bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic Value of Early Postoperative Troponin T in Patients Undergoing Coronary Artery Bypass Grafting
Authors: Gahl Brigitta , Göber Volkhard , Odutayo Ayodele , Tevaearai Stahel Hendrik T. , da Costa Bruno R. , Jakob Stephan M. , Fiedler G. Martin , Chan Olivia , Carrel Thierry P. , Jüni Peter 
Published: February 2018

Background

Cardiac troponin T (
cTnT
) is elevated after coronary artery bypass grafting surgery. The aim of this study was to determine the association between
cTnT
elevations between 6 and 12 hours after coronary artery bypass grafting and in‐hospital outcome.

Methods and Results

We prospectively studied 1722 patients undergoing isolated coronary artery bypass grafting. We assessed the association between conventional cTnT (749 patients) and high‐sensitivity
cTnT
(hs‐cTnT; 973 patients) 6 to 12 hours postoperatively with in‐hospital major adverse cardiac or cerebrovascular events (
MACCE
), a composite of all‐cause death, myocardial infarction, or stroke. The prespecified secondary outcome was a safety composite of
MACCE
, resuscitation, intensive care unit readmission or admission ≥48 hours, inotrope or vasopressor use ≥24 hours, or new‐onset renal insufficiency. Among patients with a conventional
cTnT
measurement, 92 experienced a
MACCE
(12%) and 146 experienced a safety composite event (19%). Likewise, for hs‐
cTnT
, 114 experienced a
MACCE
(12%) and 153 experienced a safety composite event (16%). Compared with
cTnT
≤200 ng/L, each 200‐ng/L increment in
cTnT
was associated with a monotonous increase in the odds of
MACCE
and the safety composite outcome. Conventional and hs‐
cTnT
demonstrated moderate discrimination for
MACCE
(areas under the fitted receiver operating characteristics curve, 0.72 and 0.77 for conventional and hs‐
cTnT
, respectively) and the safety composite outcome (areas under the fitted receiver operating characteristics curve, 0.66 and 0.74 for conventional and hs‐cTnT, respectively) and resulted in improved prognostic performance when added to the Euro
SCORE
. At a cutoff of 800 ng/L, conventional and hs‐
cTnT
provided clinically relevant power to rule in
MACCE
and the safety composite outcome.

Conclusions

cTnT
levels assessed between 6 and 12 hours after coronary artery bypass grafting identify patients at increased risk of
MACCE
or other complications.
Evaluating Humidity and Sea Salt Disturbances on CO2 Flux Measurements
Authors: Nilsson Erik , Bergström Hans , Rutgersson Anna , Podgrajsek Eva , Wallin Marcus B. , Bergström Gunnar , Dellwik Ebba , Landwehr Sebastian , Ward Brian 
Published: February 2018

AbstractGlobal oceans are an important sink of atmospheric carbon dioxide (CO2). Therefore, understanding the air–sea flux of CO2 is a vital part in describing the global carbon balance. Eddy covariance (EC) measurements are often used to study CO2 fluxes from both land and ocean. Values of CO2 are usually measured with infrared absorption sensors, which at the same time measure water vapor. Studies have shown that the presence of water vapor fluctuations in the sampling air potentially results in erroneous CO2 flux measurements resulting from the cross sensitivity of the sensor. Here measured CO2 fluxes from both enclosed-path Li-Cor 7200 sensors and open-path Li-Cor 7500 instruments from an inland measurement site are compared with a marine site. Also, new quality control criteria based on a relative signal strength indicator (RSSI) are introduced. The sampling gas in one of the Li-Cor 7200 instruments was dried by means of a multitube diffusion dryer so that the water vapor fluxes were close to zero. With this setup the effect that cross sensitivity of the CO2 signal to water vapor can have on the CO2 fluxes was investigated. The dryer had no significant effect on the CO2 fluxes. The study tested the hypothesis that the cross-sensitivity effect is caused by hygroscopic particles such as sea salt by spraying a saline solution on the windows of the Li-Cor 7200 instruments during the inland field test. The results confirm earlier findings that sea salt contamination can affect CO2 fluxes significantly and that drying the sampling air for the gas analyzer is an effective method for reducing this signal contamination.
Teacher Preparation for Educating the Disturbed: Graduate, Undergraduate, or Functional?
Authors: Johnson John L. 
Published: February 2018

