bluuebunny/crossref_metadata_2025_split huggingface dataset:
An independent review of the KayserBed from Theraposture
Authors: McDonald Jackie 
Published: May 2014

A standard bed may not always be suitable for some children with learning disabilities and behavioural problems, who might be hyperactive, self-harming and unpredictable. In these circumstances, following a thorough assessment, interventions may be implemented to minimize falls and encourage better sleep patterns for the child. A specialist bed may be a consideration. This article provides an independent assessment of the KayserBed KB CM KR4 from Theraposture: a specialist cot bed with a high-sided bed frame and an electrically operated variable height sleeping platform. It is a robustly made bed, which may be particularly suitable to meet the needs of severely disabled children who exhibit challenging behaviour.
Promoting the integration of theory and practice by the use of a learning contract
Authors: Matheson Ruth 
Published: May 2014

This qualitative study presents occupational therapy BSc students' perceptions of the value of learning contracts to promote the integration of theory and practice within a problem-based learning course. Focus groups, consisting of first- and third-year students, were used to generate data. Content analysis was carried out to establish common themes. The main findings indicated that students use learning contracts within the academic field to structure their learning, identify knowledge and remain client-centred. Within the fieldwork setting, learning contracts were influenced by supervisory styles and the ability of the students to negotiate their learning needs. The key factor that promoted integration was negotiation, enhanced greatly when students were given the lead role as negotiator. Learning contracts were perceived as being of value in integrating theory and practice. Placements using group or long-arm (off-site) supervision were seen as making the best use of learning contracts. Recommendations centre on the need for the continuing education of students, staff and clinicians on the process and benefits of using learning contracts to enhance development.
A comparison of three kinematic systems for assessing spinal range of movement
Authors: Chockalingham Nachiappan , Dangerfield Peter H , Rahmatalla Aziz , Cochrane Tom , Ashford Robert L 
Published: May 2014

Although previously published studies have indicated the usefulness of optoelectronic and videobased kinematic systems for gait analysis and for the measurement of dynamic back movements, there remains a paucity of research for both three-dimensional spine and back movement analysis and the comparison of systems used for this analysis. This study used three different motion analysis systems for the estimation of the range of spinal movement on a specially devised model of the vertebral column. An electrogoniometer was also used to record the same angles, thus allowing a comparison between direct and indirect kinematic measurements. The accuracy of the angle estimation and intra- and inter-observer variability were recorded for each system and a calculation of potential operator-driven error in movement of the spine highlighted. The results of this pilot study offer clinicians a more informed position as to which system to select for their particular use.
Chromobacterium violaceum infection
Authors: Tee Hoi-Poh , Francis Alex L , How Soon-Hin 
Published: May 2014

A 22-year-old Indonesian oil palm plantation worker presented with a 1-week history of fever associated with severe headache, pain in the right upper abdomen and seizure a day earlier. He had a cough with expectoration but no bowel symptom. There was no history of injury reported before the present illness. The patient was febrile, dehydrated and drowsy on admission, with Glasgow coma score of 14/15. His blood pressure and pulse rate were 100/60 mmHg and 96/min respectively. Lung examination showed right-sided crackle, with no neck stiffness or any signs suggestive of immunocompromized state. Abdominal examination revealed tender hepatomegaly of 10 cm in length. The initial chest radiograph showed opacity in the right middle lobe. Total white cells count was 11.1 × 109/litre. Platelet count was 100 × 109/litre with normal haemoglobin. Random blood glucose and renal profile were normal. Coagulation profiles were deranged with international normalization ratio of 4.5 and activated partial thromboplastin time ratio of 3.4. Liver function tests revealed alanine aminotransferase of 446 U/litre, aspartate aminotrasferase of 253 U/litre and albumin of 30.5 g/litre. The patient was given empherical intravenous ceftriaxone, metronidazole and acyclovir for possibility of meningo-encephalitis. Despite fluid resuscitation, he remained hypotensive and required inotropic support. On the second day, multiple pustular skin lesions (Figure 1) were noted on the patient's trunk, upper and lower limbs. Aspiration of the pustules revealed pus that contained gram-negative bacilli. Lumbar puncture was done and cerebrospinal fluid was normal. He required multiple platelet concentrates and plasma transfusions for disseminated intravascular coagulation. Abdomen ultrasound revealed multiple liver abscesses (Figure 2). He was intubated and ventilated for worsening respiratory failure. Samples of pus and blood cultures were positive for Chromobacterium violaceum. Intravenous imipenem 500 mg four times daily and ciprofloxacin 400 mg twice daily were administered. However, he died the same evening.
Tuberculosis of the prostate
Authors: Rachapalli V , Natale S , Awasthi R 
Published: May 2014

