bluuebunny/crossref_metadata_2025_split huggingface dataset:
Remote Village Survey for Agents Causing Hepatosplenic Disease in the Republic of Yemen
Authors: Gray Gregory C , Kassira Edward N , Rodier Guénaël R , Myers Martha C , Calamaio Craig A , Gregory Martin , Nagi Musaid Ahmed M , Kamal Karim , Botros BAM , Soliman Atef Kamal , Hassan Nassef F , Gregory Rosamund , Arunkumar B K , Cope Amyanne , Hyams Kenneth C 
Published: January 2017

The objective of this study was to epidemiologically describe potential infectious agents among rural people in the Republic of Yemen. This would aid clinicians in designing empirical therapy and public health officials in planning disease prevention. We sought to examine evidence for the geographical distribution of pathogens causing human hepatic and splenic disease among villagers and domestic animals living in three remote areas with differing altitudes. In June 1992, a cross-sectional survey was conducted at three survey sites of differing altitudes: 3080, 1440 and 250 m above sea level. Questionnaires, parasitic and serological tests were administered to 627 human volunteers. Additionally 317 domestic animals were studied. Malaria, schistosomiasis, and hepatitis B and C infections were found to be likely causes of human hepatic or splenic disease. Additionally, evidence of human and animal infections with the agents of brucellosis and Q fever was found: IgG antibodies against hepatitis E virus were discovered in two (2.0%) of the 100 volunteers. The prevalence of markers for human and animal disease was often lowest at the village of highest elevation, suggesting that increasing altitude, as a surrogate or a true independent risk factor, was protective against infection with the agents studied.
Quackery
Authors: Mehlman Maxwell J. 
Published: January 2017

Everyone condemns medical quackery. Government regulators seek to protect us from it. Alternative providers strive to distance themselves from it. Orthodox medicine wants to stamp it out.The question is: What constitutes “quackery”? How do we distinguish quacks from mainstream practitioners? Even more problematic, how do we distinguish between quackery, which everyone agrees is beyond the pale and therefore should be fair game for sanction, and practices that, while unorthodox, should be tolerated in the interests of promoting medical progress and patient choice? These are particularly challenging questions now, when a number of factors are combining to undermine the hegemony of mainstream medicine, when some of the same forces that spurred the growth of quackery in the 19th century are remerging, and when neo-conservatives are clamoring for greater freedom of choice for health care consumers.This article begins with a brief history of quackery in America and the factors that encourage its growth. The article then attempts to distinguish between quackery and acceptable medical practice.
Compulsory Licenses: A Tool to Improve Global Access to the HPV Vaccine?
Authors: Maybarduk Peter , Rimmington Sarah 
Published: January 2017

AbstractCervical cancer disproportionately affects women in lower- and middle-income countries. But the new vaccines developed to prevent infection with some strains of the human papillomavirus (HPV) that cause cervical cancer are priced beyond the reach of most women and health agencies in these regions, due in part to the monopoly pricing power of brand-name companies that hold the patents on the vaccines. Compulsory licenses, which authorize generic competition with patented products, could expand access to HPV vaccines under certain circumstances. If high-quality biogeneric HPV vaccines can be produced at low cost and be broadly and efficiently registered, and if Merck and GSK are unwilling to grant licenses on a voluntary basis, compulsory licensing could play a pivotal role in ensuring vaccinations against HPV are available to all, around the world, regardless of ability to pay.
Changes in Biliary Lipid Concentrations in Bile Duct Obstruction: An Experimental Study
Authors: Guorong Xu , Kirk C J C , Goode A W 
Published: January 2017

