bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lipid profile studies in long term thiazide treated hypertensives
Authors: Rao R A C , Hegde B M , Bhat E K , Vidyavathi U , Rao R R 
Published: December 2008

Summary
Serum cholesterol and its subfractions were estimated in 23 patients on thiazide diuretics, for treatment of mild hypertension, for at least 30 months. The results were compared with those obtained in a matched set of 25 untreated mild hypertensives. It was found that while there was no difference in the level of total cholesterol, the LDL-cholesterol was significantly lower and HDL-cholesterol significantly higher in the treated group. It was also found that the total:LDL-cholesterol ratio was more in the treated group and the total:HDL-cholesterol ratio was less in the treated group. These findings suggest that coronary risk attributable to cholesterol and its subfractions does not seem to operate in long term thiazide treated patients.
A comparative study of danazol and norethisterone in dysfunctional uterine bleeding presenting as menorrhagia
Authors: Bonduelle M , Walker J J , Calder A A 
Published: December 2008

Summary
This randomized open study compared the efficacy and safety of norethisterone, 5 mg three times a day from day 19 to 26, and danazol, 200 mg daily, in the treatment of dysfunctional uterine bleeding presenting as menorrhagia. Clinical criteria were employed to confirm the diagnosis, and subjective assessment of the condition was performed during one pre-treatment and three treatment cycles. Fourteen patients commenced norethisterone and 10 danazol.
Bleeding intensity scores were significantly lower with danazol than with norethisterone, and patients assessed their blood loss to be significantly less with danazol than with norethisterone. Associated symptoms of backache and abdominal pain were improved to a similar degree by both treatments. Adverse reactions were reported with similar frequency and were of a similar nature in both treatment groups.
Doppler echocardiography in elderly patients with ejection systolic murmurs
Authors: McKillop G M , Stewart D A , Burns J M A , Ballantyne D 
Published: December 2008

Summary
Thirty-nine elderly patients, mean age 77 years (range 65 to 96), with ejection systolic murmurs were studied to evaluate the functional significance of these murmurs. Subjects were evaluated clinically, by 2-D echocardiography, and by a full Doppler echocardiography study. Good quality Doppler signals were obtained in 35 subjects. Mitral regurgitation was found to be the only significant valvular lesion in 6 patients (17%). Doppler gradients in systole across the aortic valve were less than 30 mmHg in 28 subjects (80%) and were considered not significant. Gradients of greater than 30 mmHg representing significant aortic stenosis were found in 7 subjects (20%). The clinical sensitivity in detecting significant aortic stenosis was 44% and specificity was 81%. Doppler evidence of significant aortic stenosis was found in a substantial proportion of these elderly subjects. Neither clinical assessment nor 2-D echocardiography can be relied on to exclude this condition.
Cerebral arteriovenous malformation in Noonan's syndrome
Authors: Schon F , Bowler J , Baraitser M 
Published: December 2008

Summary
Noonan's syndrome involves the association of multiple congenital abnormalities including neck webbing, pectus excavatum, facial anomalies with a variety of cardiac defects. In this paper the association of Noonan's syndrome with a large cerebral arteriovenous malformation is reported. Congenital cerebrovascular abnormalities are not a recognized feature of the syndrome. The paper also reviews previous reports of neurological associations with Noonan's syndrome, the commonest being mild intellectual impairment and ptosis.
The law and medical fitness to drive--a study of doctors' knowledge
Authors: King D , Benbow S J , Barrett J A 
Published: December 2008

Summary
We assessed doctors' knowledge on laws and recommendations regarding fitness to drive in certain medical conditions by a questionnaire survey. A total of 646 doctors consisting of 400 general practitioners and 246 hospital doctors of all grades were circulated with the questionnaire. The survey was anonymous so non-responders could not be re-circulated. The response rate was 26% general practitioners and 32% (hospital doctors). The results show the poor knowledge of doctors on several aspects of fitness to drive.
It is necessary for all doctors to have a basic knowledge on the laws and recommendations on fitness to drive so that they can advise their patients correctly. Our survey clearly shows that doctors' knowledge is poor. Many drivers may therefore be placing themselves and others at risk. It is mandatory that this subject receives more attention in undergraduate and postgraduate education and that doctors should be regularly updated on new recommendations from the Driver and Vehicle Licensing Agency.
Acute renal failure in a case of paraquat poisoning with relative absence of pulmonary toxicity
Authors: Florkowski C M , Bradberry S M , Ching G W K , Jones A F 
Published: December 2008

