bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of multisensory environments on children with disabilities: a literature review
Authors: Yuen-yi Lai C 
Published: May 2014

The use of multisensory environments (MSEs) for educating children with learning disabilities has gained widespread acceptance in recent years. However, scientific research studies on the use of MSEs are limited. This article reviews the literature concerning the use of MSEs in the paediatric field to provide sensory stimulation, promote relaxation, manage behavioural problems and develop skills. Research methodology and findings of the studies are discussed. The author discovered a paucity of scientific literature on the effects of MSEs in the paediatric field. Positive findings on the use of MSEs are reported by the researchers. However, owing to the limitation of sample size, diversity of experimental population and variety of dependent variables, the effect of MSEs is difficult to generalize. Therefore, results should be interpreted with caution. Conducting vigorous studies on MSEs with improved research methodology is recommended.
Coexistent gout and rheumatoid arthritis: a case report
Authors: Modesto dos Santos Vitorino , Cézar Breno F , Barbosa Elber R , Gomes Filomena R , de Oliveira Carvalho Fereira 
Published: May 2014

A 56-year-old Brazilian man, non-alcoholic, with no family history of arthritis, complained of weight loss and fever during haemodialysis. Over the previous 3 years he had asymmetric podagra responsive to colchicine and allopurinol, and developed subcutaneous nodules in fingers and forearms, where tophi of monosodium urate crystals were found on needle aspiration. He also had recurrent symmetric polyarthritis in wrists and hands without morning stiffness. On admission his temperature was 36.5°C. The heart was rhythmic at 99 beats per minute and blood pressure 190/110 mmHg. The lungs were clear and respiratory rate 20 incursions per minute. The liver was normal and the spleen was enlarged. Symmetric nodules were found in the third proximal interphalangeal hand joints (Figure 1) and near the elbows (Figure 2) without rheumatoid deformities. The results of blood tests were as follows: erythrocytes 2.77×106/mm3, haemoglobin 8.1g/dl, haematocrit 25.9%, leukocytes 13 100/mm3 (neutrophils 72%, lymphocytes 20%), platelets 280 000/mm3, erythrocyte sedimentation rate 89 mm/hr, albumin 3.6 g/dl, globulins 4.8 g/dl, Bence-Jones proteinuria negative, uric acid 11.3 mg/dl, iron 57 μg/dl, glucose 84 mg/dl, urea 93 mg/dl, creatinine 8.4 mg/dl, sodium 135 mEq/litre, potassium 4.8 mEq/litre, calcium 1.44 mmol/litre, phosphorus 5.3mg/dl, aspartate transaminase 20U/litre, alanine transaminase 33U/litre, gamma-glutamyl transpeptidase 170 UI/litre, triglycerides 101 mg/dl, cholesterol 117 mg/dl. C-reactive protein 4.8 mg/dl, acid alpha1-glycoprotein 235 mg/dl, rheumatoid factor 82.3 UI/dl, antinuclear, anti-DNA, and anti-microsomal antibodies negative. Complement levels were C3 116 mg/dl and C4 55 mg/dl. Tests for hepatitis C and toxoplasmosis immunoglobulin G were positive; and hepatitis B, brucellosis, mononucleosis, syphilis and human immunodeficiency virus were negative. Radiograph of hands showed cortical erosions in the third proximal interphalangeal joints, with normal joint spaces, erosions and cysts in metacarpal epiphyses, with symmetrical periarticular osteoporosis and soft tissue swelling (Figure 3). Medial epicondyle erosion with overhanging edges and fluffy calcifications of chronic tophaceous gout (Monu and Pope, 2004) were seen in the left olecranon. Biopsy of subcutaneous nodule disclosed granulomas with central zones of fibrinoid necrosis surrounded by palisades of mononuclear cells (Figures 4 and 5), and characterized rheumatoid arthritis coexistent with gout.
Oesophago-bronchial fistula causing cough and recurrent lower respiratory tract infections in a patient with Crohn's disease
Authors: Brittenden J , Hosker HSR , Healey C , Porter G 
Published: May 2014

