bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Conventional and Three-Dimensional Thallium-Technetium Scans on Surgery for Primary Hyperparathyroidism
Authors: Jenkins B J , Newell M S , Goode A W , Boucher B J , Monson J P , Brown C L 
Published: February 2018

Twenty-nine patients with primary hyperparathyroidism underwent double-tracer subtraction scanning after injection of 201T1 as thallous chloride for thyroid and parathyroid images followed by 99mtechnetium as sodium pertechnetate for thyroid images prior to surgical exploration of the neck. The operative findings were correlated with the scans. All 23 adenomas (100%) and 13 of 18 (72%) hyperplastic glands were correctly localized. The ability of the scan to identify abnormal parathyroids was determined by the gland mass rather than whether the tissue was adenomatous or hyperplastic as all 32 (100%) abnormal glands weighing more than 180 mg were successfully localized in contrast to four of nine (44%) glands weighing less than 180 mg. An additional technique, in which emission tomography was carried out after subtraction scintigraphy, was used on 11 patients in the series. In all 11, the site of a single abnormal gland was predicted by the conventional subtraction scan: in nine of these patients, emission tomography provided additional localization of the gland in the anteroposterior plane.
Double J Stents in the Treatment of Gynaecological Injury to the Ureter
Authors: Turner W H , Cranston D W , Davies A H , Fellows G J , Smith J C 
Published: February 2018

Ureteric injury is a recognized complication of hysterectomy and may present with obstruction or fistula. Between 1987 and 1989 in Oxford nine patients with 10 injured ureters underwent attempted retrograde placement of double J stents. Three patients had successful outcomes and one patient with bilateral ureteric obstruction required reimplantation of the right ureter after successful stenting of the left ureter. One patient required removal of a stent due to irritation but her fistula eventually closed. In three patients placement was unsuccessful and in one patient injury to the bladder base prevented the ureteric orifices from being seen and hence stenting was not possible. Thus five of these 10 injured ureters were managed successfully with double J stents. We advocate the initial use of double J stents in gynaecological ureteric injury. This approach is simple and may cure the fistula. If it is unsuccessful, subsequent reimplantation is not hindered.
Failure of Perception of Hypocapnia: Physiological and Clinical Implications
Authors: King J C , Rosen S D , Nixon P G F 
Published: February 2018

Hyperventilation causes hypocapnia and respiratory alkalosis and thereby predisposes to coronary vasoconstriction and cardiac arrhythmia. Diagnostic methods for use between episodes have not been established. In this study of 100 patients and 25 control subjects the resting end-tidal PCO2 (Pet CO2) levels and the results of a forced hyperventilation test did not show a significant difference between the groups. However the patients hyperventilated more profoundly in response to emotional stimulation, and were less aware of inappropriate breathing and hypocapnia. It is suggested that these differences should be accommodated in cardiac rehabilitation.
Adenocarcinoma of the Gallbladder – a 5 Year Review of Outcome in Newcastle upon Tyne
Authors: Burgess P , Murphy P D , Clague M B 
Published: February 2018

Patients presenting with adenocarcinoma of the gallbladder within Newcastle upon Tyne over a 5 year period (1980–1985) were reviewed retrospectively. The mean age of patients on diagnosis was 74 years. Of the 29 patients diagnosed, two were detected after routine cholecystectomy. Laparotomy was performed in 21 patients (72%) of which only 14 patients had a cholecystectomy performed. Mean survival after surgery was 6.6 months with only one patient alive after 5 years. Metastatic disease was present in 72% of patients. The poor prognosis of carcinoma of the gallbladder reflects its late diagnosis and early metastasis to distant sites. Improvement in survival will depend upon early detection of in situ lesions and identification of at risk patients.
Are our Babies Becoming Bigger?
Authors: Alberman E 
Published: February 2018

I have tried to show, using a contemporary international data set, the overall consistency in shape of curves of national birthweight distributions which reflect the biological and social characteristics of the population from which they are derived, and the effects of changes in these characteristics. For several countries, including the United States and England and Wales, the trends in recent years have been such as to shift the main distribution upwards, so that the median weight has increased. Also shown has been the close and specific relationship within each population group between infant mortality and birthweight, with sharp falls of mortality with increasing birthweight. It has been shown elsewhere that similar patterns are seen with short- and long-term morbidity, thus underlining the importance to be attached to increasing birthweight particularly in underprivileged groups. In the short term this can be done by reducing the frequency of parental smoking, where this is a problem, and in the longer term by improving maternal health and nutrition. The shift towards higher birthweights if it persists, should make an important contribution towards the improvement of the public health of the next generation.
The Changing Pattern of Thoracic Surgery in the United Kingdom 1963–1982
Authors: Paraskevopoulos J A , Gunning A J , Dennison A R 
Published: February 2018