Summary
A 37 year old male presented after the ingestion of paraquat ('Gramoxone', 20% w/v). Plasma paraquat concentrations indicated that he had a greater than 50% probability of death. The patient survived following a period of acute oliguric renal failure and with only mild pulmonary toxicity.
Miliary tuberculosis presenting with thyrotoxicosis
Authors: Nieuwland Y , Tan K Y , Elte J W F 
Published: December 2008

Summary
A male patient is described who presented with thyrotoxicosis, and a large painful neck mass. From the excised mass and stomach aspiration Mycobacterium tuberculosis was cultured and a diagnosis of miliary tuberculosis was made. The thyrotoxicosis was attributed to tuberculous thyroiditis.
Ménétrier's disease in a child
Authors: Vujanić Gordan M , Miladinović Mirko 
Published: December 2008

Summary
A case of Ménétrier's disease in a 3 year old child presenting with subtotal pyloric stenosis and fatal outcome due to postoperative complications is reported. It is emphasized that although radiographic and gastroscopic studies are helpful, a full-thickness mucosal biopsy is essential for the diagnosis of Ménétrièr's disease.
The prevalence and nosocomial acquisition of Clostridium difficile in elderly hospitalized patients
Authors: Rudensky B , Rosner S , Sonnenblick M , van Dijk Y , Shapira E , Isaacsohn M 
Published: December 2008

Summary
Rectal swabs obtained from 10 of 49 chronic-care geriatric patients were positive for Clostridium difficile, for a prevalence rate of 20.4%. Simultaneous sampling of 29 patients in an acute geriatric ward revealed four colonized patients, for a prevalence rate of 13.7%.
A prospective study of C. difficile colonization in 100 consecutive patients admitted to an acute geriatric ward was carried out. All patients were sampled upon admission and biweekly during hospitalization. Two patients (2%) were positive on admission, and 12 of the 98 initially negative patients became colonized, representing a nosocomial acquisition rate of 12.2%. A major determinant for C. difficile colonization in asymptomatic patients appears to be length of hospitalization. Previous antibiotic administration was not found to be a significant factor.
Subcutaneous versus intravenous administration of heparin in the treatment of deep vein thrombosis; which do patients prefer? A randomized cross-over study
Authors: Robinson A M , McLean K A , Greaves M , Channer K S 
Published: December 2008

Summary
Patient preference for intravenous or subcutaneous heparin in the treatment of deep venous thrombosis was assessed in a randomized cross-over study. Twenty patients with venographically proven deep venous thrombosis were randomized to receive subcutaneous or intravenous heparin for 3 days followed by 3 days of the other treatment. Discomfort at the injection site, assessed by visual analogue scale, was significantly less for the subcutaneous than the intravenous administration route (P &lt; 0.001), mobility was thought to be better when receiving subcutaneous heparin (P &lt; 0.005) and patients' overall preference was for subcutaneous treatment (P &lt; 0.001).
Useless hand of Oppenheim--magnetic resonance imaging findings
Authors: Coleman R J , Russon L , Blanshard K , Currie S 
Published: December 2008

Summary
A patient with multiple sclerosis developed a useless, deafferented left hand, as described previously by Oppenheim. Magnetic resonance imaging demonstrates that this is caused by an ipsilateral plaque of demyelination in the posterior columns of the cervical cord.
Blind drunk: alcoholic pancreatitis and loss of vision
Authors: Steel James R , Cockcroft John R , Ritter James M 
Published: December 2008

Summary
Acute loss of vision and alcoholic intoxication suggests the possibility of methanol poisoning. In this report we describe an alcoholic patient who complained of blindness after recovering from alcoholic pancreatitis and delirium tremens. Visual acuity was severely impaired and fundoscopy revealed florid bilateral cotton wool spots and a cherry red spot at the right macula. Such appearances have previously been reported in cases of post-traumatic visual loss, and may share a common aetiology of fat embolization. The association between alcoholic pancreatitis and visual loss is rare, and fundal examination should be performed on all patients with pancreatitis, especially those who complain of visual disturbance.
Raising HDL cholesterol with low-dose nicotinic acid and bezafibrate: preliminary experience
Authors: Luria Myron H , Sapoznikov Dan 
Published: December 2008

