bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spontaneous rectus sheath haematoma in pregnancy
Authors: Banerjee AK , Waugh JJS 
Published: May 2014

A 20-year-old, primiparous, Caucasian woman presented at 32 weeks and 6 days gestation with sudden onset severe left-sided abdominal pain. She denied any history of recent trauma, falls or vaginal bleeding. She had no history of previous abdominal pain in this pregnancy and had booked at 9 weeks gestation. Her booking weight was 96 kg with a body mass index of 39 kg/m2 and her booking haemoglobin was 13.6 g/dl. No relevant past medical or surgical history was noted and so far her pregnancy had been uneventful. Clinically she was very distressed with the pain, was sweaty and had cold extremities. Her pulse was 130/minute, blood pressure was 130/87 mmHg and her temperature was 36.4°C. Abdominal examination revealed marked tenderness in the left upper quadrant of the abdomen over the upper pole of the uterus, which had a symphysiofundal height of 34 cm. Her haemoglobin was 8.8 g/dl, white cell count was 9.1×109/litre, and platelet count was 454×109/litre with a normal clotting screen. The cardiotocograph (CTG) was normal. On ultrasound scan a large haematoma was noted associated with the left uterine wall. This was directly associated with her tenderness. With a presumptive diagnosis of placental abruption a decision was made to perform emergency caesarean section delivery under general anaesthetic. At laparotomy a large rectus sheath haematoma (RSH) was noted. There were no signs of intraperitoneal bleeding and the uterus was 32 weeks in size. Both tubes and ovaries appeared normal. Caesarean delivery was not performed. About 400 ml of blood clot was evacuated from the left rectus muscle. No active bleeding vessels were noted. The peritoneum was closed followed by the rectus sheath after leaving a sub-rectus drain in the haematoma cavity. Postoperatively fetal CTG monitoring remained normal. She did not require blood transfusion. On her second postoperative day her haemoglobin was 9.7 g/dl and the abdominal drain was removed. She was allowed home on the fifth postoperative day on oral ferrous sulphate. At 34 weeks sonographic fetal biometry was on the 50th centile, liquor volume was normal and the haematoma was resolving (size 72 mm × 60 mm × 35 mm). She was seen again at 36 and 38 weeks. At 39 weeks and 2days she presented in spontaneous labour and proceeded to a forceps delivery, for failure to progress, of a 2.81 kg healthy baby. Her 6-week postnatal follow-up scan showed complete resolution of the RSH.
Persistent neonatal hypoglycaemia as a result of hypoplastic pituitary gland
Authors: Yong Sin-Chuen , Boo Nem-Yun , Wu Loo-Ling 
Published: May 2014

An Indonesian female infant developed hypoglycaemia shortly after delivery by lower segment caesarean section. Following admission to the neonatal intensive care unit, she continued to have episodes of hypoglycaemia despite adequate glucose intake of up to a maximum of 12 mg/kg/minute. During the episodes of hypoglycaemia, repeated measurement of her blood samples revealed persistently low levels of serum insulin of <2 IU/ml, serum free thyroxine of 4.78 pmol/litre, thyroid stimulating hormone of 0.31 uIU/ml and growth hormone of 0.27 mIU/litre, all suggesting a diagnosis of hypopituitarism. Empirical replacement therapy with hydrocortisone (10 mg four times daily) was started at 26 days. However, her hypoglycaemic attacks ceased only with commencement of additional hormone replacement therapy of growth hormone (0.1 mg once daily for 6 days per week) and thyroxine (50 μg once daily). The hydrocortisone dose was gradually tailed to a maintenance dose of 2.5 mg twice daily. Stimulatory tests such as adrenocorticotropic hormone and luteinizing hormone-releasing hormone tests and posterior pituitary function were not performed at that time as the infant developed Klebsiella pneumoniae and coagulase negative staphylococcus sepsis which may have affected the test results. A magnetic resonance imaging (MRI) scan of her brain at 1 month of age showed a hypoplastic pituitary gland with a shallow pituitary fossa (Figure 1). The posterior lobe of the gland was undescended, lying ectopic at the base of the third ventricle with an absent pituitary stalk (Figure 2). The rest of the MRI was normal with no associated anomalies of the midline forebrain structures. No abnormalities were detected in detailed opthalmological examination of her eyes excluding the possibility of septo-optic dysplasia. When followed up at 8 months of age, she remained well with improved hormonal profiles and normal levels of serum urea and electrolytes. Her weight, height and occipito-frontal circumference were all below the third percentile.
Cholecystocolonic fistula: an unusual cause of large bowel obstruction
Authors: Sinha S , Pullan RD 
Published: May 2014