During the period 1963–1982 a total of 11 459 patients with general surgical and thoracic conditions were admitted to the Churchill and John Radcliffe Hospitals in Oxford under the care of a single thoracic surgeon. 55.1% of the admissions were for general surgical conditions whereas 44.9% were for a thoracic disorder. The total period has been studied by dividing it into three subgroups of 7, 6 and 7 years (1963–1969, 1970–1975, 1976–1982). The percentage of thoracic patients treated during the three periods was found to be 48.86%, 41.73% and 50.11% respectively. The three periods studied have been subdivided into major disease groups and the changes in these groups have been studied in detail. During this 20-year period there has been a dramatic change in the makeup of a typical thoracic surgical practice. This is in part due to the changing pattern and prevalence of many of the diseases treated by thoracic surgeons, but is also due to a change in referral patterns, the distribution of patients between thoracic and general surgeons and also the dichotomy emerging between thoracic and cardiac surgeons.
Breast Liver Metastases – Incidence, Diagnosis and Outcome
Authors: Hoe A L , Royle G T , Taylor I 
Published: February 2018

Breast liver metastases are uncommon and have not been well reported. We studied the clinical outcome of 47 patients who developed liver metastases out of 912 breast cancer patients treated between 1982 and 1987, an incidence of 5.2%. The median disease free interval prior to clinical liver metastases was 20.2 months (range 4–192 months). The most frequent clinical presentations were hepatomegaly (70%) and abdominal pain (34%). The diagnosis was confirmed on ultrasound scan in 72.7% patients. Thirty-one patients (70.5%) received specific treatment with both hormone and chemotherapy but only six showed any evidence of objective response, the majority of whom had metastases only in the liver. The median survival of treated patients was 4 months and absence of jaundice, response to treatment and liver metastases only were associated with significantly better survival. In conclusion breast liver metastases usually present as a manifestation of disseminated disease and have an appalling prognosis. When they occur as an initial site the prognosis is better but very few patients overall respond to conventional treatment.
A new imaging technology to reduce the radiation dose during uterine fibroid embolization
Authors: Thomaere Eveline , Dehairs Michiel , Laenen Annouschka , Mehrsima Abdoli , Timmerman Dirk , Cornelissen Sandra , Op de Beeck Katya , Bosmans Hilde , Maleux Geert 
Published: February 2018

Background Uterine fibroid embolization (UFE) is a minimally invasive imaging-guided treatment using radiation exposure. Purpose To compare the patients’ radiation exposure during UFE before and after introduction of a new X-ray imaging platform. Material and Methods Forty-one patients were enrolled in a prospective, comparative two-arm project before and after introduction of a new X-ray imaging platform with reduced dose settings, i.e. novel real-time image processing techniques (AlluraClarity). Demographic, pre-interventional imaging, and procedural data, including dose area product (DAP) and estimated organ dose on the ovaries and uterus, were recorded and angiographic quality of overall procedure was assessed. Results There were no significant differences in demographic characteristics and preoperative fibroid and uterine volumes in the two groups. The new imaging platform led to a significant reduction in mean total DAP (102 vs. 438 Gy.cm2; P < 0.001), mean fluoroscopy DAP (32 vs. 138 Gy.cm2; P < 0.001), mean acquisition DAP (70 vs. 300 Gy.cm2; P < 0.001), and acquisition DAP estimated organ dose in ovaries (42 vs. 118 mGy; P < 0.001) and uterus (40 vs. 118 mGy, P < 0.001), without impairment of the procedure and angiographic image quality. Conclusion A substantial 77% reduction of DAP values and 64% and 66% reduction in organ dose on ovaries and uterus, respectively, was demonstrated with the new imaging platform, while maintaining optimal imaging quality and efficacy.
The contribution of CACNA1A, ATP1A2 and SCN1A mutations in hemiplegic migraine: A clinical and genetic study in Finnish migraine families
Authors: Hiekkala Marjo Eveliina , Vuola Pietari , Artto Ville , Häppölä Paavo , Häppölä Elisa , Vepsäläinen Salli , Cuenca-León Ester , Lal Dennis , Gormley Padhraig , Hämäläinen Eija , Ilmavirta Matti , Nissilä Markku , Säkö Erkki , Sumelahti Marja-Liisa , Harno Hanna , Havanka Hannele , Keski-Säntti Petra , Färkkilä Markus , Palotie Aarno , Wessman Maija , Kaunisto Mari Anneli , Kallela Mikko 
Published: February 2018

