bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurosyphilis Revisited
Authors: Allan S. G. , Smith C. C. , Downie Aileen G. 
Published: January 2017

Neurosyphilis has become an uncommon clinical problem, for primary and secondary infections are usually recognised and treated early and successfully. However, patients occasionally receive no treatment for their acute infections—usually because they fail to seek advice—or may receive inadequate therapy when prescribed oral penicillin for other infections. The natural course of the disease is thus influenced, but the syphilis is not cured. Variegated clinical presentations of late disease arise and may make objective diagnosis difficult, especially when this occurs in a clinical setting where neurosyphilis may not be entertained in the initial diagnostic deliberations. Details of three such patients, seen during the last five years in the Aberdeen hospitals, are described—and highlight the range and diversity of clinical presentations which may occur, and typify the problem of making a firm diagnosis while the condition is still potentially curable.
Was Mary, Queen of Scots, Anorexic?
Authors: McSherry J. A. 
Published: January 2017

Medical historians have traditionally believed that Mary, Queen of Scots, suffered from gastric ulceration which began when she was aged thirteen years. More recent evidence indicates that she may have suffered from porphyria with her first severe attack occurring when she was aged twenty four years. The medical history of Queen Mary's teenage years is reviewed and thought to be compatible with a diagnosis of anorexia nervosa. A brief outline of the historical awareness, diagnostic criteria and epidemiological aspects of anorexia nervosa supports this view.
Infective Endocarditis as a Complication of a Permanent Indwelling Right Atrial Catheter in a Patient with Severe Aplastic Anaemia
Authors: Morrison A.E. , Burnett A.K. , Simpson I. 
Published: January 2017

Endocarditis is a recognised complication of both temporary and permanent indwelling right atrial catheters. Endocardial damage by the catheter may result in non-bacterial thrombotic endocarditis. Sterile vegetations composed of platelets and fibrin may become infected, either by direct spread of bacteria along the catheter, or following an episode of bacteraemia. Bacteria in infected vegetations may be protected from phagocytosis by a ‘roof’ of fibrin. Echocardiography is a valuable non-invasive method of diagnosis and may be used to monitor the resolution of vegetations and valve function. The right atrial catheter produces reflections which must be distinguished from cardiac abnormalities. We report a case of infective endocarditis in a patient with severe aplastic anaemia and a permanent indwelling right atrial catheter which was managed conservatively.
State Regulation of Canadian Pharmacies: A Prescription to Violate the Supremacy Clause
Authors: Kleiman Mary Ellen Fleck 
Published: January 2017

“This Constitution, and the Laws of the United States … shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding.”Under the Supremacy Clause of the United States Constitution, federal law, such as the Federal Food Drug and Cosmetic Act (“FDCA”), is supposed to be the “supreme Law of the Land.” The FDCA establishes a national closed domestic distribution system for approved prescription drugs in an effort to ensure drug integrity and safety. In doing so, it purportedly sets the “gold standard” for prescription drugs regulation around the world. Lately, though, this “gold standard” has been tarnished by personal importation, the practice of buying prescription drugs directly from foreign pharmacies—primarily Canadian—in conflict with the FDCA's restrictions on unapproved drugs and importation.
A Randomised Controlled Trial of the Effect of Esmarch Tourniquet Use on Blood Loss, Bruising and Quality of Life in Elective Varicose Vein Surgery
Authors: Fowler A. , Stechman M. , Mitchell D. 
Published: January 2017

Objective: To assess the effect of tourniquet use on bleeding, bruising and quality of life in varicose vein surgery. Method: A prospective randomised trial of 49 patients undergoing varicose vein surgery was carried out. All patients were having single leg surgery as a day case. Blood loss was assessed by weighing swabs. Bruising was measured at 10 days, and quality of life assessed with SF36 questionaires. Synthesis: In the tourniquet group blood loss was significantly reduced but not the area of bruising. The SF36 scores showed deterioration in the non-tourniquet group at 10 days but this was not present at 6 weeks. We saw no complications of tourniquet use but the study was limited by disappointing recruitment reducing the power. Conclusion: Tourniquet use may be of clinical value. A larger study is required to assess the significance.
Thromboprophylaxis and Total Hip Replacement: A Cost-Efficacy Study Comparing Duplex Screening of Asymptomatic Venous Thrombosis versus Prolonged Prophylaxis with Low-Molecular-Weight Heparins
Authors: Barrellier M. T. 
Published: January 2017

