bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health-related behaviours and wellbeing in children aged 10–13 years
Authors: Solley Heather , Lyttle Christopher Paul 
Published: May 2014

Children's diets, lifestyle and health-related behaviours have changed in recent years. For example, physical activity now has to compete with the internet and social media, mobile phones and 24-hour television. Fruit and healthy snacks have to compete with a vast variety of sweets, chocolates, cakes, biscuits and crisps. In order to improve children's health and wellbeing it is important to have a firm understanding of children's health-related behaviours. School nurses have unique access to school children and have the ability to positively influence children, their parents and the education system to empower them to make healthy choices and improve their lifestyle. This study critically examines health-related behaviours in children aged 10–13 years in a rural area in Scotland. It aims to establish how often the children participate in physical exercise and how much time they spend on sedentary behaviour, their diet and their perception of their own health.
Towards an objective method of gait analysis
Authors: Petrofsky Jerrold Scott , Bweir Salameh , Andal Ailene , Chavez Jennifer , Crane Andrea , Saunders Julie , Laymon Michael 
Published: May 2014

A sample of individuals aged 5–68 years (n = 39) were examined to determine the relationship between age, the timing of the gait cycle and movement of the joints and eyes when walking in a straight line and turning. Timing of the gait cycle was measured by the use of electrically conductive rubber placed in the shoes, while accelerometers measured movement of the joints. Four electrodes around the eyes assessed eye movement. Stance time, swing time, stance to swing ratio and velocity of movement were unaffected by age from those aged 10–60 years walking in a straight line. Above the age of 60 years, velocity of walking was reduced. There was little difference between individuals aged 10–60 years in terms of timing and velocity of movement in turning. Movement slowed during turns in those aged over 50 years. Accelerometry and ocular data showed that individuals over the age of 40 years had a fivefold increase in movement at the knees and hips and on the head compared to the younger groups. These results seem to show that accelerometry analysis of turns is a better method of evaluating gait and looking for gait abnormalities associated with ageing than analysis of walking in a straight line.
Cavitating lung disease in ankylosing spondylitis may have other causes
Authors: Nour EM , Taylor KJ 
Published: May 2014

A 64-year-old man, who was an ex-miner with a 15-year history of ankylosing spondylitis was admitted with cough, purulent sputum and shortness of breath. He was a smoker with a 20 pack-year history. His lung function tests showed mainly restrictive disease but clinically there was an element of chronic obstructive pulmonary disease (COPD). Physical examination showed him to be cachectic, afebrile, there was no finger-clubbing or lymphadenopathy. Chest examination showed reduced expansion and scattered wheezes. There was marked kyphoscoliosis of the dorsal spine and limited cervical spine movement. While his chest X-ray in 1994 was normal, subsequent chest X-rays showed progressive fibrocystic disease with extensive changes in the right side (Figure 1). His thoracic computed tomography scan showed bilateral fibrobullous disease and the right cavities were thick-walled with at least one fluid level, suggesting active disease, and there was marked pleural thickening over both apices (Figure 2). Radiograph of the spine showed typical changes of ankylosing spondylitis with complete bony bridging of sacroiliac joints and ankylosing of the spine. Full blood count was normal; there was no evidence of eosinophilia. Tuberculin test was negative. Sputum smear and culture for acid-fast bacilli were negative. He was treated for exacerbation of COPD and his condition improved with a course of antibiotic and he was discharged home. He was readmitted a few months later with type 2 respiratory failure but, despite treatment, died. A post-mortem macroscopic examination showed severe bilateral apical pleural fibrous adhesions, severe emphysematous changes and marked scarring with fibrosis in the upper lobes and a 5 cm cavity in the right upper lobe. Histological examination showed caseating granuloma (Figure 3), indicating active tuberculosis but no acid-fast bacilli were seen.
Pitfalls in recurrent varicose vein surgery
Authors: Cheung KS , Khan SM , How P , Hamilton HEC 
Published: May 2014

