bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palpating Ankle Pulses is Insufficient in Detecting Arterial Insufficiency in Patients with Leg Ulceration
Authors: Moffatt C. J. , Oldroyd M. I. , Greenhalgh R. M. , Franks P. J. 
Published: January 2017

Objective: To investigate the ability of district nurses to detect lower limb arterial disease by palpation of ankle pulses. Design: Ankle pulse palpation of patients presenting with ulcerated limbs and comparison with Doppler ankle-brachial pressure index (ABPI). Patients: Sequential patients presenting to community ulcer clinics. Main outcome measure: Sensitivity and specificity of pulse palpation to detect arterial disease compared with ABPI. Results: Of 533 limbs with ulceration in 462 patients (mean age 74 years, 67% female), 167 (31%) had no detectable pulses at the ankle. Of the 93 limbs with ABPI <0.9, 34 (37%) had detectable pulses. Of those limbs with ABPI ≥ 0.9, 108 out of 440 (25%) had no detectable ankle pulses. Sensitivity for lack of pulses as a predictor of arterial disease (ABPI <0.9) was 63% with a specificity of 75% and positive predictive value of only 35%. Using only the absence of palpable pulses would lead to 37% of patients with arterial disease being treated inappropriately. Conclusion: Palpation of pedal pulses by community nurses is a poor predictor of leg arterial disease and must be used in combination with ABPI. Only when significant arterial disease is excluded should compression be applied.
Ambulatory Venous Pressure and Leg Volume Measurements before and after Surgery for Primary Varicose Veins
Authors: Vayssairat M. , Chakkour K. , Gouny P. , Taccoen A. , Cheynel C. , Baudot N. , Nussaume O. 
Published: January 2017

Objective: To compare clinical disability, ambulatory venous pressure (AVP) and leg volume before and after venous surgery, and to relate the changes to those observed after one night preoperative in-hospital rest. Design: Prospective study. Setting: Department of Vascular Surgery, University Hospital, Paris, France. Subjects: Nineteen patients with primary varicose veins and mild chronic venous insufficiency (CVI), scheduled for venous surgery. Main outcome measures: Clinical disability recorded by the analogue scale method, and leg volume and AVP measurements. These evaluations were repeated three times: on the day before surgery, in the afternoon; in the early morning on the day of surgery; and 2 months after surgery, in the afternoon. Results: Varicose vein surgery improved disability ( p = 0.001) and two AVP parameters: recovery time (RT, p = 0.0049) and the calf muscle pump index (CMPI), which rose by 345% (95% confidence intervals: 29, 659). Preoperative supine rest for one night improved disability ( p = 0.0016) and reduced leg volume ( p = 0.0002). The improvements induced by surgery correlated with the changes induced by rest, for disability ( p = 0.016), RT ( p = 0.006) and CMPI ( p = 0.033). Conclusion: Surgery improves venous function in patients with primary varicose veins. AVP remains a standard method of evaluating CVI. Combined with volumetry, it allows sensitive comparisons between different treatments. Because venous function varies greatly with daily activity, it is imperative to standardize the times at which venous function is evaluated.
‘Inversion’ Stripping of the Long Saphenous Vein
Authors: Wilson S. , Pryke S. , Scott R. , Walsh M. , Barker S. G. E. 
Published: January 2017

Objective: To assess a novel device designed for ‘inversion’ stripping of the long saphenous vein during varicose vein surgery. Design: A prospective, randomized trial. Setting: The Day Surgery Unit of a District General Hospital. Patients: Thirty consecutive patients undergoing unilateral, varicose vein surgery, all fulfilling appropriate requirements for day surgery. Outcome: Peroperative assessment of blood loss and postoperative assessment of complications, bruising, pain and length of stripper exit wound. Results: ‘Inversion’ stripping caused less peroperative blood loss ( p < 0.01). It reduced postoperative morbidity (for pain at 1 week, p = 0.02) and gave an improved cosmetic result (with a smaller stripper exit wound, p < 0.01). Conclusion: An easy-to-use, ‘inversion’ stripping device is described that can reduce the postoperative morbidity often associated with primary varicose vein surgery and can enhance cosmesis.
Measurement of Peripheral Venous Oxygen Saturation in the Leg Using Near-Infrared Spectroscopy
Authors: Wertheim D. , Salaman R. , Melhuish J. , Williams R. , Lane I. , Harding K. 
Published: January 2017

