bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carcinoid syndrome due to a malignant somatostatinoma
Authors: Ozbakir O , Keleştimur F , Oztürk F , Sözüer E , Unal A , Patiroğlu T E , Güven K 
Published: December 2008

Abstract
Somatostatinoma is one of the rarest tumours of the endocrine pancreas. Cardinal manifestations of a somatostatinoma include gallstones, mild diabetes mellitus, steatorrhoea, diarrhoea and dyspepsia. Like any other pancreatic islet cell carcinoma, a somatostatinoma may also produce several different hormones such as adrenocorticotropic hormone, calcitonin, vasoactive intestinal polypeptide, pancreatic polypeptide, gastrin, insulin, and glucagon. In many cases, the clinical picture is dominated by the effect of these other hormones. We present a patient with somatostatinoma in which an immunocytochemical study of the specimens from pancreas and liver showed a weak positive reaction for gastrin besides a strong positive reaction for somatostatin. Interestingly, this patient also showed the signs of carcinoid syndrome which was successfully treated with octreotide.
Medullary carcinoma of the thyroid metastatic to breast
Authors: Kiely N , Williams N , Wilson G , Williams R J 
Published: December 2008

Abstract
Medullary carcinoma of the thyroid commonly spreads to the lymphatics and later on in the disease process, to distant sites such as lung, liver and bone. Spread to the breast is rare (only two previous reported cases) and presents a major diagnostic dilemma. We report a case of metastatic medullary carcinoma of the thyroid which presented as a primary breast nodule with ipsilateral axillary lymphadenopathy. Clearly it was important to distinguish this tumour from a breast primary as each are managed differently. Both cytological and radiological investigations were inconclusive but excision biopsy was diagnostic.
Bacterial meningitis after MMR immunisation
Authors: Riordan F A , Sills J A , Thomson A P , Hart C A 
Published: December 2008

Abstract
Two children developed bacterial meningitis within five days of measles-mumps-rubella (MMR) immunisation. Diagnosis was delayed because symptoms were attributed to the vaccine, although both had a raised C-reactive protein. Fever or rash within five days of MMR vaccination are unlikely to be due to the vaccine and a raised C-reactive protein suggests bacterial infection.
Neuropathic urinary retention in the absence of neurological signs
Authors: Sylvester P A , McLoughlin J , Sibley G N , Dorman P J , Kabala J , Ormerod I E 
Published: December 2008

Abstract
We present two cases of painless urinary retention secondary to central intervertebral disc prolapse. In neither case were there signs or symptoms suggesting an underlying neurological insult. Both patients voided spontaneously following neurosurgical intervention. The classical features of acute cauda equina compression may be absent in patients with central lumbar disc protrusion. Painless urinary retention may be the only physical sign.
Diagnostic and management problems in a complex case of connective tissue disease
Authors: Yeap S S , Deighton C M , Powell R J , Read R C , Finch R G 
Published: December 2008

Abstract
A 28-year-old Nigerian woman presented with persistent pyrexia, marked pruritis, eosinophilia, myalgias, flitting arthralgias, serositis and massive splenomegaly. Intensive investigation for an infective or neoplastic aetiology proved negative. Empirical treatment for helminthic infections and tuberculosis was unhelpful. Although there were no specific clues to suggest an underlying connective tissue disease, a trial of steriods and azathioprine was introduced, with no obvious response. Her condition deteriorated to a point where it was decided that intravenous immunosuppressive therapy was needed and subsequently, her condition improved remarkably. This patient illustrates the problems in the diagnosis and management of complex disorders, particularly when classical tests for connective tissue diseases are absent. Also, we would like to report that marked pruritis can be associated with connective tissue disease.
Massive reversible pulmonary cysts in a patient with AIDS
Authors: Collazos J , Martínez E , Mayo J , Miguélez J L 
Published: December 2008