Summary
Nicotinic acid is an effective agent for elevating HDL cholesterol but is limited by side effects. In order to improve tolerance and lipid levels, we combined low-dose nicotinic acid with bezafibrate. We gave low-dose (mean 435 mg/day) nicotinic acid to 37 patients with low HDL cholesterol, bezafibrate (mean 476 mg/day) to 58 patients with elevated total cholesterol and both agents (mean nicotinic acid 435 mg/day and bezafibrate 512 mg/day) to 25 patients with low HDL cholesterol and elevated total cholesterol. A total of 53 additional patients were followed as controls. Three intervals of treatment were studied: 0-6, 6-12 and &gt; 12 months.
The combination of drugs resulted in significant (P &lt; 0.05) percentage changes in total cholesterol, triglycerides and total/HDL cholesterol compared to nicotinic acid alone and significant (P &lt; 0.04) percentage changes in HDL cholesterol compared to bezafibrate alone. It is concluded that low doses of nicotinic acid may result in significant changes in HDL cholesterol; when combined with bezafibrate significant alterations in total cholesterol, triglycerides and total/HDL cholesterol also result.
Timing of intervention in acute pancreatitis
Authors: Johnson C D 
Published: December 2008

Summary
This review examines the appropriate timing of intervention in acute pancreatitis. In gallstone pancreatitis, it is now clear that cholecystectomy during the primary admission carries no greater risk of complications than delayed cholecystectomy and enables earlier recovery to normal activity. This course of action pre-empts a second, possibly fatal attack of acute pancreatitis. Cholecystectomy should be done after the acute phase has settled, before discharge from hospital. Patients with gallstones should now be offered endoscopic sphincterotomy within 48 hours of admission. This approach is safe, and reduces the risk of complications.
When complications develop, early necrosectomy is only indicated if conservative measures fail. Delayed (&gt; 10 days) necrosectomy is appropriate if there is evidence of sepsis, or clinical failure to improve. Pancreatic pseudocysts can often be managed expectantly; a high proportion will resolve spontaneously. After a delay of 12 weeks, persistent cysts require evaluation by endoscopic pancreatography, which gives crucial information in the choice between percutaneous or surgical drainage of the pseudocyst.
A patient with pancreatitis is usually treated under the care of a surgeon, who has traditionally taken the decision on the timing of any intervention, and has performed such intervention at open operation. Recently, the development of alternative techniques has enabled the surgeon to call on the skills of his colleagues in endoscopy and interventional radiology. However, the availability of these alternatives to surgery should not affect the timing of intervention unless it can be clearly shown that such a change in timing combined with the minimally invasive technique can improve the outcome for the patient.
Intervention may be required to deal with gallstones in the gallbladder or in the bile duct, to deal with, or ideally prevent, the deleterious systemic effects of pancreatic and peripancreatic necrosis, or to drain a peripancreatic abscess. Peripancreatic fluid collections and pancreatic pseudocysts may also require either internal or external drainage to relieve symptoms or prevent complications.
Serum lipids and coronary heart disease in British elderly
Authors: Mangion D M , Roy S S 
Published: December 2008

Summary
To assess the relationship between serum lipids and coronary heart disease (CHD) in an elderly population (mean age = 77.4; SEM +/- 0.4; range 70-92 years), serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured in 84 (males = 52) subjects with evidence of definite myocardial infarction and 125 (males = 77) age- and sex-matched controls free of CHD on Rose questionnaire and resting electrocardiogram.
On multivariate logistic regression analysis, CHD showed inverse association with HDL-C (odds ratio for decrease by 1 s.d. = 1.6, P = 0.02) in males and positive association with TC (odds ratio for increase by 1 s.d. = 1.8, P = 0.03) and LDL-C (odds ratio for increase by 1 s.d. = 1.8, P = 0.04) in females. Of the other variables only diabetes in males (odds ratio 2.4, P = 0.05) and left ventricular hypertrophy in females (odds ratio 8.8, P = 0.03) were associated with CHD.
The results suggest that further prospective studies to further evaluate the relation of serum lipids with CHD in this age group are indicated.
Spontaneous rupture of the spleen in association with idiopathic thrombocytopaenic purpura
Authors: Winslet M C , Webberley M J , Melikian V , Donovan I A 
Published: December 2008

