bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bleeding in a patient taking Lorenzo’s oil: evidence for a vascular defect
Authors: Chai B C , Etches W S , Stewart M W , Siminoski K 
Published: December 2008

Abstract
We describe a man with adrenoleukodystrophy receiving Lorenzo’s oil (glycerol trioleate and glycerol trierucate) who developed purpura, petechiae, and bleeding. Bleeding time was markedly increased (&gt;20 min), although he had only borderline thrombocytopenia (120 x 10(9)/1) and conventional platelet aggregation studies were normal (except for a borderline response to low concentration collagen), as were results using a new technique employing immobilised von Willebrand factor. Together these results suggest that bleeding in this man resulted from a defect in vascular wall function or in the interaction of platelets with the endothelium.
Coronary flow reserve and oesophageal dysfunction in syndrome X
Authors: Chauhan A , Mullins P A , Gill R , Taylor G , Petch M C , Schofield P M 
Published: December 2008

AbstractThe relative prevalence of abnormalities of coronary flow reserve and oesophageal function was ascertained in 32 syndrome X patients with typical angina chest pain, a positive exercise test, and normal coronary arteries. Coronary flow reserve in response to a hyperaemic dose of papaverine was measured using an intracoronary Doppler catheter positioned in the left anterior descending coronary artery. An abnormal coronary flow reserve was defined as being &lt; 3.0. Patients were investigated for oesophageal dysfunction by manometry and 24-hour pH monitoring. Thirteen patients had an impaired coronary flow reserve (group 1) and 19 patients had a normal flow reserve (group 2). Eight of the 13 group 1 patients (62%) and 13 of the 19 group 2 patients (68%, p = NS) had evidence of oesophageal dysfunction on either manometry or pH studies. Therefore, a total of 26 (81%) syndrome X patients had either an abnormality of coronary flow reserve or oesophageal dysfunction suggesting that chest pain in these patients may be due to myocardial ischaemia or oesophageal dysfunction, thus confirming the heterogeneous nature of this syndrome. The prevalence of oesophageal abnormalities was independent of any abnormalities of coronary flow reserve.
Your child is brain dead
Authors: Blair A W , Steer C R 
Published: December 2008

AbstractOne to two per cent of admissions to Paediatric Intensive Care Units eventually fulfil the criteria for brain death, implying the need for very difficult decisions. Brain death is defined as irreversible loss of function of the whole brain. The diagnostic criteria caused a great deal of anxiety but are now the subject of a consensus approach. When the situation can be anticipated it is of immense value for the professional staff to develop a good working relationship with the parents to help and support them through the phase of impending disaster and facing the issue when the time actually comes. However, it is vital to help parents to make their own decision regarding continuation or otherwise of life support and they should be supported in whichever decision they take. They must be absolutely convinced that the child is brain dead and this territory may have to be covered again and again in discussion, questions must be answered factually, and time allowed for reflection. Stage management of the process of ‘switching off’ is vital and the parents’ wishes may vary widely from one family to another. They must be warned what is likely to happen and provided with appropriate privacy and support for expression of their grief. The question of asking for post-mortem permission has to be handled sensitively and long-term support for the parents must be offered. Education of undergraduate and postgraduate doctors in this area is now receiving more attention with skills being increased by video teaching and role play. It should not be overlooked that the professional staff attending such patients sometimes require counselling and support themselves.
Intestinal permeability and orocaecal transit time in elderly patients with Parkinson’s disease
Authors: Davies K N , King D , Billington D , Barrett J A 
Published: December 2008

Abstract
The aetiology of weight loss in patients with Parkinson’s disease is likely to be multifactorial. We studied 15 patients with Parkinson’s disease and 15 age- and sex-matched controls and looked for evidence of malabsorption due to small bowel bacterial overgrowth or alteration of intestinal permeability. There was a marked increase in orocaecal transit time in the patients with Parkinson’s disease, although lactulose hydrogen breath testing did not show evidence of small bowel bacterial contamination. Intestinal permeability measured by the differential sugar absorption test was also deranged. There was reduced absorption of mannitol in patients with Parkinson’s disease while lactulose absorption was similar in both groups, suggesting decreased non-mediated uptake across the enterocyte brush border membrane in patients with Parkinson’s disease.
Hirsutism in the United Arab Emirates: a hospital study
Authors: Gatee O B , Al Attia H M , Salama I A 
Published: December 2008