Background: Despite use of the anti-thrombotic prophylaxis, clinical thrombo-embolic events and fatal pulmonary embolism are still observed after total hip replacement. To reduce these complications, two strategies have been adopted: to prolong the use of low-molecular-weight heparins (LMWH) to 35 days or to screen patients systematically before discharge, using duplex ultrasonography, following the short-course prophylactic treatment. Objective: To assess, based on published literature, the relative costs and benefits of these two strategies for prophylaxis following total hip arthroplasty. Method: The author identified relevant papers in this field from his own resources and from medical literature databases. Synthesis: Prolonging LMWH treatment to a total of 35 days represents a direct cost in France of approximately £340 per patient, or for 100000 total hip replacements per year, an annual budget of £34 000000. If this strategy attained maximum efficacy, it would avoid 150 fatal pulmonary embolisms. The direct cost would therefore be at least £227000 per life saved. A systematic single duplex ultrasound examination before discharge from hospital would cost £76 per patient, or for 100 000 arthroplasties a total annual budget in France of £7 600000. If this approach achieved maximum efficacy, preventing the 150 fatal pulmonary embolisms corresponding to 100000 total hip replacements, the minimum direct cost would be £50 300 per life saved. Conclusion: Duplex screening may be more effective and lest costly than prolongation of prophylactic treatment using LMWH. This deduction needs to be confirmed by complex cost-benefit studies using clinical end-points.
Microcirculation in Chronic Venous Insufficiency
Authors: Steins Anke , Häfher Hans-Martin , Hahn Martin , Jünger Michael 
Published: January 2017

Objective: To study the microcirculation of the skin of the leg in patients with chronic venous disease of the lower limb, and to assess the effect of compression treatment. Patients and Methods: Patients were recruited from the vascular clinic and investigated by direct capillary pressure, transcutaneous oxygen tension, intravital video capillaroscopy and fluorescence video microscopy. The microcirculation was observed over the healing period in patients with venous leg ulcers. The effects of compression therapy on microcirculatory changes were studied in patients with Widmer stage I and II chronic venous disease. Results: In patients suffering from lipodermatosclerosis or venous leg ulcers retrograde pressure waves were detected in the nutritive capillaries of the skin by the ‘servo nulling’ pressure measurement during simulated calf muscle contraction. A close correlation was found between the degree of trophic skin change and the microangiopathy observed. Healing of venous ulcers occurred only if the cutaneous microcirculation in the ulcer area improved. Capillary density in base of the ulcer and at the border predicted venous ulcer healing. Conclusions: Cutaneous microangiopathy precedes the development of trophic skin alterations due to chronic venous disease and microcirculatory changes are closely related to the clinical stage of the disease as well as to the outcome of treatment.
Assessment of a New One-Layer Adhesive Bandaging Method in Maintaining Prolonged Limb Compression and Effects on Venous Ulcer Healing
Authors: Travers J. P. , Dalziel K. L. , Makin G. S. 
Published: January 2017

Objective: To evaluate the effective duration of compression of acrylic adhesive bandaging compared to non-adhesive bandaging and to compare rate of venous ulcer healing using one layer adhesive bandaging as compared to standard three layer bandaging. Design: The first trial involved patients who had undergone bilateral operations for varicose veins. Adhesive acrylate bandage was applied to the experimental limb and non-adhesive crepe to the control limb. The second trial involved patients with venous ulcers randomly allocated to two groups. The experimental group used the one layer acrylic adhesive bandage whilst the control was treated by the three layer bandage technique (zinc oxide paste bandage followed by a non-adhesive compression bandage and tubular overlay). Setting: Hospital patients in the first trial and clinic patients in the second. Patients, participants: First trial, 11 patients with bilateral varicose veins of which 10 completed. Second trial, 15 patients in the experimental group and 12 patients in the control group all of which completed. Results: Non-adhesive bandaging lost effective compression after 24 hours. Acrylic adhesive bandage maintained effective compression after 1 week. The rate of venous ulcer healing was similar between the one layer adhesive bandage group and three layer group. One layer adhesive bandaging took only one quarter of the time to apply (p<0.01%). Conclusions: Adhesive bandaging produced more effective sustained compression than non-adhesive crepe. Adhesive bandaging was as effective as the currently used three layer bandaging technique in healing venous ulcers and was quicker to apply.
The Phlebographic Distribution of Deep Venous Thrombosis in the Calf and its Relevance to Duplex Ultrasound
Authors: Thomas M. Lea , Solis G. 
Published: January 2017