Changes in biliary concentrations of bile acids, phospholipids and cholesterol and biliary pressures were measured in dogs. These parameters were studied during 7-day periods of partial biliary obstruction, of varying degrees, and after 24-hour and 48-hour periods of complete obstruction. The samples were obtained via an exteriorized but intact enterohepatic circulation allowing the introduction of varying degrees of obstruction and bile sampling. Biliary obstruction reduced the concentration of all biliary lipids especially when the obstruction produced pressures in excess of 75% of the maximum biliary secretion pressure. Only immediately after the release of a 48-hour period of complete obstruction did the risk of cholesterol supersaturation of bile occur. However, at that time there was a greatly reduced concentration of lipids in the bile and the amount of cholesterol that could potentially have precipitated was very small. It is suggested that this supersaturation would not play a significant role in the formation of gallstones.
Alcohol Consumption of Patients Attending Two Accident and Emergency Departments in North-West England
Authors: Yates D W , Hadfield J M , Peters K 
Published: January 2017

The impact of alcohol use on the workload of two accident & emergency departments in north-west England was assessed by blood alcohol concentration (BAC) measurement, inspection of clinical records and interview of all patients aged 16 and over attending throughout a two-week period. The frequency of intoxication was similar to the previous reported rate in Scotland: 13.2% of all patients had a positive BAC. Inebriated injured patients arrived at all times of the day — varying in frequency from 2.5% of midday attenders to 78% of those presenting after midnight. The incidence of alcohol-related industrial accidents was low, but 60% of all assaulted patients were inebriated, many having sustained head injuries. Of patients attending within 2 hours of an accident at home, 19% also had a positive BAC, but 92% of those with ankle sprains were sober. Patients in lower social classes reported higher rates of alcohol consumption. The popularity of beer in comparison to wines and spirits was inversely related to age and unrelated to social class. Alcohol abuse is commonly associated with injuries sustained at home and with assaults occurring in public places. Prevention campaigns directed at the reduction of these types of incidents should be as concerned with the inebriation of the patient as with the architectural, environmental and legal framework within which the ‘accident’ occurs.
The ‘Think Test’: A Further Technique to Elicit Hyperventilation
Authors: Nixon P G F , Freeman L J 
Published: January 2017

Hyperventilation can undermine cardiovascular homeostasis by generating autonomic imbalance, sympathetic dominance, hypokalemia, and intracellular alkalosis with calcium ion shifts. The role of hyperventilation in episodic disorders such as arrhythmia and coronary vasospasm can be difficult to identify if the patient does not present in an attack and so a provocation challenge is required. Today, the standard challenge is the forced hyperventilation provocation test (FHPT). A capnograph enables the resting end-tidal PCO2 to be compared with the level 3 min after the period of overbreathing. We report the use of a patient-specific challenge. After the FHPT, the subject is invited to close his eyes and think about the circumstances of an attack, feelings and sensations experienced (breathing is not mentioned) or topics that were seen to disturb the rhythm of breathing when the medical history was taken. A fall of end-tidal PCO2 of 10 mmHg or more lasting at least one minute was taken as a positive response. Out of 57 patients with cardiovascular symptoms suggesting a hypocapnic influence, resting hypocapnia (end-tidal Pco2=30 mmHg) was present in 3 (5%). Of the remaining 54, the FHPT was positive in 16 (30%) and the ‘think test’ in 33 (61%). This suggests that patient-specific stimulation has advantages over an unspecific challenge in testing for episodic hypocapnia.
Liaison Psychiatry in a Breast Cancer Unit
Authors: Ramirez A J 
Published: January 2017

The first 50 referrals to a newly established liaison psychiatry service for the breast cancer unit at Guy's Hospital, London, have been examined. The majority of referrals were for psychological reactions to malignant disease, most of these were mood disturbances. Patients with sustained psychological reactions to their malignant disease were more likely to have had treatment for previous psychiatric illness and to lack a confiding relationship compared with those whose psychological reactions were transient. Teaching doctors and nurses to deal effectively with the transient psychological reactions of patients to their malignant disease is an important task of liaison psychiatry.
Adenocarcinoma of the Appendix
Authors: Burgess P , Done H J 
Published: January 2017