Abstract
In a study of 102 women (Arabs and Asians) with hirsutism, polycystic ovary syndrome was diagnosed in 93 patients (91%) including 26 cases with hirsutism and regular menstrual periods. In more than half of the cases the diagnosis was made on the basis of transabdominal ultrasonography, which was the single test with the highest yield. Luteinising hormone hyperresponsiveness to gonadotropin-releasing hormone was positive in only seven of 50 patients tested. Late onset congenital adrenal hyperplasia due to 21-hydroxylase deficiency was identified in two cases, thus forming a prevalence of 8% in those who underwent adrenocorticotropin stimulation. In one case, polycystic ovary syndrome was an associated condition. In this study of a population of women with hirsutism and regular menses, the majority had polycystic ovaries. It is suggested that the term ‘idiopathic or racial’ hirsutism should not be applied unless a thorough evaluation has failed to reveal a diagnosable underlying disorder.
Sarcoidosis
Authors: Peckham D G , Spiteri M A 
Published: December 2008

SummarySarcoidosis is a multisystem granulomatous disorder of unknown aetiology. The condition commonly affects young adults and frequently presents with bilateral hilar lymphadenopathy with or without pulmonary infiltration, ocular or cutaneous lesions. The clinical presentation can be extremely varied depending upon the organs affected. The diagnosis is firmly established when recognised clinical and radiographic findings are supported by histological evidence of discrete non-necrotising epithelioid cell granulomata in one or more organs. Sarcoidosis is usually self-limiting with spontaneous resolution, although in a few patients there is a progressive downhill course, culminating in irreversible fibrosis and severe impairment of organ function.
The development of healthcare services for diabetic prisoners
Authors: MacFarlane I A 
Published: December 2008

Summary
The conditions experienced by people in custody in the UK have received considerable attention recently and there has been considerable debate concerning the standards of healthcare in British prisons. The Prison Health Care Service works under great pressure and difficulties and doctors have to deal with a large and ever-changing population, often with mental and physical disorders, who are frequently manipulative. This article highlights problems encountered in delivering diabetes care in prisons. Prisoners may self-induce diabetic ketoacidosis by refusing insulin injections, in order to be transferred to an outside hospital. On the other hand, prison staff may mis-interpret the symptoms of poorly controlled diabetes as ‘acting up’ by prisoners and inappropriate treatment can be given. If structured diabetes care is provided in prison, however, with close liaison between the Prison Staff and the local Diabetes Care Team, the basics of modern diabetes management can be provided. Good diabetic metabolic control can be achieved in the majority of patients, probably due to the rigid dietary regime, no alcohol and compliance with treatment. Imprisonment can ensure screening for diabetic complications and reassessment of treatment regimens. The British Diabetic Association guidelines for the provision of diabetes care in British prisons are outlined in this article.
Primary coronary angioplasty in acute myocardial infarction
Authors: Grech E D , Ramsdale D R 
Published: December 2008

Summary
It is well established that recanalisation of the infarct-related artery is of great benefit in the early hours after acute myocardial infarction. This can be achieved by the use of thrombolytic agents and/or by percutaneous transluminal coronary angioplasty (PTCA). This article reviews data on the role of primary PTCA and summarises current opinion on its use.
The distribution of antibodies to streptokinase
Authors: Lynch M , Pentecost B L , Littler W A , Stockley R A 
Published: December 2008

Summary
To determine the distribution of antibodies to streptokinase that might be anticipated in patients requiring treatment with streptokinase, specific anti-streptokinase antibody titres were determined in a group of subjects from the general population and in a group of patients presenting with acute myocardial infarction. Enzyme-linked immunosorbent assays were developed to measure specific anti-streptokinase IgG and subclass IgG1 in 95 subjects from the general population and in 160 patients presenting with acute myocardial infarction. Low titres of IgG1 were found in both the general population (median = 5; range: 0-490) and in the myocardial infarction group (median = 7; range: 0-2000). A minority of subjects in both groups had high titres. The findings suggest that low titres of antibody are widespread in the population. The minority of subjects in both groups who had high titres may explain the infrequent type III immune reactions encountered with streptokinase.
Gerstmann’s syndrome
Authors: Sukumar S , Ferguson G C 
Published: December 2008