A40-year-old non-smoking woman was referred to the outpatient clinic because of an increasing dry cough and recurrent lower respiratory tract infections over a 10-year period. The patient was diagnosed with Crohn's disease in 1979. The disease was initially confined to the large intestine but despite intensive medical treatment she required a total colectomy with ileostomy formation and, 2 years later, she was treated with a proctectomy. In 1996 she developed a problematic nocturnal cough with associated early morning sputum expectoration and intermittent wheeze, which did not respond to a trial of inhaled bronchodilators. In 1998 she was admitted to hospital with a severe left lower lobe pneumonia, which responded well to oral ampicillin and erythromycin. She subsequently complained of coughing during meals but denied any indigestion or heartburn. There was no background of atopy, or history of asthma or rhinitis. Systemic examination was unremarkable. Review of previous chest radiographs revealed recurrent changes of left lower lobe consolidation (Figure 1). Initial investigations including spirometry, biochemical screen, full blood count, immunoglobulin subclasses, aspergillus precipitins and sputum culture for bacteriology and tuberculosis were normal. An initial diagnosis of minor localized bronchiectasis was made and the patient was referred to the physiotherapy department for postural drainage. Because of the persistent nocturnal cough, gastro-oesophageal reflux with aspiration was considered and a barium swallow arranged. The barium swallow (Figure 2) demonstrated a fistula between the oesophagus and the left lower lobe bronchus arising approximately 10 cm from the gastro-oesophageal junction. Multiple ‘rose-thorn’ ulcers were also seen in the mid- and lower oesophagus. The barium, which passed into the left lower bronchial tree, did not demonstrate bronchiectatic changes (Figure 3). This was confirmed with high resolution computer tomography, which revealed some localized fibrosis in the left lower lobe, but did not show any evidence of bronchiectasis. At endoscopy a 4 mm defect was seen at 32 cm, which was biopsied. The histology showed hyperplastic squamous epithelium with inflammatory changes but no features of malignancy. The patient gained considerable relief of her symptoms from the use of antacid suspensions and propping the head of her bed at night. She discontinued the proton pump inhibitor owing to side effects, but has remained relatively symptom free during the last year. She has consistently refused enteral feeding and surgical intervention despite being aware of the potential risks of complications from the oesophago-bronchial fistula.
Hyper-elevated prostate-specific antigen levels are not always carcinoma
Authors: Lawrentschuk Nathan , Davidson Adee-Jonathan , Hurley Michael R , Crowley Peter F , Bolton Damien M 
Published: May 2014

An 81-year-old man with a past history of diabetes, hypertension, ischaemic heart disease and cerebrovascular disease was admitted to hospital with hypotension and bradycardic collapse. Owing to persistent hypotension and a low urine output, an indwelling catheter (IDC) was inserted per urethra and a cardiac pacemaker was placed the following day. A serum prostate-specific antigen (PSA) level was back-ordered on initial bloods taken before IDC insertion, as passing the catheter was difficult and he was noted to have an enlarged prostate. A trial of void without catheter was successful 24 hours after initial insertion, leading to discharge that evening He represented to the emergency department in acute urinary retention the day following discharge and gave no past history of significant lower urinary tract symptoms. An IDC was again inserted draining 700 ml and notes were obtained from his previous admission indicating that he had a PSA of 933 ng/ml (Immulite 2000, Diagnostic Products Corporation, Los Angeles, USA) on admission. The plan was for staging of prostate cancer and needle biopsy in the future to confirm the diagnosis. On examination, his prostate was enlarged and firm with no obvious nodular change. A bone scan was negative for metastatic prostate cancer. Prostatic needle biopsies (18 gauge) were undertaken revealing benign glands and also the edge of coagulative necrosis (Figure 1). The necrosis involved both stroma and glands, and was surrounded by a zone of immature fibrous tissue containing nests of metaplastic squamous epithelium (Figure 2). Findings were consistent with prostatic infarction and there was no evidence of malignancy. A repeat serum PSA demonstrated a rapid descent to 9.3 ng/ml. The patient was discharged after a successful trial of void and is now catheter free.
Lung abscess rather than pneumatocele following kerosene ingestion
Authors: Aziz Azian Abd , Abdullah Ahmad Fadzil , Mahmud Azhar 
Published: May 2014

