bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paraplegia due to thoracic disc herniation
Authors: Pal B , Johnson A 
Published: December 2008

SummaryDisc herniation at the thoracic the spine level is more common than generally thought. Localisation of pain may be vague and may erroneously point to cardiopulmonary, gastrointestinal, genito-urinary or even psychiatric disease. Magnetic resonance imaging is the investigation of choice, especially if spinal cord compression is suspected.
Pancreatic adenocarcinoma: why and when should it be resected?
Authors: Ravichandran D , Johnson C D 
Published: December 2008

SummaryAdenocarcinoma of the pancreas is a common and dreadful disease with an extremely poor prognosis. In practice, only a few patients are cured but surgical resection, although feasible in less than 20% of patients, offers maximum prolongation of life and provides good palliation of symptoms. This can now be performed safely, even in elderly patients, in specialist units. Better radiological imaging and laparoscopy allow selection of resectable tumours effectively. All patient with pancreatic cancer should now be assessed for surgical resection and potentially suitable patients should be referred to a specialist team at an early stage.
Sudden death in Whipple's disease
Authors: McGettigan P , Mooney E E , Sinnott M , Sweeney E C , Feely J 
Published: December 2008

Summary
Despite antibiotic therapy, some patients with uncomplicated Whipple's disease die suddenly and inexplicably. We describe one such patient who died following unexplained cardiorespiratory arrest and was found to have chronic active myocarditis related to the causative organism. We postulate myocarditis as a cause of sudden death.
Creutzfeldt-Jakob disease in the elderly
Authors: de Silva R , Findlay C , Awad I , Harries-Jones R , Knight R , Will R 
Published: December 2008

Summary
Creutzfeldt-Jakob disease (CJD) is typically described as a pre-senile dementia. However, cases do occur in the elderly and a case of sporadic CJD in an 86-year-old patient is described. The database of the UK national surveillance unit has been studied, and the age-specific incidences for various age groups over the period 1980–93 calculated. Cases of CJD in those over 80 years old have been identified and their clinical characteristics examined. There is no evidence that CJD presents atypically in the elderly, or that large numbers of cases are being missed in the elderly due to poor ascertainment.
Missed curable carcinoma of the pancreas presenting as chronic pancreatitis
Authors: Wharton S M , Rahman Z , Johnson C D 
Published: December 2008

Summary
We present a case of pancreatic malignancy which presented as chronic pancreatitis. The diagnostic difficulties are discussed. We recommend that when there is any doubt about a diagnosis of chronic pancreatitis with a pancreatic mass, then early resection is appropriate.
Information technology in medical education: current and future applications
Authors: Mooney G A , Bligh J G 
Published: December 2008

Summary
Information technology has the potential to revolutionise the way medicine is learned by students and healthcare professionals. This potential was recognised by the General Medical Council in their 1993 report Tomorrow's doctors in which the need for future generations of doctors to be familiar with the application and scope of information technology is described. This paper focuses on the use of computers as aids to learning medicine and discusses two key applications of information technology to medical education: multimedia and the internet. The current use and potential for these areas of information technology are described and future developments discussed.
Male pseudohermaphroditism due to 5 alpha-reductase-2 deficiency in an Arab kindred
Authors: al-Attia H M 
Published: December 2008

Summary
Six Arabs subjects (three postpubertal, two prepubertal and one pubertal) from three interrelated Omani families with male pseudohermaphroditism due to 5 alpha-reductase-2 deficiency were evaluated. These subjects had been raised as girls since birth as they were born with a clitoral-like phallus and ambiguous external genitalia of pseudovaginal perineoscrotal hypospadias with separate urethral and vaginal orifices. They underwent variable degrees of increased muscular habitus and phallic enlargement during puberty and beyond. Gynaecomastia was absent and the body and facial hair was insignificant. After diagnosis, a transition to male social sex occurred in two cases, one of which was interventional. Two retained the female social sex, one of which was also interventional, while the other two maintained an equivocal gender status. This report provides new data on the characterisation of 5 alpha-reductase-2 deficiency in various clusters.
Ectopic Cushing's syndrome and pulmonary carcinoid tumour identified by [111In-DTPA-D-Phe1]octreotide
Authors: Matte J , Roufosse F , Rocmans P , Schoutens A , Jacobovitz D , Mockel J 
Published: December 2008

