bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exercise Responses Following Heart Transplantation: 5 Year Follow-Up
Authors: Carter R , Al-Rawas OA , Stevenson A , Mcdonagh T , Stevenson RD 
Published: March 2011

Heart transplantation is an established treatment for end stage heart failure. In addition to increased life expectancy, heart transplant recipients report a remarkable improvement in symptoms and functional capacity. Exercise performance following heart transplantation, however, remains impaired even in the absence of exertional symptoms. We have assessed the response to exercise in 47 patients with cardiac failure prior to and then at yearly intervals to five years post transplantation. All patients performed incremental symptom limited exercise tests during which minute ventilation (V'E), oxygen consumption (V'O2) and carbon dioxide production (V'CO2) and heart rate (HR) were measured. Ventilatory response (V'E/V'CO2), anaerobic threshold (V'O2 AT %predicted) and heart rate response (HR/VO2) were calculated. The dead space to tidal volume ratio (VD/VT) and alveolar-arterial oxygen gradient (A-aO2) were computed from transcutaneous monitoring. Despite substantial improvement in subjective functional capacity, heart transplant recipients continue to have limited exercise performance [Maximal V'O2% predicted pre-transplant 41.3 (2.2); 1 year 48.6 (1.7), p <0.001: V'O2 AT% 31.5 (1.1); 1 year 35.6 (1.0); respectively p<0.05]. The maximal oxygen uptake continued to improve at two years post-transplant but, thereafter, there was no further significant change at up to 5 years post transplant [50.9 (1.5)]. At one year post-transplantation peak HR [65.2 (0.9) vs 79.1(1.4)] and the HR/VO2 response [24.0(1.8) vs 79.6(4.2)] were significantly reduced compared to pre-transplant values. The heart rate response remained lower compared to predicted at 5 years post-transplant although there was a significant increase compared to one year post-transplant (32.9 vs 24.0mls/bt). There was a weak but significant relationship between maximal VO2 and peak HR (0.39, p<0.05) and HR/VO2 (r= 0.37, p<0.05) at one year post-transplant. Prior to transplantation the ventilatory response to exercise was elevated [V'E/V'CO2 45.6 (2.5)] and decreased significantly following transplantation [1 yr 34.1 (1.3), respectively p<0.001]. In addition, despite significant improvement in VD/VT after transplantation, it remained higher than normal [Pre VD/VT at maximum exercise 0.35 (0.02); 1 yr 0.31 (0.02); p<0.05]. There was a further fall in the VE/VCO2 and VD/VT at two years post-transplantation with no further change at up to 5 years post transplantation [VE/VCO2 32.0 (1.0); VD/VT 0.29 (0.01)]. Although cardiac output is markedly improved after transplantation, due to chronotropic incompetence associated with denervation, its response remains subnormal and this may explain the residual abnormalities of ventilatory and gas exchange responses to exercise following transplantation.
Patients’ attitudes towards mydriasis for diabetic eye disease screening
Authors: Murgatroyd H , Macewen C , Leese Gp 
Published: March 2011

Aims The purpose of the questionnaire was to explore attitudes of patients towards mydriasis for diabetic retinopathy screening. Methods Two groups of patients were invited to take part: group 1 comprised patients attending the diabetic clinic and had previous experience of mydriasis, group 2 patients attending the mobile screening unit for non-mydriatic digital retinal photograph and who were not previously used to receiving mydriatic eye drops. Basic demographic data was recorded and the volunteers invited to complete a questionnaire. Results 292 patients were recruited into group 1 (median age 63 years range 20-94) and 103 into group 2 (median age 68 years range 29-96). 42% of patients in group 2 indicated that they were unhappy with the use of dilating eye drops and 26% of this group reported that they may be discouraged from attending screening for diabetic retinopathy if drops were introduced. These figures were statistically lower in group 1 at 8% and 1-8% respectively (p<0.001). Blurring of vision was identified as the most troublesome feature of the use of mydriasis for patients. A large proportion of patients drove themselves to their last screening appointment; 58% in group 2 and 39% in group 1. A third of all patients (33%) indicated that they worked outside the home. Conclusions Many patients attending diabetic eye screening return to driving and work immediately after the appointment. Introduction of the use of routine drops may discourage attendance. Education and experience may have an important role in improving acceptability of mydriatic eye drops. Retinal screeners need to have clear guidelines with which to advise patients.
The Relationship Between Serum Creatinine and Estimated Glomerular Filtration Rate: Implications for Clinical Practice
Authors: Nelson Aw , Mackinnon B , Traynor J , Geddes CC 
Published: March 2011