Objective To study the position of hemiplegic migraine in the clinical spectrum of migraine with aura and to reveal the importance of CACNA1A, ATP1A2 and SCN1A in the development of hemiplegic migraine in Finnish migraine families. Methods The International Classification of Headache Disorders 3rd edition criteria were used to determine clinical characteristics and occurrence of hemiplegic migraine, based on detailed questionnaires, in a Finnish migraine family collection consisting of 9087 subjects. Involvement of CACNA1A, ATP1A2 and SCN1A was studied using whole exome sequencing data from 293 patients with hemiplegic migraine. Results Overall, hemiplegic migraine patients reported clinically more severe headache and aura episodes than non-hemiplegic migraine with aura patients. We identified two mutations, c.1816G>A (p.Ala606Thr) and c.1148G>A (p.Arg383His), in ATP1A2 and one mutation, c.1994C>T (p.Thr665Met) in CACNA1A. Conclusions The results highlight hemiplegic migraine as a clinically and genetically heterogeneous disease. Hemiplegic migraine patients do not form a clearly separate group with distinct symptoms, but rather have an extreme phenotype in the migraine with aura continuum. We have shown that mutations in CACNA1A, ATP1A2 and SCN1A are not the major cause of the disease in Finnish hemiplegic migraine patients, suggesting that there are additional genetic factors contributing to the phenotype.
Compensations in Bone Morphology and the Dentition in Patients With Untreated Unilateral Cleft Lip and Palate
Authors: Woods McKenzie E. , Beeman Cynthia S. , Westgate Philip M. , Cardinal Lucas , Huja Sarandeep S. 
Published: February 2018

Objective: The purpose of this study was to quantitatively assess dentoalveolar and skeletal compensations in patients with untreated unilateral cleft lip and palate (UCLP). We hypothesized that there are significant skeletal and dental adaptations in UCLP cases compared to a comparison maxillary crossbite group. Design: A convenience retrospective sample of 30 patients with UCLP and a comparison group of 30 patients with unilateral posterior crossbite without CLP. Cone-beam computed tomography scans (CBCTs) were used to evaluate dental and skeletal compensations. In addition, alveolar bone thickness was measured at 2-mm increments in mesiodistal and faciolingual cross-sectional views along the long axis of the central incisors. Alveolar bone height was measured, and the percentage of root length supported by bone was calculated. Results: Compensations for unilateral cleft lip and palate were restricted to the cleft site and adjacent structures. Dental compensations include alteration in the position of cleft-adjacent maxillary incisors and maxillary canines. No gross skeletal compensations were found. Alveolar support of cleft adjacent incisors was similar to controls except for measurements in the most coronal and apical regions. The cleft group contralateral incisors exhibited buttressing effects and had significantly higher alveolar thickness in the coronal half of the tooth. There was less (5%) alveolar coverage of the cleft-facing aspect of the central incisor root than all other incisors. Conclusion: The bone adaptation to the presence of a cleft was localized in the vicinity of the cleft, and adaptations in the mandible were not apparent.
Cilioretinal artery occlusion associated with cisplatin
Authors: Alkan Ali , Talaz Serap 
Published: February 2018

