bluuebunny/crossref_metadata_2025_split huggingface dataset:
Day-Case Rigid and Flexible Ureteroscopy
Authors: Bromwich EJ , Lockyer R , Keoghane SR 
Published: August 2007

INTRODUCTION The aim of this study was to evaluate the feasibility of rigid and flexible ureteroscopy as a day-surgery procedure. PATIENTS AND METHODS All patients requiring elective ureteroscopy from March 2004 were considered for a day-surgery procedure. The standard day-surgery exclusions existed but there were no urological criteria for exclusion. A single consultant urologist performed or supervised all procedures. RESULTS A total of 64 patients underwent 50 rigid and 14 flexible procedures. Six diagnostic ureteroscopies were performed. There was a 96% stone clearance rate. Five patients required an unplanned admission within the first 2 weeks' postoperatively. Three of these patients were admitted on the day of surgery, two for pain and one for social reasons. Two patients were admitted at 24 h and 48 h, respectively, for urinary retention. CONCLUSIONS Ureteroscopy, both rigid and flexible, is a safe procedure for the day-surgery setting. Routine use of prophylactic antibiotics, intravenous non-steroidal anti-inflammatory drugs resulted in an acceptable re-admission rate.
Mortality Following Hip Fracture Surgery in Patients with Recent Myocardial Infarction
Authors: Komarasamy Baskaran , Forster Mark C , Esler Colin N , Harper William M , Hall Andrew P 
Published: August 2007

INTRODUCTION In an elective setting, surgery is best avoided for at least 6 months following myocardial infarction. However, in the presence of a femoral neck fracture, this would most probably lead to significant complications in relation to prolonged immobilisation. There is no published mortality data for patients undergoing surgery for hip fracture following a recent myocardial infarction. The aim of this retrospective study was to assess the mortality of hip fracture patients with a recent myocardial infarction that have undergone surgery at our institution. PATIENTS AND METHODS Between January 2003 and October 2005, 2270 patients were admitted to our unit with a proximal femoral fracture. Of these, 11 patients were found to have a recent myocardial infarction. RESULTS Of these 11 patients, 8 were female. The average age was 78.2 years (range, 59–90 years). Average delay from the time of infarction to operation was 11.2 days (range, 3–23 days). Mortality at 1 and 6 months was 45.4% and 63.5%, respectively. DISCUSSION This is much higher than the overall reported mortality following proximal femur fracture. This information may be useful when planning future peri-operative care and discussing overall prognosis with patients and their relatives.
Inguinal Hernia Repair: Local or General Anaesthesia?
Authors: Sanjay P , Woodward A 
Published: August 2007

INTRODUCTION Specialist hernia centres and public hospitals with a dedicated hernia service (Plymouth Hernia Service) have achieved remarkable results for inguinal hernia repair with the use of local anaesthesia and set the standards for groin hernia surgery. There is minimal data in the literature as to whether such results are reproducible in the National Health Service in the UK. PATIENTS AND METHODS A retrospective analysis of all inguinal hernia repairs performed in one district general hospital over a 9-year period was performed. The outcome measures were type of anaesthesia used, early and late postoperative complications and recurrence. A postal questionnaire survey was conducted to obtain satisfaction rates. In addition, a postal questionnaire survey of consultant surgeons in Wales was performed to determine the use of local anaesthesia and day-case rates for inguinal hernia repair. RESULTS A total of 577 hernia repairs were performed during the study period. Of these, 369 (64%) repairs were performed under local anaesthesia (LA) and 208 (36%) under general anaesthesia (GA). Day-case repair was achieved in 70% (400) of cases. The day-case rates were significantly higher under LA compared to GA (82.6% versus 42.6%; P < 0.05). Patients operated under LA had lower postoperative analgesic requirements and lower incidence of urinary retention compared with the GA group (P < 0.05). There were 7 (1.2%) recurrences at a median follow-up of 5.1 years (range, 10.3–2.5 years). Postal questionnaire revealed higher satisfaction rates with LA compared to GA repair. Only 15% of surgeons in Wales offer the majority of their patients local anaesthetic repair. CONCLUSIONS The use of LA results in increased day-case rates, lesser postoperative analgesic requirements and fewer micturition problems. The excellent results obtained by specialist hernia centres can be reproduced by district general hospitals by increasing the use of LA to repair inguinal hernias.
Post-Discharge Symptomatic Thromboembolic Events in Hip Fracture Patients
Authors: Anand Sanjeev , Buch Keyur 
Published: August 2007