Introduction A new classification of chronic kidney disease (CKD) has been widely adopted that stratifies patients into 5 ‘stages’ according to estimated glomerular filtration rate (eGFR). In adults the most commonly used formulae to calculate eGFR are the Cockcroft and Gault (C&G) and Modification of Diet in Renal Disease (MDRD) formulae. The UK Renal Association has recommended calculation of MDRD eGFR to screen for reduced kidney function in primary and secondary care. Aim The aim of this study was to explore the implication of using these predictive formulae. Methods We searched for patients currently attending a renal clinic who have ever had a serum creatinine (SCr) of exactly 100 mol/L, 150 mol/L or 200 mol/L. The C&G and MDRD eGFRs corresponding to that SCr were calculated. The proportion of patients in each stage of the CKD classification was determined. Results For a SCr of 100 mol/L mean eGFR was 86.5ml/min (range 31.0 - 192.8) by C&G and 63.8ml/min (range 39.7 - 99.9) by MDRD (p<0.0001; t-test of mean). For SCr 150 mol/L mean eGFR was 51.7ml/min (18.0 - 110.4) by C&G and 38.0ml/min (20.7 - 54.8) by MDRD (p<0.0001). For SCr of 200 mol/L mean eGFR was 34.4ml/min (12.6 - 89.5) by C&G and 27.3ml/min (16.7 - 41.3) by MDRD (p<0.0001). Using MDRD eGFR 46.5% patients with a SCr of 100 mol/L have stage 3 CKD (GFR 30-60ml/min) and all patients with a SCr of 150 mol/L or 200 mol/L have CKD 3 or worse. 8.6% of males with SCr 100 mol/L had stage 3 CKD or worse compared with 86.8% females. 70.2% patients > 65 years old with SCr 100 mol/L had stage 3 CKD. Conclusions Targeted screening of patients at-risk for CKD will identify a large number of patients who require management of CKD and potential referral to nephrology services even at levels of SCr regarded as ‘normal’ or mildly elevated. This will apply especially to elderly patients and females.
Acute Abdomen as a Cause of Death in Sudden, Unexpected Deaths in the Elderly
Authors: Ng CY , Squires TJ , Busuttil A 
Published: March 2011

Aims This study profiles patients aged 70 years or above dying suddenly of an ‘acute abdomen’ and investigates the specific features associated with the conditions and their diagnoses. Methods A retrospective study using data obtained from autopsy and police reports held in the Forensic Medicine Section of the University of Edinburgh. Results From 1997 to 2000, out of 2121 autopsies of patients aged 70 or above, an ‘acute abdomen’ was considered as a primary cause of death in 111 cases. The number of cases increased over the period of study. Peptic ulcer disease was the commonest underlying cause of death. Twenty-nine (26.1%) cases were due to its complications, namely gastrointestinal haemorrhage and perforation. Sixty-nine (62.2%) patients were seen by a medical practitioner in circumstances arising from the onset of acute abdomen. In 27 (39.1%) cases a provisional diagnosis was recorded. Conclusion The ‘acute abdomen’ is still an appreciably frequent cause of death in sudden, unexpected deaths in the older age group. Some of the deaths may have been preventable with an early diagnosis. A high level of vigilance and early attention to an ‘acute abdomen’ by medical practitioners is therefore advocated.
Presence of Herpes Simplex Virus on the Oral Mucosa in Patients Undergoing Chemotherapy
Authors: Djuric M , Pavlica D , Jankovic Lj , Milasin J , Jovanovic T 
Published: March 2011

