bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Overview of the Surgical Aspects of Lower Limb Venous Disease
Authors: Parnaby Cn , Welch Gh , Stuart Wp 
Published: March 2011

Summary Points Lower limb venous disease encompasses a wide spectrum of pathology, the importance of which relates to high prevalence rather than mortality. The complications of chronic venous insufficiency (CVI), namely lipodermatosclerosis and chronic venous ulceration, represent a major burden to healthcare providers and a high degree of personal morbidity for patients. Management is based upon accurate clinical diagnosis supported by non-invasive imaging. Open surgical and minimally invasive techniques are used to treat varicose veins. Chronic skin complications of CVI require a multi-disciplinary approach.
The Doctor's Casebook – A Process of Discovery
Authors: Fraser S , Ayres C 
Published: March 2011

Background and Aims A bound manuscript describing the medical cases seen by a mid-eighteenth century Scottish doctor was discovered in the possession of the first author's family. The identity of the doctor is not revealed in the book. The aims were to identify the doctor and understand the significance of this book in the context of Scottish medical history of that period. Methods The process of investigation involved transcribing the book in order to undertake detailed study of the text, with particular focus on style of writing, location, and the names of patients and doctors mentioned. This information was then used in searches of the Wellcome Library for the History and Understanding of Medicine, London and the Department of Special Libraries and Archives of the University of Aberdeen as well as searches of the internet. Results The author was discovered to be a doctor working in Aberdeenshire in the middle of the eighteenth century. His style of writing suggests an educational purpose, with a particular interest in midwifery, and evidence of teaching midwifery techniques to students. He associated with other prominent local doctors of the time and was aware of the current thinking being put forward by his contemporaries. He had a particular association with Dr John Gregory, with whom he not only worked, but whose extended family he also treated. Conclusions The author of this casebook was identified as Dr David Skene, and this adds to our knowledge of this important figure of the Scottish Enlightenment who had a particular interest in midwifery and campaigned for the proper instruction of midwives
Esophageal lipoma presenting as a paraesophageal omental hernia in a 68-year-old man: Report of a case
Authors: Han Yong , Lu Qiang , Gu Zhongping , Wang Xiaoping , Li Xiaofei 
Published: March 2011

A case of esophageal lipoma resembling a paraesophageal omental herniation is described herein. A 68-year-old male with symptoms of epigastric gas pains was noted. A barium swallow examination showed a large mass in the lower esophagus, which could move up and down along the esophagus easily and intermittently. Computed tomography scan of the chest and upper abdomen demonstrated a mass with fatty like density at the lower thoracic esophagus. A left posterior-lateral thoracotomy was performed. Histological examination revealed large mature lipocytes and lipoma of the esophagus was diagnosed. Diagnosis and treatment of lipoma of the esophagus were discussed. Lipomas of the esophagus are extremely rare benign tumors with an overall incidence of only 0.4%[1]. The leading clinical presentations of esophageal lipoma included dysphagia, mass regurgitation and signs of compression of the tumor. Preoperative diagnosis can be confirmed by CT, magnetic resonance imaging (MRI) and endoscopic ultrasonography. The present report describes a patient who suffered from an esophageal lipoma with symptoms of epigastric gas pains with a burning retrosternal sensation, which resembling a paraesophageal omental herniation. We also discuss the associated diagnosis and treatment of lipoma of the esophagus.
Two Novel Mutations Causing Familial Benign Hypocalciuric Hypercalcaemia in Three Scottish Families
Authors: Hinnie J , Vass JK , Rolfe E , Marchesi VA , MacFarlane FC , McShea L , McKibbin CC , Henderson P , Gaffney D 
Published: March 2011