Introduction Cancer is an important risk factor for venous and arterial thromboembolic events. Treatment with chemotherapy was associated with a 6.5-fold increase in the risk of thromboembolic events. Here, we present a patient with cilioretinal artery emboli during cisplatin-based therapy. Case report A 54-year-old male patient with a diagnosis of metastatic small cell carcinoma was under cisplatin-based regimen. He presented with visual disturbance. Retinal fluorescein angiography showed multiple plaques located in cilioretinal artery and cilioretinal artery occlusion. After excluding other potential etiological factors, patient was diagnosed with cilioretinal artery occlusion associated with cisplatin. Discussion In oncology practice, patients are prone to thromboembolic events due to primary disease, underlying comorbidities and treatment modalities. In addition to numerous toxicities, cisplatin is an important risk factor for thromboembolic events. Clinicians caring patients with a diagnosis of cancer should be aware of this rare complication of cisplatin-based therapies.
Do clinicians prescribe exercise similarly in patients with different cardiovascular diseases? Findings from the EAPC EXPERT working group survey
Authors: Hansen Dominique , Rovelo Ruiz Gustavo , Doherty Patrick , Iliou Marie-Christine , Vromen Tom , Hinton Sally , Frederix Ines , Wilhelm Matthias , Schmid Jean-Paul , Abreu Ana , Ambrosetti Marco , Garcia-Porrero Esteban , Coninx Karin , Dendale Paul 
Published: February 2018

Background Although disease-specific exercise guidelines for cardiovascular disease (CVD) are widely available, it remains uncertain whether these different exercise guidelines are integrated properly for patients with different CVDs. The aim of this study was to assess the inter-clinician variance in exercise prescription for patients with various CVDs and to compare these prescriptions with recommendations from the EXercise Prescription in Everyday practice and Rehabilitative Training (EXPERT) tool, a digital decision support system for integrated state-of-the-art exercise prescription in CVD. Design The study was a prospective observational survey. Methods Fifty-three CV rehabilitation clinicians from nine European countries were asked to prescribe exercise intensity (based on percentage of peak heart rate (HRpeak)), frequency, session duration, programme duration and exercise type (endurance or strength training) for the same five patients. Exercise prescriptions were compared between clinicians, and relationships with clinician characteristics were studied. In addition, these exercise prescriptions were compared with recommendations from the EXPERT tool. Results A large inter-clinician variance was found for prescribed exercise intensity (median (interquartile range (IQR)): 83 (13) % of HRpeak), frequency (median (IQR): 4 (2) days/week), session duration (median (IQR): 45 (18) min/session), programme duration (median (IQR): 12 (18) weeks), total exercise volume (median (IQR): 1215 (1961) peak-effort training hours) and prescription of strength training exercises (prescribed in 78% of all cases). Moreover, clinicians’ exercise prescriptions were significantly different from those of the EXPERT tool ( p < 0.001). Conclusions This study reveals significant inter-clinician variance in exercise prescription for patients with different CVDs and disagreement with an integrated state-of-the-art system for exercise prescription, justifying the need for standardization efforts regarding integrated exercise prescription in CV rehabilitation.
Relative peak exercise oxygen pulse is related to sudden cardiac death, cardiovascular and all-cause mortality in middle-aged men
Authors: Laukkanen Jari A , Araújo Claudio Gil S , Kurl Sudhir , Khan Hassan , Jae Sae Y , Guazzi Marco , Kunutsor Setor K 
Published: February 2018

Background Preliminary evidence suggests that peak exercise oxygen pulse – peak oxygen uptake/heart rate-, a variable obtained during maximal cardiopulmonary exercise testing and a surrogate of stroke volume, is a predictor of mortality. We aimed to assess the associations of peak exercise oxygen pulse with sudden cardiac death, fatal coronary heart disease and cardiovascular disease and all-cause mortality. Design A prospective study. Methods Peak exercise oxygen pulse was assessed in a maximal cycling test at baseline in 2227 middle-aged men of the Kuopio Ischaemic Heart Disease cohort study using expired gas variables and electrocardiograms. Relative peak exercise oxygen pulse was obtained by dividing the absolute value by body weight. Results During a median follow-up of 26.1 years 1097 subjects died; there were 220 sudden cardiac deaths, 336 fatal coronary heart diseases and 505 fatal cardiovascular diseases. Relative peak exercise oxygen pulse (mean 19.5 (4.1) mL per beat/kg/102) was approximately linearly associated with each outcome. Comparing extreme quartiles of relative peak exercise oxygen pulse, hazard ratios (95% confidence intervals) for sudden cardiac death, fatal coronary heart disease and cardiovascular disease, and all-cause mortality on adjustment for cardiovascular risk factors were 0.55 (0.36–0.83), 0.58 (0.42–0.81), 0.60 (0.46–0.79) and 0.59 (0.49–0.70), respectively ( P < 0.001 for all). The hazard ratios were unchanged on further adjustment for C-reactive protein and the use of beta-blockers. The addition of relative peak exercise oxygen pulse to a cardiovascular disease mortality risk prediction model significantly improved risk discrimination (C-index change 0.0112; P = 0.030). Conclusion Relative peak exercise oxygen pulse measured during maximal exercise was linearly and inversely associated with fatal cardiovascular and all-cause mortality events in middle-aged men. In addition, relative peak exercise oxygen pulse provided significant improvement in cardiovascular disease mortality risk assessment beyond conventional risk factors.
Expression profile of circulating microRNAs in the Correa pathway of progression to gastric cancer
Authors: Lario Sergio , Brunet-Vega Anna , Quílez María E , Ramírez-Lázaro María J , Lozano Juan J , García-Martínez Lorena , Pericay Carles , Miquel Mireia , Junquera Félix , Campo Rafael , Calvet Xavier 
Published: February 2018