Summary
The differential diagnosis and management of Cushing's syndrome remain difficult, particularly for ectopic adrenocorticotropin (ACTH) syndromes resulting from small bronchial carcinoids. We report the case of a 41-year-old man with ectopic ACTH-dependent Cushing's syndrome. Two computed tomography scans of the thorax were normal and magnetic resonance imaging of the chest showed a 6-mm hyperintense T1-weighted area close to the left pulmonary hilus, interpreted as probably vascular by the radiologists. An [111In-DTPA-D-Phe1]octreotide scintigraphy scan demonstrated a positive image for somatostatin receptors in exactly the same location and surgery confirmed the presence of a small ACTH-secreting carcinoid tumour in the upper left lung lobe which was resected. Surgery cured the hypercorticism of the patient. The differential diagnosis of Cushing's syndrome and the procedure for localisation of an ACTH source are discussed.
First-aid treatment of epistaxis–confirmation of widespread ignorance
Authors: Strachan D , England J 
Published: December 2008

Summary
A survey of 500 members of the public was carried out in which they were asked how they would deal with a nose bleed. Only 50 out of 443 responses were judged as being correct, confirming a clinical impression, long held by those dealing with epistaxis, that there is a high level of ignorance as to the correct first aid treatment. The survey also suggested that the lack of knowledge was not confined to the general public but evident in those trained in healthcare.
The neuroleptic malignant syndrome: a logical approach to the patient with temperature and rigidity
Authors: Balzan M V 
Published: December 2008

SummaryThe neuroleptic malignant syndrome is a rare, potentially fatal, adverse reaction to neuroleptic drugs characterised by severe rigidity, high temperature and autonomic dysfunction. In the light of the hypothesized pathophysiology of this condition, a rational approach to the management of patients presenting with temperature and rigidity is provided. The aims of this approach are three-fold: to reduce the incidence of the condition, to be able to recognise it early so as to treat before life-threatening complications arise, and to be able to recognise early those conditions which mimic neuroleptic malignant syndrome, so as not to delay their specific treatment.
Giant cell arteritis presenting as renal vasculitis
Authors: Govil Y K , Sabanathan K , Scott D 
Published: December 2008

SummaryGiant cell arteritis commonly presents with headache, polymyalgia, and visual signs and symptoms. Other neurological, respiratory or vascular symptoms occur in 10–30% of patients. It is extremely rare for giant cell arteritis to present initially with haematuria. Here we describe a case which presented with fever and haematuria, which emphasise the need to be vigilant about the diagnosis of giant cell arteritis as an underlying cause.
The role of surgery in pseudomembranous enterocolitis
Authors: Viswanath Y K S , Griffiths C D M 
Published: December 2008

Summary
Pseudomembranous enterocolitis is an inflammatory bowel disorder caused by Clostridium difficile toxins. Classical presentation includes abdominal pain, pyrexia, diarrhoea and leucocytes. The management is mainly conservative but in extreme cases surgery is necessary. Resectional procedures (colectomy) carry a better prognosis than diversion procedures (colostomy). A careful history, a high index of suspicion, and early diagnosis and treatment would reduce the associated morbidity and mortality of this condition. The aetiopathogenesis, pathology, clinical presentation, diagnosis, differential diagnosis, complications, medical and surgical management are reviewed, and three case reports briefly discussed. A management algorithm is also suggested.
An adolescent girl with abnormal liver profile
Authors: Nair S , Pitchumoni C S 
Published: December 2008