Summary
Spontaneous rupture of the spleen is rare and has not been previously reported in association with idiopathic thrombocytopaenic purpura. Its rarity makes familiarity with its presentation difficult and may result in a potentially fatal delay in diagnosis and treatment.
Open access endoscopy: is the lost outpatient clinic of value?
Authors: Saunders B P , Trewby P N 
Published: December 2008

Summary
To test the value of an outpatient visit in patients with dyspepsia, 79 patients considered suitable for open access endoscopy by their general practitioners were instead seen in the medical outpatient clinic first. In 35 patients immediate endoscopy was seen as an inappropriate investigation and 23 of these were spared endoscopy. In 11 patients important extra diagnoses were made in the clinic which would have been delayed or missed had the patients been sent straight for open access endoscopy. Sixty-eight per cent of patients, when asked by questionnaire, said they preferred to be seen in the clinic first rather than come for open access endoscopy. These results lend support to the traditional medical clinic appointment followed by endoscopy if and when appropriate rather than the open access endoscopy system.
Thyroid storm in a young woman resulting in bilateral basal ganglia infarction
Authors: Page S R , Scott A R 
Published: December 2008

Summary
We describe a 30 year old woman who presented with thyroid storm. She had non-specific symptoms and few clinical signs of hyperthyroidism despite markedly raised thyroid hormone concentrations. Soon after admission her behaviour became abnormal and her level of consciousness deteriorated. Despite the rapid restoration of thyroid hormone concentrations to normal using conventional therapies, and correction of hypoxia resulting from acute pulmonary oedema, her level of consciousness did not improve. Cranial CT scanning revealed extensive bilateral basal ganglia infarction, a previously unreported complication of thyroid storm. This observation suggests that thyroid storm may predispose to hypoxic neurological damage.
New markers of bone and collagen turnover in children and adults with growth hormone deficiency
Authors: Sartorio A , Conti A , Monzani M 
Published: December 2008

SummarySerum bone Gla protein (BGP), a marker of osteoblastic function, serum carboxyterminal cross-linked telopeptide of type I collagen (ICTP), a marker of bone resorption, and serum aminoterminal propeptide of type III procollagen (PIIINP) levels, an index of collagen synthesis, were determined in seven children and eight adults with congenital growth hormone deficiency (GHD).In children with GHD, serum BGP (mean +/- s.e.: 12.9 +/- 0.7 ng/ml), ICTP (8.3 +/- 1.3 ng/ml) and PIINP (3.5 +/- 0.5 ng/ml) levels were significantly lower (P &lt; 0.001) than those recorded in normal children (BGP 18.9 +/- 0.8 ng/ml, ICTP 14.4 +/- 0.5 ng/ml and PIIINP 6.7 +/- 0.7 ng/ml). Total alkaline phosphatase (184.7 +/- 13.4 IU/l) and bone alkaline phosphatase (77.8 +/- 4.1 IU/l) levels were also significantly lower (P &lt; 0.0001) than in controls (338.1 +/- 14.9 IU/l and 181.0 +/- 7.8 IU/l, respectively). Serum BGP, ICTP and PIIINP levels were not significantly correlated with height velocity values.In adults with GHD, mean BGP levels (3.8 +/- 0.3 ng/ml) were significantly lower (P &lt; 0.0001) than those recorded in normals (5.4 +/- 0.1 ng/ml). On the contrary, serum ICTP levels were similar to those found in controls (patients: 4.7 +/- 0.8 ng/ml vs normals: 4.1 +/- 0.3 ng/ml), suggesting the presence of a normal resorption activity associated with a reduced osteoblastic function. This finding was also confirmed by the presence of reduced bone alkaline phosphatase levels (GHD: 44.9 +/- 6.9 IU/I vs controls: 58.3 +/- 2.0 IU/I; P&lt;0.02), while the less specific total alkaline phosphatase levels (119.5 +/- 14.8 IU/I) were similar to those recorded in normal subjects (122.3 +/- 4.0 IU/I). Serum PIIINP levels (3.7 +/- 0.6 ng/ml) were similar to those recorded in normals (3.2 +/- 0.2 ng/ml), suggesting that in adulthood the collagen turnover is not negatively influenced by the chronic GHD. No significant correlations were found between BGP/ICTP/PIIINP and IGF-I levels.In conclusion, our data show that in children with GHD the lack of GH insulin-like growth factor-I (IGF-I) effects on bone and collagen turnover is associated with a significant reduction of bone turnover (low bone formation plus low bone resoRption) and collagen synthesis. On the contrary, adult GHD seems to exert less relevant effects on bone and collagen turnover, probably due to the fact that in adult life further hormones or local factors might partially counteract the negative consequences of chronic GH-IGF-I deficiency.
Community-acquired bacteraemic Acinetobacter pneumonia with survival
Authors: Achar Kesarakodi N , Johny Molly , Achar Mohini N , Menon N Kochunny 
Published: December 2008

