bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘Not just an ordinary bump to the head’: traumatic superficial temporal artery false aneurysm
Authors: Fassiadis Nicholas , Kuhanendran Damayanthi , M South Leah 
Published: May 2014

A 79-year-old man who came to a general surgical clinic for evaluation of his asymptomatic bilateral inguinal herniae was noticed incidentally to have a swelling over his right temporal bone (Figure 1). The patient had injured his head 6 weeks previously following a fall, and this was thought by the GP to be a small haematoma that would eventually settle. Since then, the swelling had progressively become larger and tender. On examination, he had a 3 cm diameter pulsatile mass over his temporal bone, which on clinical grounds represented a superficial temporal artery pseudoaneurysm. With the view that the aneurysm was likely to enlarge and rupture, it was arranged for the patient to undergo an urgent operation to remove it. A cervical block supplemented by 10 ml 1% lignocaine locally was used as the patient was unfit for a general anaesthetic. A transverse incision was made just anterior to the tragus in order to ligate the superficial temporal artery, thus gaining proximal control of the blood supply to the pseudoaneurysm. Excision of the pseudoaneurysm (Figure 2) was then undertaken through a second elliptical incision over the swelling. Distal ligation was not required as the lumen of the superficial temporal artery was obliterated. The patient recovered well from the operation and was discharged on the same day.
Hepatosplenomegaly in a patient returning from Spain
Authors: J Williams Michael , Korsheed Shvan , F Goddard Andrew , Venkatesan Pradhib 
Published: May 2014

A 73-year-old man presented with a 1-month history of anorexia, malaise, fevers, night sweats and weight loss. He had no past medical history of note. Since his retirement, he spent the winter months in Spain. He often travelled around Spain and recalled sleeping on the ground while camping in the Mazarron region 8 months before his illness. In the vicinity he recalled seeing dogs. On examination, he was jaundiced with hepatosplenomegaly. His liver was palpable 20 cm below the costal margin in the mid-clavicular line, and the spleen 16 cm. There was no lymphadenopathy. Blood tests showed a pancytopenia with a haemoglobin of 10.3 g/dl, white cell count of 2.86 × 109/litre and platelets of 84 × 109/litre. His inflammatory markers were elevated with a C-reactive protein (CRP) of 231 mg/litre. His liver function tests were deranged with a bilirubin of 73 mmol/litre, alkaline phosphatase of 402 U/litre (reference range 40–130), alanine transaminase of 101 U/litre (reference range 0–45) and albumin of 26 g/litre. During his admission, he spiked frequent fevers of up to 39.5°C. He was treated empirically with cefuroxime but with no improvement. Multiple sets of blood, urine and stool cultures were negative. Hepatitis B and C, Epstein–Barr virus and human immunodeficiency virus serology and blood films for malaria parasites were all negative. Serum electrophoresis showed a polyclonal increase in gammaglobulins. A computed tomography scan of his chest and abdomen showed hepatosplenomegaly with no focal lesions and minimal lymphadenopathy. A bone marrow aspirate and trephine biopsy showed a reactive picture with increased immature myeloid cells, but no evidence of haematological malignancy. A liver biopsy showed an interface hepatitis, consistent with infection. No parasites were seen in either sample. A sample of bone marrow sent for polymerase chain reaction analysis for Leishmania donovani was positive. He was referred to the local infectious diseases unit who started liposomal amphotericin 3 mg/kg for 5 days with a further dose at day 10. Three months later, he had regained 3 kg, his hepatomegaly measured 5 cm and his spleen was no longer palpable. His haemoglobin was 13.7 g/dl, white cell count 11.8 × 109/litre, platelets 616 × 109/litre, CRP < 5 mg/litre and albumin 38 g/litre.
Aortic regurgitation associated with cabergoline therapy
Authors: Lyons Kristopher , Flannery Danny 
Published: May 2014

A 57-year-old man with a history of Lewy body dementia was referred for cardiac assessment with a history of exertional dyspnoea and orthopnoea. Symptoms developed 12 months after commencement of cabergoline by his neurologist. Transoesophageal echo demonstrated aortic regurgitation, which was moderate by vena contracta (0.6 cm) (Figure 1). The aortic valve was tricuspid and was not thickened or calcified. The leaflets appeared tethered and failed to coapt (Figure 2). Other cardiac valves were normal. The appearance was typical of that associated with ergot-derived dopamine agonists, so the aortic regurgitation was considered to be secondary to treatment with cabergoline.
Commotio cordis
Authors: Sharma Neel , Andrews Sam 
Published: May 2014