A 62-year-old lady previously had a left sapheno-femoral ligation with stripping of the long saphenous vein and multiple avulsions 10 years ago. The pre-operative duplex scan, performed by an experienced vascular technologist, showed a patent and competent deep venous system with no evidence of previous deep vein thrombosis. The sapheno-femoral junction (SFJ) was shown to have been surgically ligated but a small tortuous recurrence was noted to fill the groin varices. It was evident that the proximal long saphenous vein had been stripped. The residual mid-thigh long saphenous vein was significantly incompetent and filled by the sapheno-femoral junction recurrence and by a large atypical incompetent branch that coursed medially and proximally to the sapheno-femoral junction. The duplex report was reviewed by the surgeons and operative religation of the SFJ with avulsion of the new varicose veins was considered the best management. The patient had no clinical episode of deep venous thrombosis before surgery, but the large medial thigh varicose vein appeared to be unusual. Chase Farm Hospital have a policy of performing on-table varicogram for all atypical veins because a significant proportion could be a result of ovarian vein incompetence (Giannoukas et al, 2000) and the source may not be detected by duplex imaging (Urigo et al, 1993). Peri-operatively, a tributary of the atypical large medial thigh varicose vein was cannulated and an on-table varicogram was performed (Figures 1–3). It showed the absence of the ipsilateral left femoral vein with the contrast draining across the pubis into the contralateral femoral vein. The left groin was explored surgically to verify the varicogram findings and the surgeons were expecting to find an SFJ recurrence. The left femoral vein was found to be a thin solid cord structure with no doppler signal audible. This was presumed to have become fibrotic either from previous sapheno-femoral ligation or from previously unknown deep venous thrombosis prior to surgery. It was therefore decided that the SFJ recurrence should be left alone as the only venous outflow for the left leg was via these upper medial thigh recurrent varicose veins and the superficial collaterals that had developed across the pubis. The latter was recognized as being exactly the superficial venous reconstruction described by Palma (1976) for iliac venous obstruction. This phenomenon occurred naturally in our patient as a consequence of an unrecognized deep venous thrombosis in the left common femoral and external iliac veins (auto-Palma phenomenon) (Figure 4 (iv)).
Hepatic hydrothorax
Authors: Awasthi AK , Cramp ME 
Published: May 2014

A 67-year-old man was admitted with a 1-week history of shortness of breath. He was a heavy smoker with alcohol consumption exceeding 40 units per week. On examination he was apyrexial and had signs of a right-sided pleural effusion. His liver was enlarged 3 cm below the costal margin. There was no ascites or splenomegaly. His jugular venous pressure was normal and there was no pedal oedema. On his initial investigations, he had normal urea and electrolytes and normal liver function tests except for a low albumin level of 28 g/litre. The chest X-ray confirmed a large right-sided pleural effusion. The pleural fluid had a low protein/albumin content (pleural fluid albumin 8 g/litre), but in view of the history of heavy smoking, large pleural effusion and hepatomegaly, a diagnosis of possible bronchogenic carcinoma with liver metastasis was made. The computed tomography (CT) scan of the chest failed to reveal a cause for the pleural effusion. The pleural fluid cytology, bronchoscopy and echocardiogram were normal. An ultrasound of the abdomen showed an irregular liver with possible single metastasis and minimal free fluid in the abdominal cavity. He had a chest drain inserted which continued to drain more than 3 litres of fluid daily for 5 days. A thoracoscopy and pleural biopsy were normal. He had two attempts at pleurodesis with talc and tetracycline both of which failed to stop fluid from reaccumulating. He then had a tunnelled pleural drain inserted. This still continued to drain large amounts of fluid for the next 8 days. Therefore a parietal pleurectomy was carried out. A repeat ultrasound at this stage showed no ascites but an irregular liver suggestive of cirrhosis and a possible malignant lesion within the liver. He had a modestly raised alpha-fetoprotein level of 65 ng/ml (normal range 0–10 ng/ml). He was referred to the authors and a diagnosis of hepatic hydrothorax was made. He was treated with salt restriction and spironolactone. He responded well to treatment and stopped reaccumulating fluid. A biphasic CT of the abdomen and hepatic angiography confirmed the diagnosis of multifocal hepatoma. His liver biopsy was consistent with cirrhosis secondary to alcohol.
Diffuse cerebral oedema mimicking subarachnoid haemorrhage on computed tomography
Authors: Vaidhyanath R , Khan MA , Messios N 
Published: May 2014