Abstract
We report the case of a patient with AIDS who presented with bilateral, massive pulmonary cystic disease and pneumothorax presumably caused by Pneumocystis carinii which responded to treatment with cotrimoxazole. Follow-up with sequential chest X-rays and computed tomography scans showed a progressive improvement in the lung cysts which had resolved almost completely 11 months later. Several theories have been proposed to explain the cavitary lesions in this infection. The course observed in our patient suggests that a non-destructive mechanism was responsible for his lung cysts.
Clinical guidelines and their implementation
Authors: Forrest D , Hoskins A , Hussey R 
Published: December 2008

Abstract
Within the UK there has been increasing interest in the development and implementation of guidelines, as the emphasis on clinical effectiveness is gathering momentum. This paper outlines some of the practical issues encountered in developing and implementing guidelines, based on experiences within Liverpool. Developing local guidelines can be a lengthy process, but that process is not a waste of time if it means there is more likely to be compliance in the end. Dissemination of guidelines alone is not enough; it needs to be combined with an appropriate implementation strategy. There is a danger of primary care being overloaded with new guidelines; there needs to be a timed strategy for their introduction. More imaginative thought needs to be put into the marketing of new ideas in order to change practice. We need to encourage the ethos amongst healthcare professionals of expecting to have to constantly update knowledge and practice.
Incidental mucinous cystadenocarcinoma of the appendix
Authors: Lee J , Gardiner K R , Wilson B G 
Published: December 2008

Abstract
The incidental finding of a rare appendiceal tumour in a previously healthy male patient is described. He presented as an emergency with a self-inflicted abdominal stab injury. At laparotomy, there was no visceral damage but the appendix was hugely distended and appendectomy was performed. Subsequent histological examination of the appendix revealed a low-grade mucinous cystadenocarcinoma. A right hemicolectomy was performed two months later which demonstrated no residual tumour.
Local anaesthesia for major general surgical procedures. A review of 116 cases over 12 years
Authors: Dennison A , Oakley N , Appleton D , Paraskevopoulos J , Kerrigan D , Cole J , Thomas W E 
Published: December 2008

Abstract
Between 1980 and 1992, 116 patients had either a simple mastectomy (32) or intra-abdominal procedures (84) under local anaesthesia (0.5-1% lignocaine with 1:200 000 adrenaline). A wide variety of general surgical procedures were feasible using only supplementary intravenous sedation (54%). Complications were uncommon and related to surgical procedure (three incorrect diagnoses, three procedures impossible) rather than the anaesthetic technique. There were no anaesthetic toxicity or postoperative problems. Local anaesthesia is extremely safe and facilitates larger surgical procedures than is generally appreciated.
The risk of severe salicylate poisoning following the ingestion of topical medicaments or aspirin
Authors: Chan T Y 
Published: December 2008

Abstract
Apart from isolated reports of severe salicylate poisoning after ingesting an unusually large amount of a medicinal oil, there are no published data on the threat arising from attempted suicide with topical medicaments containing methyl salicylate or wintergreen oil compared with aspirin tablets. In this retrospective study, the admission plasma salicylate concentrations and clinical presentations were compared in 80 subjects who had taken aspirin tablets (n = 42) or topical medicaments (n = 38). The proportions of subjects being symptomatic were similar in the two groups. Although the admission plasma salicylate concentrations were generally higher in subjects who had ingested aspirin tablets, the two highest readings (4.3 and 3.5 mmol/1) belonged to two of the subjects who had taken topical medicaments. Because of its liquid, concentrated form and lipid solubility, methyl salicylate poses the threat of severe, rapid-onset salicylate poisoning. The toxic potential of topical medicaments containing methyl salicylate or wintergreen oil should be fully appreciated by both physicians and the general public.
Abdominal pain in a young girl
Authors: Handa R , Chirukpalli R , Agarwal S , Mukhopadhyaya S , Gupta R , Sood R , Meena H S , Wali J P 
Published: December 2008

Abstract
A 14-year-old girl was admitted to our hospital with peri-umbilical pain associated with obstipation and vomiting. Plain erect X-rays of the abdomen revealed multiple air fluid levels. A supine X-ray is shown in this figure.
Four years of problem-based learning: a student’s perspective
Authors: von Doebeln G 
Published: December 2008