A 5-year-old Malay boy was admitted to the authors' hospital for accidental kerosene oil ingestion with possible aspiration. He accidentally ingested kerosene oil which had been kept in a mineral water bottle but the amount ingested was not known. He then had several episodes of vomiting and subsequently became tachypnoeic. There was no history of seizures. On physical examination, he was conscious but tachypnoeic with a respiratory rate of 50 per minute. There was a smell of kerosene from his mouth. He was afebrile and other vital signs were normal. His oxygen saturation ranged from 97% to 99%. Respiratory system examination did not show other abnormalities. Examination of other systems was unremarkable. His chest radiograph on admission (Figure 1) showed no abnormal findings. He was observed in the ward and managed conservatively. He became more tachypnoeic and developed a high grade fever of about 39°C 12 hours after admission. His repeated chest radiograph (Figure 2) suggested pneumonitis of the left lung. Intravenous cefuroxime was instituted. He showed clinical improvement and was asymptomatic 1 week later. However, a chest radiograph taken before discharge (Figure 3) showed a thick wall cavity approximately 3 × 2.5 cm in size with evidence of air–fluid level in the left lower lobe. Computed tomography of the thorax (Figure 4) showed that only one cavity was present. This was presumed to be a partially treated lung abscess and intravenous ceftriaxone was commenced. He completed 2 weeks of intravenous ceftriaxone and a further 2 weeks of oral cefuroxime. He responded well to the antibiotics and a chest radiograph taken on follow up about 5 months later showed the cavity in the left lower lobe had completely resolved.
Sporadic Creutzfeldt–Jakob disease presenting as stroke mimic
Authors: Winn Simon , Bhalla Ajay 
Published: May 2014

A hypertensive 75-year-old woman with hypertrophic cardiomyopathy, hypercholesterolaemia and paroxysmal atrial fibrillation was referred to the author's neurovascular clinic with sudden onset word-finding difficulty and right-sided weakness. Examination confirmed mild right pyramidal drift and expressive dysphasia in an otherwise relatively independent patient. Computed tomography (CT) confirmed a lacunar infarct involving the posterior limb of the internal capsule (Figure 1). Neurorehabilitation afforded initial improvement, but her family reported deterioration in concentration, coordination and continence control with emotional lability over the next 4 weeks, prompting hospital admission. On examination, she was bedbound, with severe expressive dysphasia (abbreviated mental test score 0/10), dysphagia, global weakness, hypertonia, hyperreflexia and bilateral upper limb myoclonus (more on the right hand side). Repeat CT confirmed previous findings. Lumbar puncture was acellular with a protein count of 0.42 g/dl. Sequential electroencephalograms (EEGs) demonstrated bilateral periodic lateralized epileptiform discharges which were abolished by intravenous lorazepam suggesting nonconvulsive status epilepticus. However, deterioration continued despite antiepileptic therapy. Magnetic resonance imaging demonstrated bilateral putamen and caudate nucleus enhancement on T2 FLAIR with left temporal lobe cortical ribboning on diffusion weighted imaging (Figures 2 and 3). A subsequent EEG showed an evolving picture, with bilateral triphasic waves (1Hz) (Figure 4) compatible with a diagnosis of probable sporadic Creutzfeldt–Jakob disease. This was supported with a positive cerebrospinal fluid 14-3-3 protein assay. The patient died 59 days after the initial presentation. No tissue diagnosis was made.
A variant of Munchausen syndrome presenting as a gynaecological emergency
Authors: Ogbonmwan Stephen EO , Abidogun Kenny 
Published: May 2014