Background and Aims Familial benign hypocalciuric hypercalcaemia (FBHH) is a benign autosomal dominantly inherited condition which results in elevated serum calcium and low urinary calcium. This condition is of clinical interest because it can be mistakenly diagnosed as primary hyperparathyroidism (PHP). In most cases FBHH can be shown to be due to a mutation in the calcium sensing receptor (CASR) gene and we aimed to find the causative mutation in three Scottish kindreds with FBHH. Methods We used a combination of denaturing gradient gel electrophoresis and direct DNA sequencing to detect mutations in the CASR gene. Results We detected a mutation in the CASR gene in each of the three kindreds. Two different mutations were detected (the same one was present in two kindreds). Neither mutation has been reported previously. All hypercalcaemic individuals from each kindred had the appropriate mutation while all normocalcaemic individuals did not. Conclusion In the vast majority of kindreds with FBHH which have been reported previously, the CASR mutation responsible is private to that kindred. In three Scottish kindreds we have identified two new mutations.
Acute Caffeine Ingestion: Clinical Features in Patients Attending the Emergency Department and Scottish Poison Centre Enquiries Between 2000 and 2008
Authors: Waring WS , Laing WJ , Good AM , Malkowska AM 
Published: March 2011

Background and Aims Little information is available regarding the healthcare burden associated with deliberate caffeine ingestion. The present study sought to establish the impact of caffeine ingestion on hospital attendances and Poisons Centre enquiries in Scotland. Methods Retrospective analyses of clinical data from patients attending the Royal Infirmary of Edinburgh after acute caffeine ingestion, and TOXBASE enquiries from Scotland regarding caffeine poisoning between 2000-2008 inclusive. Cochran-Armitage trend tests were used to evaluate changes in annual admissions and TOXBASE enquiries. Results There were 43 hospital attendances due to deliberate caffeine ingestion, representing 0.2% of all poisoning cases. The median (interquartile range) stated dose was 1040 mg (600-1500 mg). Minor gastrointestinal symptoms were common, and no patient developed features of severe toxicity. There were 1418 enquiries to TOXBASE concerning caffeine poisoning, representing 0.2% of all poisoning enquiries from Scotland. The proportions of hospital admissions and TOXBASE enquiries due to caffeine ingestion have remained constant. Conclusion Caffeine ingestion is uncommon, and results in only a small number of hospital attendances and Poisons Centre enquiries. In contrast to patterns reported elsewhere, the prevalence of caffeine abuse has not increased in Scotland over recent years.
Indiscriminate Coagulation Screening of Acute Medical Admissions: National Cost Ramifications.
Authors: Hughes MA , Duckworth AD , Edmond I , Tan LL , Ripley DP , Tucker J , Leslie PJ 
Published: March 2011

Background Routine coagulation screening constitutes poor medical practice and is wasteful of resources. We aimed to determine the extent of inappropriate coagulopathy screening of acute medical admissions in a Scottish general hospital. Methods One hundred consecutive medical admissions were prospectively analysed, assessing whether or not a coagulation screen had been conducted on admission and whether or not this was indicated according to current hospital guidelines. Following targeted dissemination of guidelines to appropriate front door medical and nursing staff the audit was repeated. Results Pre-education, 58% of those for whom coagulation screening was not indicated were being tested. After targeted education, this figure was reduced to 32%. Preeducation, 81% of all patients in whom coagulation screening was indicated were tested. After targeted education, this figure was 86%. Conclusion Indiscriminate coagulation screening is widespread amongst medical admissions to our unit. With simple targeted education, we reduced the rate of inappropriate testing by 26% without reducing the rate of appropriate testing. In a small district general hospital (where the mean local cost for processing a haematology specimen is £8.59) this translates into a saving of £21,000 per annum. Extrapolated nationwide this represents a cost saving of £1.15 million per annum in Scotland.
Prevalence of Genetic Haemochromatosis and Iron Overload in Patients Attending Rheumatology and Joint Replacement Clinics
Authors: Donnelly Sc , Joshi Ng , Thorburn D , Cooke A , Reid G , Neilson M , Capell H , Stanley Aj 
Published: March 2011

