bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe acute exacerbation of chronic hepatitis B: A unique presentation of a common disease
Authors: Wong Vincent Wai‐Sun , Chan Henry Lik‐Yuen 
Published: July 2009

AbstractSevere acute exacerbation is a unique presentation of chronic hepatitis B characterized by very high alanine aminotransferase level accompanied by jaundice and hepatic decompensation. The underlying pathogenesis is likely related to excessive immune clearance, which may be related to the genotype of hepatitis B virus. The mortality is very high once hepatic encephalopathy develops, but some patients can recover to almost normal liver function in contrast to patients with end‐stage liver cirrhosis. This condition should be differentiated from acute hepatitis B and other causes of acute hepatitis must be excluded. Conventional prognostic systems may not be applicable to severe acute exacerbation of chronic hepatitis B. In general, patients who have thrombocytopenia, hyperbilirubinemia and coagulopathy have a higher risk of mortality regardless of the serum alanine aminotransferase levels. There is no evidence that lamivudine treatment can reduce the short‐term mortality of severe acute exacerbation. However, patients with severe acute exacerbation tend to have a higher rate of maintained virological response, higher rate of hepatitis B e antigen seroconversion and low rate of drug resistance on extended lamivudine treatment as compared to other chronic hepatitis B patients. Virological relapse and severe hepatitis reactivation is common after treatment cessation and therefore long‐term antiviral treatment is recommended. Liver transplantation, particularly living donor liver transplantation, should be considered for patients who develop hepatic failure secondary to severe acute exacerbation.
Rescue strategies against non‐steroidal anti‐inflammatory drug‐induced gastroduodenal damage
Authors: Lim Yun Jeong , Lee Jeong Sang , Ku Yang Suh , Hahm Ki‐Baik 
Published: July 2009

AbstractNon‐steroidal anti‐inflammatory drugs (NSAIDs) are the most commonly prescribed drugs worldwide, which attests to their efficacy as analgesic, antipyretic and anti‐inflammatory agents as well as anticancer drugs. However, NSAID use also carries a risk of major gastroduodenal events, including symptomatic ulcers and their serious complications that can lead to fatal outcomes. The development of “coxibs” (selective cyclooxygenase‐2 [COX‐2] inhibitors) offered similar efficacy with reduced toxicity, but this promise of gastroduodenal safety has only partially been fulfilled, and is now dented with associated risks of cardiovascular or intestinal complications. Recent advances in basic science and biotechnology have given insights into molecular mechanisms of NSAID‐induced gastroduodenal damage beyond COX‐2 inhibition. The emergence of newer kinds of NSAIDs should alleviate gastroduodenal toxicity without compromising innate drug efficacy. In this review, novel strategies for avoiding NSAID‐associated gastroduodenal damage will be described.
A case of renal mucinous tubular and spindle cell carcinoma
Authors: Kato Manabu , Soga Norihito , Arima Kiminobu , Sugimura Yoshiki 
Published: July 2009

AbstractA 33‐year‐old man was hospitalized for treatment of a left renal tumor. The radiological findings were consistent with those of a left renal cell carcinoma (RCC). Subsequently, a radical nephrectomy was carried out. Macroscopic examination showed that a well‐demarcated tumor measuring 2.9 × 2.6 × 2.5 cm was present in the middle portion of the resected kidney. The cut surface of the tumor was grayish‐white in color. Pathological examination of the resected specimen showed a mucinous tubular and spindle cell carcinoma of the kidney (MTSCC‐K). MTSCC‐K is a low‐grade renal epithelial neoplasm that has recently been recognized as a specific entity in the World Health Organization 2004 classification of RCC. To our knowledge, 17 cases of MTSCC‐K in Japan have been reported by Japanese investigators. To avoid administration of excessive adjuvant treatment to patients, pathologists and urologists should consider this newly recognized low‐grade malignancy when diagnosing renal tumors.
Ketamine‐associated bladder dysfunction
Authors: Tsai Tsung‐Hsun , Cha Tai‐Lung , Lin Chang‐Min , Tsao Chih‐Wei , Tang Shou‐Hung , Chuang Feng‐Pin , Wu Sheng‐Tang , Sun Guang‐Huan , Yu Dah‐Shyong , Chang Sun‐Yran 
Published: July 2009