Background The aim of this study was to confirm the presence of herpes simplex virus type 1 and 2 on the oral mucosa, in patients undergoing chemotherapy, by means of polymerase chain reaction (PCR). Methods The research was carried out on 40 patients receiving chemotherapy as treatment for different malignancies. The status of oral mucosa and viral presence were assessed in all patients at the initial examination (prior to chemotherapy), and at the control examination (two weeks after the initiation of the chemotherapeutic cycle). Results The presence of HSV-1 was detected in 28 patients (70%) prior to chemotherapy, of whom 7 (25%) manifested oral complications. The control examination showed the presence of HSV-1 in 35 patients (87.5%), of whom 23 (65.7%) presented oral mucosa changes. HSV-2 has not been detected in any of the patients.
Birth Weight and Maternal Glycated Haemoglobin in Pregnancies Complicated by Type 1 Diabetes
Authors: Kernaghan D , Penney GC , Pearson DWM 
Published: March 2011

Aim To re-examine the relationships between birth weight and maternal glycated haemoglobin (HbA1c) concentration at different time points in pregnancies complicated by pre-gestational type 1 diabetes. Methods A dataset was collected prospectively on all deliveries in Scotland to women with pre-gestational type 1 diabetes occurring during two 12 month periods (01/04/98 to 31/03/99 and 01/04/03 to 31/03/04). Relationships between standardised measures of birth weight and HbA1c at each time point were examined using correlation analysis. Results Standardised birth weights (Z scores) were calculated for 338 singleton live born infants. HbA1c concentrations were available for: 204 women (pre-pregnancy), 297 women (1st trimester), 314 women (2nd trimester) and 303 women (3rd trimester). Standardised birth weight showed a unimodal distribution shifted to the right relative to a reference population (Mean, +1.62 S.D). There was a significant negative correlation between pre-pregnancy HbA1c and birth weight (Spearman's Rho -0.138; p=0.049). Conclusions Standardised birth weights of the infants of diabetic mothers are higher than those of a reference population. There is no simple relationship between maternal glycaemic control and birth weight, but the previously described paradoxical inverse relationship between pre-pregnancy glycaemic control and birth weight has been confirmed using a larger dataset.
Vasectomy Reversal: Is the Microscope Really Essential?
Authors: Gopi SS , Townell NH 
Published: March 2011

Objective To evaluate the outcomes of bilateral vasectomy reversal procedure in relation to the macroscopic technique, surgical time and duration of obstructive interval. Materials and methods We performed a retrospective study over a twelve-year period using a macroscopic technique. All cases of vasectomy reversal were consecutive and performed by the same surgeon. The procedure was performed using a single layer, spatulate end to end anastomosis technique using 6×6-0 prolene. No loupe magnification was used. Results The median age of the men was 42 years (range 30-56). The median obstructive interval in years was 8.5 years (range 2-23). The procedure was a day case and the median surgical time under general anaesthetic was 75 minutes (range 45-90). None of the patients required hospital admission following discharge. 63 of the 70 patients had positive patency test postoperatively (90 %). The sperm count was more than twenty million /ml. The pregnancy rate was 54 % and the miscarriage rate was 7.1%. Conclusion The outcomes of macroscopic vasectomy reversal performed by an experienced surgeon can have a high success rate using the macroscopic single layer spatulate end to end anastomosis technique. This technique is easy to learn compared to the learning curve involved in microsurgery and is an effective means of “re- establishing” fertility in vasectomised men.
Clinical Audit: Optimal Positioning of Endotracheal Tubes in Neonates
Authors: Whyte KL , Levin R , Powls A 
Published: March 2011

Background The malposition of endotracheal tubes (ETTs) can be associated with endo-bronchial intubation or accidental extubation. A variety of methods have been reported for predicting insertional length (IL) including weight, nasal-tragus length (NTL) and sternal length (STL) measurements. In our unit no consistent predictor method was being used. Aim To audit the proportion of endotracheal tubes that required a significant position change after oral intubation. Our standard set was that the endotracheal tube should be in a satisfactory position in >80% of cases. If not met, practice would then be re-audited after a consistent predictor method had been implemented. Methods Data regarding changes in endotracheal tube position were collected. Significant position changes were defined as adjustments>0.5 cm. Results Twenty two babies were included in the initial audit, and only 73% of endotracheal tubes had a satisfactory position. Thirty six babies were included in the re-audit and when the nasal-tragus length predictor was used, 94% of endotracheal tubes had a satisfactory position, meeting the standard. Conclusion The nasal-tragus length predictor improved the accuracy of endotracheal tube positioning after oral intubation. It is a simple, fast, reproducible method and can be used in everyday practice to help avoid significant endotracheal tube malposition.
Outcome of Aggressive Fibromatosis Treated with Radiation Therapy
Authors: Guney Y , Hiçsönmez A , Andrieu MN , Kurtman C 
Published: March 2011