A 45-year-old man of South Asian origin was referred with urinary symptoms of urgency, dysuria and a feeling of incomplete bladder emptying and one episode of macroscopic haematuria. He had no other symptoms apart from an unexplained 2 stone (12.6 kg) weight loss with occasional evening temperature rise. He had lived in the UK for the past 25 years and his mother had recently visited him from his home country. A digital rectal examination demonstrated an enlarged non-tender right prostatic lobe with a craggy consistency. Prostatic specific antigen level was 2.6 ng/ml (normal level ≤2.5 ng/ml). Ultrasound of the renal tract and kidney, ureter and bladder imaging were normal. Flexible cystoscopy showed a diffusely red oedematous bladder and he underwent a transrectal ultrasound-guided prostate biopsy. Histological assessment showed chronic inflammation associated with multiple non-necrotizing epitheloid granulomas with acid-fast bacilli on Ziehl Nielsen staining. Culture of mid-stream urine demonstrated Mycobacterium tuberculosis. The patient was subsequently referred to the respiratory physicians who diagnosed him with pulmonary tuberculosis and treated his condition with anti-tuberculous therapy.
Subependymal nodular heterotopia
Authors: Larner AJ 
Published: May 2014

29-year-old woman complained of episodic dizziness with a feeling of unsteadiness. She was referred to the ear, nose and throat clinic. Examination was normal and a pure tone audiogram was within normal limits. Although her symptoms improved with vestibular rehabilitation exercises, they did not resolve entirely and so magnetic resonance (MR) imaging of the brain was requested. Imaging changes (Figure 1a) prompted an urgent referral to the neurology clinic. In her past medical history, the patient had developed seizures at the age of 5 years, initially brief ‘absences’ (eye blinking, head nodding, mouth twitching) with very occasional generalized tonic-clonic seizures. She was the product of a normal full-term vaginal delivery, with normal developmental milestones. There was no family history of seizure disorder. Formal testing at the age of 7 years showed that she was of average intellectual ability and above average ability on the arithmetic subtest. An electroencephalogram showed right temporal slow and sharp wave features. A diagnosis of ‘idiopathic’ temporal lobe epilepsy was made and she was commenced on carbamazepine with reduction in seizure frequency. A computed tomography brain scan performed at the age of 13 years after a further generalized seizure was reported to show a large cerebellar cistern but was otherwise normal. Family history was negative for seizure disorder. Her neurological examination was normal. MR brain imaging (Figure 1b) showed multiple bilateral subependymal nodules of grey matter, lining both lateral ventricles, appearances diagnostic of subependymal nodular heterotopia. No other cerebral or cortical malformation was seen.
Tuberculosis of the peripancreatic lymph nodes in an immunocompetent patient
Authors: Liu YM , Satyadas T , Cheong E , Smith S , Sinclair MT , Rae DM 
Published: May 2014