A 70-year-old woman was admitted to the emergency department with a 2-week history of pain in the upper abdomen, vomiting, fever and jaundice. She was also complaining of pale stool and dark urine. Subsequently she developed abdominal distension with colicky pain and absolute constipation. There was no history of previous biliary symptoms. On examination she was pale and tachycardic with a fever of 37.9°C. Abdominal examination revealed generalized abdominal distension with a tender mass at right upper quadrant and hyperactive bowel sounds on auscultation. Laboratory examination showed a white blood cell count of 15 600/mm3 (neutrophil 85%), bilirubin of 47mmol/litre, alkaline phosphatase of 220 U/litre with normal liver enzymes and amylase. Plain abdominal X-ray demonstrated pneumobilia and dilated small and large bowel loops suggestive of intestinal obstruction (Figure 1). An unprepared barium enema showed a large smooth filling defect in sigmoid colon with large bowel obstruction (Figure 2). A diagnosis of large bowel obstruction presumably caused by a gall-stone was made. Surgical treatment followed a period of physiological optimization. At laparotomy the abnormalities were large bowel obstruction caused by an impacted gall-stone in a section of sigmoid diverticular disease plus right upper quadrant mass. A sigmoid colectomy with removal of diverticular disease and the stone, then a primary anastomosis was performed. Exploration of right upper quadrant mass revealed an inflamed friable gall bladder with a fistula between its fundus and the transverse colon. A partial cholecystectomy was performed, the cystic duct closed in-situ and the defect in transverse colon was brought out as a loop colostomy. Her postoperative course was uneventful. Closure of colostomy was performed 3 months later and she made a full recovery.
Health and health care in south Asian communities in the UK
Authors: Singh Iqbal , Ayyar Anita , Ahmed Rizwan Yahya , Rashid Sheikh Tamir 
Published: May 2014

In the 2001 census the population of the UK was estimated to be around 59 million, of which the ethnic minorities comprised just over 4.5 million (Office of National Statistics, 2001). People from India, Pakistan and Bangladesh (the south Asian communities) made up nearly 2 million or 4% of the total UK population. The health-related problems of this section of the population are in many ways different from the native Caucasian population. Moreover, this section of the population is itself heterogeneous, with different cultural and religious beliefs and varying dietary and lifestyle habits.
Scrotal cystocele: a surgical pitfall
Authors: Angus LD George , Cardoza Supriya 
Published: May 2014

A 91-year-old male nursing home patient with numerous medical problems was admitted to the medical service with rapid atrial fibrillation and congestive heart failure. A large scrotal hernia was noted and surgical consultation obtained. His past urological history was significant for chronic urinary retention secondary to benign prostatic hypertrophy, intermittent haematuria and recurring urinary tract infections. Given his overall poor general health, his outlet obstruction had been managed with an indwelling Foley catheter. Examination of the scrotum revealed a large, oedematous left hemiscrotum that could not be transilluminated. Scrotal content was not reducible and no bowel sounds were audible. A computed tomography scan of the abdomen revealed herniation of bladder into the left scrotal sac (Figure 1). Owing to persistent swelling and drainage from the scrotum, retrograde cystography was performed and demonstrated massive herniation of the bladder through the inguinal canal and into the scrotum (Figure 2). Given his overall general condition, a decision was made to manage the herniation non-operatively.
Primary venous aneurysm of the long saphenous vein: an uncommon case
Authors: Syed Abdul , Bhagat Tasnim , Bradpiece Howard 
Published: May 2014