Summary
Although Gerstmann’s syndrome has been well documented since it was characterised in the latter half of last century, there has not been much literature on it in the last few years. We present a classical case in a patient who was admitted into hospital for an unrelated problem. We conclude that clinical examination still has a valuable role in neurology, despite the availability of excellent imaging techniques.
Asymptomatic primary hyperparathyroidism
Authors: Birkenhäger J C , Bouillon R 
Published: December 2008

Summary
The prevalence of hypercalcaemia in the adult population is probably between 0.6 and 1.1%, sufferers being predominantly women over 50 years of age. Most apparently asymptomatic hypercalcaemic patients are found to have primary hyperparathyroidism, and may in fact show some symptoms of the condition (lowered bone mineral density, cardiovascular disease and/or neuropsychiatric symptoms). The criteria for surgical intervention in these cases are discussed in the light of the high success rate of parathyroidectomy in experienced hands and the lack of effective alternative treatments.
Training in anaesthesia: the US perspective
Authors: Strang T I , Ball D R 
Published: December 2008

Summary
In the light of the recent Calman Report and the Royal College of Anaesthetists document ‘Specialist training in anaesthesia, supervision and assessment’, there is currently much debate concerning the future of anaesthesia training in the UK. We present a description of anaesthesia training in the US for discussion and comparison. US residency training is short and seamless. It is highly structured, but retains a capacity for specialisation. It may offer ideas for the future direction of training in the UK.
Klippel-Trenaunay syndrome
Authors: Jolobe O M 
Published: December 2008

Summary
The Klippel-Trenaunay syndrome, typically characterised by the triad of cutaneous haemangioma, venous varicosities, and limb hypertrophy, may also have a formes frustes presentation, with absence of the cutaneous naevus. A case is reported in a 75-year-old woman with a presumptive diagnosis of renovascular hypertension.
Changes in haemodynamic parameters following Tai Chi Chuan and aerobic exercise in patients recovering from acute myocardial infarction
Authors: Channer K S , Barrow D , Barrow R , Osborne M , Ives G 
Published: December 2008

Summary
In this study, 126 patients (90 males, average age 56 years, range 39-80) were randomised to Wu Chian-Ch’uan style Tai Chi (38), aerobic exercise (41) or a non-exercise support group (47) following acute myocardial infarction. Patients attended twice weekly for three weeks then weekly for a further five weeks. Heart rate and blood pressure were recorded before and after each session. Over the 11 sessions of exercise there was a negative trend in diastolic blood pressure only in the Tai Chi group (Rs = 0.79, p &lt; 0.01). Significant trends in systolic blood pressure occurred in both exercise groups (Rs = 0.64 and 0.63, both p &lt; 0.05). Only four (8%) patients completed the support group eight-week programme which was less than the number completing Tai Chi (82%; p &lt; 0.001) and aerobic exercise groups (73%; p &lt; 0.001).
Coronary subclavian steal syndrome following coronary by-pass surgery
Authors: Kneale B J , Irvine A T , Coltart D J 
Published: December 2008

Summary
The coronary steal syndrome is an uncommon but well recognised occurrence following coronary artery by-pass surgery using the internal mammary artery. We report a case of coronary steal successfully treated with percutaneous transluminal angioplasty of a subclavian stenosis.
Cytomegalovirus causing acute colonic pseudo-obstruction in a renal transplant recipient
Authors: Shrestha B M , Darby C , Fergusson C , Lord R , Salaman J R , Moore R H 
Published: December 2008