Background: It has been suggested that poor healing of wounds may be associated with reduced tissue oxygenation. A non-invasive method of assessing peripheral venous oxygenation has been investigated. Method: Changes in oxyhaemoglobin (O2Hb), deoxyhaemoglobin (HHb), oxidized cytochrome aa3 (cyt aa3) and total haemoglobin (tHb) were monitored in the left lower leg of seven healthy volunteers. A short period of venous occlusion was achieved by rapidly inflating a sphygmomanometer cuff placed around the leg to 60 mmHg. The changes in O2Hb and tHb, with respect to the baseline readings, were evaluated. PSvO2 was calculated from (ΔO2Hb/ΔtHb) × 100%. Results: From 17 sets of readings on the seven volunteers the median PSvO2 calculated was 64% (range 50–86%). Conclusion: This method appears to be a simple means of evaluating PSvO2. A change in cyt aa3 was often seen associated with the venous occlusion.
Preoperative Digital Photoplethysmography Predicts Improvement in Venous Function after Superficial Venous Surgery for Chronically Ulcerated Limbs
Authors: Sullivan J. G. , Ghauri A. S. K. , Whyman M. R. , Poskitt K. R. 
Published: January 2017

Objective: To evaluate digital photoplethysmography (d-PPG) in predicting the influence of superficial surgery on venous function in chronically ulcerated limbs. Design: Prospective case-study. Setting: Vascular Laboratory of a District General Hospital. Patients: Patients with ulcerated limbs referred to a specialized community leg ulcer service were assessed with colour venous duplex ultrasound and ankle–brachial pressure index and offered surgery in cases of superficial venous reflux alone. Interventions: Superficial venous surgery. Four-layer compression bandaging. Main outcome measures: D-PPG derived venous refill time (VRT) and pump power (PP) were measured preoperatively with and without a tourniquet, and again after surgery. Results: Thirty ulcerated limbs in 27 patients were assessed. VRT increased from a median (interquartile range) of 10 s (7–17) preoperatively to 26 s (19–29)* with an above-knee tourniquet, 26 s (18–32)* with a below-knee tourniquet and 19 s (15–25)* after superficial venous surgery (* p < 0.01). PP increased from 2.3% (1.3–3.1) preoperatively to 3.0% (2.0–4.2)* with an above-knee tourniquet, 2.9% (2.1–4.3)** with a below-knee tourniquet and 4.4% (2.3–7.2)* after surgery (* p < 0.01, ** p < 0.05). The increase in VRT with an above-knee tourniquet preoperatively correlated with an increase in VRT after surgery ( r = 0.40, p < 0.05). Conclusion: Superficial venous surgery improves venous function measured by d-PPG in chronically ulcerated limbs. Preoperative assessment with d-PPG and an above-knee tourniquet predicts functional improvement after surgery.
Improving the Diagnosis of Chronic Leg Ulcers: A One-Stop Vascular Assessment Clinic in a Community Service
Authors: Ghauri A. S. K. , Currie I. C. , Grabs A. J. , Whyman M. R. , Farndon J. R. , Poskitt K. R. 
Published: January 2017

Objective: To evaluate the influence of a specialized vascular-led community leg ulcer service on assessment and diagnosis of leg ulcers. Design: Before-and-after study with prospective and retrospective data collection. Setting: East Gloucestershire, England, UK. Subjects: Patients treated for chronic leg ulcers before and within a specialized service incorporating a one-stop assessment including ankle–brachial pressure index (ABPI) and colour venous duplex. Main outcome measures: The means of assessment and the identified aetiology of leg ulcers in community patients. Results: Before clinics, only 40 (26%) limbs had a diagnosis recorded. After clinics, 83 (21%) limbs had arterial disease, including 64 (16%) with mixed arterial/venous disease. Venous duplex identified 279 (70%) limbs with venous disease of which 121 (43%) had superficial venous disease alone. Conclusion: A one-stop assessment clinic with ABPI and colour venous duplex ultrasound within a specialized community service improves diagnosis of leg ulcers. This is essential before appropriate and safe management by specialist nurses in the community.
Benzoctamine and Chlordiazepoxide in Anxiety: Some Predictors of Improvement
Authors: Rickels Karl , Downing Robert W , Case W George , Feldman Harold S , Pereira-Ogan Jorge A , Weise Charles C 
Published: January 2017