A 62-year-old man with a history of petrol consumption was admitted to the accident and emergency department of an adjacent district general hospital by paramedics. He complained of headache and difficulty in breathing. On admission his Glasgow Coma Scale was 10/15 which rapidly deteriorated to 4/15. An unenhanced computed tomography (CT) scan was performed immediately which showed obliteration of basal cisterns consistent with brainstem oedema. He was mechanically ventilated with inotropic support and then transferred to the intensive care unit of the authors' institution. Relevant past history included alcohol abuse, manic depressive psychosis and carbamazepine overdose. Following transfer, sedation was withdrawn and the patient reassessed. He had fixed dilated pupils, no respiratory effort, absent gag reflex and response to pain. He was also hypernatraemic with a serum sodium level of 170 mmol/litre (normal range 133–144 mmol/litre). Toxicology for paracetamol and salicylates was negative. A repeat unenhanced CT scan was performed at this stage. This showed high attenuation in the tentorium (Figure 1a), basal cisterns (Figures 1b and c) and in the sylvian fissures (Figure 1d). There was no history of injection of intravascular or intrathecal iodinated contrast media. This was initially interpreted as subarachnoid haemorrhage. On subsequent review, the diagnosis was changed to diffuse cerebral oedema. In view of a failing brainstem and after discussion with the patient's family, treatment was withdrawn. A post mortem examination performed by the coroner showed no evidence of subarachnoid haemorrhage.
Different diagnosis for two decades of dysphagia
Authors: Parr J , Macdonald CE 
Published: May 2014

A 76-year-old man was referred in 2004 for assessment of longstanding dysphagia. His symptoms had changed slightly in that he had been experiencing some regurgitation of food up to 24 hours after a meal. He had first presented in 1984 with a complaint of food sticking on the way down, at the level of the epigastrium, which was intermittent in nature and worse with meat and bread. He had a 15-year history of indigestion at that time and was investigated with a barium meal and a gastroscopy (OGD), both of which were normal. As his symptoms were not progressive or troublesome he was discharged from follow up. He was referred again in 1996 with similar symptoms. The dysphagia had been well controlled by avoiding foods that worsened his symptoms. OGD at that stage proved normal and the patient had settled. He was discharged with a diagnosis of mild motility disorder and advice to re-refer should things change. He attended in 2004 with a change in symptoms – he felt food now seemed to get stuck higher up with regurgitation of contents of previous meals. No worrying symptoms were noted and physical examination was normal. The patient was booked for further OGD and oesophageal manometry to take place on the same day. The OGD was carried out first and it became apparent he had developed a pharyngeal pouch, which was later confirmed on barium swallow (Figure 1). The rest of the examination was normal. He also underwent manometry with the probe being placed over a guidewire. This revealed the presence of incoordination of peristaltic waves with simultaneous pressure rises in the lower oesophagus (Figure 2). It also showed a hypertensive lower oesophageal sphincter (max pressure 53 mmHg) that relaxed appropriately (Figure 3). The patient was referred to the ear, nose and throat surgeons for further management as the pouch was the main contributing factor in the new symptoms. He underwent an uncomplicated endoscopic stapling diverticulotomy with a return to previous level of function.
Tonsillar haematoma presenting as a large oropharynx mass caused by toothbrush trauma
Authors: Leong Samuel C 
Published: May 2014