A generally well 82-year old man presented to a general surgical outpatient clinic with a swelling of the medial aspect of his left thigh. It started as a small lump which grew quickly over a few weeks to approximately 6 cm. There was no history of trauma or thromboembolic complication and the patient was asymptomatic. On examination, there was a firm round swelling which was non-tender and non-pulsatile. It did not seem to be attached to deeper structures and was not anatomically related to the nervous system.The patient was reviewed by a consultant – the diagnosis of a chronic sebaceous cyst was considered and he was offered an excision biopsy under local anaesthetic. Postoperatively, the patient had an unremarkable recovery but presented with a localized haematoma (Figure 1) on routine follow up, which was managed conservatively. Histology revealed the mass was in fact a venous aneurysm of the long saphenous vein.
Interferon-alpha induced ‘tertiary mania’
Authors: Kingsley David 
Published: May 2014

A 32-year-old woman with no previous history of psychiatric illness was admitted to an acute psychiatric unit, having been behaving increasingly bizarrely over the previous week. She had persecutory delusions and grandiosity, but admitted to a 2-week history of low mood. Her sleep was disturbed and she had not slept at all on the night before admission. At admission she fluctuated between elation and aggression. Her speech was pressured and she demonstrated flight of ideas as well as poor attention and marked distractability. She had been treated for the previous 4 years with recombinant interferon-alpha by subcutaneous injection for essential thrombocythaemia, her dose having been gradually reduced to 3 megaunits twice-weekly at the time of admission. Physical examination on admission revealed no abnormalities. However, routine biochemical investigation revealed her to be profoundly hypothyroid, with a free thyroxine of 1 pmol/litre (10–26) and a thyroid- stimulating hormone of >84 mU/litre (0.5–6.5). Further investigation revealed a raised thyroid microsome antibody at 6400 units (<400). Her platelet count was 435×109/litre, revealing her essential thrombocythaemia to be well controlled. All other investigations, including electrocardiogram, lipids, creatinine kinase and lactate dehydrogenase, were normal. The patient required restraint and sedation. Her mental state improved rapidly over the following few days on oral haloperidol 5 mg three times daily. On discovery of her hypothyroidism, she denied a history of any classical physical symptoms. She was commenced on thyroxine 50 μg daily and her interferon-alpha discontinued. Her haloperidol was reduced and then discontinued at 1 month post-discharge. She has since remained well during the subsequent 12 months.
A triple dose of iron deficiency anaemia
Authors: Levison John , Bhandari Sunil 
Published: May 2014

A81-year-old ex-smoker, who previously smoked 20 cigarettes/day, and had an alcohol consumption of 8–10 units/week, presented with a 3-month history of ‘indigestion’ and breathlessness. He denied weight loss, dysphagia, vomiting, change in bowel habit or melaena. He denied taking aspirin or other non-steroidal anti-inflammatory medication. He suffered from ischaemic heart disease with biventriciular dysfunction. He was pale and had a blood pressure of 140/60 mmHg with no postural drop. The rest of the examination was unremarkable. Investigations showed a hypochromic (mean corpuscular volume 56.1 fL) microcytic (mean corpuscular haemoglobin 13 pg) anaemia with numerous hypersegmented neutrophils on blood film, a haemoglobin of 7.1 g/dl and serum ferritin of 4 μg/litre. Vitamin B12 and serum folate concentrations were normal. Upper gastrointestinal endoscopy demonstrated a 5 mm prepyloric ulcer and a 10 mm benign duodenal ulcer. Multiple biopsies were negative for Helicobacter pylori. Histology showed chronic gastritis and no malignant or dysplastic cells. He was transfused 3 units of packed cells, and commenced on ferrous sulphate and omeprazole before discharge home with a stable haemoglobin (11.4 g/dl). Six months later he again developed iron deficiency anaemia. His haemoglobin remained low (haemoglobin 8.2 g/dl, mean corpuscular volume 62.5 fL and ferritin 6 μg/litre). His appetite remained reasonable, weight steady and bowel habit unchanged. Repeat upper gastrointestinal endoscopy showed an abnormal ulcerated duodenal cap. Biopsy excluded neoplasm, Helicobacter pylori or infestation with giardiasis. Flexible sigmoidoscopy revealed grade II haemorrhoids and a large 2 cm tubulovillous adenomatous polyp in the sigmoid colon at 30 cm (Figure 1). Chest X-ray, abdominal ultrasound and carcinoembryonic antigen level were normal. Double contrast barium enema showed sub-total obstruction in the ascending colon (Figure 2). Radical right hemicolectomy and mesenteric node clearance of a bulky, Dukes B moderately differentiated mucinous adenocarcinoma was performed. Three years on he remains well, his haemoglobin level is 11 g/dl and there is no evidence of tumour recurrence.
Culinary delights in kitchen pathology
Authors: Patel Freddy 
Published: May 2014

