with this condition is that the regional medical officer (RMO) should be contacted. It is then his responsibility to contact other RMOs, who in turn pass the information on to accident and emergency consultants in their area.
High dose Chemotherapy for Breast Cancer: The Case for Trials in Adjuvant Therapy
Authors: Leonard R C F 
Published: March 2018

Adjuvant polychemotherapy reduces the annual mortality for breast cancer, the effect being seen for at least the first decade after primary treatment for stage II disease. However, the overall benefit is modest with an annual reduction in the odds of death of the order of 20%–30%. For patients at standard or low risk of recurrence this appears to be an acceptable benefit given low toxicity of treatment. However, some patients have a very much worse prognosis identifiable on the basis of the number of involved axillary nodes at surgery. Patients with more than 10 lymph nodes, for example, have a predicted survival of less than 30% at 5 years and around 10% at 10 years. High dose chemotherapy has shown immediate benefits in terms of complete response rates in advanced breast cancer. Potential benefits of this treatment could be even higher in the adjuvant setting given the patient's fitness and the fact that micrometastatic disease represents the best clinical analogue of the successful laboratory experimental conditions. Now that the safety factors appear to be favourable with a treatment-related mortality of less than 5% it would appear that stage II poor risk disease is an appropriate setting to test high dose chemotherapy against the best conventional therapy in randomized trials.
Alcohol Abuse and Stage of HIV Disease in Intravenous Drug Abusers
Authors: Lake-Bakaar Gerond , Grimson Roger 
Published: March 2018

Our objective was to identify factors that might correlate with human immunodeficiency virus (HIV) disease stage in intravenous drug abusers (IVDA). Particular attention was given to alcohol abuse. We accordingly explored in a cross-sectional study the relation between stage of HIV disease and age, sex, needle sharing, ethnicity, self-reported history of alcohol consumption and CAGE scores. IVDA from a single municipal hospital were subdivided into three groups according to HIV disease status. Group 1 comprised 42 individuals with AIDS; group 2 comprised 114 who were HIV positive but without AIDS; and group 3 comprised 52 who were HIV negative. Information on alcohol consumption and CAGE responses were obtained by questionnaire and interview. Discriminant analysis indicated that alcohol abuse, assessed either by self-reported consumption or by CAGE scores, was significantly more common in the AIDS group than in either the HIV positive or the HIV negative groups, when controlled for age, sex, and needle sharing status. The relative risk of AIDS was 3.8 times higher in the heavy drinkers than in moderate drinkers. Needle sharing was also more common in the AIDS group than in the HIV positive or HIV negative groups when the other factors were controlled for. AIDS was more common in black than white IVDA, and this increased frequency did not appear related to alcohol consumption since the distribution of heavy drinkers within each category of HIV disease did not differ within the ethnic groups. These data indicate that a history of heavy alcohol consumption is more common in IVDA with AIDS than in IVDA at earlier stages of HIV disease.