Objective:  To assess the impact of ketamine abuse on genitourinary tract dysfunction.Methods:  Eleven patients with urinary tract symptoms and a history of ketamine abuse in recent years were studied. Urinalysis, urine culture, renal function tests, abdominal sonography and urodynamic studies were done. Bladder biopsies were carried out in selected cases.Results:  The most common complaints were lower urinary tract symptoms, including dysuria, frequency, urgency and gross hematuria. Urinalyses showed nonbacterial pyuria and were negative for tuberculosis. All biopsy specimens showed infiltrations of granulocytes (mostly eosinophils) and mast cells within the bladder tissue. Medications produced only slight clinical improvements. Intravesical instillation of hyaluronan solution was performed for some patients and a significant improvement of lower urinary tract symptoms was observed.Conclusions:  Although the dosage and duration of ketamine abuse causing severe side‐effects are still unclear, some patients develop irreversible histological changes in the urinary tract. Therefore, clinicians should be aware of the negative effects of ketamine abuse on genitourinary tract function.
Chronic pain following a Lichtenstein inguinal hernia repair: a clinical and legal dilemma
Authors: Paily Abhilash , Thornton Michelle 
Published: July 2009

AbstractBackground:  Chronic pain following a Lichtenstein inguinal hernia is frequent and raises major concerns regarding informed consent recallObjective:  To assess the frequency of chronic pain and associated factors following inguinal hernia repair in a district general hospital. To assess patient recall of the consent process as it pertains to chronic pain.Methods:  A random sample (170/293 patients) of those who underwent a Lichtenstein inguinal hernia repair between 2002 and 2004 were retrospectively assessed for the frequency, intensity and other co‐factors of chronic pain. They were also questioned about their recollection of the consent process and information given regarding chronic pain.Results:  50 percent of patients reported chronic pain at a median follow‐up of 62 months with 30% reporting a significant impact on daily activities. Younger age, the absence of a lump at presentation, pre‐operative pain and elective repair were the only factors significantly shown to increase the likelihood of post‐operative pain. Patients with post‐operative pain were significantly more likely to report that they had not been informed of the possibility of chronic pain pre‐operatively or at the time of consent. Twenty percent of these patients stated that they would not have undergone the operation if they had been informed of the possibility of chronic pain.Conclusion:  Chronic pain is frequent and debilitating. Documentation of chronic pain as a possible outcome at the time of consent should be mandatory as patient recall is poor.
The harassment and stalking of plastic surgeons by their patients in Australasia
Authors: Allnutt Stephen , Samuels Anthony , Taylor Gregory 
Published: July 2009

AbstractMedical professionals come into direct contact with the public. The relationships are often personal. The aim of the survey is to examine the prevalence of harassment of plastic surgeons by their patients.Survey questionnaires were mailed to all plastic surgeons listed in the 1999 Australasian Society of Aesthetic Plastic Surgery List of Members. A very wide definition of harassment was then provided and information in regard to the nature of the harassment was obtained.This was a descriptive survey of plastic surgeons’ experiences of harassment by patients in Australia and New Zealand. More than half of the plastic surgeons in Australia and New Zealand who responded to the questionnaire reported having been a victim of harassment at some point of their careers. One quarter had been harassed in the previous year. Over 20% of cases met the legal criteria for stalking. These estimates are in excess of those reported in the other studies of the general community. Harassment persisted in the majority of cases for at least a month and in a third of cases for up to 5 years.The recognition of psychiatric disorder, particularly personality dysfunction, prior to embarking on surgery may limit the likelihood of harassment by difficult patients. Formal teaching may be helpful to surgical registrars and consultants. Expert intervention could assist in reducing clinician anxiety.
Estimating the risk of rare complications: is the ‘rule of three’ good enough?
Authors: Ludbrook John , Lew Michael J. 
Published: July 2009