Introduction The purpose of this study is to report the clinical course and outcome in 7 patients with aggressive fibromatosis. Material and Methods Between the years 2000 and 2003, 7 patients who were treated with combined modalities were evaluated retrospectively. Patients' demographic information, including age and gender, tumour characteristics, surgical resection, and the use of radiotherapy were recorded and evaluated. Results The mean patient age was 34 years. The median time to follow-up was 15.5 months. Resection was performed with positive surgical margins in three cases. Three patients were evaluated as inoperable and one patient was treated with debulking surgery. All patients received radiation therapy with a median dose of 51 Gy. At followup, three patients had no evidence of disease, three patients were alive with disease, and one patient died 15 days after radiotherapy. Conclusion Local control is the primary problem in aggressive fibromatosis. There is no appropriate treatment for aggressive fibromatosis and the type of treatment depends on tumour characteristics and location as well as patient characteristics.
A Survey of Current Surgical Treatment of Acute Gallstone Disease in the West of Scotland
Authors: Campbell E J , Montgomery D A , MacKay C J 
Published: March 2011

Background National guidelines exist for the treatment of acute gallstone pancreatitis, but not for the management of acute cholecystitis (AC). Aims To establish the preferred management of uncomplicated AC and adherence to guidelines for the management of mild gallstone pancreatitis in the west of Scotland. Methods A postal survey of all 100 consultant general surgeons in the west of Scotland. Results 67 of 71 responses received were suitable for analysis. For uncomplicated AC, 24 (36%) perform urgent laparoscopic cholecystectomy (LC), 16 (24%) perform same admission LC after clinical improvement. 23 (34%) perform interval LC after discharge. Within this group, 9 surgeons (13%) manage AC conservatively due to insufficient operating time or equipment when on call. In mild gallstone pancreatitis, 33 (49%) perform same admission LC, 13 (19%) perform sphincterotomy, 3 (4.5%) perform one of these depending on the patient and 6 (9.5%) refer to a colleague with an interest in upper gastrointestinal surgery. Conclusions The majority of surgeons (over 60%) manage AC with same admission LC. Of those who do not, more than a third report lack of resources as being the reason. The majority of surgeons in the West of Scotland manage mild gallstone pancreatitis in accordance with current guidelines.
Childhood Empyema in North-East Scotland over the Past 15 Years.
Authors: Roxburgh CSD , Youngson GG 
Published: March 2011

Introduction The incidence of paediatric empyema is rising in the United Kingdom and North America. The reasons for increasing admissions are unclear. Management in tertiary units is often required. We report our experience in North-East Scotland over the last 15 years. Methods Empyema patients <15yrs admitted to the Royal Aberdeen Children's Hospital between 1st January 1990 and 1st June 2006 were identified using discharge coding. Data was collated from case notes. Patient characteristics, microbiology results, hospital stay and management are studied. Results Twenty eight children (M:F=1:1) were admitted. Mean age=6.8 yrs. Twenty seven out of twenty eight presented with localising respiratory symptoms or signs. In 12/28 an organism was isolated. Streptococcus pneumoniae was the commonest isolate, and where polymerase chain reaction (PCR) testing was employed, 3/3 cases were serotype 1. Fourteen out of twenty eight required surgery: open (8/14) or thoracoscopic (6/14) decortication. Two thoracoscopic cases proceded to open decortication. No complications were observed. Mean hospital stay=11.4 days. Twelve were managed in high dependency unit (HDU) with a mean stay of 7.1 days. Discussion We demonstrate similar trends in North-East Scotland to those reported elsewhere. Serotype 1 streptococcus pneumoniae is the most isolated. Multi-drug resistance is not seen in our population. A surveillance programme is now established and reasons for the increasing incidence should become apparent.
The Early Impact of the United Kingdom Chronic Kidney Disease (CKD) Guidelines on the Number of New Attendances at Renal Clinics
Authors: Aghaie-Jaladerany H , Cowell D , Geddes C C 
Published: March 2011