Background &aims Genetic Haemochromatosis (GH) is common in North European and Celtic populations and is associated with arthropathy. We aimed to measure the frequency of the common GH mutations (C282Y and H63D), the carrier frequency of C282Y and markers of iron overload in patients who were referred to our rheumatology and joint replacement clinics. Methods Unselected patients attending these clinics were anonymously tested for the described mutations. Transferrin saturation and serum ferritin were also measured and if elevated, the patients had predictive counselling then named GH mutation testing. The carrier and mutation frequencies were also determined in 340 local controls. Results One hundred and sixty-one unselected patients attending these clinics were studied. The C282Y mutation carrier frequency was 1 in 5.2 in patients compared with 1 in 8.1 in controls (p<0.005). The overall mutation frequencies were similar in patients and controls. One patient was found to be a homozygous for the C282Y mutation and eight were compound heterozygotes. Seven other patients had a raised ferritin, one of whom was a C282Y heterozygote. Conclusion The C282Y carrier frequency is significantly higher in patients attending rheumatology and joint replacement clinics than in controls. Screening of these patients for GH should be considered.
Use of a Chaperone during Breast Examination: The Attitude and Practice of Consultant Breast Surgeons in the United Kingdom
Authors: Sinha S , De A , Williams Rj , Vaughan-Williams E 
Published: March 2011

Background Professional guidelines and clinical practice regarding use of chaperones vary substantially in different health care settings. Although there are several studies in primary care practice, no such studies are available in a breast care setting. We have undertaken a questionnaire survey of practicing consultant breast surgeons in the UK regarding the use of a chaperone during breast examination. Method A self-completion questionnaire, with 18 items was developed, piloted, modified and mailed to 400 consultant breast surgeons across the UK. Result 302/400 questionnaires were returned (76%). Sixty-five per cent had a policy on the use of chaperone. Although 73% always offer a chaperone, the majority never documented the offer (74%) or identity (73%). Overall use of chaperone was significantly higher among male (82%), compared to female surgeons (38%, p<0.001). The majority said that patient embarrassment (54%) and the availability of a nurse (57%) strongly influence chaperone use unlike patient's age, marital status, ethnicity, anxiety, instinct. Seventy per cent of respondents believed that the presence of a chaperone was important for medico-legal protection of doctor and patient (55%). Conclusion Our study shows that the majority of consultant breast surgeons in the UK use a chaperone. The overall use of a chaperone in secondary breast care setting is higher compared to previous studies in primary care. Documentation of the offer and identity of the chaperone is very poor.
Closure of Loop Ileostomies: Is Early Discharge Safe and Achievable?
Authors: Ihedioha U , Muhtaseb S , Kalmar K , Donnelly L , Muir V , Macdonald A 
Published: March 2011

A prospective audit of the complications associated with reversal of a loop ileostomy was carried out between March 2000 and March 2005. The complication rate, length of inpatient hospitalisation and re-admission rate were assessed in 100 patients, in a single clinical practice. The median (interquartile range) length of time between the primary procedure and closure was 133 days (120 – 270) days. Median length of inpatient stay was two days (one - three) days. The overall complication rate was 18 %. One patient had a post-operative leak leading to local abscess formation. This was drained surgically after initial failure with radiological drainage. A second patient had a late leak, three weeks after closure, leading to fistula formation. This patient required surgical resection of the anastomosis after failure of conservative management. Twelve patients were re-admitted with small bowel obstruction (12%), of whom 11 were managed conservatively, while one underwent further surgery. There was one post- operative death as a result of acute cardiac failure secondary to undiagnosed hypertensive cardiomyopathy. Thus early discharge following closure of a loop ileostomy, can be achieved with an acceptably low serious complication rate.
Bronchial Carcinoid Tumour in Pregnancy
Authors: Cornell Rl , Wilkens J , Cooper Tk , Beattie Gj , Sethi T 
Published: March 2011

Summary Breathlessness is a commonly encountered symptom in pregnancy. The differential diagnosis for acute breathlessness in pregnancy is broad and possibilities range from physiological changes and psychological causes to acute respiratory disorders, which include pulmonary embolism (PE), acute asthma, infection and pneumothorax. It is rare to find a malignancy as the underlying cause of breathlessness. We report a case of severe breathlessness and chest pain in a 26-year-old woman presenting at 36 weeks gestation. A chest radiograph was normal but a computertomogram (CT) identified a mass, which was subsequently demonstrated to be a malignant bronchial carcinoid tumour. Although abdominal carcinoid tumours have been reported in the literature, to our knowledge, this is the first reported pulmonary carcinoid tumour, presenting during pregnancy.
Sensori-neural hearing loss in Sensory ataxic neuropathy, dysarthria and ophthalmoparesis (SANDO): A Case Report
Authors: Achar P , Kumar Bn 
Published: March 2011