A 42-year-old woman presented to the accident and emergency medicine department and was triaged to the gynaecological emergency unit with vaginal bleeding and incomplete miscarriage of 13 weeks’ gestation, which she brought in as a ‘specimen of products of conception’, following a miscarriage at home, in a plastic bag. Her last menstrual period was on 11 December 2005, which made her about 13 weeks’ gestation by date. She had three children and had had ‘three miscarriages’ previously. Her periods were regular, bleeding for 4–6 days in a regular cycle of 26–28 days. She had two ‘positive pregnancy tests’ at home but had never had an ultrasound scan before presentation. In her three previous miscarriages, there was no documented evidence of pregnancy either by a positive pregnancy test, elevated beta human chorionic gonadotrophin level, ultrasound scan findings of intrauterine pregnancy, whether viable or non-viable, or histological evidence of products of conception. She looked very distressed but her general physical examination was normal and her vital signs were within normal limits. Pelvic examination revealed minimal blood in the vagina and the cervix looked normal, but patulous. The uterus felt slightly bulky in size and mobile. An intravenous line was put up and blood taken for full blood count, C-reactive protein, grouping and saving serum, and serum beta human chorionic gonadotrophin estimation, and a pelvic ultrasound scan was arranged. The need for hospital admission was explained to complete the investigations and initiate appropriate management. She was also prescribed a course of antibiotics and analgesics. The specimen, which was in the early stage of decay, was inspected and found to be offensive. It was sent in formalin to the histopathology department for histology. The patient refused admission into the gynaecological ward and also a transvaginal ultrasound scan which had been arranged. She signed the discharge against medical advice form in spite of advice to the contrary. Further inquiry of her GP confirmed that she had had treatment for depressive illness in the past and has changed her GP frequently, making it difficult to arrange effective follow-up. The GP promised to a range psychiatric assessment as soon as practicable. It was not known at this stage that she was not actually having a miscarriage and that the purported products of conception were in fact chicken giblets.
Multiple cranial nerve palsies as a result of perineural invasion by squamous cell carcinoma
Authors: Chan Weng Onn , Madge Simon , Dodd Thomas J , Higgs Braden , Davis Garry 
Published: May 2014

A 70-year-old man presented with a 1-month history of right-sided proptosis, ptosis and intermittent dull ache of the right temple. Three years before, a squamous cell carcinoma had been removed from his right temple at another hospital; excision had been initially incomplete, requiring three further operations over 8 months. Two days after the last operation, he developed a right facial palsy, initially thought to be Bell's palsy and managed with prednisone with no effect. His right forehead, cheek and upper lip had also felt numb since around this time. Five months later, he lost hearing in his right ear and reported some loss of balance but no vertigo. Six months later, he lost sight in his right eye secondary to exposure keratopathy; an upper lid gold weight was inserted and right-sided temporalis transfer performed. Examination revealed a complete right ptosis and 4 mm of proptosis with restricted extraocular movements in all directions. There was a right lower motor neurone facial palsy, reduced sensation in the distribution of the 1st and 2nd division of the trigeminal nerve and sensorineural hearing loss in the right ear. His right cornea was completely vascularized with a visual acuity of counting fingers. There was no relative afferent pupillary defect. No lymphadenopathy was detected. His imaging and histology results are shown in Figures 1 and 2. As a result of these findings, palliative radiotherapy was administered.
Cocaine ‘body packers’ and the clinical management of packet rupture
Authors: Peake Simon TC , Das Saroj , Greene Shaun , Dubrey Simon W 
Published: May 2014

A 43-year-old Afro-Caribbean man was behaving oddly in the arrivals lounge at London Heathrow Airport. He was agitated, sweating profusely and disorientated. Urinalysis was positive for cocaine, and he was transferred to the local accident and emergency department. On arrival, he was hyperactive, tachycardic (rate 140/min), hypertensive (blood pressure 235/140 mmHg) and agitated. A plain abdominal radiograph identified multiple, well-defined objects throughout the gastrointestinal tract (Figure 1) with no evidence of bowel obstruction. Whole bowel irrigation with polyethylene glycol (2 litres/hour orally) was started. The patient remained agitated and hypertensive despite aggressive medical treatment for cocaine toxicity using intravenous diazepam (total 45 mg intravenously over 2 hours) and glyceryl trinitrate (maximum infusion rate 8 mg/hr). Following surgical consultation, it was decided to perform a laparotomy (Figures 2a and b). In total, 89 packets of cocaine were surgically removed from the stomach, small and large bowel (Figure 2c), with an estimated street value of £50 000–100 000 depending on purity. Postoperatively the patient made an uneventful recovery.
Psychotic mania induced by the withdrawal of pegylated interferon and ribavirin treatment
Authors: Ganeshalingam Y , Suleman S , Francis M 
Published: May 2014