AbstractThe clinical problem:  If a surgeon has performed a particular operation on n consecutive patients without major complications, what is the long‐term risk of major complications after performing many more such operations? Examples of such operations are endoscopic cholecystectomy, nephrectomy and sympathectomy.The statistical problem and solutions:  This general problem has exercised the minds of theoretical statisticians for more than 80 years. They agree only that the long‐term risk is best expressed as the upper bound of a 95% confidence interval. We consider many proposed solutions, from those that involve complex statistical theory to the empirical ‘rule of three’, popular among clinicians, in which the percentage risk is given by the formula 100 × (3/n).Our conclusions:  The ‘rule of three’ grossly underestimates the future risks and can be applied only when the initial complication rate is zero (that is, 0/n). If the initial complication rate is greater than zero, then no simple ‘rule’ suffices. We give the results of applying the more popular statistical models, including their coverage. The ‘exact’ Clopper–Pearson interval has wider coverage across all proportions than its nominal 95%, and is, thus, too conservative. The Wilson score confidence interval gives about 95% coverage on average overall population proportions, except very small ones, so we prefer it to the Clopper–Pearson method. Unlike all the other intervals, Bayesian intervals with uniform priors yield exactly 95% coverage at any observed proportion. Thus, we strongly recommend Bayesian intervals and provide free software for executing them.
Moral responsibility to attain thorough pediatric drug labeling
Authors: WAISEL DAVID B. 
Published: July 2009

SummaryMany drugs used in children have not been labeled for pediatric use. While this was the standard for many years, recent regulations and incentives have improved the depth and breadth of pediatric drug labeling. Nonetheless, common pediatric drugs have not been adequately labeled, particularly generic and orphaned drugs and drugs that were approved for one age group but never tested in other age groups. Anesthesiologists have a moral responsibility to encourage government, pharmaceutical companies, and researchers to study drugs in children.
Comparison of the Cobalt Glidescope® video laryngoscope with conventional laryngoscopy in simulated normal and difficult infant airways*
Authors: WHITE MICHELLE , WEALE NICOLA , NOLAN JUDITH , SALE STEVEN , BAYLEY GUY 
Published: July 2009

SummaryAim:  To evaluate the new pediatric Glidescope® (Cobalt GVL® Stat) by assessing the time taken to tracheal intubation under normal and difficult intubation conditions. We hypothesized that the Glidescope® would perform as well as conventional laryngoscopy.Background:  A new pediatric Glidescope® became available in October 2008. It combines a disposable, sterile laryngoscope blade and a reusable video baton. It is narrower and longer than the previous version and is available in a greater range of sizes more appropriate to pediatric use.Methods:  We performed a randomized study of 32 pediatric anesthetists and intensivists to compare the Cobalt GVL® Stat with the Miller laryngoscope under simulated normal and difficult airway conditions in a pediatric manikin.Results:  We found no difference in time taken to tracheal intubation using the Glidescope® or Miller laryngoscope under normal (29.3 vs 26.2 s, P = 0.36) or difficult (45.8 and 44.4 s, P = 0.84) conditions. Subjective evaluation of devices for field of view (excellent: 59% vs 53%) and ease of use (excellent: 69% vs 63%) was similar for the Miller laryngoscope and Glidescope®, respectively. However, only 34% of participants said that they would definitely use the Glidescope® in an emergency compared with 66% who would be willing to use the Miller laryngoscope.Conclusions:  The new Glidescope® performs as well as the Miller laryngoscope under simulated normal and difficult airway conditions.
Newly Diagnosed, Insulin‐dependent Diabetes Mellitus in Elderly Patients
Authors: Kilvert A. , FitzGerald M. G. , Wright A. D. , Nattrass M. 
Published: July 2009

Over a two‐year period 398 out of 1776 new referrals to a diabetic clinic were newly diagnosed diabetic patients aged 65 years and over. Initial treatment of this group was diet—122 (31%), diet plus oral hypoglycaemic agents—232 (58%) and diet plus insulin—41 (10%).Sixteen (39%) of the group treated initially with insulin died within 3.5 years of diagnosis compared with 21% of the 345 patients treated with diet ±oral hypoglycaemic agents who were followed for this time. Twenty‐five patients treated initially with insulin survive but 8 have stopped insulin and are treated with diet ±oral hypoglycaemic agents, and a further 5 had a period of 6–24 months on oral therapy. Twelve patients have been treated with insulin continuously but of these only 3 are clearly insulin‐dependent. These data suggest that true dependence on insulin is uncommon in patients aged 65 years or over at diagnosis.
Pharmacokinetics of Human Insulin Zinc Suspension (Recombinant DNA) in Normal Man: A Comparison with Porcine Insulin Zinc Suspension
Authors: Frier B. M. , Sullivan F. M. , Mair Frances S. , Koch Isobel M. , Scotton Janet B. 
Published: July 2009