It is fascinating that so much of the descriptive pathology appears to have originated in the kitchen. The evidence is plain to the past medical students of the older textbooks of general pathology from an era dominated by male pathologists. It is curious that in modern times it is no longer trendy to use the cook's vocabulary when more and more pathologists are women. One wonders how often the mortuary apron was changed for the kitchen variety to transform into the naked chef, or has there always been a good wife behind the pathologist. The tabby cat must have wandered into the kitchen when the pathologist was trying to imagine the tabby heart in anaemia. An amusing spin is that the red kidney bean would not have been so named but for the clinical gourmet at the kitchen table. A compilation of delightful culinary ingredients has been prepared in alphabetical order and served up with the associated morbid anatomical diagnosis. The author would be grateful for other interesting gems from the cookery book which can be added on to the list.
Influence of pain and quality of life on desire for hastened death in patients with advanced cancer
Authors: Mystakidou Kyriaki , Parpa Efi , Katsouda Emmanuela , Galanos Antonis , Vlahos Lambros 
Published: May 2014

Objective To assess the relationship between quality of life, pain and desire for hastened death in advanced cancer patients. Methods 120 Greek patients with advanced cancer were interviewed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 version 3.0 (EORTC QLQ-C30), the Greek Brief Pain Inventory (G-BPI), the Greek Hospital Anxiety and Depression Scale (G-HADS) and the Greek Schedule of Attitudes toward Hastened Death (G-SAHD). Results Statistically significant associations were found between total G-SAHD scores and scores for the worst level of pain in the previous 24 hours (G-BPI3)(r=0.279, P=0.002), and between total G-SAHD scores and scores for the level of pain relief obtained in the last 24 hours (G-BPI8) (r=-0.326, P=0.0005). The strongest correlations were found between G-SADH and emotional functioning (r=0.569, P<0.0001) and global quality of life (r=-0.331, P<0.0001) from EORTC QLQ-C30. In multivariate analyses, emotional functioning, social functioning, financial impact, and the interference of pain in general activity and mood were significant predictors of G-SAHD (all P<0.0001). Conclusion Quality of life and pain appeared to have a statistically significant relationship with desire for hastened death. Adequate palliative care should alleviate pain and the desire for hastened death, improving quality of life.
Survey of UK hospice and specialist palliative care adult bereavement services
Authors: Field David , Reid David , Payne Sheila , Relf Marilyn 
Published: May 2014

Method Postal survey of UK hospices and specialist palliative care services providing adult bereavement support. Analysis Descriptive statistics and content analysis of free text replies. Results Three hundred services were identified, with 248 valid responses (83%). Of these, 198(80%) were in England and 180(73%) were associated with inpatient units. Most had been in existence for at least 10 years. Paid staff were used by 219 services (88%) and volunteers were involved in 168 services (68%). A small minority did not provide supervision for their bereavement staff. A quarter of services had insufficient staff. The most common activities were individual support, telephone support, written information, memorialization events and group support. Ninety five services (43%) formally assessed the need for individual support. One hundred and fourteen services (51%) had no formal mechanisms for bereaved people to provide feedback about such support. Formal audit and evaluation of bereavement services was uncommon. Conclusions The main elements of bereavement support can be identified but their combination varies. Assessment of people for individual support varies and the small size of many services may inhibit the effective delivery of support. Audit and evaluation of bereavement support may need to be developed.
The experience of suffering as lived by women with breast cancer
Authors: Perreault Annie , Bourbonnais Frances Fothergill 
Published: May 2014