Objective To report a case of bilateral sensorineural hearing loss in a patient with sensory ataxic neuropathy, dysarthria and ophthalmoparesis (SANDO). Method Case report and review of literature on mitochondrial disorders to facilitate understanding of the type of hearing loss. Case report We present a 37 year old lady diagnosed with SANDO, who was seen in the ENT department with a history of progressive hearing loss for 6 months. Audiogram showed bilateral trough shaped sensorineural hearing loss, dipping at 1 KHz. Earlier, this patient had presented to the neurology department with classical neurological signs of progressive sensory ataxia. Diagnosis of SANDO was confirmed by muscle biopsy and mitochondrial studies. Conclusion This is the first case report on SANDO documenting associated hearing loss in ENT literature. Further studies are required to explain the pattern of hearing loss in these patients
Women and Sport
Authors: O'Brien M , Robertson A 
Published: March 2011

Women have historically taken part in sports for many centuries. The first recorded female game competitions were the Herean Games in approximately 1,000 BC, named after the Goddess Hera. Held at Olympia in Greece, these games were for women alone and were thought to have originated as part of ancient fertility rights. Historically there is evidence of sporting activities involving women, but nothing of significance until after the 1948 summer Olympic Games, when 385 female athletes participated. Over the last six decades there has been a noted rise in the number of female athletes, reaching its maximum with the 2008 Beijing Olympics, where over 42% of the 11,028 athletes were women. Similarly in 2006, at the Turin Winter Olympics in Italy, 40% of the 2,500 athletes were females. In the 2012 Olympics, the Olympic Committee anticipates that approximately 44% of all athletes participating will be female. Despite there being a significant rise in the number of elite athletes in the UK, there appears to be an overall decrease in the amount and intensity of physical exercise undertaken by teenage girls. This is considered to be due to the fact that physical education is no longer an integral part of the school curriculum in the UK. There is, however, a small but significant group of elite athletes who start to train at a very early age (9-10 years old) especially in gymnastics, skating, swimming and athletics.
Education in Sports Medicine
Authors: Hureibi KA , Mclatchie GR 
Published: March 2011

One of the innovative developments in Sports Medicine education has been the establishment of medical student options in Sport and Exercise Medicine. The first such option to attend the Department of Sports Medicine at the General Hospital, Hartlepool and the University of Sunderland took place in January and February of 1997 when twelve medical students were attached to the units for a seven week period. During this time they received formal lectures, clinical teaching, laboratory assessment of fitness, workshops on sports psychology, interpretation of X-rays and workshops on resuscitation and life support. The subsequent introduction of Modernising Medical Careers by the Department of Health has made the undergraduate experience more significant in contributing to career decisions. In the past, clinical education was almost exclusively provided in hospital but there is now much more emphasis on learning in ambulatory settings. Day surgery units can provide the students with better learning opportunities compared to hospital in-patients. It was in the day surgery unit that the students learned basic clinical skills such as suture techniques which could then be transferred to injuries in the field of play. As part of the practical aspects of Sports Medicine the students accompanied medical officers to rugby and football teams. They were particularly privileged to attend Premiership matches in both rugby and football and gain on-field expertise. As part of the option, students in the 4th year of medicine were required to undertake a project which they selected themselves. The projects were presented to their teachers at the University Hospital of Hartlepool and at the University of Newcastle. Three of the projects are listed below and are available online at www.smj.org.uk .
Timely Troponins Avoid Admissions: Clinical Assessment of Undifferentiated Chest Pain
Authors: Baker K , Harrison C 
Published: March 2011