Summary
A 17-year-old previously healthy high school student who lived in a dormitory was referred to our office by her private physician for evaluation of abnormal liver function tests. She was sexually active with one partner but denied any current or past substance abuse. The patient was not taking any medications or nutritional supplements. Family history was unremarkable. Physical examination revealed scleral icterus and minimal hepatomegaly. Spleen was not palpable. The liver function tests are shown in table 1. Total leucocyte count was 6.3 × 109/l with 53% lymphocytes. The platelet count was normal. Anti-Hbc IgM antibody was negative, so were anti-HAV IgM and anti-HCV antibodies. HBsAg was negative and anti-HBs antibody was positive. Erythrocyte sedimentation rate was 16 mm in the first hour. An abdominal sonogram was done to evaluate a persistent elevation in alkaline phosphatase and it showed only hepatomegaly.
Nasal ventilation
Authors: Simonds A K 
Published: December 2008

SummaryNasal intermittent positive pressure ventilation is likely to have an increasing role in the management of acute ventilatory failure, weaning, and chronic ventilatory problems. Further improvements in ventilator and mask design will be seen. Appropriate application is likely to reduce both mortality and admissions to intensive care, while domiciliary use can improve life expectancy and/or quality of life in chronic ventilatory disorders. As with any new technique, enthusiasm should not outweigh clear outcome information, and possible new indications should always be subject to careful assessment.
Three visual techniques to enhance interprofessional learning
Authors: Parsell G , Gibbs T , Bligh J 
Published: December 2008

Summary
Many changes in the delivery of healthcare in the UK have highlighted the need for healthcare professionals to learn to work together as teams for the benefit of patients. Whatever the profession or level, whether for postgraduate education and training, continuing professional development, or for undergraduates, learners should have an opportunity to learn about and with, other healthcare practitioners in a stimulating and exciting way. Learning to understand how people think, feel, and react, and the parts they play at work, both as professionals and individuals, can only be achieved through sensitive discussion and exchange of views. Teaching and learning methods must provide opportunities for this to happen. This paper describes three small-group teaching techniques which encourage a high level of learner collaboration and team-working. Learning content is focused on real-life health-care issues and strong visual images are used to stimulate lively discussion and debate. Each description includes the learning objectives of each exercise, basic equipment and resources, and learning outcomes.
Pyrexia, anaemia and acute renal failure secondary to omeprazole
Authors: Landray M J , Ringrose T , Ferner R E , Arnold I R 
Published: December 2008

SummaryWe present the case of a 77-year-old woman who initially presented with pyrexia of unknown origin, anaemia and mild renal impairment. When her omeprazole was stopped she improved rapidly. When omeprazole was re-started she developed fever and acute renal failure, which again settled quickly on discontinuation of omeprazole. This case demonstrates how drugs can cause severe multisystem disorders that may appear to be infective or inflammatory.
Elevated glycated haemoglobin in non-diabetic patients is associated with an increased mortality in myocardial infarction
Authors: Chowdhury T A , Lasker S S 
Published: December 2008

Summary
Diabetes is associated with increased mortality following acute myocardial infarction compared to the general population. Elevated glycated haemoglobin (HbA1c) in diabetic patients is also associated with increased mortality following acute myocardial infarction, while mild elevation in HbA1c are associated with impaired glucose tolerance. The aim of this study was to determine the influence of HbA1c on outcome of acute myocardial infarction in 253 non-diabetic patients, 46 of whom died in one year. In univariate analysis, risk factors for death included smoking, glucose, cholesterol and HbA1c. In logistic regression analysis HbA1c was an independent risk factor for death. Over one-third of the fatality group had an HbA1c in the highest quartile, compared to one-fifth of the surviving group (p = 0.02). Elevated HbA1c is a risk marker for short-term mortality following acute myocardial infarction in non-diabetic subjects.
Cytomegalovirus infection associated with ulcerative colitis in immunocompetent individuals
Authors: Rachima C , Maoz E , Apter S , Thaler M , Grossman E , Rosenthal T 
Published: December 2008