A 22-year-old man, Mr X, and his friend, were playing a game of softball. His friend (as batsman) accidentally struck the ball into Mr X's chest. Mr X subsequently collapsed and lost consciousness. Cardiopulmonary resuscitation began following the arrival of paramedics. The patient was found in ventricular fibrillation and defibrillated to sinus rhythm. Upon arrival in the emergency department, the patient remained unresponsive but haemodynamically stable. An echocardiogram was performed which showed no structural abnormalities, pericardial effusions or valvular damage. The patient soon reverted back to ventricular fibrillation and despite the best efforts of the medical team could not be revived. An autopsy was warranted which indicated no evidence of injury or natural disease to account for his death. A section from the autopsy report is as follows: ‘The heart weighs 316 g. The pericardial sac is free of significant fluid or adhesions. The coronary arteries arise normally and follow the distribution of a right dominant pattern with no significant atherosclerosis. The chambers and valves are proportionate. The valves are normally formed, thin and pliable and free of vegetations and degenerative changes. The myocardium is dark red brown, firm and free of focal or regional fibrosis, erythema, pallor or softening. The atrial and ventricular septa are intact and the septum and free walls are free of muscular bulges.' Microscopic assessment of the heart as well as toxicological analysis of the blood proved unremarkable. The medical examiner assigned commotio cordis as the immediate cause of death.
Emergency laparoscopic repair of an obstructed Bochdalek hernia in an adult
Authors: Akhtar Kashif , Qurashi Kamran , Rizvi Arshad , Isla Alberto 
Published: May 2014

A previously fit 27-year-old man presented to the authors' casualty department with a 24-hour history of severe vomiting, dizziness and lethargy. Examination was unremarkable except for marked dehydration. The patient was found to be hypokalaemic (K+ 2.8 mmol/litre) and in acute renal failure (urea 16.8 mmol/litre, creatinine 259 ¼mol/litre). After admission the patient became pyrexial and began to vomit uncontrollably. Chest auscultation revealed decreased air entry at the left lung base and the chest radiograph was reported as showing cystic bronchiectasis for which antibiotic therapy was commenced (Figure 1). The abdominal radiograph showed a paucity of intestinal gas. Upper gastrointestinal endoscopy to investigate the hyperemesis demonstrated an extremely dilated stomach containing 3 litres of fluid, with reflux oesophagitis. Computed tomography scans displayed a small left lung, a dilated stomach and herniation of abdominal viscera into the left side of the chest, with an empty abdominal cavity. Laparoscopy confirmed the striking absence of small bowel, ascending and transverse colon, and spleen in the abdominal cavity, all of which had herniated into the left chest through a patent congenital Bochdalek foramen (8 × 10 cm), with no hernial sac. The defect was closed in a tension-free manner with a Goretex dual mesh patch, attached posteriorly with an anchoring device (Pro Tak) and secured with interrupted Ethibond sutures (Figure 2). At the end of the procedure the entire bowel was inspected from the duodeno-jejunal flexure and found to be correctly positioned. Postoperative recovery was quick and uneventful and the patient was discharged home well on day 3 following a normal gastrograffin study (Figure 3). Outpatient follow up at 18 months, examination and imaging confirmed no recurrence or complications.
Osseous sarcoidosis masquerading as metastatic disease
Authors: Barratt Shaney , Burn Paul R , Stone Robert 
Published: May 2014