A 34-year-old man of Indian origin presented with a week’s history of epigastric and upper abdominal pain associated with malaise and jaundice, but no fever, 2 months after returning from India. He also noticed pale stools and dark urine. He denied any weight loss, nausea and vomiting. He had no previous history of liver disease or jaundice and had had childhood bacillus Calmette–Guérin (BCG) vaccination. He was otherwise fit and well, and not on any regular medication. There was no history of recreational drug use and no family history of liver disease. Blood tests at initial presentation showed a raised alkaline phosphatase of 1012 u/litre (range 80– 260 u/litre), alanine aminotransferase 463 u/litre (range 0–37 u/litre) and bilirubin 120 μmol/litre (range 0–20 μmol/litre). Abdominal and respiratory examinations were unremarkable with no gross lymphadenopathy. At this stage, a biliary cause was suspected and an ultrasound scan was organized which showed a slightly dilated common bile duct. Magnetic resonance cholangiopancreatography showed a constant filling defect in the distal common bile duct but no obvious visible mass (Figure 1). Computed tomography scanning revealed no biliary dilatation but an irregular mass measuring 4x3 cm, inseparable from the upper aspect of the pancreatic head and the portal vein. There was also a 1.3 cm rounded density anterior to the pancreas close to the mesenteric vessels, showing low central attenuation (Figure 2). This mass was thought to be separate from the pancreas itself, even though the point of origin could not be accurately determined from the images, and enlarged lymph nodes were present. Exploratory laparotomy revealed enlarged rubbery lymph nodes in the lower omentum and around the portal triad. Pus was aspirated from these lymph nodes and sent to the laboratory, and neighbouring tissue biopsies were taken. The liver, spleen and peritoneum were normal, as was the pancreas on frozen section of trucut biopsy. Frozen section of the lymph nodes showed features consistent with tuberculosis. Mycobacterium tuberculosis was subsequently grown from the aspirated pus and tissue histology revealed evidence of granulomas. The patient was started on anti-tuberculosis therapy (isoniazid, rifampicin, pyrazinamide and pyridoxine) and referred to the respiratory physicians. The respiratory physicians continued the anti-tuberculosis medications, and added ethambutol, with a view to continuing this combination for a total of 2 months. After this period, the patient continued to take pyridoxine and rifampicin for 6 months. To date, the patient continues to be fit and well.
Myeloma in a very young woman presenting with bone pain
Authors: W Dubrey Simon , Patel Ketan 
Published: May 2014

Figure 1 shows the chest X-ray of a 29-year-old Ethiopian woman who presented to the accident and emergency department with a 9-day history of vomiting and a 3-month history of chest and back pain. She had been previously fit and healthy and had no past history of any illnesses. On examination she appeared dehydrated and had lower abdominal tenderness with no palpable organomegaly. Palpation of the ribs themselves was particularly uncomfortable for the patient. The chest X-ray (Figure 1) shows fractures with callus formation in the posterior left 6th rib, the left 10th and the right 7th rib posterolaterally. In addition there is abnormal bone texture in virtually all the thoracic bones, particularly the clavicles and the ribs. There are multiple lucent areas within the marrow, causing endosteal scalloping of the cortex. There are similar lucencies in the scapulae. There is also a band of atelectasis in the left lung base. Blood tests revealed a haemoglobin of 91 g/litre (the mean cell volume was normal at 87 fL), erythrocyte sedimentation rate 57 mm/h, potassium 3.1 mmol/litre, creatinine 233 umol/litre, albumin 23 g/litre and a corrected calcium 3.29 mmol/litre. Subsequent investigations showed a paraprotein band consisting of immunoglobulin G kappa at 62 g/litre. A bone marrow aspiration and trephine confirmed the diagnosis of multiple myeloma with approximately 50% of the cells thought to be plasma cells on the aspirate. Immunophenotyping of the bone marrow showed CD138 expression of 24% and kappa chain restriction. Treatment was started with a regimen of cyclophosphamide, thalidomide and dexamethasone, with a view to subsequent autologous bone marrow transplantation.
An unusual presentation of giant cell arteritis
Authors: Currie Samantha , Linnane Seamus J 
Published: May 2014

A 72-year-old woman presented with a 6-month history of dry, persistent cough after visiting a deer park. Initially a transient rash developed on the ankles and spread proximally. This was associated with malaise, weight loss and arthralgia which all quickly resolved. Examination revealed a right carotid bruit, impalpable left brachial artery and reduced left radial and dorsalis pedis pulses. The blood pressure was 120/80 mmHg in the right arm but unrecordable in the left. Respiratory examination was unremarkable. Temporal arteries were impalpable and non-tender; fundoscopy was normal. Borellia burgdorferi serology was negative. The haemoglobin was 10.2 g/litre (normal range 12.0–15.1 g/litre), mean corpuscular volume was 79.8 fl (normal range 80.0–99.0 fl) and platelets were 634×109/litre (normal range 130–475×109/litre); white cell count was minimally elevated at 11.3×109/litre (normal range 4.0–11.0×109/litre). Erythrocyte sedimentation rate was 100 mm/hr (normal range 0–35 mm/hr) and C-reactive protein 140 mg/litre (normal range <6 mg/litre). Lung function tests and chest radiography were normal. Computed tomography pulmonary angiography detected a descending aortitis (Figure 1). The Venereal Disease Research Laboratory (VDRL) enzyme-linked immunosorbent assay (ELISA) for IgG for Treponema pallidum was negative and a white cell scan identified normal uptake within the aorta, excluding syphilis. Bronchoscopy was grossly normal. Bronchoalveolar lavage showed a differential cell count of 75% macrophages, 24.9% lymphocytes and less than 1% of both neutrophils and eosinophils, indicative of a lymphocytic alveolitis. A transbronchial biopsy identified non-specific chronic inflammatory changes; granuloma and changes of vasculitis were absent. Stains for fungi, pneumocystis, legionella and acid-fast bacilli were negative. Temporal artery biopsy identified chronic inflammation with occasional giant cells. Giant cell arteritis with descending thoracic aortitis and lymphocytic alveolitis was diagnosed. A complete resolution of the cough occurred within a week of starting high-dose steroids.
Spontaneous splenic rupture in the postpartum period
Authors: Paravastu Sharath CV , Burdge Anthony , da Silva Antonio 
Published: May 2014