Patients presenting with adenocarcinoma of the vermiform appendix at the Royal Preston and Chorley District General Hospitals were reviewed for the 15 year period 1972–1986. Eleven cases were identified, representing a rate of 1 in 956 for all appendicectomies performed. A third of the cases presented as acute appendicitis. However, of 8 patients who initially had an appendicectomy, only 4 subsequently underwent further surgery (right hemicolectomy). One patient died of recurrent disease. Five of the patients presenting were under 60 years of age. During the same period, the total number of appendicectomies performed annually declined by 50%. The study highlights the need to subject all appendicectomy specimens to histological examination, and that the disease presents in a younger age group than commonly seen for malignant colonic neoplasms.
Performance consistency in second language acquisition and language testing research: a conceptual gap
Authors: Douglas Dan 
Published: January 2017

Arguing from the premise that a language test is a special case of a second language acquisition (SLA) elicitation device, I suggest that SLA and language testing share much common ground in terms of research methods, which have similar properties in that they are both used to make systematic observations of language performances from which inferences can be made about the state of a learner’s interlanguage ability underlying the performance. However, I also argue that whereas the concept of demonstrating validity and reliability has been integrated into how language testing research is conducted, SLA researchers have generally failed to recognize the need to demonstrate these qualities. I compare examples of SLA and language testing research articles in terms of their treatment of validity and reliability and argue: • that it is important for SLA researchers to provide evidence that the methods they employ to elicit data are appropriate for the purposes intended; • that the procedures provide stable and consistent data; and, consequently • that the interpretations they make of the results are justified.
Day Case Varicose Vein Surgery: Patient Health Outcome
Authors: Sweeney K. J. , Cheema T. , O'Keefe S. , Johnston S. , Burke P. , Grace P. A. 
Published: January 2017

Background: The success of day case varicose vein surgery (DCWS) is traditionally denned clinically. However, the patient's perception of his or her own health prior to and following DCWS has not been established. This study prospectively measured the health status of patients with varicose veins, compared this with established population norms and assessed the impact of DCWS on both general health perception and varicose vein symptoms. Method: Fifty-three consecutive patients undergoing DCWS over a 9 month period were enrolled in this study. The SF-36 health assessment questionnaire and a vein-symptom-specific questionnaire were administered on the morning of surgery, 7 weeks postoperatively and 1 year following surgery. All patients in this study underwent a standard varicose vein operation and followed a standard protocol of postoperative management. Results: DCWS population health scores were lower than general population norms preoperatively. There was a significant improvement in the 7 week postoperative group in physical function and health perception (p<0.05). One year after surgery physical function, health perception, mental health and physical role were significantly improved from preoperative scores (p<0.05). Symptom-specific scores demonstrated a sustained trend towards improvement over the postoperative year. Conclusion: Varicose veins are associated with diminished well-being. Day case varicose vein surgery improves patient health perception and symptoms and is the treatment of choice for suitable patients with varicose veins.
Evidence-Based Follow-up after Varicose Vein Surgery
Authors: Bailey C. M. H. , Perkins J. M. T. , Garnett S. , Libertiny G. , Umeh H. , Magee T. R. , Galland R. B. 
Published: January 2017

Objective: To determine the optimum timing and need for outpatient follow-up of patients after varicose vein operations. Methods: Ninety-six consecutive patients undergoing varicose vein operations were enrolled. Patients completed linear analogue scales to record pain, bruising and swelling on postoperative days 1 to 10, 12, 14, 21 and 28. Return to daily activities, visits to the general practitioner (GP) and outpatient review at 6 weeks were recorded. Results: Maximum scores were on day 2 for swelling, day 4 for bruising, and days 1 and 6 for pain. Median time to return to work was 14 days (range 1-42 days). During the postoperative period 29 patients visited their GP, 24 (83%) within 2 weeks of operation. Median length of outpatient consultation at 6 weeks was 5 min. Although 57 patients found the appointment reassuring, none required further treatment. Conclusions: Outpatient follow-up after varicose vein operations cannot be justified on clinical grounds. The majority of patients who have postoperative problems develop them within the first 2 weeks, coinciding with the peaks of pain, swelling and bruising, and these problems can be dealt with in the community.
Histopathological Studies of the Valves of Varicose Veins
Authors: Obitsu Y. , Ishimaru S. , Furukawa K. , Yoshihama I. 
Published: January 2017