A 64-year-old woman presented with suspected malignancy, characterized by unexplained weight loss of 2 stone over the preceding year, lethargy and widespread musculoskeletal and back pain for which she was taking Zomorph 10 mg twice daily. She was iron deficient; endoscopy and colonoscopy were unremarkable. A bone scan showed widespread increase in uptake of radioisotope (Figure 1). A computed tomography scan showed multiple lytic lesions throughout the thoracolumbar spine, ribs and iliac blades, consistent with metastatic disease (Figure 2). There was no evidence of cord compression. There were multiple soft tissue nodules throughout both lungs, in tandem with small volume mediastinal lymph node enlargement. Fine needle sampling of a small volume (7 mm) supraclavicular lymph node revealed no malignant cells but surprisingly the sample demonstrated well-formed non-caseating granulomata, staining negative for acid-fast bacilli. Serum angiotensin-converting enzyme levels were high (114 U/litre; normal range 16–53 U/litre), with a calcium level of 2.61 mmol/litre and normal creatinine levels. There was concern that the patient might have dual pathology and so a vertebral body was additionally biopsied, the result again showing a non-caseating granuloma compatible with sarcoid (Figure 3). The diagnosis was revised to systemic sarcoidosis with extensive bony involvement. Prednisolone and bisphosphonate were commenced. There was immediate symptomatic improvement, mirrored by declining serum angiotensin-converting enzyme levels. Interestingly, on commencing treatment there was an initial rapid rise in her alkaline phosphatase level (Figure 4), possibly related to increased bone turnover. At her 2-month review she was virtually free of symptoms. Repeat computed tomography of the chest showed marked regression of the pulmonary nodules but persistence of the skeletal lesions.
Maternal congenital diaphragmatic hernia causing cardiovascular collapse during pregnancy
Authors: Hunter John D , Nimmagadda Jyothi , Quayle Anthony 
Published: May 2014

A 31-year-old primigravid female presented to the obstetric department with severe left flank pain at 27 weeks' gestation. Her pregnancy had otherwise been straightforward and there was no significant past medical history. Physical examination was unremarkable apart from some vague tenderness and fullness in the left upper quadrant, and routine blood tests and urinalysis revealed no abnormalities. Obstetric ultrasound confirmed a 27-week gravid uterus with a single live fetus. Analgesia was administered and an ultrasound scan of her abdomen requested for the next morning. Over the next few hours her abdominal pain got progressively more severe and the patient became increasingly distressed. Further examination revealed her to be hypotensive (blood pressure 85/40 mmHg), tachycardic and tachypnoeic with obvious central cyanosis (SpO2 88% on room air). Auscultation of her chest revealed decreased air entry over the left lung and tracheal shift to the right. An urgent chest X-ray suggested left diaphragmatic herniation of abdominal contents (Figure 1). Insertion of a nasogastric tube was attempted without success. Owing to increasing hypoxia and respiratory distress a decision was made to intubate and ventilate the patient before transfer to theatre. Emergency laparotomy revealed at least 3.5 litres of blood within the peritoneal cavity and a large congenital defect in the postero-lateral portion of the left hemi-diaphragm (Bochdalek hernia). Most of the small bowel, the whole of the transverse colon and the stomach with the attached spleen had herniated through the defect causing the left lung to collapse. The abdominal contents were reduced back into the abdominal cavity, and the diaphragmatic defect repaired. A dead fetus was removed by caesarean section. The patient required several weeks of intensive therapy, and her recovery was complicated by pancreatitis which required laparotomy for desloughing of necrotic pancreatic tissue. She eventually went on to make a full recovery, and has subsequently had a healthy baby.
Peritoneal mesothelioma
Authors: Berrill James , Haboubi Hasan , Duane Paul 
Published: May 2014

A 59-year-old building surveyor presented with a 2-month history of lethargy and abdominal swelling. There was no associated abdominal pain, change in bowel habit or jaundice. There was no significant past medical history. His alcohol intake was approximately 60 units per week. Examination revealed gross ascites, but no palpable masses, lymphadenopathy or stigmata of chronic liver disease. Blood tests revealed a microcytic anaemia (haemoglobin 9.3 g/dl, mean corpuscular volume 72.5 fl). Other abnormalities were high platelets (740 ×109/litre), raised erythrocyte sedimentation rate (101 mm/hr) and low albumin (30 g/litre). Other laboratory investigations were normal. Computed tomography scan revealed calcified pleural plaques suggesting previous asbestos exposure (Figure 1) and extensive ascites with a sizeable omental mass (Figure 2). Diagnostic tap of the ascitic fluid showed atypical mesothelial cells suspicious of malignancy (Figure 3). An omental biopsy was performed, and immunohistochemistry showed positive staining for calretinin (Figure 4a) and thrombomodulin (Figure 4b), and negative for carcinoembryonic antigen (CEA) (Figure 4c) and BerEP4 (Figure 4d). A diagnosis of malignant mesothelioma was made. On further questioning regarding his occupational asbestos exposure he admitted to ‘throwing it around like snowballs’. His ascites was drained for symptomatic benefit, and after an oncology review he proceeded to a course of chemotherapy.
Protocol-guided hip fracture management reduces length of hospital stay
Authors: Kumar Gautam 
Published: May 2014