BackgroundHelicobacter pylori infection causes long‐term chronic active gastritis, a risk factor for the intestinal and diffuse forms of gastric cancer. Most gastric cancers develop in a stepwise progression from chronic active gastritis to precursor lesions of gastric cancer. The early detection of gastric cancer improves survival. Studies with recent evidence have proposed circulating‐microRNAs as biomarkers of cancer.ObjectiveThe purpose of this study was to explore the circulating‐microRNA profile from H. pylori infection to gastric adenocarcinoma.MethodsOne hundred and twenty‐three patients were enrolled and assigned to the discovery or the validation sets. In the discovery phase, circulating‐microRNAs were measured by dye‐based quantitative polymerase chain reaction and a selection of circulating‐microRNAs was validated by probe‐based quantitative polymerase chain reaction. A quality control protocol was used.ResultsOne hundred and sixty‐seven circulating‐microRNAs were detected. Precursor lesions of gastric cancer and gastric cancer patients showed the downregulation of eight and five circulating‐microRNAs, respectively. We further validated the deregulation of miR‐196a‐5p in precursor lesions of gastric cancer and the deregulation of miR‐134‐5p, miR‐144‐3p and miR‐451a in gastric cancer. However, circulating‐microRNAs exhibited moderate diagnostic performance due to the overlap of circulating‐microRNA expression between non‐cancer and cancer patients. miR‐144‐3p/miR‐451a expression levels were correlated. Interestingly, these microRNAs are in 17q11.2, a site of rearrangements associated with gastric cancer.ConclusionCirculating‐microRNAs are deregulated in precancerous and gastric cancer patients but efforts are needed to improve their diagnostic accuracy.
Five Basic Concepts for Tetanus Prophylaxis
Authors: Furste Wesley 
Published: February 2018

As a surgeon, Dr. Wesley Furste has been interested in two anaerobic infections - tetanus and gas gangrene -from the time he served as a surgeon with the United States Army, 22nd Field Hospital, in China in the 1943-1946 period. There, Dr. Furste saw Chinese soldiers who developed tetanus and died because they did not have the benefit of tetanus toxoid. There, also, he saw Chinese soldiers have limbs amputated because gas gangrene developed in bullet and shrapnel wounds which had been closed primarily. At the termination of his Army duty and in the year following, Dr. Furste collaborated in studies concerning the etiology, pathology, clinical picture, prophylaxis and treatment of gas gangrene under a contract with the United States Office of Scientific Research and Development. Dr. Furste's interest in superior tetanus prophylaxis was considerably stimulated when he had to care for the vice president of a large drug and medical instrument distributing company. This patient developed severe serum sickness following the administration of heterologous tetanus antitoxin prepared from horse serum. In 1965, Dr. Furste was invited by President Johnson to attend his White House signing of the Community Health Services Extension Amendments Act of 1965. One of the purposes of this Act of 1965 was to make available throughout the nation adequate amounts of tetanus toxoid. Dr. Furste was an invited essayist and participant at the Second International Conference on Tetanus, which was held in Bern, Switzerland, July 1966.
President's Message
Authors: O'Brien Patricia E. 
Published: February 2018

To assure safe and healthful working conditions for working men and women; by authorizing enforcement of the standards developed under the Act; by assisting and encouraging the States in their efforts to assure safe and healthful working conditions; by providing for research, information, education, and training in the field of occupational safety and health; and for other purposes. Occupational Safety and Health Act of 1970