In order to elucidate the cause and pathology of varicose veins in the lower limb, the terminal valves of the long saphenous vein in 36 patients with varicose veins and ten control cases have been examined by light and transmission electron microscopy. Valve failure in the varicose group was thought to start with a depression in the valvular commissure and to proceed to extension of this depression and expansion of the space between the two valves. It was further thought that, in this group, reversal and tortuosity of the valve cusps, hyperplasia of the collagen fibres and irregularity of the course of elastic fibre layers represented secondary changes. In almost all cases, intimal fibrous thickening was present in the vein wall, and this was histologically similar to so-called phlebosclerosis. It was further confirmed that the degree of intimal thickening was correlated to the disease period, with greater thickening noted at the region under greater pressure load. Phlebosclerosis seemed to be proportional to the size of stress and pressure load time.
Effect of Time and Posture on Pressure Profiles Obtained by Three Different Types of Compression
Authors: Callam M. J. , Haiart D. , Farouk M. , Brown D. , Prescott R. J. , Ruckley C. V. 
Published: January 2017

There is controversy concerning the merits and safety of elastic versus inelastic compression in the treatment of venous leg ulceration. Thirty legs were randomized to elastic, minimal stretch and non-elastic (Circaid®) bandages. Pressure profiles (repeated thrice) were measured with the Borgnis MST device on bandage application and at 4 h, in both the standing and lying positions. All bandages produced significant graduated compression in the leg ( P < 0.001), in the standing position, with no significant difference in gradient between the bandages ( P = 0.5). However, 4 h after application the bandages collectively exerted less pressure than on application, though gradients were maintained. Elastic bandages, at 4 h, recorded a mean 94% of the initial level compared to 70% for minimal stretch and 63% for non-elastic ( P < 0.001) in the standing position. In the lying position the decrease at 4 h was 72% for elastic, 59% for minimal stretch and 44% for non-elastic compression ( P < 0.001). Elastic bandages provided the most sustained compression, but with the smallest margin of safety (least reduction of pressure on lying).
The Long-Term Effect of Elastic Compression on the Venous Haemodynamics of the Leg
Authors: Christopoulos D. , Nicolaides A. N. , Belcaro G. 
Published: January 2017

The long-term haemodynamic effect of elastic compression has been evaluated in 16 patients (20 limbs) with superficial venous incompetence. Ambulatory venous pressure (AVP) and pressure recovery time (RT90) were measured with foot vein canulation. Air-plethysmography was used to measure venous volume, venous reflux and the ejecting capacity of the calf muscle pump, before and after the application of graduated elastic stockings, for 4 weeks. Limbs were tested without the stockings. Elastic compression for 4 weeks produced a significant reduction in the venous volume ( P < 0.01), a significant decrease in venous reflux and an increase in the ejecting capacity of the calf muscle pump ( P < 0.01). The above changes explain the significant reduction in AVP and prolongation of RT90 ( P < 0.01) which was observed. The results indicate that there is a considerable improvement in venous haemodynamics after 4 weeks support with graduated elastic compression.
Endoscopic Exploration of the Subfascial Space of the Lower Leg with Perforator Vein Interruption Using Laparoscopic Equipment: A Preliminary Report
Authors: Conrad P. 
Published: January 2017

Objective: To describe a method of endoscopic exploration of the medial subfascial space of the lower leg using laparoscopic equipment and dividing incompetent perforating veins crossing this space with diathermy. Design: Prospective study in seven patients with significant perforating vein incompetence in the medial lower leg. Setting: Department of Surgery, Nepean Hospital, New South Wales, Australia. Intervention: Laparoscopic equipment is used to explore endoscopically the medial subfascial space of the lower leg. Incompetent perforating veins preoperatively marked by duplex examination are identified and divided by endoscopic diathermy. Main outcome measures: The endoscopic division close to their source from the deep veins of incompetent perforating veins of the medial compartment of the lower leg. Results: Endoscopic interruption of incompetent perforators in the medial compartments of seven legs achieved with minimal morbidity. Conclusions: Endoscopic diathermy interruption of incompetent perforators in the medial compartment of the lower leg using laparoscopic equipment is a rapid and accurate procedure with minimal morbidity, as shown in a small series of seven legs.
Changes of Skin Microcirculation in Patients with Chronic Venous Insufficiency Assessed by Laser Doppler Fluxmetry and Transcutaneous Oxymetry
Authors: Creutzig A. , Caspary L. , Alexander K. 
Published: January 2017