Summary
A 65 year old man was admitted with segmental consolidation of the left upper lobe after having stayed in a hotel for 2 days. He deteriorated rapidly on conventional antibiotic therapy and required ventilatory support. Acinetobacter calcoaceticus var. anitratus was grown from the sputum and blood cultures, which was treated with a combination of anti-pseudomonal agent, aminoglycoside and cotrimoxazole. He made a slow but remarkable recovery from the pneumonia. Acinetobacter is a rare potentially fatal cause of community-acquired pneumonia.
Autonomic neuropathy in African diabetic patients
Authors: Tuch P S , Gill G V , Huddle K R L 
Published: December 2008

Summary
To determine the prevalence and extent of autonomic neuropathy amongst Africans with insulin-dependent diabetes mellitus (IDDM), we investigated 50 such patients at our clinic. Mean age (+/- 1 s.d.) was 26 +/- 6 years, male:female ratio was equal (25M:25F) and duration of diabetes was 4.0 +/- 3.0 years. A battery of six validated tests of autonomic function was performed, testing both sympathetic and parasympathetic systems. Overall 16 (32%) had evidence of autonomic damage, affecting parasympathetic only in 14, and both sympathetic and parasympathetic in two. Those with autonomic neuropathy had a significantly longer diabetes duration than those without (6.0 +/- 2.8 years versus 3.1 +/- 2.7 years, P &lt; 0.005), but there was no difference in glycosylated haemoglobin (HbA1) between the two groups. Autonomic neuropathy was also not significantly associated with peripheral neuropathy or other diabetic complications. Autonomic neuropathy carries a poor prognosis in IDDM and this high prevalence in a group of patients with relatively short diabetes duration gives cause for concern.
Air pollution and asthma
Authors: Barnes Peter J 
Published: December 2008

SummaryThe role of air pollution in the increased prevalence and morbidity of asthma has been widely debated, but results to date indicate that the normally encountered levels of air pollution are unlikely to contribute to a worsening of asthma. When the levels of sulphur dioxide (SO2) are exceptionally high it is possible that asthmatic patients may have increased symptoms after exertion, since this irritant gas acts as a trigger to bronchoconstriction. There is also evidence that suspended particles may also act as an inciter of asthma symptoms when concentrations are high. Experimentally, ozone in high concentrations may increase airway responsiveness in both normal and asthmatic subjects by inducing airway inflammation, but asthmatic individuals show the same responses as normal subjects and there is little or no evidence to link increases in ambient ozone with an increase in asthma. There is little evidence that nitrogen dioxide (NO2), even at the peak levels recorded, has any significant effect on airway function in normal or asthmatic individuals.Other air pollutants which are present in lower concentrations have not been studied as extensively, but there is no convincing evidence that they cause significant respiratory symptoms in asthmatic patients. It is still possible that combinations of air pollutants may have greater effects on airway function than exposure to a single pollutant, although there is little evidence to support this. Epidemiological evidence provides little support for the idea that atmospheric pollution levels are related to the frequency of asthma symptoms or the frequency of attacks. More importantly, there is no evidence that asthma prevalence or aetiology is related to the level of air pollution.A review of currently available information therefore provides little evidence for the widely expressed view that atmospheric pollution is related to increased prevalence or morbidity of asthma or is related to the causation of asthma.
Hashimoto's thyroiditis, Sjogren's syndrome and orbital lymphoma
Authors: Ko G T C , Chow C C , Yeung V T F , Chan H , Cockram C S 
Published: December 2008

Summary
A 69 year old Chinese housewife presented with periorbital puffiness, and dry eyes and mouth. Subsequent investigations confirmed the presence of Hashimoto's thyroiditis, Sjogren's syndrome and orbital lymphoma. This unusual combination is discussed with reference to previous publications.