A 43-year-old man was referred urgently by his GP with a large mass at the back of his throat. The patient had complained of a mild foreign body sensation for the past 3 days, but was distraught to see the mass in the mirror while he was flossing. On further questioning, he recalled brushing his teeth too vigorously and having injured himself. He reported spitting out some blood into the sink but not being unduly distressed. He was a non-smoker and was had no significant past medical history. On examination, there was a 3 cm smooth mass in the right orophapryx (Figure 1). The mass was soft and attached to the right tonsil via a pedicle. Flexible nasendoscopy was normal and there was no evidence of airway obstruction by mass effect. Under local anaesthesia, the mass was removed with the use of a snare. Full blood count and coagulation studies were entirely normal. Follow-up outpatient clinic at 4 weeks was unremarkable. The tonsillar remnant had healed completely and there was no suspicion of any underlying pathology. Histopathology was consistent with that of infarcted tonsillar tissue.
Thyrotoxic hypokalaemic periodic paralysis
Authors: Balami Joyce , Jones Hywel , Newey Paul , Seymour Jonny 
Published: May 2014

A 24-year-old male Chinese student from southern China presented with sudden onset of generalized weakness. The evening before admission he had played football for 3 hours, and eaten a Chinese takeaway plus two hamburgers. He awoke in the early hours of the following morning unable to move his arms or legs. There was no history of any recurring illness and in particular there were no symptoms suggestive of hyperthyroidism. On examination the only abnormality was a profound symmetrical muscle weakness more marked proximally than distally (Medical Research Council (MRC) classification grade 1–2). Sensation to light touch and pinprick was normal. There were no signs of thyrotoxicosis. Laboratory investigations revealed the following (normal values in parentheses): serum potassium 1.2 mmol/litre (3.5–5.0); urinary potassium 14 mmol/litre (20–60); phosphate 0.18 mmol/litre (0.8–1.45); sodium, urea, and creatinine levels were normal. Electrocardiogram showed first degree atrioventricular block, prolonged QT interval and right axis deviation. He was given 120 mmol of intravenous potassium supplement over 12 hours. Over the next 24 hours his serum potassium returned to 4 mmol/litre, with complete resolution of the weakness. Subsequent investigations showed the following thyroid hormone measurements: thyroid-stimulating hormone (TSH) <0.08 mU/litre (0.5–6.0), triiodothyronine (T3) 3.7 nmol/litre (1.0–2.5), free thyroxine (T4) 53.7 pmol/litre (9.0–25.0), and thyroid peroxidase antibodies 124 IU/ml (0–75). He was HLA B46 and D9 positive. Ultrasonography of the thyroid gland revealed a mildly enlarged, heterogeneous thyroid with no discrete nodules and increased vascularity throughout. He was started on treatment with propranolol and carbimazole and returned home to China to seek further medical treatment.
Giant coronary artery aneurysms and myocardial infarction: aetiology and management
Authors: Gurtu Rokesh , Uemura Hideki , Tsuda Etsuko , Dubrey Simon W 
Published: May 2014

A 28-year-old man developed central chest pain while walking at altitude in South America. An electrocardiogram showed ST segment elevation anteriorly, suggestive of acute myocardial infarction. An echocardiogram demonstrated anteroseptal hypokinesia. Biochemistry confirmed elevated cardiac enzymes. Coronary angiography revealed giant aneurysms in both right (Figure 1) and left (Figure 2) coronary arteries. Occlusive thrombus in the left anterior descending artery was treated by primary angioplasty. The patient had no known conventional risk factors or family history for coronary artery disease. Treatment with aspirin, clopidogrel and warfarin was commenced to prevent further coronary thrombosis. Post angioplasty he was repatriated to the UK and remains well on planned long-term therapy with aspirin and warfarin.
The use of computed tomography for screening can be effective and safe
Authors: Giles John , Marshall John 
Published: May 2014

The development of multislice computed tomography (CT) and the associated newer CT techniques over 5 years ago led to a surge in interest in the potential use of this exciting modern technology in preventative medicine. An initial rapid expansion in the provision of such screening tests in an uncontrolled manner led to increasing mistrust and scepticism among both the media and the medical establishment.
Abdominal pain in a 9-year-old: omental torsion masquerading as appendicitis
Authors: St J Floyd Jr M , Kelly BJ , Udani P , Nabri M , O'Donnell N , Morrison P 
Published: May 2014