A multiple regression search analysis was conducted with 76 anxious outpatients treated in a 4 week clinical trial with either benzoctamine 60 mg/day or chlordiazepoxide 60 mg/day. Better response was predicted: For benzoctamine, in patients who are less educated, have an adequate occupational adjustment, and are initially higher in anxiety. For chlordiazepoxide, in patients who are more educated and have a marginal occupational adjustment. For both drugs, in patients who are black, are diagnosed as anxious rather than anxious-depressed, and are higher in initial depression. A major factor accounting for the differential effectiveness predicted for these 2 anti-anxiety agents was felt to be the large number of sedative side effects reported by patients receiving benzoctamine 60 mg/day.
Drug Profile: Synadrin
Authors: Murphy J Eric 
Published: January 2017

Synadrin (prenylamine lactate) is well established in the long-term management and prophylaxis of angina pectoris. It moderates the cardiac effects of sympathetic stimulation by decreasing the uptake of noradrenaline at the sympathetic nerve endings in the myocardium, and by slowing calcium transport through the endoplasmic reticulum. Extensive clinical investigation and usage has shown Synadrin to have beneficial effects in angina within a narrow dosage range and without frequent or troublesome side-effects.
Biochemical and Haematological Effects of Clomipramine (Anafranil)
Authors: Bartrop R 
Published: January 2017

The sporadic and frequently idiosyncratic occurrence of toxicity in several bodily systems during Anafranil therapy has been reviewed. Particular attention is given to the reports between the Madrid World Psychiatric Congress, in 1966, and the marketing of the drug four years later. Whether the changes in haemopoietic, gastro-intestinal or electrolyte parameters represent a drug-related assault on actively dividing or metabolising cells—or whether other preparatory or coincidental factors are important—is a matter of conjecture. Some studies had prompted work in 1970-71 to examine the possibility of adverse effects on calcium metabolism: this is not proven. The possible significance of calcium kinetics in altering the periodicity of affective states is discussed. Little evidence of significant or lasting changes in calcium levels were shown.
The Effect of Bumetanide and Frusemide on Frequency of Micturition
Authors: Bennion-Pedley J , Postlethwaite D L , Lomas D M , Donald J F , Molla A Layes 
Published: January 2017

General practice patients with mild to moderate congestive cardiac failure recorded their frequency of micturition after taking frusemide 40 mg or bumetanide 1 mg at 8 a.m. or bumetanide 1 mg at 6 p.m. Morning doses of bumetanide or frusemide caused a similar pattern of urinary frequency, although the period of increased frequency appeared to be shorter with bumetanide. If an evening diuresis is required, bumetanide should be given between 4 and 6 p.m. The use of potent and short acting diuretics such as bumetanide allow the physician and patient scope to decide upon the most appropriate time for administration and so reduce major disruptions in the patient's daily routine.
Role of High-Dose Intravenous Frusemide Therapy in the Management of Chronic Renal Failure
Authors: Chandra Mam , Mitra M K , Gupta N N 
Published: January 2017

The results of using high doses of intravenous frusemide in the management of 28 patients suffering from chronic renal failure are presented. The results are compared with those obtained from 14 patients also suffering from chronic renal failure, who received identical ‘conservative management’ but were not treated with diuretics. Large doses of intravenous frusemide produced a satisfactory diuretic response in a higher percentage of treated patients (71%) compared with controls (36%). It was also observed that in the treated group of patients a significant diuretic response could be obtained in patients with a creatinine clearance below 4 ml per minute. The study also demonstrated that in the group of patients receiving frusemide the response was better in those who were given a progressive-dose regime; 88% of patients improved with this regime compared with 68% of patients who were treated with a fixed dose of frusemide. Transient deafness with tinnitus and vertigo were the only side-effects observed. However these effects were only seen in patients who received 1000 mg or more frusemide in one day, administered over a period of one to two hours. It is concluded that all patients suffering from chronic renal failure should be given a trial of large doses of intravenous frusemide therapy, along with other conventional measures, particularly where facilities for dialysis are not immediately available.
A Clinical Impression of a Combination-Type Contraceptive: Neo-Lyndiol
Authors: Gede C E 
Published: January 2017