INTRODUCTION The aim of this study was to audit referral rates for post-discharge symptomatic thromboembolic events follow-hip fracture surgery to assess the extent of the clinical problem and to initiate discussion on prolonged chemoprophylaxis. PATIENTS AND METHODS All patients who underwent surgery for proximal hip fractures in one year (2001–2002) were followed up. Patient case-notes were used to identify all morbidity episodes within 3 months following discharge. Patients with suspected symptomatic thromboembolic episodes were investigated to confirm the diagnoses objectively. Reasons for hospital readmission and causes of death were identified. RESULTS A total of 267 patients who underwent surgery for proximal hip fractures were included in the study. Forty-three patients died during initial admission episode. Of the 224 patients discharged, 46 (20.54%) patients were referred back to hospital within 3 months, for unplanned emergency management. Of these, 8 patients (3.57%) were referred back for suspected thromboembolic events. Of these, 6 (2.67%) were referred with a clinical diagnoses of deep vein thrombosis (DVT) but only 1 patient (0.45%) was confirmed to have DVT. Two patients (0.89%) were referred with features of pulmonary embolism (PE). Both were confirmed on ventilation-perfusion scans and both patients died. One patient died following PE in the community. Thus, overall, 3 deaths (1.34%) following discharge were recorded to be due to pulmonary embolism. CONCLUSIONS Suspected thromboembolic events constitute a major proportion of unplanned referrals back to the hospital. Three deaths due to delayed pulmonary embolism may justify prolonged universal chemoprophylaxis following hip fracture surgery.
Comment: ‘The Problem Surgical Colleague’
Authors: Taylor Irving 
Published: August 2007

The review of ‘The problem surgical colleague’ by Mr John Mosley is both timely and relevant. All surgeons are naturally concerned about the mechanisms in place, both locally and through the General Medical Council (GMC) to deal with fitness-to-practise issues. It is inevitable that criticisms, often unfounded, are voiced by the profession. Most surgeons welcome a fair and transparent system to deal with such matters whilst maintaining the principle of self-regulation. We must accept that there are a small number of surgeons whose practice is impaired to such a degree that they represent a serious patient-safety risk and they must be dealt with appropriately. As a GMC medical case examiner since 2003, and having dealt with over 600 fitness-to-practise cases, I wish to comment on some of the important issues raised by Mr Mosley, specifically in relation to the surgeon and his or her practice. In doing so, I will set out the investigative process to be followed when fitness-to-practise concerns are brought to the attention of the GMC.
Pharmaceutical Care in Community Pharmacies: Practice and Research in Brazil
Authors: Castro Mauro Silveira de , Correr Cassyano Januário 
Published: August 2007

Objective: To discuss the provision of pharmaceutical services and pharmaceutical care in Brazil. Findings: Professional training and pharmaceutical services are undergoing a period of restructuring in Brazil, including the adoption of incentives for pharmaceutical care. Some important national measures include the rational use of medications, evidence-based medicine, and pharmacovigilance. A new and more generalist pharmacy curriculum is being implemented and tailored for the Brazilian Public Health System; recently, the Brazilian government has provided resources for pharmaceutical care research. Discussion: A proposal for national consensus in Brazilian pharmaceutical care was published in 2002. The components of this proposal include drug dispensing, counseling, health education, symptoms advice, and pharmacotherapy follow-up. Pharmacy practice is currently focused on drug dispensing and logistic aspects of drug distribution. Professionals are satisfied with patients' confidence in being counseled by pharmacists and reveal interest in extending their role in patient care. Most pharmacy customers were originally unaware of the term “pharmaceutical care”; however, following an explanation, they showed an interest in this service. Furthermore, over 50% stated that they would pay for this service. Despite these initiatives, numerous barriers to the development of pharmaceutical care remain, the main ones being the commercial objective of most pharmacies that sell medications and the insufficient training of professionals. Although government-owned pharmacies also distribute medications, they do not meet all of the needs of the population and lack sufficient pharmacists. Conclusions: Several actions are required to stimulate the implementation and development of pharmaceutical care and services in Brazil. Recent research incentives in pharmaceutical care and reorientation of pharmacy education will contribute to this development.
Pegfilgrastim-Induced Hyperleukocytosis
Authors: Snyder Ronald L , Stringham Delevan J 
Published: August 2007