Objective: To evaluate whether microcirculatory disturbances of the skin in patients with chronic venous insufficiency are a generalized phenomenon or restricted to visible skin changes. Design: Open, prospective study in patients and healthy, age-matched subjects. Setting: Department of Angiology, Hannover Medical School. Patients: Seventy-one patients with chronic venous insufficiency. Measurements: Transcutaneous oxygen pressure (tc Po2) at electrode core temperatures of 37°C and 44°C and laser Doppler flux (LDF) were measured simultaneously in different regions of the legs. Results: On the forefoot, tc Po2 (37°C) at rest and tc Po2 (44°C) during arterial ischaemia were significantly higher in patients ( P<0.05), increasing with the severity of chronic venous insufficiency. Conclusions: Cutaneous capillary flow on the forefoot is increased in patients with chronic venous insufficiency, demonstrating the general effect of venous hypertension.
Chronic Venous Disease May Delay the Diagnosis of Malignant Ulceration of the Leg
Authors: Lagattolla N. R. F. , Burnand K. G. 
Published: January 2017

Objective: To emphasize the association of cutaneous malignancy and chronic venous disease of the lower limb. Design: A descriptive study, reporting six cases, with a discussion of the literature. Setting: St Thomas' Hospital Outpatient Department. Patients: Six outpatients. Conclusions: The development of both squamous carcinoma and basal cell carcinoma may be associated with chronic venous disease of the lower limb. Modest dimensions or a healthy appearance that are out of keeping with a protracted course may be signs of malignancy in a leg ulcer. A punch biopsy under local anaesthesia in the outpatient department provides accurate diagnosis of a malignant ulcer allowing prompt treatment.
Venous Reflux at the Sapheno-Femoral Junction
Authors: Somjen G. M. , Donlan J. , Hurse J. , Bartholomew J. , Johnston A. H. , Royle J. P. 
Published: January 2017

Objectives: To clarify reflux patterns in the sapheno-femoral junction in legs with varicose veins that display incompetence in the proximal long saphenous vein on duplex scan examination. Patients and method: One hundred consecutive extremities were selected for ultrasound studies. Venous reflux was examined in the common femoral vein and long saphenous vein at five selected levels in the vicinity of the sapheno-femoral junction. Results: Duplex ultrasound examination confirmed that in 44 extremities reflux was detectable both in the long saphenous vein and common femoral vein indicating ‘true’ sapheno-femoral incompetence. In 56 legs reflux was limited to the long saphenous vein, whilst the first saphenous valve remained competent. The ultrasound examination suggested that in these cases the reflux originated from the numerous tributaries of the proximal long saphenous vein. Conclusion: Our findings emphasize the transfascial escape (reflux from the deep veins) is not a necessary precondition of long saphenous vein incompetence and related varicose veins.
The Effects of Long Term Graduated Compression Treatment on Venous Function during Pregnancy
Authors: Austrell C. , Thulin I. , Norgren L. 
Published: January 2017

Objectives: To evaluate venous function during pregnancy and to compare two levels of graduated compression. Design: Prospective, randomized study. Setting: Vascular Surgery and Vascular Laboratory, University Hospital. Patients: Fifty pregnant women using graduated compression with pantyhose stockings exerting either 25 or 13 mmHg ankle pressure. Eight pregnant women acting as controls. Interventions: Foot volumetry to determine venous function (venous emptying during exercise and reflux) close to week 20, week 33 and post-partum. Results: The expelled volume increased significantly when graduated compression stockings were used. Refilling flow did not change significantly. Few patients with reflux were found. Conclusion: Graduated compression stockings of pantyhose type are effective in increasing venous emptying during pregnancy. Stockings exerting an ankle pressure of 13 mmHg at the ankle level were as effective as those exerting 25 mmHg.