One hundred and sixty-five women were treated during a total of 3,281 cycles with Neo-Lyndiol, a combined oral contraceptive containing 2·5 mg lynestrenol and 0·050 mg ethinyloestradiol per tablet. The tablets were taken for 32 days, with six tablet-free days. No pregnancies were seen and the proportion of patients experiencing irregular bleeding and side-effects was very low and in fact their complaints decreased considerably as medication continued. There was a drop-out rate of only 5·5%, which is exceptionally low. Neo-Lyndiol proved to be a reliable preparation, controlling the cycle well and causing few side-effects.
A Comparative Double-Blind Trial of the New Antidepressant Caroxazone and Amitriptyline
Authors: Cecchini S , Petri P , Ardito R , Bareggi S R , Torriti A 
Published: January 2017

On the grounds of pharmacological properties and preliminary clinical trials the efficacy of the new antidepressant caroxazone was compared to amitriptyline in the management of depression. Forty patients mostly suffering from a neurotic or anxious-neurotic depression were admitted to a double-blind trial. All patients completed the study. The Hamilton Rating Scale for Depression was used for the clinical assessment at the beginning, during and at the end of treatment. The trial lasted three weeks. A significant improvement was seen for both drugs after seven days on most symptom scores and on total symptom score. No significant differences were found either at seven days or at the end of treatment between the two drugs. There were no significant differences in the incidence and severity of side-effects. In conclusion, caroxazone appears as an effective and well tolerated drug in the treatment of depression.
The Effect of Bromazepam on Psychomotor Activity and Subjective Mood
Authors: Hobi V , Dubach U C , Skreta M , Forgo J , Riggenbach H 
Published: January 2017

The effects of short-term (acute) doses of bromazepam were studied in a double-blind trial with the aid of three dosage groups comprising a total of fifty-five healthy male medical students (who received placebo, and 1.5 mg or 3.0 mg bromazepam, respectively). Subjective well-being was recorded through self-ratings by the volunteers, and the variables of psychomotor function by standard testing instruments. In terms of subjective well-being, fatigue and decreased performance (statistically confirmed throughout) were reported by the probands in all three dosage groups after they were administered either the drug or placebo. None of the dose-effect relationships were statistically significant, although this trend was more pronounced, purely in quantitative terms, in the group that received 3 mg bromazepam than in either the placebo or the 1.5 mg bromazepam group. In the reaction time test and in critical flicker frequency (CFF) testing, the trend mentioned above was confirmed. In the attentiveness and memory span test, learning effects were statistically confirmed in equally uniform fashion. The action of the substance was again not statistically significant. It may be concluded from this that subjective, and also in part objective, fatigue and decreased performance were related to the type of trial design employed, and not, generally speaking, to the action of the substance. However, again independently of the drug's activity, statistical confirmation was obtained of improved performance and/or learning activity in three variables of the alertness testing apparatus. Variables of driving ability were not adversely affected, but – if anything – stabilized. Our investigation studied the single-dose schedules of bromazepam – viz. 1.5 mg and 3 mg – that are most commonly prescribed for patients. The subacute and personality-related effects of the drug will be the subject of a later report.
Double-Blind Evaluation of Domperidone in Acute Vomiting and Dyspeptic Disorders
Authors: Agorastos I , Zissis N P , Kaprinis I , Goulis G 
Published: January 2017

The anti-emetic effects of domperidone were evaluated under double-blind conditions in twenty-four patients with acute vomiting randomly assigned to treatment either with 10 mg i.m. domperidone (six females, five males) or with placebo (seven females, six males). The therapeutic results were better with domperidone and the differences from placebo were statistically significant (p < 0.02). In a second randomized, crossover, double-blind trial, domperidone (10 mg t.i.d.) evaluated according to a nine-symptom rating scale, in eighteen dyspeptic patients, proved significantly more effective than placebo. The duration of treatment was 6 weeks and the drugs were crossed-over after 3 weeks. The difference between the two groups was most marked during the second phase of the trial. No side-effects were reported.
Oxidative Stress and Apoptosis in Immune Diseases
Authors: Agostini M. , di Marco B. , Nocentini G. , Delfino D. V. 
Published: January 2017