Abstract
After four years as a student in a medical school using problem-based learning I still find it an excellent way to learn. Group work has developed my personal skills and abilities. Learning how to obtain knowledge on my own has given me independence and confidence. Motivation to study has been encouraged by early clinical experience. Training in critical thinking has been further enhanced by in-depth studies. Medical education at the University of Linkoping has developed over the years and a contributing factor has been students’ involvement in designing the medical training. There are benefits and disadvantages with problem-based learning, but on the whole it is an enjoyable and fruitful experience.
Making medical recruitment practices fair
Authors: Maddock S 
Published: December 2008

Abstract
The fact that in the past each medical student was assured of a post when qualified has led many in medicine to believe that selection for recruitment is merely a formality based on qualification and accreditation. Consequently little thought has gone into developing detailed person or post selection criteria. As a result most recruitment panel members are unclear on what basis to discriminate between equally qualified candidates and invariably plump for ‘the face that fits’. This practice discriminates against women, black doctors and those white men not quite acceptable in manner, dress or attitudes. In this article, advice is offered on the development of equality strategies for public sector organisations and on the implementation of fair practices.
Aerosol delivery systems for bronchial asthma
Authors: Ariyananda P L , Agnew J E , Clarke S W 
Published: December 2008

AbstractMany different inhalation devices are now available for the treatment of asthma. Pressures towards the elimination of chlorofluorocarbon propellants are driving forward development of new devices-as are obvious commercial pressures, including the increased availability of generic formulations. We still, however, often cannot tell exactly where within the lung we want to target a particular medication, be it a bronchodilator or a steroid. The basic processes of aerosol deposition are readily comprehensible. Nevertheless, even under carefully supervised inhalation conditions, one can only roughly estimate where the medication is deposited. We can, however, hope to give our patients good guidance on how to make the best use of a metered-dose inhaler or a jet nebuliser. From the array of available devices, we will increasingly be able to select the most comfortable and convenient for the patient-and therefore most likely to encourage good compliance.
Adrenal incidentaloma: subclinical Cushing’s syndrome
Authors: Newell-Price J , Grossman A 
Published: December 2008

Summary
Adrenal incidentalomas present a significant differential diagnostic challenge. All patients with an incidentally discovered adrenal lesion should be carefully considered and re-evaluated to exclude extra-adrenal malignancy. Tumours with hypersecretory syndromes require excision, whilst those tumours more than 6 cm in size, particularly if they exhibit other features of malignancy on computed tomography (CT), magnetic resonance imaging (MRI) or scintigraphy, should also be excised. In all cases screening for phaeochromocytomas should be performed, and in the context of hypertension and spontaneous hypokalaemia, a primary aldosterone-secreting tumour requires exclusion. However, the natural history and treatment regimens for those individuals demonstrating ‘subclinical Cushing’s syndrome’ is far from clear. Size, as determined by CT or MR scanning, does not in itself reliably distinguish benign from malignant disease. Scintigraphy may be a useful adjunct, with discordant patterns suggesting malignant disease. Fine needle aspiration should not routinely be used but may be useful in cases of doubt about other extra adrenal malignancy.
Satellite-delivered continuing medical education in Europe
Authors: Geraghty J G , Young H L 
Published: December 2008

Summary
There is increasing recognition of the need for continuing medical education in the medical profession. There are now many ways of delivering medical education including conferences, books, journals amongst others. This paper describes a novel method of delivering medical education using satellite transmission. This medium allows live medical education programmes to be broadcast to over 150 receiver sites in Europe. It also enables two-way live satellite links to be made between countries during the broadcast. EuroTransMed has an editorial board, in much the same way as a journal, which is representative of the differing medical societies in Europe. As the barriers between the various countries fall, EuroTransMed is an ideal medium to promote high quality, easily accessible, continuing medical education at a pan-European level.
Minoxidil, hypercoagulability and thromboembolic disease of the lung
Authors: Keohane S G , Edmunds M , Holton J , Swales J D 
Published: December 2008

Summary
Minoxidil is a potent antihypertensive agent used in the treatment of resistant hypertension. A case is presented which illustrates a probably fatal interaction between minoxidil and a coagulation disorder.
Thoracic spondylosis presenting with spastic paraparesis
Authors: Chana J S , Afshar F 
Published: December 2008