Summary
Gastrointestinal infection with cytomegalovirus (CMV) is usually found in immunocompromised patients and rarely affects immunocompetent subjects. We describe two immunocompetent patients who had primary CMV infection, and in both the disease was associated with ulcerative colitis. Both patients recovered from the CMV infection spontaneously.
Pneumonitis secondary to the influenza vaccine
Authors: Johnston S D , Kempston A , Robinson T J 
Published: December 2008

Summary
We report a 58-year-old man who developed respiratory distress and interstitial shadowing on chest X-ray 10 days after receiving the influenza vaccine. He failed to respond to intravenous antibiotics but his clinical condition, hypoxia and chest X-ray changes improved dramatically on oral steroids. The clinical diagnosis was pneumonitis secondary to recent influenza vaccination.
Increased serum CA 19-9 antibodies in Sjögren's syndrome
Authors: Safadi R , Ligumsky M , Goldin E , Ilan Y , Haviv Y S , Nusair S 
Published: December 2008

Summary
A 67-year-old woman with a history of thyroiditis presented with recent intermittent epigastric pain and nausea. Hyperamylasaemia, oedema of the pancreas, and high serum levels of lipase and CA 19-9 were found. Xerostomia and dry eyes developed later, accompanied by an abnormal Schirmer's test. The diagnosis of Sjögren's syndrome was confirmed by increased anti-Ro and anti-La antibodies and the histological findings of parotid gland biopsy. Two additional cases of Sjögren's syndrome with elevated serum CA 19-9 are also described. These observations of elevated serum lipase and serum CA 19-9 in Sjögren's syndrome without evidence of malignancy may reflect pancreatic involvement in this disorder.
Acute barium intoxication following ingestion of ceramic glaze
Authors: Thomas M , Bowie D , Walker R 
Published: December 2008

Summary
A case of deliberate overdose of barium sulphide in a psychiatric setting is presented, with resulting flaccid paralysis, malignant arrhythmia, respiratory arrest and severe hypokalaemia, but ultimately with complete recovery. The degree of paralysis appears to be related directly to serum barium levels. The value of early haemodialysis, particularly with respiratory paralysis and hypokalaemia, is emphasised.
De Quervain's subacute thyroiditis presenting as a painless solitary thyroid nodule
Authors: Bianda T , Schmid C 
Published: December 2008

Summary
We describe a 39-year-old woman presenting with a painless solitary thyroid nodule, initially without signs suggesting thyroiditis. The serum level of thyrotropin was suppressed whereas those of thyroxine and triiodothyronine were normal. Fine needle aspiration cytology showed no signs of inflammation or malignancy. One week later, the patient felt pain and tenderness on her neck, and erythrocyte sedimentation rate and C-reactive protein were markedly elevated. Thyroid scintigraphy showed a suppressed thyroid pertechnetate uptake. At that time, the diagnosis of subacute thyroiditis was made. Upon treatment with steroids the patient's symptoms as well as the thyroid nodule resolved. This case illustrates that subacute thyroiditis de Quervain may present as a solitary, painless nodule with suppressed thyrotropin and should therefore be considered in the differential diagnosis of such lesions.
Sudden death associated with group A streptococcal infection in an 8-year-old girl with undiagnosed hypertrophic cardiomyopathy
Authors: Bragonier R , Oades P 
Published: December 2008

Summary
An 8-year-old girl died suddenly without prior symptoms. Post-mortem examination identified both systemic group A streptococcal infection and hypertrophic cardiomyopathy. She had no history of cardiac symptoms and was not in a high-risk group for sudden death due to hypertrophic cardiomyopathy. We believe the disseminated but asymptomatic group A streptococcal infection precipitated her early death from hypertrophic cardiomyopathy. Sudden unexpected death during systemic infection should be followed by post-mortem examination to look for evidence of hypertrophic cardiomyopathy, as this diagnosis has genetic implications for other family members.
Oesophageal subepithelial fibrosis: an extension of oral submucosal fibrosis
Authors: Misra S P , Misra V , Dwivedi M , Gupta S C 
Published: December 2008