A 24-year-old woman, who was 8 weeks postpartum, presented to the surgical emergency unit with sudden onset of severe generalized abdominal pain. Apart from a previous ovarian cyst, there were no other significant past medical problems. She denied any recent abdominal trauma or strain. On examination, the patient had a very tender upper abdomen. Ultrasound scan demonstrated free fluid in both the abdomen and the pelvis. It also showed a large complex focal lesion in the spleen, close to the hilum, measuring 80×76 mm (Figure 1). Conservative management was planned initially, but surgery was performed as the patient developed signs of generalized peritonitis along with severe pain in both shoulders. A diagnostic laparoscopy revealed massive haemoperitoneum and bleeding from the upper pole of the spleen (grade II splenic rupture). Haemostasis could not be achieved, and hence a splenectomy was performed via an upper midline laparotomy. The patient made an uneventful recovery. Appropriate vaccinations were given post splenectomy (Haemophilus influenzae, Neisseria meningitides and pneumococcus). On macroscopic examination, the spleen measured 160×120×75 mm and weighed 342 g (Figure 2). Transverse section revealed a unilocular cyst of 85–90 mm in diameter containing haemorrhagic material. Histological examination revealed that the cyst was an epidermoid cyst and showed the presence of both old and new clots. Further additional history from the patient after splenectomy disclosed an admission to the medical ward 4 weeks after her delivery with left shoulder pain, left-sided chest pain and left-sided neck pain that was worse on movement and with cough. There was no history of trauma or fall. She was stable haemodynamically and all her haematological investigations were normal. She was treated as having musculoskeletal pain, given analgesics and was discharged home on the day of presentation. She had two further episodes of left shoulder pain that were treated similarly at a different hospital.
A simple case of heart failure?
Authors: Lee Lydia , Donaldson Anna , Lok She 
Published: May 2014

A 68-year-old woman presented with a 6-week history of progressive lethargy and weight loss. Over the previous 2 weeks she had also complained of increased ankle swelling, orthopnoea, a sensation of chest tightness, dyspnoea and dry cough. Her only past medical history was hypothyroidism, for which she was on adequate replacement therapy and hypertension. She had no other cardiovascular risk factors, had given up smoking at 32 years of age and was a retired health-care worker with no known exposure to asbestos. Clinical examination revealed signs of heart failure and a left-sided pleural effusion. Her blood pressure was 125/55 mmHg, pulse rate 90 beats per minute and oxygen saturation of 94% on air. Basic blood tests, including cardiac enzymes, came back within normal parameters except for white cell count of 15.0×103/mm3 and a C-reactive protein of 114 mg/litre. An electrocardiogram showed inverted T waves across the chest leads. A chest radiograph demonstrated a left-sided pleural effusion, with no apparent cardiomegaly or lung lesion. A diagnostic pleural aspirate was performed, fluid was blood stained. It was a borderline transudate according to Lights criteria (pleural:serum ratio of total protein and lactate dehydrogenase being 0.48 and 0.47 respectively). Two separate aspirates were negative for malignant cells on cytological analysis. A computed tomography scan to investigate the effusion further revealed irregular pericardial thickening, a large left pleural effusion and some consolidation in the posterior aspect of the left lung base (Figures 1 and 2). Echocardiography demonstrated a pericardial effusion but without evidence of tamponade. For definitive diagnosis of the suspicious pericardial thickening a decision was made to undertake a radiologically-guided biopsy. This was performed at a local tertiary referral centre. The histology obtained on balance suggested that this was pericardial mesothelioma.
Adult-onset diabetes insipidus caused by congenital midline brain abnormalities
Authors: Zachariah Sunil , Byrne Paul , Hyer Stephen 
Published: May 2014