One can submit that the issue of undergraduate versus graduate education for teachers of emotionally disturbed children reflects a form of rigidity in our own behavior in the field and a lack of recognition of what truly are the underlying problems of effective preparation and need for qualified people in a critical area. To arbitrarily state that it is inadvisable to have undergraduate programs is to deny both the evidence which can be gathered and the experience of several universities. The evidence seems to show that undergraduates can and do have a role in teaching emotionally disturbed children. We might also want to look at the idea that longer training does not necessarily mean better training, and that, rather, the intensity and therefore the quality of preparation enable one to approximate the behavioral outcomes which may be desired as a result of any particular program. There is little evidence to demonstrate the inadvisability of carrying on certain preparation programs. Currently, the prevailing opinion is expert, and this is conceptually limiting to the field. What is required is a new teacher preparation—a breaking away from the traditions of the university and a movement into functional, innovative preparation. The demand is highest in special education. One particular preparation mode, the intensive training institute, has been suggested. We cannot afford to wait—the time for revitalization is upon us.
Fibre Endoscopic Insertion of Palliative Oesophageal Tubes with the Nottingham Introducer1
Authors: Rose J D R , Smith P M 
Published: February 2018

Using the Nottingham introducer and diazepam sedation, 93 of 100 patients with oesophagogastric malignancy have been successfully intubated, 67 with Celestin tubes and 26 with Atkinson tubes. Their mean age was 72 years (range 36–91). Six of the failures were in patients with fundal adenocarcinoma. Sixty-nine patients were discharged from hospital after initial intubation (74%). Nine patients developed a perforation, 6 died and there were 5 deaths from aspiration. Nine patients are alive up to 11 months later. The mean survival after discharge was four months with a maximum of 18 months. Later 11 tubes obstructed and 12 Celestin tubes displaced upward. Endoscopic insertion of oesophageal prosthetic tubes provides satisfactory palliation for inoperable oesophagogastric malignancy. The development of the Atkinson tube with a distal flange has eliminated tube displacement upwards.
Effect of Different Corticosteroid Regimens on Hypothalamic-pituitary-adrenal Axis and Growth in Juvenile Chronic Arthritis
Authors: Byron M A , Jackson J , Ansell B M 
Published: February 2018

Linear growth was recorded in 36 children with juvenile chronic arthritis. In 20, the hypothalamic-pituitary-adrenal axis (HPA axis) was assessed by insulin-induced hypoglycaemia, the results of which correlated well with resting Cortisol levels. Three groups were identified according to type of corticosteroid regimen administered. Group 1 (6 children), receiving daily corticosteroid therapy, were clearly suppressed and failing to grow. Group 2 (13 children) had received an alternate-day regimen from the initiation of corticosteroid therapy; they were not suppressed and growth was satisfactory in 11. Group 3 (17 children) were receiving alternate-day therapy, but had had daily corticosteroid in the past; they showed no clear pattern of suppression or growth. Factors influencing the recovery of the HPA axis and resumption of growth were assessed. No difference was found in the individual growth of 7 children who commenced alternate-day therapy before the age of 5, compared with matched controls. It is suggested that daily divided doses of corticosteroid should not be used. Ideally, a single morning dose (up to 2 mg/kg) alternate-day regimen should be employed, as this regimen has minimal effects on HPA function and growth, even in young children. For very severe systemic features, it may be necessary to add a small single dose on the alternate day.
Use of Hypnosis in Criminology: Discussion Paper
Authors: Waxman David 
Published: February 2018

Memories of events which are unremarkable may pass unrecorded or may fade with the passage of time. In any situation of stress, anxiety may cloud the memory of the incident and in the case of some intensely frightening or humiliating experience such material may not be subject to voluntary conscious recall and may be repressed. A technique for uncovering certain ‘forgotten’ or repressed memories with the use of hypnosis is described. A similar method has been used in order to retrieve such memories in the investigation of witnesses and victims of serious crime. Nevertheless, various aspects of the overall validity of such a procedure have been called into question and for this reason the results of numerous experiments and the conclusions arrived at in many papers are discussed. It is emphasized that a rigid code of conduct be followed if hypnosis is to be used as an investigatory tool.
Use of Ultrasound Localization to Improve Results of Fine Needle Aspiration Cytology of Breast Masses
Authors: Patel J J , Gartell P C , Guyer P B , Herbert A , Taylor I 
Published: February 2018