Summary
Fifty-five patients with oral submucosal fibrosis and an equal number of patients with no evidence of the disease were studied. All patients underwent upper gastrointestinal endoscopy and any abnormality was noted. Multiple oesophageal biopsies were obtained from the upper end of the oesophagus and from any endoscopically observed abnormality. The histological changes in the two groups were assessed blindly by an experienced histopathologist. Histological abnormalities were noted in the oesophageal mucosa in 2% of controls and 66% of patients with oral submucosal fibrosis (p &lt; 0.0001). In the control group, acanthosis was seen in one patient, while in the patient group atrophy of the squamous epithelium was evident in 52%, hyperkeratosis in 52%, parakeratosis in 30%, dyskeratosis in 14%, acanthosis in 14%, and papillomatosis and mild dysplasia in 2% patients. Subepithelial collagenization was seen in 32 (64%) patients. The oesophageal abnormalities were seen more frequently in patients who had consumed Pan masala, Gutka, betel nut, tobacco or a combination of some or all of these, with or without betel leaf, for &gt; or = 5 years compared to those consuming them for a shorter period of time (91% vs 46%, p &lt; 0.001). It is concluded that oral submucosal fibrosis is not a disease confined to the oral cavity; the oesophagus may also be involved in about two-thirds of patients.
Medical education in the USA—adult-friendly?
Authors: Whitehouse A 
Published: December 2008

Summary
In the United States of America, the Area Health Education Center (AHEC) system of training residents has allowed high-quality postgraduate education to flourish. This paper describes the evolution of the AHECs in the context of medical education over the past 50 years. The arrangements for programme administration and design, resident assessment and appraisal, training of trainers in educational methods, and the accreditation of training programmes are discussed. The fast-evolving UK postgraduate education scene can learn some useful lessons from the US system.
Total gastrointestinal endoscopy in the management of Peutz-Jeghers syndrome
Authors: De Luca N , Chia Y , Gorard D A 
Published: December 2008

Summary
Peutz-Jeghers syndrome was diagnosed in a 51-year-old woman presenting with iron deficiency anaemia. Upper gastrointestinal endoscopy and colonoscopy revealed several hamartomatous polyps in the stomach, duodenum and colon, which were removed. At a combined surgical-endoscopic procedure, 42 hamartomatous polyps were removed from the small intestine by snare polypectomy. This enteroscopic procedure reduces symptoms, may protect against future intestinal obstructive episodes and their associated surgery, and may reduce the risk of developing gastrointestinal malignancy.
Effectiveness of physiotherapy for adults with cerebellar dysfunction: a systematic review
Authors: Martin CL , Tan D. , Bragge P. , Bialocerkowski A. 
Published: December 2008

Objective: To systematically review the literature investigating the effectiveness of physiotherapy in adults with cerebellar dysfunction and to document treatment strategies currently employed in the physiotherapy management of this patient population. Data sources: Eight electronic databases were searched to source English-language studies published up to December 2007. Secondary searching of reference lists was also undertaken. Review methods: Studies were included if they used a quantitative research design to investigate the effect of physiotherapy on adults with diagnosed cerebellar dysfunction. Three reviewers were involved in study selection. Eligible studies were assessed for methodological quality. Data pertaining to the participants, interventions received, outcomes measured, and the effectiveness of the intervention were systematically extracted and synthesised in a narrative format. Results: Nine studies were included in the review. The majority of the studies (n = 7) were case studies or case series. The median quality score was 8/16 (range 4—10). The studies were heterogeneous in terms of patient characteristics, interventions received and outcomes measured. All studies reported positive effects of physiotherapy over a range of outcomes measured, in particular balance, gait and function. Conclusion: There is some evidence that supports the effectiveness of physiotherapy in adults with cerebellar dysfunction. However, these results need to be interpreted with caution due to the low volume, quality and clinical applicability of this evidence. There is a need for further high-quality research in this area.