Objective: To report a pediatric case of pegfilgrastim-induced hyperleukocytosis. Case Summary: A 3-year-old boy with medulloblastoma therapy presented with white blood cell (WBC) count 0.1 × 103/μL and absolute neutrophil count (ANC) 0.014 × 103/μL on day 27 following a course of induction chemotherapy. The patient received pegfilgrastim 200 μg/kg the following day. On his return 6 days later for the next planned course of chemotherapy, hyperleukocytosis was determined, with WBC 149 × 103/μL and ANC 110 × 103/μL (“neutrophil overshoot”). No sources of the elevated WBC count other than administration of pegfilgrastim (eg, steroids, antiepileptics, infection) were present. Chemotherapy was delayed until the WBC count had fallen to 35.2 × 103/μL (ANC 28.9 × 103/μL). No sequelae from this adverse effect occurred. Discussion: Pegfilgrastim has unique saturable neutrophil receptor-mediated clearance, the ability for self-regulation. Due to this clearance mechanism, hyperleukocytosis associated with pegfilgrastim use is uncommon in adults and has not been previously reported in pediatrics. The pegfilgrastim dose in children is under investigation; however, 100–110 μg/kg has been effective and safe in this population. Use of the Naranjo probability scale suggested that pegfilgrastim was the probable cause of hyperleukocytosis in our patient. Conclusions: Pegfilgrastim 200 μg/kg, in excess of the 100 μg/kg dose used in limited pediatric clinical trials, appeared to exceed saturable neutrophil receptor-mediated clearance. The inability of this mechanism to self-regulate neutrophil counts in the normal range led to neutrophil overshoot. Routine pediatric use of the pegylated dosage form of G-CSF should await further published clinical trials to validate a safe and effective dose.
Limited Efficacy of Gastrointestinal Decontamination in Severe Slow-Release Carbamazepine Overdose
Authors: Lurie Yael , Bentur Yedidia , Levy Yishai , Baum Elena , Krivoy Norberto 
Published: August 2007

Objective: To report the limited efficacy of both multiple doses of activated charcoal (MDAC) and whole bowel irrigation (WBI) in a patient with severe overdose of slow-release carbamazepine. Case Summary: A 25-year-old man was admitted in a comatose state with seizures after a suicide attempt with slow-release carbamazepine. Serum carbamazepine concentration on admission (16 h postingestion) was 52.08 μg/mL. The patient was mechanically ventilated and treated with MDAC and a 4 hour charcoal hemoperfusion. Carbamazepine concentration at the end of hemoperfusion was 27.16 μg/mL. Despite continuous treatment with MDAC, a rebound in carbamazepine concentration to 36 μg/mL was observed 32 hours after hemoperfusion (58 h postingestion). WBI was performed over a 10 hour period. The carbamazepine concentration continued to increase to 38.55 μg/mL and seizures recurred. After WBI was performed, MDAC was reinstituted; 33 hours later (102 h postingestion), the carbamazepine concentration began to decline. The hospitalization course was complicated by pneumonia, which necessitated continuation of mechanical ventilation and administration of antibiotics. The patient recovered completely and was discharged without sequelae 15 days after admission. Discussion: Serum carbamazepine concentration and toxicity were effectively reduced by hemoperfusion. The role of MDAC coadministered during hemoperfusion cannot be ruled out. However, a rebound in carbamazepine concentration with recurrent seizures was observed despite MDAC and WBI. The most likely explanation for this rebound (65 h postingestion, 39 h posthemoperfusion) is prolonged absorption, possibly from a pharmacobezoar. Redistribution cannot be excluded, but this is not supported by the concentration–time course and previous reports. Conclusions: Both MDAC and WBI may be ineffective in reducing absorption and enhancing elimination in overdose of slow-release carbamazepine. Repeated hemoperfusion or other elimination enhancement techniques should be considered when the clinical and toxicokinetic course suggests the presence of a refractory pharmacobezoar.
Effect of Clonazepam on Raynaud's Phenomenon and Fingertip Ulcers in Scleroderma
Authors: Colakoğlu Murat , Cobankara Veli , Akpolat Tekin 
Published: August 2007