Objective: To see if protocolised hip fracture care led to an improvement in patient management and more standardized treatment with the aim of reducing wait for surgery and postoperative length of stay. Design: Following the introduction and establishment of a care pathway a retrospective, observational audit was conducted with patient data and pathway compliance obtained from analysing medical notes and accessing electronic patients' records. Setting: The audit analysed all patients who sustained a fractured hip admitted to University College London Hospital over an 18-month period between August 2009 and February 2011. Measurements: In addition to demographic data, a comparison was made between those who were and were not managed with the care pathway. Investigations, preoperative management, time to surgery, length of stay and mortality were all evaluated. Results: Patients managed via the care pathway had significantly more investigations and preoperative interventions, and subsequently had a reduced length of hospital stay (a mean average of 13 compared to 17 days). There was no significant difference in time from admission to surgery, and 30-day mortality. Conclusions: Using a care pathway to manage those patients sustaining fractured femur appears to make preoperative management more consistent. This, in turn, leads to a reduction in length of hospital stay.
National Joint Registry data inaccuracy: a threat to proper reporting
Authors: Kosy Jonathan D , Kassam Al-Amin M , Hockings Michael 
Published: May 2014

Introduction: The authors set out to investigate the accuracy of the information their unit was inputting onto the National Joint Registry. This is important both in relation to implant surveillance and also to the use of these data to monitor the performance of surgeons. Method: A single consultant's arthroplasty patients were audited over 12 months. Data taken from the National Joint Registry were compared to the operation notes and the hospital's computer system. Results: Of 78 cases inputted, 27 (35%) were incorrect. Sixteen cases (21%) had the incorrect ‘consultant in charge’ recorded, eight cases (10%) had the incorrect ‘operating surgeon’ recorded and three cases (4%) had both errors. The most frequent inaccuracies resulted from listing by another consultant and incorrectly recorded trainee supervision. These errors were highlighted to the unit and a corrected process was designed. The intervention was to implement this process by presenting to the involved groups and displaying posters to prevent the error-producing process. The audit was repeated (after 6 months) showing eradication of the problem. Discussion: It is the surgeon's duty to ensure data recorded under his/her name are accurate and justify any discrepancies when compared to other surgeons. Pooling of patients and supervision of trainees are sources of potential error.
Relapsed non-Hodgkin's lymphoma with high CA-125 mimicking ovarian tumour
Authors: Leong CF , Cheong SK , Ng P , Amran AR 
Published: May 2014

A25-year-old woman was initially diagnosed to have stage IIB non-Hodgkin's lymphoma in April 1999 when she presented with shortness of breath and features of superior vena cava obstruction. She was treated with eight courses of CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) and showed complete response with disappearance of all the enlarged lymph nodes. She remained well for about 18 months until July 2001, when she presented again with shortness of breath, loss of appetite and loss of weight. Physical examination and investigations confirmed relapsed non-Hodgkin's lymphoma (huge mediastinal mass with right pleural effusion). She was then treated with salvage therapy with ICE (ifosfamide, carboplatin, etoposide). She was given six courses of ICE followed by irradiation to the mediastinum in view of the bulky disease. At the end of the radiotherapy, computed tomography of the thorax and abdomen showed no residual mediastinal mass or mediastinal lymph nodes, but bilateral ovarian tumours (Figure 1a) (the right ovarian mass measured 27 × 20 cm, left ovarian tumour measured 15 × 20 cm), and bilateral hydronephrosis (Figure 1b) were visible. Investigations showed markedly raised CA-125 (1216 U/ml) and lactate dehydrogenase (3147 umol/litre), and normal CEA and alpha-fetoprotein. During open biopsies of the ovaries, multiple nodules were noted in the omentum. The histopathological examination of both ovarian (Figure 2) and omentum biopsies indicated non-Hodgkin's lymphoma, diffuse, large cell and B cell type. After the operation, the patient deteriorated rapidly with malignant ascites and massive pleural effusion, and died.
Thyrotoxic periodic paralysis in a Caucasian male
Authors: Chatterjee Apurba K , Dhakam Zahid , Morrish Nicholas J , Manford Mark R 
Published: May 2014