Antigenic stimuli increase ROS that influence T-cell activation by interfering with the oxidant-antioxidant balance. Oxidative stress takes place when excess of ROS production is not counterbalanced by antioxidant mechanisms and bcl-2 gene product that inhibits apoptosis by interacting with mitochondrial superoxide dismutase. ROS Excess induces apoptosis both by activation of NF-κB-dependent genes and DNA damage. The latter has been shown to elicit the activation of poly-ADP-ribose transferase and the accumulation of p53, thus determining apoptosis. Additionally, oxidative stress may induce formation of cell membrane oxidized lipids, potent inducers of apoptosis. Oxidative stress is also involved in immune diseases. In AIDS, ROS excess and deficiency of antioxidants lead to apoptosis and virus activation. ROS produced at sites of chronic inflammation, have genotoxic effects. As a consequence, abnormalities of the p53 genes might explain the conversion from an inflammatory phase into autonomous progression of rheumatoid arthritis or other chronic inflammatory disorders.
What Factors Contribute to Senior Psychiatry Residents' Interest in Geriatric Psychiatry? A Delphi Study
Authors: Lieff Susan J , Clarke Diana 
Published: January 2017

Objective: To generate hypotheses regarding factors that influence senior psychiatric residents, to consider treating geriatric patients in their future practices. Method: Using the Delphi technique, designed to generate ideas and consensus, we asked psychiatry residents at the University of Toronto who had completed, or were completing, their geriatric rotation about the factors they thought might influence residents in devoting some of their practice to geriatric patients. Residents then rated the degree of influence of these factors which had been synthesized into a questionnaire. Results: Twenty-six items were rated according to their degree of influence. The most influential item was positive clinical experiences with seniors. This was followed closely by supervisor characteristics such as enthusiasm, role modeling, competence, and mentoring. Interest in and comfort with the medical psychiatric and neuropsychiatric nature of the field were also felt to be influential. Conclusions: The factors that influence senior psychiatry resident interest in the practice of geriatric psychiatry are primarily educational and result from exposure to the field under optimal educational circumstances (positive clinical experiences and excellent supervisors). The medical and neuropsychiatric nature of the field also likely exerts a unique influence and should be considered in stimulating interest in this population.
Fright (Effroi) and other Peritraumatic Responses after a Serious Motor Vehicle Accident: Prospective Influence on Acute PTSD Development
Authors: Vaiva Guillaume , Brunet Alain , Lebigot François , Boss Virginie , Ducrocq François , Devos Patrick , Laffargue Philippe , Goudemand Michel 
Published: January 2017

Objective: We prospectively examined the relation between various peritraumatic responses (that is, fear, helplessness, horror, amnesia, and fright) and the development of posttraumatic stress disorder (PTSD) 2 months after a trauma. Method: Participants included 123 motor vehicle accident (MVA) victims consecutively hospitalized in a traumatology department for over 72 hours during a 16-month period. Between day 2 and day 5 of their hospitalization, a psychiatrist assessed the patients' peritraumatic responses and acute stress disorder (ASD). Two months after the accident, an experienced psychiatrist contacted the patients by telephone, and the PTSD symptoms and the diagnosis were assessed with a modified version of the Clinician-Administered PTSD Scale (CAPS). Results: Of the participants, 48 reported an immediate fright reaction when faced with the prospect of their own death. Participants who reported a fright experience had a 17 times greater risk of subsequently meeting the diagnostic criteria for PTSD (odds ratio 16.75). A fright reaction predicted PTSD development with a specificity of 0.93 and a sensitivity of 0.60. Conclusion: The immediate reactions described in criterion A2 of the DSM-IV (that is, fear, helplessness, and horror) did not seem to be equally relevant. An initial feeling of fright seems to be an essential qualitative factor in the clinical description of psychological trauma.