Summary
Spondylotic change of the spine is common in the cervical and lumbar regions and may present with compression of the spinal cord and nerve roots. Myelopathy due to degenerative disease in the thoracic spine is exceptional. Only a few cases have been reported in the literature and these reports have described disease in the lower four thoracic segments. We report a case of paraparesis caused by degenerative disease in the upper thoracic spine which has not previously been described.
The evaluation and management of subclinical pituitary disease
Authors: Soule S G , Jacobs H S 
Published: December 2008

Summary
The advent of sophisticated and sensitive radiologic techniques has undoubtedly improved the evaluation of patients with established endocrine disease. An inevitable consequence of the increased sensitivity and widespread availability of modern imaging is, however, the discovery of apparently asymptomatic mass lesions in endocrine tissues. The clinician is then required to determine the appropriate degree of often uncomfortable and costly investigation in a patient with no overt disease. This article attempts to provide guidelines for the management of the ‘pituitary incidentaloma’, a pituitary mass lesion evident on a computed tomography or magnetic resonance imaging scan performed for a reason other than the evaluation of the pituitary gland.
Nocturnal and respiratory disturbances in Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy)
Authors: De Bruin V S , Machado C , Howard R S , Hirsch N P , Lees A J 
Published: December 2008

Summary
Respiratory and sleep disturbances may be important causes of morbidity in Steele-Richardson-Olszewski syndrome but the frequency and character of nocturnal abnormalities remains uncertain. A prospective study of 11 patients with Steele-Richardson-Olszewski syndrome and age-matched control subjects was undertaken using clinical assessments, a structured sleep questionnaire, spirometry, static maximum inspiratory and expiratory pressures and nocturnal oximetry. The mean age of the Steele-Richardson-Olszewski syndrome patients was 63.2 (52-70) years and mean disease duration was 4.0 (2-6) years. There was moderate to severe motor disability in nine and mild to moderate dementia in eight. In the patients with Steele-Richardson-Olszewski syndrome the following abnormalities contributed to sleep disturbances significantly more frequently than in normal controls: depression, dysphagia, frequent nocturnal awakenings (usually associated with urinary frequency), immobility in bed, difficulty with transfers, impaired dressing and feeding. There was profound impairment of voluntary respiratory control whilst automatic and limbic control were well maintained. Nocturnal respiratory abnormalities were not present even in the most severely disabled. In Steele-Richardson-Olszewski syndrome sleep abnormalities are common; they relate to the cognitive, pseudobulbar and extrapyramidal disturbances and may therefore be amenable to symptomatic control.
Gallstone ileus--beware the silent second stone
Authors: Davies J B , Sedman P C , Benson E A 
Published: December 2008

Summary
Gallstone ileus remains a rare but important cause of small bowel obstruction. We report a case of recurrent gallstone ileus, presumably caused by an unidentified second stone resident within the gallbladder at the time of the initial laparotomy. This raises important questions about the traditional surgical management of this interesting condition.
Transitional cell carcinoma of the bladder in an HIV-infected patient
Authors: Al Soub H 
Published: December 2008

Summary
A case of transitional cell carcinoma of the urinary bladder in a patient infected with the human immunodeficiency virus is reported. The tumour was very large, occupying most of the bladder, however cystoscopic removal of the tumour was successful with no recurrence after one year. This association has never reported before. The possible contribution of human immunodeficiency virus infection to its occurrence is discussed.
Spindle cell stromal tumour of the rectum treated by restorative resection
Authors: Harrison J D , Musgrove C , Kirby R M 
Published: December 2008

Summary
Stromal tumours of the rectum and anal canal are rare, representing 0.02-0.03% of malignant neoplasms in the region. Current advice in their management is treatment by abdomino-perineal resection. We report a case of malignant spindle cell stromal tumour in which adequate clearance was obtained whilst preserving the anal sphincter, using a posterior parasacral approach.
Chronic pancreatitis: diagnosis and treatment
Authors: Sidhu S , Tandon R K 
Published: December 2008