Introduction In April 2006 the United Kingdom (UK) Chronic Kidney Disease (CKD) guidelines and laboratory estimated glomerular filtration rate (eGFR) reporting were introduced to encourage identification and appropriate management of patients with CKD. The aim of this study was to assess the early impact of the implementation of the UK CKD guidelines on new patient attendances at nephrology clinics in our unit. Methods The number of adult new patients, sex, mean age and number in each CKD stage were analysed in consecutive 6 month blocks from 2000 to 2006. Results The number of new attendances gradually rose 2000 to 2006 until an abrupt 48% rise from 333 to 492 patients in the 6 months before and after June 2006. Between the second 6 months of 2005 and second 6 months of 2006 the proportion of females (43.4% to 56.3%; p<0.0001) and mean age (61.3 v 66.4 years; p<0.0001) rose abruptly. The increase was mainly in patients with stage 3B (eGFR 30-44.9ml/min/1.73m2) and stage 4 CKD (15- 29.9ml/min/1.73m2). Discussion The data demonstrate that substantial changes in practice can be implemented rapidly within both primary and secondary care. Further studies will determine if this is going to improve outcome in patients with CKD.
Knowledge about Genital Herpes Amongst First Time Attenders at a Department of Genitourinary Medicine
Authors: Ray AG , Mcmillan AM 
Published: March 2011

Background and Aims Genital herpes is the most common cause of genital ulceration in the developed world, and its prevalence in the United Kingdom is rising. Public knowledge of the infection is often limited. We aimed to assess knowledge among patients attending an outpatient genitourinary clinic in Scotland. Methods A questionnaire was designed to collect information about educational qualifications and knowledge of genital herpes. In the knowledge section, each correct answer was given a score of 1; thus the maximum possible score was 12. Two hundred and ten individuals who attended as new patients at a walk-in genitourinary medicine clinic were invited to complete the questionnaire. Results Two hundred and seven patients completed the questionnaire. Overall 63% of responses were answered correctly. Knowledge of genital herpes was better in patients who worked in healthcare (8.3 v 6.9, p=0.019) and in patients with educational qualifications gained from college or university compared to those gained at school (7.6 v 6.5, p=0.009). Level of knowledge was not related to age or gender; receiving sex education at school did not appear to improve knowledge of genital herpes. Conclusion Knowledge of genital herpes among patients attending an outpatient genitourinary clinic in Scotland is reasonable but needs to improve to combat the rising prevalence of the infection. The areas of misunderstanding identified in our study could be targeted for public education.
The Effect of Intra-Neural Local Anaesthetic Infusion on Pain Following Major Lower Limb Amputation.
Authors: Grant AJ , Wood C 
Published: March 2011

Background Critical lower limb ischaemia has an annual incidence of 500 — 1000 per million and around a quarter will undergo a major lower limb amputation. Post operative pain and phantom pain are recognised complications. Aim The aim of this study was to assess the role of postoperative intraneural infusion of local anaesthetic in patients under-going major lower limb amputation. Methods Between May 1998 and July 2001, following amputation patients either had standard post-operative analgesia or had an intra-neural infusion of 0.5% bupivicaine via an infant feeding catheter connected to a standard syringe pump (Alaris®). This was a retrospective review and clinical notes of these patients were analysed to assess their post operative course, analgesic requirements and to ascertain phantom limb pain/sensation rates. All the data collected was from standard drug charts, case note entries and out-patient letters. Results During this time period 64 patients had a major lower limb amputation (31 patients treated routinely and 33 patients had an intra-neural anaesthetic (INA) catheter placed). In the INA group median post-operative opioid analgesia requirement was 10mg versus 74mg (p=0.0002, Mann-Whitney U) and post-operative prescription of amitriptyline for phantom pain was less common (4 patients versus 11 patients; p=0.0281, Mann-Whitney U). There was no obvious increase in complications or significant adverse events. Conclusions Postoperative intra-neural local anaesthetic infusion is a safe and effective technique. It reduces post-operative opioid analgesia requirement and seems to reduce phantom pain development.