A prospective randomized controlled trial of 116 patients with breast masses was conducted to compare the accuracy of ‘blind’ aspiration cytology performed in the clinic with aspiration cytology using ultrasound localization. The unsatisfactory aspiration cytology rate was significantly reduced by ultrasound localization (P=0.028). This was mainly due to an improvement in the unsatisfactory rate for tumours less than 3 cm in diameter (P=0.036). The results were influenced by the number of needle manoeuvres performed, < 10 needle manoeuvres being associated with a 54% unsatisfactory aspiration rate compared with 25% when > 10 manoeuvres were performed (P= <0.02). One experienced aspirator in the clinic had results comparable to those achieved with ultrasound localization. It is concluded that experience and technique are the most important factors in obtaining a satisfactory aspirate from breast masses. Routine ultrasound localization prior to aspiration confers some benefit. Consideration should be given to the use of the ultrasound-assisted technique following a previous unsatisfactory aspiration, particularly if the tumour is less than 3 cm in diameter.
Neonatal Septal Deviations
Authors: Kent S E , Reid A P , Nairn E R , Brain D J 
Published: February 2018

In a review of 1000 consecutive neonates of all races, nasal septal deformity was identified in 29, an incident of 2.9%; significantly fewer cases were found in negroid babies (0.1>P > 0.05). Ten cases (35%) underwent manipulation of the deviated septum. Six-monthly review revealed that symptoms associated with the septal deformity are rare. In 7 (44%) of the 16 cases not manipulated, the septum straightened spontaneously during the first few months of life. The appearance of the deviation is not of a dislocation of the caudal edge of the cartilage but a smooth concavity. In vitro compression of the neonatal nasal cavity reproduced this C-shaped deformity, but only temporarily. Histological serial sections of 6 postmortem nasal cavities showed that the high laminae of the vomer prevent any caudal dislocation of the septal cartilage.
Place of Abdominoperineal Excision in Rectal Cancer
Authors: Christiansen J 
Published: February 2018

In an attempt to elucidate if and when there is a place for abdominoperineal excision in rectal cancer, we have evaluated survival, risk of local recurrence and functional results of alternative procedures. There seems to be no difference in survival rate after intended curative surgery for rectal cancer between rectal excision and sphincter-saving resection. This is also true with respect to risk of local recurrence, except in patients with poorly differentiated Dukes’ C tumours, where the risk of significant distal intramural spread is increased. Functional results are satisfactory after low anterior resection with colorectal anastomosis, whereas coloanal anastomosis is followed by less satisfactory results especially in elderly patients. In these patients rectal excision with a permanent colostomy is probably preferable.
Septicaemia in Patients with Temporary and Permanent Endocardial Pacemakers
Authors: Smyth E G , Pallister D 
Published: February 2018

Twenty-four patients with staphylococcal septicaemia due to permanent (14) and temporary (10) endocardial pacemakers were reviewed. With permanent pacemakers local inflammation was usually present and the onset of septicaemia rapid. If patients were treated with high dose intravenous flucloxacillin combined with removal, recovery was usual. In patients with retained endocardial tips (6) we eradicated infection with medical treatment alone in four cases. We would advocate antistaphylococcal prophylaxis for patients undergoing revision in the presence of local inflammation and high dose intravenous flucloxacillin plus a second anti-staphylococcal antibiotic (e.g. gentamicin) in patients with septicaemia and a pacemaker in situ.
Exclusion from Resuscitation
Authors: Keatinge R M 
Published: February 2018

Resuscitation was attempted for 156 (19.9%) of the 783 cases in St Thomas's Hospital, aged 16 or over, who suffered first cardiac or respiratory arrest of the current admission during the year to 13 April 1987. Seventeen (11%) of the 156 were discharged alive from hospital after resuscitation. All seventeen had been active outside the home before admission, and all except one remained so after discharge. The factors which were associated with exclusion from resuscitation attempts are analysed. Most accorded with known prognostic factors, but resuscitation was attempted for some persons who seemed to have little chance of benefiting from resuscitation attempts. Routine collection, analysis, and dissemination of information on pre-arrest characteristics in relation to their outcome, on which clinicians can base their decision to with-hold resuscitation in the event of an arrest, is recommended.
Seizure Induction by Alcohol in Patients with Epilepsy Experience in two Hospital Clinics
Authors: Heckmatt J , Shaikh A A , Swash M , Scott D F 
Published: February 2018