A 30-year-old man presented with a 4-month history of polyuria and polydypsia. There was no significant past medical history and no significant family history as he was adopted Clinical examination revealed an obese gentleman with a body mass index of 45 kg/m2. His blood pressure was 130/80 mmHg and fundus examination was normal. Examination of his external genitalia revealed a small penis and testicular volume of 10 ml each. His full blood count, glucose, electrolytes, liver and bone profile were normal. Serum prolactin=463 mU/litre, insulin-like growth factor=15.7 nmol/litre (normal range (NR) =13–45 nmol/litre), free thyroid hormone level=9.8 pmol/ litre (NR=10–23 pmol/litre), testosterone=1.7 nmol/litre (NR=10–40 nmol/litre), cortisol=484 nmol/litre rising to 880 nmol/litre after Synacthen. Luteinizing hormone level was 0.1 u/litre rising to 1.7 after luteinizing hormone-releasing hormone, thyroid-stimulating hormone=0.98 mU/litre rising to 8.9 mU/litre after thyrotropin-releasing hormone stimulation. These results suggested partial anterior pituitary deficiency affecting the gonadal and thyroid axis. Urine failed to concentrate more than 100 mmol/litre during an 8-hour water deprivation test. After desmopressin, urine osmolality rose to 535 mmol/litre. Plasma arginine vasopressin levels were undetectable throughout the test indicating cranial diabetes insipidus. A magnetic resonance imaging scan of the brain (Figure 1) showed absence of the posterior portion of the corpus callosum. A transsphenoidal encephalocele was demonstrated with stretching of the hypothalamus, optic chiasm and pituitary gland through the defect.
Is the ovary a sanctuary for non-Hodgkin's lymphoma? Successful surgical management
Authors: Anwer Saiyed , Murdoch John , Pawade Joya , Price Chris 
Published: May 2014

In May 1999, a 30-year-old woman presented with a 2-month history of lower back pain and symptoms of sacral root compression. Systemic examination revealed a large right inguinal lymph node and a palpable right iliac fossa mass arising from the pelvis. A computed tomography scan showed bilateral hydronephrosis with some compression of the collecting systems, gross retroperitoneal and pelvic lymphadenopathy and an enlarged right inguinal lymph node. The lactate dehydrogenase level was raised at 665 iu/litre (normal range < 450 iu/litre). A lymph node biopsy confirmed the diagnosis of diffuse large B-cell non-Hodgkin's lymphoma. It was bulky stage 2 at presentation with an International Prognostic Index score of 1. The patient received six courses of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone). Following this there was no palpable disease but her computed tomography scan showed residual para-aortic lymphadenopathy with some calcification. A decision was taken to observe without further therapy. She remained clinically very well until March 2000, when a right pelvic mass was palpable on clinical examination. She had an ultrasound scan followed by a computed tomography scan which showed pelvic lymphadenopathy and adnexal mass. In view of this she had two courses of mini BEAM (carmustine, etoposide, cytarabine and melphalan) (Chopra et al, 1992) in April–May 2000. A repeat ultrasound of the abdomen showed a reduction in right iliac fossa nodes. This was followed by high-dose therapy (BEAM) with autologous bone marrow transplantation in July 2000. This was consolidated with radiotherapy (40 Gray in 20 fractions) to the site of recurrence in the right pelvis in September and October 2000, and subsequent evaluation was consistent with remission. Following mild elevation of lactate dehydrogenase levels in November 2002, she had an ultrasound and computed tomography scan which showed a complex ovarian mass of 7×4 cm on her right side, with no evidence of significant lymphadenopathy (Figure 1). A biopsy showed relapse of lymphoma and a bone marrow sample was normal. The pelvic mass was removed laparoscopically in June 2003, and turned out to be an ovary completely replaced by a solid lobulated tumour. Histology showed high-grade B-cell non-Hodgkin's lymphoma similar to her previous disease (Figures 2 and 3). She had three courses of adjuvant chemotherapy with R-ESHAP (Velasquez et al, 1994) (rituximab, etoposide, methylprednisolone, cytarabine and cisplatin) in July 2003. Following this she has remained in complete remission for more than 5 years.