Summary
A female patient presented with pyrexia and features of large intestinal obstruction, 10 weeks posttransplantation, with biopsy-proven colitis caused by cytomegalovirus (CMV) and positive CMV antigenaemia and IgM tests. The symptoms resolved after treatment with ganciclovir, nasogastric aspiration and intravenous fluid replacement.
Schmidt’s syndrome associated with sarcoidosis
Authors: Watson J P , Lewis R A 
Published: December 2008

Summary
We present a case of Schmidt’s syndrome (autoimmune Addison’s disease and hypothyroidism) associated with sarcoidosis. There have been only four previous reports of Schmidt’s syndrome with sarcoidosis, and a possible fifth with negative autoantibodies. We have been able to find only four other reports of adrenal failure (without hypothyroidism) in sarcoidosis. It is important to be aware of the potential for masking the diagnosis of Addison’s disease by steroid treatment.
Reverse sequestration in a case of sickle crisis
Authors: Lee E S , Chu P C 
Published: December 2008

Summary
A patient with homozygous sickle cell disease presented with sickle crisis complicated by hepatic and pulmonary sequestration and required intensive therapy. During the recovery phrase she developed a rapid rise of haemoglobin concentration, unrelated to blood transfusion, followed by hypertension, congestive cardiac failure and catastrophic intracerebral haemorrhage. This serious haemodynamic disturbance was considered to be caused by a reversal of the sequestration process. Careful monitoring of a sickle cell patient’s blood pressure, blood counts, haematocrits, haemoglobin S level and plasma viscosity, even after the end of a sequestration crisis, is recommended.
Training for visiting registrars: experience in East Anglia, UK
Authors: Jenkins P F , Biggs J S 
Published: December 2008

Summary
A questionnaire was sent to 24 visiting registrars in East Anglia to obtain information on their perceptions of their training experiences. The results suggest that the needs of overseas doctors and the requirements of training authorities would benefit from organisational changes aimed at improving selection and training programmes. Formal training programmes are needed, tailored to an individual’s requirement, with identification of educational supervisors for each trainee. An improved system of introduction to the National Health Service is also required.
Excessive libido in a woman with rabies
Authors: Dutta J K 
Published: December 2008

Summary
Rabies is endemic in India in both wildlife and humans. Human rabies kills 25,000 to 30,000 persons every year. Several types of sexual manifestations including excessive libido may develop in cases of human rabies. A laboratory proven case of rabies in an Indian woman who manifested excessive libido is presented below. She later developed hydrophobia and died.
Percutaneous endoscopic gastrostomy
Authors: Hussain A , Woolfrey S , Massey J , Geddes A , Cox J 
Published: December 2008

Summary
Percutaneous endoscopic gastrostomy (PEG) is now the technique of choice for patients requiring long-term enteral feeding. It is a good method for feeding patients with neurological dysphagia and can safely be kept in situ for long periods. PEG feeding requires a multidisciplinary approach, involving doctors, nurses, pharmacists, speech therapists, dieticians and carers. The insertion of a PEG, which requires two operators and two endoscopy nurses, is described in full. Feeding can commence after a few hours. Various types of feed and feed-ing patterns are described and their relative merits discussed. Although psychological problems may occur following PEG insertion, the procedure is usually well accepted by patients.
Diagnosis and management of chronic persistent dry cough
Authors: Chung K F , Lalloo U G 
Published: December 2008

SummaryCough is one of the commonest symptoms of lung disease and is a frequent problem encountered in general practice as well as in hospital practice. A wide range of disease processes may present with cough and definitive treatment depends on making an accurate diagnosis of the cause. A diagnostic work-up for patients with persistent dry cough is presented. The most common associated conditions are post-viral cough, asthma, rhinosinusitis (post-nasal drip or ‘nasal catarrh’) and gastro-oesophageal reflux. Treatment with angiotensin-converting enzyme inhibitors can also lead to a persistent dry cough. Specific treatment of the cause should control the cough, but this may not occur in all cases and in a sizeable proportion of patients, no associated cause can be found. An increased sensitivity of the cough reflex can be observed in patients with persistent dry cough. Symptomatic relief must be considered when the cough interferes with the patient’s health and sleep but the most effective antitussive opiates cause sedation and may be addictive. Treatment of persistent dry cough remains a challenge in some patients and there is still scope for improvement in its diagnosis and effective therapy.
Cushing’s syndrome due to autonomous macronodular adrenal hyperplasia: long-term follow-up after unilateral adrenalectomy
Authors: Boronat Mauro , Lucas Tomás , Barceló Balbino , Alameda Carmen , Hotait Hassan , Estrada Javier 
Published: December 2008