We surveyed 70 epileptic patients attending a general neurology clinic and 64 patients attending an epilepsy clinic to determine the incidence of alcohol-related seizures. Seven (10%) of the neurology clinic patients and 9 (15%) of the epilepsy clinic patients reported exacerbation of their seizures with alcohol. In the first group, two had been heavy drinkers when under-age, two had features of alcohol dependence, and three had experienced resolution of seizures following cessation of their drinking. In the second group, five drank 4 units/day or more, and one drank more heavily. The importance of alcohol in the causation of these patients’ seizures had not previously been appreciated. The relationship of alcoholism to epilepsy has been recognized for many years, but the role of alcohol in the exacerbation of primary epilepsy, and in triggering seizures in epileptic patients is often not recognized. Control of alcohol ingestion is an important factor in the management of epilepsy.
The General Practitioner'S Use and Expectations of An Accident and Emergency Department
Authors: Morrison W G , Pennycook A G , Makower R M , Swann I J 
Published: February 2018

In an attempt to establish what the general practitioner expects from an accident and emergency department, and how closely the service provided correlates with that view, a 12-point questionnaire was sent to the general practitioners in the Glasgow Royal Infirmary catchment area. Out of the 61.2% of general practitioners who replied, the majority wish to have responsibility for their own patients for conditions which are neither accidents nor emergencies. There is less agreement as to how much should be done within an accident and emergency department and on the appropriate modes of referral and communication between the general practitioner and the hospital service. Further consultation and cooperation are necessary to interpret and resolve these differences.
Prolongation of the Antiemetic Action of P6 Acupuncture by Acupressure in Patients Having Cancer Chemotherapy
Authors: Dundee J W , Yang J 
Published: February 2018

Previous work from our department has shown that P6 acupuncture is an effective adjuvant to conventional antiemetic therapy for patients having cytotoxic drugs. However, its efficacy is limited to about 8 h. The current studies show that the application of an elasticized wrist band with a stud placed over the acupuncture point, and pressed regularly every 2 h, will prolong the antiemetic action for 24 h. This proved more effective in hospitalized patients (20/20) than in outpatients (15/20), presumably due to the encouragement given to regularly press the stud. Nausea and vomiting remain problems with cancer chemotherapy1-4 despite the use of antiemetics5. Following encouraging results with P6 acupuncture (ACP) in postoperative sickness6 this has been shown to be effective in cancer chemotherapy in 105 patients who, despite the use of conventional antiemetics7 had been sick following the previous treatment. Electrical stimulation (10 Hz DC) of P6 point for 5 min before administration of the cytotoxic drugs was effective in preventing sickness in 66% and only 6% got no benefit. The ACP was given with the antiemetics which the patients had been receiving. Although there were no side effects with the ACP, the benefit only lasted 6-8 h. This was not important in hospitalized patients where the treatment could be repeated, but was a problem with outpatients. It has been shown that pressure on the P6 point (acupressure) has an antiemetic action8,9. A commercially available elasticized band with a plastic stud (Sea Band) is an effective method of applying pressure to P6 point. We report the findings of a study in which the band was applied over P6 point immediately after ACP and the patient told to press this for 5 min every 2 h.
Diuretics and Electrolyte Disturbances in 1000 Consecutive Geriatric Admissions
Authors: Byatt C M , Millard P H , Levin G E 
Published: February 2018