A single dose crossover study in 10 fasting, non‐diabetic men compared the 24‐hour profiles of blood glucose, plasma insulin, and C‐peptide following a single subcutaneous injection of either human insulin zinc suspension crystalline (recombinant DNA), or highly purified porcine insulin zinc suspension (mixed), in a standard dose of 0.2 U/kg. Both insulins produced moderate hypoglycaemia within 3 hours which persisted for 24 hours after administration. The rate of fall of blood glucose was similar from 0–3 hours but was significantly lower after the porcine insulin at 4 and 7 hours (p< 0.05). Mean plasma insulin values were higher after porcine insulin between 2 and 6 hours (p< 0.05) and a biphasic pattern was observed following injection of both insulins. Plasma C‐peptide declined after each insulin was administered, and was significantly lower between 2 and 7 hours after porcine insulin.The duration of the hypoglycaemic action of human crystalline insulin (recombinant DNA), assessed by blood glucose measurements and C‐peptide suppression, was equivalent to porcine insulin zinc suspension (mixed) (Monotard® MC, Novo) over 24 hours.
BM Strips: How Accurate are they in General Wards?
Authors: Hutchison A. S. , Shenkin A. 
Published: July 2009

In order to test the accuracy of BM Test Glycemie 20–800 strips when used in general wards, simultaneous BM strip results were obtained for 183 emergency out‐of‐hours plasma glucose requests. The results were considered accurate if the value obtained by the Emergency Biochemistry Laboratory (using a Beckman II glucose analyser) was within one strip‐range on either side of the stated BM strip value. Fifty‐nine (32.2%) of the BM strip results were considered inaccurate by this definition, and in 22 of these inaccurate results the differences were large enough to have led to inappropriate management if this was based on the BM strip result alone.The reasons for these inaccuracies are not clear, but it is suggested that improved training of ward staff and formal quality control schemes may help to improve results.
The Whitehall Study: Ten Year Follow‐up Report on Men With Impaired Glucose Tolerance With Reference to Worsening to Diabetes and Predictors of Death
Authors: Jarrett R. J. , Keen H. , McCartney P. 
Published: July 2009

Two‐hundred and four men with a defined degree of impaired glucose tolerance derived from the Whitehall Survey and its pilot study were enrolled in a therapeutic trial and followed for ten years. For the first five years of the trial approximately half the group received 50 mg phenformin daily and the other half an identical placebo. For the whole ten years of the trial approximately half the group were recommended a diet in which carbohydrate intake was limited to 120 g/day, while the other half was recommended a qualitative limitation of sugar intake. 60 men (29.4%) worsened to diabetes during the follow‐up period. The major independent predictor of worsening was the baseline blood glucose level (glucose tolerance). High baseline plasma triglyceride levels and low baseline systolic blood pressure levels were also independent predictors of worsening, though of lower significance (0.01 <p<0.05). Obesity, measured as body mass index, was not a significant risk factor.Thirty‐nine men died, with 19 deaths ascribed to coronary heart disease (CHD). Baseline blood pressure significantly predicted both all causes and CHD mortality. All causes mortality rates were higher in the less obese. Allocation to drug or diet therapy did not significantly affect mortality rates or the proportions worsening to diabetes.
Are the WHO Criteria for Hypertension Appropriate in Young Insulin‐dependent Diabetics?
Authors: Drury Paul L. , Tarn Anne C. 
Published: July 2009

The WHO Criteria for HypertensionNormal adult blood pressure is arbitrarily defined as a systolic pressure equal to or below 140 mmHg together with a diastolic (5th phase) equal to or below 90 mmHg.Hypertension in adults is arbitrarily defined as a systolic pressure equal to or greater than 160 mmHg and/or diastolic (5th phase) equal to or greater than 95 mmHg.The term ‘borderline hypertension’ is used to denote blood pressure values between the normal and the hypertensive ranges as described above.The blood pressure levels at which hypertension can be defined for children vary with age, but precise levels are under review. Clearly values that would be regarded as hypertensive are lower in children than in adults.
The Course of Incipient Diabetic Nephropathy: Studies of albumin excretion and blood pressure
Authors: Christensen C. K. , Mogensen C. E. 
Published: July 2009