Objective: To report the novel finding of a significant improvement in Raynaud's phenomenon symptoms with clonazepam in a patient with systemic sclerosis. Case Summary: A 45-year-old female with limited scleroderma and chronic renal failure was admitted to our hospital due to hyponatremia (sodium 103 mEq/L). Her hyponatremia was treated by intravenous infusion of NaCI 3%. Clonazepam, which had been prescribed previously for anxiety and insomnia, was discontinued. Three weeks after she was discharged from the hospital, the patient presented with the complaint of increased severity of Raynaud's phenomenon and digital ulcers. She told us that her fingertip ulcers had been healed while she was taking clonazepam and that episodes of Raynaud's phenomenon had increased after discontinuation of the drug. Clonazepam 1 mg twice daily was restarted, and Raynaud's phenomenon and fingertip ulcers resolved within a month. On 2 occasions after that time, we discontinued clonazepam and replaced it with alprazolam, as the patient believed alprazolam was more beneficial in alleviating anxiety. Episodes of Raynaud's phenomenon and new digital ulcers recurred on both of these occasions, and clonazepam was restarted. At the time of writing, no severe episodes of Raynaud's phenomenon or fingertip ulcers have occurred with clonazepam treatment. Discussion: Raynaud's phenomenon and recurrent digital ulcers are a manifestation of vascular disease in patients with systemic sclerosis and lead to pain, impaired function, and tissue loss. Few drugs have previously been shown to affect digital ulcers in the setting of scleroderma. Our patient experienced a significant and sustained improvement in Raynaud's phenomenon and digital ulcers following the initiation of clonazepam. To our knowledge, as of March 2007, this is the first reported use of clonazepam in Raynaud's phenomenon and digital ulcer. While its therapeutic mechanism remains unclear, clonazepam may offer some advantages compared with current agents. Conclusions: We report a case of Raynaud's phenomenon and digital ulcers responding to clonazepam. Further research is warranted to test the robustness of this preliminary finding.
Male Development Time Influences the Strength of Wolbachia-Induced Cytoplasmic Incompatibility Expression inDrosophila melanogaster
Authors: Yamada Ryuichi , Floate Kevin D , Riegler Markus , O'Neill Scott L 
Published: July 2007

AbstractCytoplasmic incompatibility (CI) is the most widespread reproductive modification induced in insects by the maternally inherited intracellular bacteria, Wolbachia. Expression of CI in Drosophila melanogaster is quite variable. Published papers typically show that CI expression is weak and often varies between different Drosophila lines and different labs reporting the results. The basis for this variability is not well understood but is often considered to be due to unspecified host genotype interactions with Wolbachia. Here, we show that male development time can greatly influence CI expression in D. melanogaster. In a given family, males that develop fastest express very strong CI. The “younger brothers” of these males (males that take longer to undergo larval development) quickly lose their ability to express the CI phenotype as a function of development time. This effect is independent of male age effects and is enhanced when flies are reared under crowded conditions. No correlation is seen between this effect and Wolbachia densities in testes, suggesting that a more subtle interaction between host and symbiont is responsible. The observed younger brother effect may explain much of the reported variability in CI expression in this species. When male development time is controlled, it is possible to obtain consistently high levels of CI expression, which will benefit future studies that wish to use D. melanogaster as a model host to unravel CI mechanisms.
Age Specificity of Inbreeding Load inDrosophila melanogasterand Implications For the Evolution of Late-Life Mortality Plateaus
Authors: Reynolds Rose M , Temiyasathit Sara , Reedy Melissa M , Ruedi Elizabeth A , Drnevich Jenny M , Leips Jeff , Hughes Kimberly A 
Published: July 2007

AbstractCurrent evolutionary theories explain the origin of aging as a byproduct of the decline in the force of natural selection with age. These theories seem inconsistent with the well-documented occurrence of late-life mortality plateaus, since under traditional evolutionary models mortality rates should increase monotonically after sexual maturity. However, the equilibrium frequencies of deleterious alleles affecting late life are lower than predicted under traditional models, and thus evolutionary models can accommodate mortality plateaus if deleterious alleles are allowed to have effects spanning a range of neighboring age classes. Here we test the degree of age specificity of segregating alleles affecting fitness in Drosophila melanogaster. We assessed age specificity by measuring the homozygous fitness effects of segregating alleles across the adult life span and calculated genetic correlations of these effects across age classes. For both males and females, we found that allelic effects are age specific with effects extending over 1–2 weeks across all age classes, consistent with modified mutation-accumulation theory. These results indicate that a modified mutation-accumulation theory can both explain the origin of senescence and predict late-life mortality plateaus.
A Selective Sweep in the Chloroplast DNA of Dioecious Silene (SectionElisanthe)
Authors: Muir Graham , Filatov Dmitry 
Published: July 2007