Objective: To assess the distribution of deep vein thrombosis in the calf by phlebography. Setting: Department of Vascular Radiology, St. Thomas' Hospital, London, England. Patients: Seventy patients with suspected deep vein thrombosis or pulmonary embolism were examined. Interventions: Bilateral ascending contrast phlebography was performed in all patients. Main Outcome Measures: The sites of any thrombus in the stem or muscle veins of the calf below the popliteal vein were recorded. Results: One hundred legs contained thrombus. In fifty-three legs thrombus was present solely in the calf veins below the popliteal vein. Isolated thrombus in either one or more of the three paired stem veins or the muscle veins was present in twenty-two calves. Conclusions: Because of the difficulty in visualising some calf veins by duplex ultrasound it is suggested that a detailed knowledge of the distribution of thrombus may assist ultrasonographers.
Complication Rate of Long Stripping of the Greater Saphenous Vein
Authors: Staelens I. , van der Stricht J. 
Published: January 2017

Aims: To evaluate the procedure of stripping by invagination of the long saphenous vein in the management of varicose veins. Design: Prospective study of 1,300 patients treated by stripping of the long saphenous vein by the invagination technique. Setting: Three quarters of the patients were treated at a private clinic and one quarter in a university hospital in Brussels, Belgium. Patients underwent stripping of the long saphenous vein under local or regional anaesthesia. Main outcome measures: The occurrence of peroperative haemorrhage, postoperative haematoma in the track of the long saphenous vein, when assessed by clinical examination and dysthaesia in the distribution of the saphenous nerve assessed by neurological examination. Results: In a total of 1,300 patients operated on using the author's technique there were only 6 haematomas in the track of the long saphenous vein and no serious peroperative haemorrhage was encountered. In 4 patients disturbances in the sensation in the area supplied by the saphenous nerve were detected. Conclusion: Stripping the long saphenous vein by invagination provides a safe alternative to conventional methods which may cause excessive damage to structures around the vein.
Treatment of Chronic Venous Ulcers Using Sequential Gradient Intermittent Pneumatic Compression
Authors: Schuler J. J. , Maibenco T. , Megerman J. , Ware M. , Montalvo J. 
Published: January 2017

Objective: To determine if a limited regimen of sequential gradient intermittent pneumatic compression (‘HomeRx’: HRx) is as effective in promoting the healing of chronic venous stasis ulcers as is the Unna's boot (UB), considered the ‘gold standard’ in compression therapy. Design: Fifty-three patients, aged 31–85 years, with ulcers ranging up to 31.8 cm2 (mean 9.9, SE 1.1) were Prospectively randomized to treatments with UB or HRx and followed weekly for 180 days or until healing was complete, whichever came first. The HRx group wore graduated compression stockings, which were removed only while intermittent pneumatic compression was applied bilaterally at home for 1 h each morning and 2 h each evening. The UB was re-applied at least weekly. The two groups were equivalent in their use of hydrocolloid dressings and periods of leg elevation. Setting: Therapy performed at home, with weekly visits to an outpatient clinic. Main outcome measures: Complete ulcer healing and the rate of healing, based on area and perimeter changes; amounts of wound exudate and pain. Results: Complete healing was achieved in 20 of 28 Patients (71%) in the HRx group, compared with 15 of 25 (60%) treated with UB. Three patients had an adverse reaction to UB, one had cellulitis and five were non-compliant. Correcting for these withdrawn patients by life table analysis, healing rates were 76% and 64%, respectively. Healing rates did not correlate with haemodynamic measurements made prior to treatment. Conclusions: Using HRx for just a few hours daily to supplement graduated elastic compression heals venous ulcers at least as well as does the UB, without its disadvantages (e.g. the need for frequent re-application by qualified personnel, difficulty bathing), affording patients greater convenience during treatment.
Full and hybrid iterative reconstruction to reduce artifacts in abdominal CT for patients scanned without arm elevation
Authors: Yasaka Koichiro , Furuta Toshihiro , Kubo Takatoshi , Maeda Eriko , Katsura Masaki , Sato Jiro , Ohtomo Kuni 
Published: January 2017

Background Abdominal computed tomography (CT) without arm elevation is associated with degraded image quality due to streak artifacts. Purpose To compare the degree of streak artifacts in abdominal CT images without arm elevation between full iterative reconstruction (IR), hybrid IR, and filtered back projection (FBP) using two commercially available scanners. Material and Methods First, a phantom study simulating CT examination without arm elevation was performed. Second, unenhanced axial images of 33 patients (17 and 16 patients for each vendor) who underwent CT without arm elevation were reconstructed with full IR, hybrid IR and FBP. A radiologist placed 50 parallel lines with lengths of 50 pixels vertical to the streaks and quantitatively evaluated the images for streak artifacts in the phantom study. Two radiologists evaluated the images of patients for streak artifacts (on the liver and the kidney) and diagnostic acceptability using a four-point scale. Results The phantom study indicated that full IR algorithms were more effective than FBP in reducing streak artifacts. In the clinical patient study, streak artifacts were significantly more reduced with full IR compared with FBP in both the liver and kidney ( P < 0.012). Streak artifact reduction was limited with hybrid IR. Model-based iterative reconstruction (MBIR) (one of the full IR algorithms) provided diagnostically more acceptable image quality ( P < 0.016) compared with FBP. Conclusion In abdominal CT without arm elevation, full IR enabled a more efficient streak artifact reduction compared with FBP and MBIR was associated with diagnostically more acceptable images.
Cases of Overdosage with Viloxazine Hydrochloride (Vivalan†)
Authors: Brosnan R D , Busby A M , Holland R P C 
Published: January 2017