Background Undifferentiated chest pain is a common presentation to acute medicine units. Targeted appropriately timed troponin analysis may reduce unnecessary admissions and relieve bed shortages. We investigated how reliably cardiac chest pain was identified clinically, whether patients had appropriately timed cardiac enzyme analysis, and implications upon rates of admission. Method A prospective data collection was completed on 100 consecutive patients admitted with undifferentiated chest pain to an acute receiving unit over 41 days. We excluded patients with acute coronary syndrome or myocardial infarction already confirmed or excluded. Troponin results were retrospectively documented. Results Of 100 patients admitted, 67 were thought to have cardiac type chest pain as their only or significant differential diagnosis, and 10 were subsequently confirmed as ACS or MI. Not all patients with cardiac type chest pain were assessed in accordance with SIGN guidelines. 38 patients were admitted overnight solely to await the result of troponin analysis, with a total of 411.5 hours spent waiting at an estimated cost of over £7400. Conclusion This study supports the extension of hours of troponin analysis or instant point of care (bedside) cardiac enzyme testing as a cost effective measure, warranting further examination in terms of laboratory service provision.
Titanium Intramedullary Nailing for Treatment of Simple Bone Cysts of the Long Bones in Children
Authors: Pogorelić Z , Furlan D , Biočić M , Meštrović J , Jurić I , Todorić D 
Published: March 2011

Background Simple or unicameral bone cysts are common benign fluid-filled lesions usually located in the long bones of children before skeletal maturity. Pathological fracture is common, and is often the presenting feature. Aim The objective of the present study was to evaluate the results of titanium intramedullary nailing for the treatment of unicameral bone cysts with or without a pathological fracture. Methods During the period 2001 to 2007, flexible intramedullary nailing for the treatment of a unicameral bone cyst was performed in 18 children. Four of these patients presented with a pathological fracture. The cyst was located in the humerus in 14 patients, in the femur in three, and in the tibia in one. The diagnosis was based on typical radiographs and computed tomography. The mean age of the patients at the time of surgery was 9.4 years, and the mean duration of follow-up was 53 months. Radiographic evaluation was performed, and the cyst was classified as completely healed, healed with residual radiolucency, recurred, or having no response. Results Mean hospital stay was 24 hours. At one to four weeks postoperatively, all patients were pain free and had full range of motion of adjacent joints. Radiographic signs of cyst healing were present at three months in all patients, and all cysts healed ompletely. All of the cysts responded to treatment, with no cyst recurrence. No major complications were observed. Conclusion Elastic intramedullary nailing has the twofold benefits of continuous cyst decompression, and early immediate stability to the involved bone segment, which permits early mobilization and return to normal activities
The Changing Face of Hepatitis B in Greater Glasgow: epidemiological trends 1993–2007
Authors: Barclay ST , Cameron S , Mills PR , Priest M , Ross F , Fox R , Goulding C , Forrest EH , Morris AJ , Neilson M , Stanley AJ 
Published: March 2011

Background and Aims Whilst hepatitis B (HBV) is historically uncommon in Scotland, anecdotal experience suggests an increasing prevalence of chronic infection. We sought to establish whether the incidence of chronic HBV is increasing in Greater Glasgow, and whether patients are assessed in secondary care. Methods The regional virus centre database identified HBV surface antigen (HBsAg) positive samples. For adult patients tested in Glasgow between 1993–2007 the first positive test was identified and classified as acute or chronic infection serologically. Clinic referral and attendance data was then obtained. Results 1,672 patients tested HBsAg positive; 1051 with chronic infection, 421 acute and 200 indeterminate. New diagnoses of HBV remained stable over time, however falling numbers of acute cases were mirrored by a rise in chronic cases from 40 to 119 per annum between 2000 and 2007. Of 193 patients diagnosed in 2006 and 2007, 51% were not seen in secondary care due to non referral (43%) or non attendance (8%). Conclusion Chronic HBV trebled in Glasgow between 2000 and 2007. Most patients were not assessed in secondary care. Improved levels of clinic referral and attendance are required to ensure best care for HBV patients in Glasgow.