SummaryThree-dimensional magnetic resonance cholangiopancreatography is currently the most exciting new imaging technique for chronic pancreatitis. Endoscopy-assisted duodenal intubation during the secretin-cholecystokinin test reduces intubation time in difficult cases. The NBT-para-amino benzoic acid test has been refined to enhance its discriminant power. The cholesteryl-[C13]octanoate breath test and the faecal elastase test are newer highly sensitive and specific tubeless tests. Pain in chronic pancreatitis continues to be a vexing therapeutic issue. Enzyme treatment continues despite criticism. Neurotensin is the new suspected mediator of the feedback mechanism, which is downregulated by enzyme therapy. Steroid ganglion block is an exciting therapeutic tool for pain relief. Endoscopic pancreatic sphincterotomy, Dormia basketing and pancreatic stenting in conjunction with extracorporeal shock wave lithotripsy should be performed early in chronic pancreatitis to prevent parenchymal atrophy with ensuing exocrine and endocrine pancreatic dysfunction. The modified Puestow’s procedure preserves endocrine and exocrine pancreatic functions besides relieving pain. Closed loop insulin infusion allows superior management of pancreatic diabetes following near total pancreatectomy. The standardised incidence rate of pancreatic cancer is 16.5 in patients with alcoholic chronic pancreatitis and 100 for tropical chronic pancreatitis. Aggressive treatment protocols combining neo-adjuvant chemoradiation and intra-operative radiation with surgery are being used to improve the prognosis in this dismal complication of chronic pancreatitis.
Influenza vaccination in the elderly
Authors: Morgan R , King D 
Published: December 2008

Summary
There is overwhelming evidence for the clinical efficacy of the influenza vaccine, especially in the elderly with chronic disease, reducing mortality and hospital admissions. There is also evidence to suggest that the influenza vaccine may be beneficial in the healthy elderly. There is some evidence to suggest that the antibody response in the elderly to the vaccine may decrease with increasing age, although there are several confounding factors that have not been taken into account in many of these studies. That aside, even if antibody response is not as good as that in younger people, the evidence that vaccination saves lives and reduces morbidity in the elderly means that the vaccination should be offered to elderly patients at high risk and perhaps even to the elderly healthy population. Although vaccination of an elderly at-risk patient does not necessarily mean that that particular patient will mount an appropriate antibody response, a significant number of elderly patients will respond appropriately. Serious side-effects from vaccination are extremely rare and the more common side-effects are mild and self-limiting. Increasing the number of elderly people receiving the influenza vaccination will not only result in cost savings for the National Health Service in terms of reduced hospitalisation but, more significantly, the elderly will benefit in terms of reduced morbidity and mortality.
Enteral nutrition and the critically ill
Authors: Shikora S A , Ogawa A M 
Published: December 2008

Summary
Critically ill patients invariably require nutritional intervention. Traditionally, enteral nutrition has not been widely employed in this patient population. This is due in part to the success of present-day parenteral nutrition, and to difficulties encountered with enteral feeding. Recent evidence has demonstrated that enteral is preferable to parenteral nutrition in terms of cost, complications, gut mucosal maintenance, and metabolic and immune function. Enterally administered nutritional support can and should be utilised as the preferred route of nourishment for the critically ill. The appropriate choice of access and formula, as well as a rational strategy for implementation, should improve the likelihood of success. This article describes the unique features of critical illness as they pertain to nutritional support, the benefits of enteral nutrition, and the obstacles to success, and offers suggestions which may improve the ability to provide nutrients adequately via the intestinal tract.
Leucocytoclastic vasculitis in a patient with azathioprine hypersensitivity
Authors: Beckett C G , Hill P , Hine K R 
Published: December 2008

Summary
We report the case of a 77-year-old man admitted nine days after being commenced on azathioprine with symptoms initially thought to be secondary to sepsis but in fact due to azathioprine hypersensitivity. He developed histologically proven cutaneous leucocytoclastic vasculitis following the re-introduction of azathioprine. We review the literature concerning adverse reactions to azathioprine and the problems of making the diagnosis as well as highlighting azathioprine as a novel cause of leucocytoclastic vasculitis.