Mr R was a 45-year-old man who had been diagnosed with hepatitis C, genotype 3a. He was commenced on a 16-week course of pegylated interferon-α2a 180 μg per week and ribavirin 400 mg twice daily. He was otherwise healthy and had recently completed the Boston marathon. During treatment the only complaints Mr R made were of sleep disturbance and weight loss as a result of reduced appetite which are recognized side effects of the treatment. Six days after completion of his treatment Mr R was picked up in the street by the police following several complaints from members of public. He was seen trying to damage parked cars and shouting repeatedly that he was God. He was agitated and had to be handcuffed by the police who escorted him to hospital. A physical examination was unremarkable except for a raised pulse rate of 120 beats per minute. There was no significant abnormality in his blood test results. He was placed on Section 2 of the Mental Health Act for assessment of a suspected mental illness. Mr R had neither a past psychiatric history nor any past family psychiatric history. On admission to the psychiatric ward he believed that he was being followed on CCTV and made sexually inappropriate comments to staff. As he continued to be highly agitated olanzapine 10 mg intramuscularly was administered. Over the next day Mr R remained elated in mood and irritable with paranoid thoughts. Mr R did not require further emergency intramuscular medications as he gradually became calmer and more cooperative. Three days after admission his mental state and behaviour began to show significant improvement. He had wished not to take oral olanzapine that was prescribed and hence no psychotropic medications were used following the initial olanzapine dose on admission. Mr R said that he had no recollection of being brought in by the police or his psychotic behaviour. He and his family denied that alcohol or illicit drugs had been used. He did recall that his sleep had been very poor, a common feature in mania, in the days before his admission. A computed tomography scan of his head was normal. Seven days after admission he was visited by his family and allowed leave off the ward as there were no remaining psychotic or manic symptoms. He was later discharged from the ward after uneventful leave at home and remained well 6 months on.
Fornix damage from solitary subependymal giant cell astrocytoma causing postoperative amnesic syndrome
Authors: Ibrahim I , Young CA , Larner AJ 
Published: May 2014

A 24-year-old right-handed woman with well-controlled insulin-dependent diabetes mellitus presented with a 1-week history of vomiting. She also gave a 1-year history of intermittent generalized headaches without obvious features of raised intracranial pressure. Neurological examination was normal. Structural brain imaging showed hydrocephalus secondary to an intraventricular heterogeneous mass lesion which compressed the left frontal horn (Figure 1) but without any brain parenchymal lesions or signal change. At operation, tumour was found to have invaded the left fornix but spared the thalamus and caudate nucleus. Histologically the lesion was moderately cellular with both ganglionic and astrocytic type cells, without evidence of mitosis or necrosis; appearances consistent with a subependymal giant cell astrocytoma. Neither the patient nor her family had any history of cutaneous stigmata of tuberous sclerosis. Postoperatively, it became apparent to care staff that the patient had short-term memory problems, repeatedly asking the same question and needing to be reminded about activities to perform. Minimental state examination (MMSE) 2 weeks postoperatively was 14/30. This rose to 24/30 by 10 weeks, and on the Addenbrooke's Cognitive Examination-Revised (ACE-R; Larner, 2007), a more detailed bedside test of cognitive function, she scored 75/100 (Table 1), with evidence of impaired delayed recall for verbal material (ACE-R memory subscore 17/26), and also for visual material (ad hoc object recall test 0/10), with recognition better than recall. There was impaired verbal fluency for both letter and category (ACE-R fluency subscore 3/14). Reassessed 9 months later, almost 1 year after tumour excision, the patient and her family noted continuing subjective improvement in memory but she needed external memory aids to remind herself of appointments, and remained vague about happenings in the year before her surgery, suggesting some possible retrograde memory impairment. She was now at ceiling on the MMSE (30/30) and on ACE-R scored 88/100 (Table 1) with improved delayed recall for verbal material (ACE-R memory subscore 21/26) and visual material (ad hoc object recall test 4/10). Verbal fluency for letter and category was also improved (ACE-R fluency subscore 8/14).