Old people are commonly receiving diuretics on admission to hospital. Diuretics are recognized as a risk factor for electrolyte disturbances; controversy exists about the relative risks of different combinations (in particular, co-amilozide [Moduretic]). We recorded the drug history and serum electrolytes in 1000 consecutive admissions to a geriatric hospital, and examined the relative prescribing rates of various diuretics in the community. Full results were obtained in 929 patients. A history of diuretic prescription was present in 353 (38%) of the patients; the mean serum sodium in this group (95% CI 136.0–137.1 mmol/1) was lower than in the 586 not prescribed diuretics (137.1–137.9 mmol/1). The difference was small but statistically significant (95% CI difference=0.3–1.6 mmol/1; P<0.01). Hyponatraemia (serum sodium < 130 mmol/l) was not significantly commoner in the 41 patients prescribed co-amilozide than in patients prescribed other diuretics. In general patients prescribed potassium-retaining diuretics had a lower serum sodium than the others. There was a significant positive correlation between the serum potassium and the log [serum urea) (r=0.26, P < 0.001) and a weak negative correlation existed between sodium and potassium (r= −0.14; P < 0.001). There was an association between the prescription of potassium-retaining diuretics and a higher serum potassium; also an association between the prescription of a loop or thiazide diuretic and a lower serum potassium. These interactions were shown by multiple regression analysis to be independent and additive. Co-amilozide formed a significantly higher proportion of all diuretics prescribed in the community group than in the inpatient group (18% versus 12%; P < 0.05). Hyponatraemia was mild and mainly associated with potassium-retaining diuretics in our patients. Our study was unable to confirm or refute any specific dangers of co-amilozide compared with other potassium-retaining diuretic combinations.
Patterns of Referral to a Menopause Clinic
Authors: Garnett T , Mitchell A , Studd J 
Published: February 2018

One hundred and fifty new patients attending the Menopause Clinic at Dulwich Hospital were questioned on their attitudes and fears about hormone replacement therapy and the perceived attitudes of their general practitioner. The majority of patients attending the clinic had initiated referral themselves and many had travelled from outside the health authority area in order to be seen. The waiting list for an appointment was often unacceptable. We conclude that specialist menopause clinics in teaching hospitals are unable to cope with the demand for information about the menopause and hormone replacement from post-menopausal women and suggest alternative means for providing this service.
Non-invasive Stimulation of the P6 (Neiguan) Antiemetic Acupuncture Point in Cancer Chemotherapy
Authors: Dundee J W , Yang J , McMillan C 
Published: February 2018

The beneficial effects of transcutaneous electrical stimulation of the P6 antiemetic point (Neiguan) as an adjuvant to standard antiemetics was studied in over 100 patients in whom chemotherapy-induced sickness was not adequately controlled by antiemetics alone. Although the results were not quite as good as with invasive acupuncture, more than 75% patients achieved considerable benefit from what was a nontoxic procedure. The use of large diffuse low impedence electrodes simplifies the technique. The 2 hourly application of Sea Bands prolongs the antiemetic action. Best results were obtained from the 2 hourly self-administration of 5 min of transcutaneous electrical stimulation of P6 using a simple battery-operated TENS machine (15 Hz) to activate a large, easy-to-place surface electrode and increasing current until Qi is elicited.
Mortality in a University Surgical Unit: What is an Avoidable Death?
Authors: McDonald P J , Royle G T , Taylor I , Karran S J 
Published: February 2018

Between January 1978 and December 1987 there were 23 557 surgical admissions to the University Surgical Unit in Southampton. During this period there were 543 deaths, an overall death per admission rate of 2.3%. During the 10-year period the number of admissions per year had risen from 1884 in 1978 (death per admission=3.6%) to 3467 in 1987 (death per admission rate=1.7%). At the monthly audit meeting an attempt was made to classify each death as ‘avoidable’ or ‘unavoidable’. During this 10-year period it was considered that there were 89 ‘avoidable’ deaths. This represents an avoidable mortality rate (AMR) of 0.38%. These ‘avoidable’ deaths were due to a wide variety of causes and this paper discusses the lessons learnt from a review of surgical mortality and outlines how units might compare results.
Anal Cancer: The Case for Earlier Diagnosis
Authors: Edwards A T , Morus L C , Foster M E , Griffith G H 
Published: February 2018

The results of treatment in 22 patients with anal carcinoma are reviewed. The overall results are disappointing with only five (28%) surviving more than 5 years. The commonest form of treatment during the study period was an abdomino-perineal excision of rectum (APER). For patients with tumours less than 2 cm in diameter local excision is an acceptable alternative. The majority (76%) of tumours were diagnosed as common benign conditions by the referring practitioners leading to a delay in initiating definitive treatment. Most tumours (81%) were greater than 2 cm in diameter and therefore unsuitable for local excision. There was a high recurrence rate (76%) amongst the group treated by APER. This along with the poor overall survival is probably due to late presentation.