AbstractGene flow occurs predominantly via pollen in angiosperms, leading to stronger population subdivision for maternally inherited markers, relative to paternally or biparentally inherited genes. In contrast to this trend, population subdivision within Silene latifolia and S. dioica, as well as subdivision between the two species, is substantially lower in maternally inherited chloroplast genes compared to paternally inherited Y-linked genes. A significant frequency spectrum bias toward rare polymorphisms and a significant loss of polymorphism in chloroplast genes compared to Y-linked and autosomal genes suggest that intra- and inter-specific subdivision in the chloroplast DNA may have been eroded by a selective sweep that has crossed the S. latifolia and S. dioica species boundary.
In VivoFunctional Specificity and Homeostasis of Drosophila 14-3-3 Proteins
Authors: Acevedo Summer F , Tsigkari K Kirki , Grammenoudi Sofia , Skoulakis Efthimios M C 
Published: July 2007

AbstractThe functional specialization or redundancy of the ubiquitous 14-3-3 proteins constitutes a fundamental question in their biology and stems from their highly conserved structure and multiplicity of coexpressed isotypes. We address this question in vivo using mutations in the two Drosophila 14-3-3 genes, leonardo (14-3-3ζ) and D14-3-3ϵ. We demonstrate that D14-3-3ϵ is essential for embryonic hatching. Nevertheless, D14-3-3ϵ null homozygotes survive because they upregulate transcripts encoding the LEOII isoform at the time of hatching, compensating D14-3-3ϵ loss. This novel homeostatic response explains the reported functional redundancy of the Drosophila 14-3-3 isotypes and survival of D14-3-3ϵ mutants. The response appears unidirectional, as D14-3-3ϵ elevation upon LEO loss was not observed and elevation of leo transcripts was stage and tissue specific. In contrast, LEO levels are not changed in the wing disks, resulting in the aberrant wing veins characterizing D14-3-3ϵ mutants. Nevertheless, conditional overexpression of LEOI, but not of LEOII, in the wing disk can partially rescue the venation deficits. Thus, excess of a particular LEO isoform can functionally compensate for D14-3-3ϵ loss in a cellular-context-specific manner. These results demonstrate functional differences both among Drosophila 14-3-3 proteins and between the two LEO isoforms in vivo, which likely underlie differential dimer affinities toward 14-3-3 targets.
Alternative Splicing Gives Rise to Different Isoforms of the Neurospora crassa Tob55 Protein That Vary in Their Ability to Insert β-Barrel Proteins Into the Outer Mitochondrial Membrane
Authors: Hoppins Suzanne C , Go Nancy E , Klein Astrid , Schmitt Simone , Neupert Walter , Rapaport Doron , Nargang Frank E 
Published: July 2007

Abstract
Tob55 is the major component of the TOB complex, which is found in the outer membrane of mitochondria. A sheltered knockout of the tob55 gene was developed in Neurospora crassa. When grown under conditions that reduce the levels of the Tob55 protein, the strain exhibited a reduced growth rate and mitochondria isolated from these cells were deficient in their ability to import β-barrel proteins. Surprisingly, Western blots of wild-type mitochondrial proteins revealed two bands for Tob55 that differed by ∼4 kDa in their apparent molecular masses. Sequence analysis of cDNAs revealed that the tob55 mRNA is alternatively spliced and encodes three isoforms of the protein, which are predicted to contain 521, 516, or 483 amino acid residues. Mass spectrometry of proteins isolated from purified outer membrane vesicles confirmed the existence of each isoform in mitochondria. Strains that expressed each isoform of the protein individually were constructed. When cells expressing only the longest form of the protein were grown at elevated temperature, their growth rate was reduced and mitochondria isolated from these cells were deficient in their ability to assembly β-barrel proteins.