With the aim of defining the transitional phase from normal or near normal albumin excretion to overt diabetic nephropathy, 23 male diabetics of more than 7 years' duration, below 40 years of age and a baseline urinary albumin excretion above 15 μg/ min but without clinical proteinuria (incipient diabetic nephropathy) were studied. For comparison 18 normals, 23 diabetics with normal albumin excretion and 10 patients with overt nephropathy were also examined. Diastolic blood pressure (DBP) was elevated to 88±9mmHg (mean±S.D.) compared to patients with normal urinary albumin excretion: 80±7 (S.D.) (2p=0.13%) but was below pressures in patients with overt diabetic nephropathy 109±15 (2p = 0.002%). Glomerular filtration rate (GFR) was elevated to 142±21 ml/min (mean±S.D.) compared to 132±9 in patients with normal urinary albumin excretion (2p=4.3%). Renal plasma flow (RPF) was not altered. Renal vascular resistance (RVR) was increased (0.200±0.035) compared to that of patients with normal urinary albumin excretion (0.180±0.025) (2p = 3.8%).In a longitudinal study of 10 of the patients with incipient nephropathy, followed for 4.9 (Mean) years, urinary albumin excretion increased significantly during the observation period, the yearly increase rate being 19±22% (mean±S.D.). DBP increased from 84±9 to 93±13 (2p = 3.8%) in 6 patients followed for more than 4 years. A significant correlation was observed between DBP and the yearly percentage increase rate in urinary albumin excretion (r = 0.77, 2p = 0.9%) and between RVR and the yearly percentage increase rate in urinary albumin excretion (r = 0.80, 2p = 0.8%). Thus incipient diabetic nephropathy is associated with high GFR and with elevated blood pressure both of which may accelerate further renal damage.
Glycaemic Effects of Bread and Marmalade in Insulin‐dependent Diabetes
Authors: Lean M. E. J. , Tennison B. R. , Williams D. R. R. 
Published: July 2009

The glycaemic responses of 12 C‐peptide negative insulin‐dependent diabetics were studied following four breakfasts with different carbohydrate sources. Total energy content of the meals was the usual for each subject, carbohydrate supplying 55% and fat 32%. The meals comprised: wholemeal bread with margarine; white bread with margarine; marmalade made with sucrose, and cheddar cheese; and marmalade (22% of total energy) on wholemeal bread with margarine.The study demonstrated powerfully that there were no statistically significant or clinically relevant differences between the meals in post‐prandial glucose peak elevation, or in incremental area under the blood glucose curve to 120 mins. On these grounds, sucrose, in amounts considered acceptable to the general population, need not be prohibited from diabetic diets.
Family Involvement and Metabolic Control of Childhood Diabetes
Authors: Standen P. J. , Hinde F. R. J. , Lee P. J. 
Published: July 2009

To investigate the association between the family environment and metabolic control of childhood diabetes 20 diabetic children aged between 4 and 12 years with same‐sex healthy siblings and two cohabiting parents were selected. The parents were interviewed separately and completed questionnaires about their own and their spouse's involvement and shared activities with both children, diabetic management, and knowledge of and attitudes towards diabetes. They also completed the Moos Family Environment Scale (FES) which yields ten sub‐scales relating to different aspects of family functioning as did 20 sets of parents with age‐ and sex‐matched healthy children, who also completed questionnaires concerning their involvement and shared activities with their children. There were no differences between the families of diabetics and of controls in the extent to which either parent was involved with their children or in the attention each child received. Fathers of diabetic children differed from controls in their use of punishment and diabetic families were less achievement oriented. The degree of metabolic control (HbA, assessment at three‐monthly intervals) was related to parental involvement with the non‐diabetic child and to some aspects of the FES including parental incongruence.These differences in family functioning suggest useful directions for possible intervention programmes.