Twelve cases of viloxazine overdosage are reported. All patients recovered without sequelae and no ECG abnormalities were observed. Gastric lavage was performed in most cases and was probably beneficial. As viloxazine is rapidly absorbed ( Bayliss & Case 1975, Case & Reeves 1975) lavage should be carried out as soon as possible after the tablets are taken. Since the drug is almost exclusively excreted in the urine, it is suggested that forced diuresis be carried out to reduce blood levels as quickly as possible.
A Comparison of the Dissolution and Bioavailability Characteristics of Three Spironolactone Tablet Formulations, Including Preliminary Data on Two Spironolactone Metabolites
Authors: Tidd M J , Collins W T , Chamberlain J 
Published: January 2017

The bioavailabilities of three spironolactone tablet formulations specially selected for major differences in in vitro dissolution tests were compared in normal male volunteers by measuring plasma and urinary levels of the pharmacologically active spironolactone metabolite canrenone. It was possible to demonstrate small but statistically significant differences in plasma canrenone concentration-time curves derived from the three formulations together with significant differences in the time course of urinary canrenone excretion. The bioavailabilities of the three formulations did not differ significantly although the tablet with the poorest in vitro dissolution produced a significantly delayed peak canrenone concentration. The dissolution rate methodology and results are described and an approach to the development of improved in vitro dissolution tests for spironolactone is suggested. The use of a new method for canrenone estimation resulted in the incidental detection of two other quantitatively significant spironolactone metabolites and preliminary information is given on these.
Methenamine Hippurate (‘Hiprex’)† in the Treatment of Chronic Urinary Tract Infections: A Trial in a Geriatric Hospital
Authors: Parvio Salme 
Published: January 2017

Fifty-two patients, all of whom were more than 66 years-old and who were hospitalized for periods in excess of two years were treated for chronic urinary tract infection. All patients received a course of antibiotic treatment for seven to ten days and were then put onto treatment with methenamine hippurate 1 g twice daily for six months. Of the original fifty-two patients, twelve did not complete the six month course. During the six month period with ‘Hiprex’ there were far fewer re-infections than in the previous six months during which time they had received intermittent antibiotic therapy and other long-term treatment. There were no adverse reactions and bacterial resistance did not occur.
Detection of Immune Complexes in the Sera of Human Newborns Suspected of Neonatal Infection
Authors: Hoyoux J , Delire M , Eyndels C , Vert P 
Published: January 2017

The special characteristics and relative immaturity of the immune system in human neonates favour the constitution and persistence of circulating immune complexes after any antigenic invasion so that their detection in serum during the first week of life could be of particular interest for the early diagnosis of a neonatal infection. In this study, using a technique based on the inhibition of a latex agglutination, we detected circulating immune complexes in sixty-four neonates suspected of infection, at a significantly higher titre than in eleven newborns considered to be completely devoid of any clinical abnormalities. The level of those circulating immune complexes was related to the severity of a clinical score of infection and of a total score including several events of the pregnancy and delivery usually considered as a high risk of infection. On the other hand, no significant correlation was found between the infection score and the level of fibrinogen in the blood or the percentage of non-segmented neutrophils. Moreover, no correlation was demonstrated between each of these two classical biological tests and the level of circulating immune complexes.
A Comparative Crossover Study on the Treatment of Heartburn and Epigastric Pain: Liquid Gaviscon and a Magnesium – Aluminium Antacid Gel
Authors: Chevrel B 
Published: January 2017

Forty-four patients with symptoms of gastro-oesophageal reflux were randomly assigned in a crossover trial to treatment for 15-day periods with Liquid Gaviscon (a reflux suppressant) or an antacid gel containing magnesium and aluminium hydroxide. Good relief of symptoms was reported by 84% of patients during therapy with Liquid Gaviscon compared to only 23% during antacid therapy. Relief of symptoms was obtained within 15 minutes by 68% of patients during therapy with Liquid Gaviscon compared to only 9% during antacid treatment. The beneficial effect lasted for more than 4 hours in 75% of patients during treatment with Liquid Gaviscon compared to only 23% of patients obtaining long-term relief during antacid therapy.