Summary
This report describes a case of Cushing’s syndrome due to autonomous macronodular adrenocortical hyperplasia in which unilateral resection of the right adrenal resolved the Cushing’s syndrome.
Papillary thyroid carcinoma associated with ulcerative colitis
Authors: Evgenikos N , Stephen J G 
Published: December 2008

Summary
A case is reported of papillary thyroid adenocarcinoma with cervical lymph node metastases in a young man who had presented earlier with severe total ulcerative colitis. The aetiological factors in the pathogenesis of papillary thyroid carcinoma are briefly reviewed and an association between this neoplasm and ulcerative colitis is suggested.
New treatments for patients with type 2 diabetes mellitus
Authors: Wolffenbuttel B H , Graal M B 
Published: December 2008

SummaryIn subjects with type 2 diabetes, both defects of insulin secretion and insulin resistance contribute to the development of hyperglycaemia. The major goals of treatment are to optimise blood glucose control, and normalise the associated lipid disturbances and elevated blood pressure. Pharmacologic treatment is often necessary. This paper discusses new forms of oral treatment for subjects with type 2 diabetes. These include a new sulphonylurea compound glimepiride (Amaryl), which binds to a different protein of the putative sulphonylurea receptor than glibenclamide, and seems to have a lower risk of hypoglycaemia. A new class of drugs with insulin secretory capacity, of which repaglinide (NovoNorm) is the leading compound, is now in phase III clinical trials. Alpha-glucosidase inhibitors reversibly inhibit alpha-glucosidase enzymes in the small intestine, which delays cleavage of oligo- and disaccharides to monosaccharides. This leads to a delayed and reduced blood glucose rise after a meal. Two compounds are in development or have been marketed, ie, miglitol and acarbose (Glucobay). Another new class of drugs is the thiazolidine-diones, which seem to work by enhancing insulin action. The ‘insulin sensitising’ effects of the leading compounds, troglitazone and BRL 49653C, do not involve any effect on insulin secretion. These drugs also seem to beneficially influence serum cholesterol and triglyceride levels. Oral antihyperglycaemic agents can be used only during a limited period of time in most patients, after which the diabetic state ‘worsens’ and insulin therapy has to be started. In this light, two new forms of treatment which require subcutaneous injections are also discussed: the synthetic human amylin analogue AC137 (pramlintide) and glucagon-like peptide-1 (7-36)-amide, a strong glucose-dependent stimulator of insulin secretion. It remains to be seen whether these compounds can be developed further for clinical use in patients with diabetes.
Breast cancer
Authors: Sainsbury R 
Published: December 2008

Summary
The management of patients with breast cancer has been changing over the last few years and this article highlights some areas of particular interest. The changes have been brought about against a background of an increasing disease incidence coupled with increasing political aspirations from patients and their relatives. This paper focuses on organisational aspects of breast cancer care, screening, induction and high-dose chemotherapy, clinical trials, genetics, training of surgical and nonsurgical oncologists and future prospects.
Cerebral venous thrombosis and chronic active hepatitis as part of the antiphospholipid syndrome
Authors: Kesler Anat , Pomeranz Itamar S , Huberman Moshe , Novis Ben , Kott Edna 
Published: December 2008

Summary
A case of antiphospholipid syndrome, presenting as sinus vein thrombosis together with chronic active hepatitis, is reported in a 35-year-old woman.
Improving the early diagnosis of acute myocardial infarction
Authors: Banerjee A 
Published: December 2008

SummaryThe diagnosis of early myocardial infarction, especially in association with atypical clinical presentations, can be difficult to establish. Continued observation of high-risk patients, with multiple serial electrocardiographs and the use of other diagnostic modalities as available, is essential to prevent the inadvertent premature discharge of patients with evolving myocardial infarcts from the accident and emergency department.