A 35-year-old Caucasian system analyst presented to his GP with a 6-month history of intermittent weakness of both upper and lower limbs lasting 30–40 minutes and resolving spontaneously. He gave no history of any precipitating factors. There was no history of headaches, dizziness, loss of consciousness or sphincter disturbances. His vision, speech and swallowing were not affected during the episodes of limb weakness. All of the episodes occurred on getting out of bed, most on waking in the morning, except for one which occurred on waking in the middle of the night when he got out of bed to go to the toilet. His legs gave way but he did not lose consciousness. There were no symptoms and signs of thyrotoxicosis. He was referred for further assessment. Neurological and systemic examination did not reveal any abnormal findings. Investigations including magnetic resonance imaging scan of the spine, vitamin B12, red cell folate, urea and electrolytes, full blood count and erythrocyte sedimentation rate were within normal limits. However, his thyroid function revealed free thyroxine >50 μmol/litre and thyroid-stimulating hormone <0.02 pmol/litre suggesting thyrotoxicosis. He was positive for anti-microsomal thyroid antibodies. A technetium scan showed symmetric enlargement of both lobes of the thyroid gland with an avid uptake. On treatment with carbimazole the attacks became less frequent and over a period of 3 months regressed completely. He remains asymptomatic after treatment with carbimazole.
Bilateral concurrent rupture of the Achilles tendon in the absence of risk factors
Authors: Kelly M , Dodds M , Huntley JS , Robinson CM 
Published: May 2014

A 36-year-old woman presented with right calf pain that had begun when she rose suddenly in celebration of a dramatic sporting victory on television. She had felt a snap and was unable to weight-bear. On examination a ruptured Achilles tendon was diagnosed. She subsequently complained of pain in the left calf and, on examination, was also found to have ruptured that Achilles tendon. There was no history of recent or chronic tendon problems, steroid use, fluoroquinolone antibiotic therapy or renal impairment. Ultrasound (Figure 1) confirmed bilateral ruptures, just below the myotendinous junctions, 10 cm from the calcaneal insertion on the right and 7 cm on the left. She was treated with serial casting for 10 weeks, after which she made a complete recovery with physiotherapy.
Ophthalmic advanced practice: ‘the lived experience’
Authors: Evans Patricia 
Published: May 2014

Aim: The aim of this study was to explore and describe the transitional experience of developing within these roles using a phenomenological approach. Methods: Purposive sampling of five advanced practitioners/nurse consultants was used. Data were generated from in depth unstructured face-to-face interviews of practitioners. Data were analyzed by thematic analysis. Results: The study is significant because it focused on the experience of role transition to consultant level in ophthalmic nursing. Key themes arising from the findings are nurse consultant/advanced practitioner role issues; the person behind the role; preparation for the role; role enjoyment; issues within the care team. Conclusions: This study helps to identify factors that support and hinder role development in this context and may inform planning for managers as well as clinical staff when considering the implementation of these roles in practice.
The National Intravitreal Injection Survey: a look at current practice
Authors: Turnbull AMJ , Trikha S , Khandhadia S , Rennie C , Lotery AJ 
Published: May 2014

Aims: As our understanding of many ocular conditions increases, the use of intravitreal injections is likely to expand significantly. Therefore, it is important to establish the most cost-effective and safe method of delivery. This survey aimed to compare current UK practice with the latest guidelines from the Royal College of Ophthalmologists regarding intravitreal injections, highlighting areas in which service provision can be streamlined. Methods: An online survey of 36 questions was distributed to all NHS ophthalmology units in the UK. Questions were designed to address each aspect of the latest guidelines. Responses were uploaded anonymously during a 6-week time frame in late 2009. Results: 127 responses were received from 110 ophthalmology units, 63.8% of which were from those with a special interest in medical or surgical retina. Interesting variations in technique were found, especially with respect to the level of asepsis and the method of service provision. Conclusion: Despite recently published guidelines, there remains considerable variation in current practice. Although there is consensus on several aspects of the technique, there is little evidence to address specific areas of debate. Further investigation into this area is warranted in order to optimize the delivery of this valuable treatment option.