Background The advances in screening and treatment technologies for breast cancer allow many women to survive. However, their experience of suffering through out this illness journey is not understood totally. Aim To explore the experience of suffering as lived by women with breast cancer. Design A qualitative inquiry based on Heidegger’s phenomenological approach was used to collect, code and analyse the data. Open-ended questions were asked to six women during an individual interview to allow the participants to voice their lived experiences. Results The voicing of their stories revealed a process of transformation as a response to the suffering experienced. The descriptions were deeply spiritual and connected to nature. The self-descriptions of their lived experience led to the construction of the Five Seasons of the Tree of Life. Conclusion Nurses need to be cognizant of the multidimensionality of suffering so that interventions can be developed.
Introduction of a pain scale for palliative care patients with cognitive impairment
Authors: van Iersel Trudie , Timmerman Denise , Mullie Arsene 
Published: May 2014

Aim: To describe the development and introduction of a pain scale for patients with cognitive impairment who are admitted to homes for older people and nursing homes in the region of northwest Flanders in Belgium. Design: A questionnaire comparing the Abbey and Pain Assessment in Advanced Dementia (PAINAD) scales was distributed in 17 homes; 185 care providers participated, evaluating 157 patients. Findings: Approximately half of the care providers evaluated both scales as being good measures of pain and easy to use. Of the different items scored in both scales, care providers agreed upon three indicators as being most valuable to use for measuring pain: facial expression; vocalization; and body language. Conclusion: The findings were not conclusive for the introduction of either Abbey or PAINAD. Based on the results, a simplified pain observation scale consisting of three items was developed. It has been introduced in the homes of the region and is being tested currently.
Advance care planning for patients with inoperable lung cancer
Authors: Horne Gillian , Seymour Jane , Shepherd Karen 
Published: May 2014

Aim To develop and pilot an advance care planning (ACP) intervention for lung cancer nurses to use in discussing end-of-life preferences and choices for care with patients diagnosed with inoperable lung cancer. Design A prospective qualitative design with semistructured individual patient interviews. A grounded theory approach was used for the analysis. Sample Fifteen patients took part in ACP discussions with their nurse and nine agreed to be interviewed by a researcher about their perceptions of the intervention. Results Patients’ reactions to the ACP process varied, but they welcomed the recording of their wishes and appreciated the courage of the nurses in bringing up the subject of future care. Conclusion This study explored the role of ACP as a method of enabling patient choice for lung cancer patients in the UK. Further research is needed to determine the components of ACP and the training needs of staff.
Adult bereavement in five English hospices: types of support
Authors: Reid David , Field David , Payne Sheila , Relf Marilyn 
Published: May 2014

Method: In-depth organisational case studies of five English hospices. Analysis: Thematic analysis of qualitative interviews and focus groups and scrutiny of documentary material provided by the hospice bereavement services. Findings: All of the hospices ran events where bereaved people met with other bereaved people who had been in contact with the hospice. They all offered some form of more intensive one-to-one support, spiritual support, and ran remembrance events. Three types of one-to-one support were offered: Counselling Befriending Support from paid bereavement staff. Ongoing telephone support from trained bereavement volunteers appeared to be an acceptable and cost-effective way of providing low intensity bereavement support. Running social bereavement support groups is difficult and resource intensive. ‘Drop-in’ events appear to perform a useful role for both bereaved people and bereavement services. There seemed to be no readily available sources of support for people with particularly complex bereavement problems. Conclusions: All of the hospices were offering appropriate types of bereavement support that clearly met Components 1 and 2 of bereavement support in the NICE guidance. In the absence of any agreement about ‘best practice’ for adult bereavement support services it is the integration of bereavement support as a central aspect of hospice activity that is most likely to improve bereavement support for adults in the future.
Factors influencing completion of advanced directives in hospitalized patients
Authors: Duke Gloria , Thompson Sue , Hastie Mariane 
Published: May 2014

Aim: A cross-sectional, descriptive study to describe characteristics and other factors that influenced the decision by hospitalized patients in the East Texas area to formulate an advanced directive (AD). Findings: Spouses, family members and sense of spirituality were the strongest influential factors for completion of an AD. Most learned about ADs from family, friends, personal attorneys, and others, while less than a quarter of the sample learned about ADs from health care providers. Not wanting to be a burden on their family was the major reason cited for completing an AD. Conclusions: Health care provider roles are vague in terms of responsibility for AD discussion and education. Further exploration of the attitudes, knowledge and practices concerning ADs of nurses and primary health care providers is recommended to provide focal points for future research in order to facilitate peace of mind for patients and families at end-of-life.