A 9-year-old boy was referred to the emergency department by his GP with abdominal symptoms. He complained of periumbilical pain for 3 days which had gradually radiated to his right iliac fossa in the 12 hours before presentation. The pain was colicky, intermittent in nature and exacerbated by moving or eating. There was associated anorexia and nausea but no vomiting. Bowel pattern had remained normal throughout and no urinary symptoms were noted. On presentation he graded the pain as 10/10. A collateral history was taken from his mother who verified the symptoms. There was no history of trauma. On examination he was flushed, dehydrated but apyrexial. Cardiorespiratory examination was normal. Abdominal examination revealed tenderness and guarding in the right iliac fossa. Bowel sounds were normal and he had a positive Rovsing's test. Laboratory investigations revealed a normal full blood count (white cell count of 8.76 × 106), a normal renal profile and a normal serum amylase. Erythrocyte sedimentation rate was marginally elevated at 18 mm/hr. Urinalysis was normal. A clinical diagnosis of appendicitis was made. A Lanz incision was made and on opening the peritoneum blood-stained fluid was noticed. On close inspection the appendix looked healthy and a routine appendicectomy was carried out. The incision was extended medially and the caecum and small bowel were fully inspected with no pathology identified. Near the right hepatic flexure an area of necrotic omentum was identified with thrombosed veins. Another area of omentum was seen which had twisted upon itself (omental torsion). This was excised and tied with vicryl sutures. Postoperatively, the patient went home on day 3 after an uneventful recovery. Histopathology revealed a normal appendix. The excised omentum revealed fat necrosis and ischaemic changes consistent with torsion (Figure 1).
Endobronchial carcinoid: an unusual cause of wheezing and chest pain
Authors: Farmer AD , Zanetto U , Lewis MJV 
Published: May 2014

A 73-year-old man presented to the authors' clinic with profuse rectal bleeding, defaecatory urgency and symptomatic anaemia. He had been treated for prostatic adenocarcinoma 12 months previously, with neoadjuvant hormones and radiotherapy (total dose of 60 Gy). Chronic radiation proctitis was confirmed endoscopically and histologically in the absence of any other left-sided colonic pathology. His initial medical management with sucralfate enemas and oral metronidazole failed. However, he withheld consent for further topical or endoscopic treatment despite continued symptomatic deterioration and transfusion dependency, presenting a therapeutic impasse. Oral thalidomide (75 mg/day) was started and he made an excellent symptomatic response and became transfusion independent. However, 23 days after starting thalidomide peripheral neuropathy ensued, a well documented side effect (Mileshkin and Prince, 2006), which resolved rapidly following its discontinuation. His symptoms and anaemia rapidly re-emerged and at this point he consented to endoscopic therapy with argon plasma coagulation. An unprepared flexible sigmoidoscopy, to the rectosigmoid junction, demonstrated features of chronic radiation proctitis and argon plasma coagulation was applied exclusively to the rectum. However, the patient developed sudden onset abdominal pain necessitating abandonment of the procedure. A chest radiograph showed free air under the right hemidiaphragm. An emergency laparotomy revealed multiple perforations and lacerations in the proximal descending colon without abdominal contamination. A Hartmann’s procedure was performed. A direct perforation as a sequelae of the procedure is unlikely as multiple perforations and lacerations were evident proximal to the upper limit of the examination. Furthermore, no perforation was observed in the rectum or sigmoid where the argon plasma coagulation was applied. As bowel preparation was not administered before the flexible sigmoidoscopy and given the aforementioned findings at laparotomy, the likely cause of the perforation was an intracolonic gas explosion, a rare iatrogenic complication of using thermocoagulative endoscopic techniques within the colon. The patient died 16 days postoperatively of multiorgan failure.