bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clustering of colorectal neoplasia: characteristics of coexisting adenomas in patients with severely dysplastic polyps or invasive (malignant) polyps as compared to patients with benign adenomas or carcinomas
Authors: Pines A , Bat L , Shemesh E , Rosenblum J , Horowitz A , Levo Y , Bubis J J 
Published: December 2008

Summary
This study compared the size, histology and morphology of coexisting neoplastic polyps found in colonoscopy, and evaluated the clustering of these polyps in patients with either colorectal carcinoma, cancerous polyps or benign adenomas. Patients were divided by their most malignant form of neoplasia: Group A included 58 patients with early invasive cancerous polyps, and Group B included 73 patients with in situ carcinoma within an adenoma. Group C consisted of 335 patients with benign adenomas, and Group D had 289 patients with colorectal carcinoma. There were no significant differences between the four groups regarding sex, age and ethnicity. The cancerous polyps were significantly larger than the benign polyps. There were significantly (P less than 0.01) more patients with multiple (greater than or equal to 5) colonic lesions in Groups A or B than in Groups C or D. Coexisting polyps were much closer to the index growth, and demonstrated more severe dysplastic changes in the case of cancerous polyps than those associated with benign polyps or cancer. Based on our data we speculate that cancerous polyps are not merely a middle link in adenoma-carcinoma sequence, but rather mark a subset of patients who are especially prone to develop neoplastic changes in their colonic mucosa. These patients should be included in a more strict colonoscopic surveillance programme.
Pedunculated left ventricular thrombus—report of two cases
Authors: John R M , Sturridge M F , Swanton R H 
Published: December 2008

Summary
In two patients presenting with myocardial infarction, one with a subendocardial infarction and the second patient with a classic Q wave infarction, pedunculated left ventricular thrombi were detected in the course of subsequent routine cardiac catheterization. Both patients underwent successful surgical thrombectomy.
Infection in exacerbations of asthma: views of different groups of practitioners
Authors: Connolly C K , Murthy N K , Prescott R J , Alcock R M 
Published: December 2008

Summary
A questionnaire designed to elucidate views on the frequency of infection in asthma and its management was circulated to general practitioners, general physicians, paediatricians and respiratory physicians in the north of England. On the whole, general practitioners agreed with the general physicians and paediatricians with respiratory physicians. The generalists, and to a lesser extent the specialists, tended to overestimate the risk of bacterial infection, which was perceived to be a particular risk following viral infection in intrinsic asthma. This resulted in more frequent prescription of antibiotics than is justified by the published evidence. There was a tendency for frequent prescribers of antibiotics to withhold corticosteroids. If prescribing habits are to be altered, education will have to be directed at those responsible for acute admissions to hospital as well as at general practitioners.
Spontaneous hyphaema as a result of systemic anticoagulation in previously abnormal eyes
Authors: Holden R 
Published: December 2008

Summary
Spontaneous hyphaema in patients on systemic anticoagulants has been described in normal eyes and also in eyes with certain intraocular lenses following cataract surgery. These cases are rare and in all the reported cases the hyphaemas resolved without sequelae. Four cases are reported here of spontaneous hyphaemas in previously abnormal eyes of patients on anticoagulants. Three of these patients suffered considerable pain as a result of this. The reasons for this are discussed and early ophthalmic referral recommended if a hyphaema is suspected in these situations.
Wernicke's encephalopathy and alcohol-related disease
Authors: Naidoo D P , Bramdev A , Cooper K 
Published: December 2008

Summary
A pilot study of 31 consecutive alcohol-related deaths over an 8-month period revealed the presence of histologically diagnosed Wernicke's encephalopathy in 17 cases. Analysis of the clinical records revealed that a disturbance of the mental state was the commonest finding and neurological signs were present in only 2 of the 17 cases (ataxia 1, peripheral neuropathy 1). Analysis of 22 ward admissions for Wernicke's encephalopathy during the same 8-month period revealed that the diagnosis is easily made when neurological deficits (ophthalmoplegia, ataxia) accompany mental changes and when Wernicke's encephalopathy is the predominant illness.
In patients with established alcohol-related disease attention is often directed to the presenting illness so that Wernicke's encephalopathy may easily be overlooked as a cause of deterioration in the mental state in these patients. It is recommended that routine management of patients with alcohol-related disease should include thiamine even if neurological signs are absent.
Angioma serpiginosum: a simulator of purpura
Authors: Cox N H , Paterson W D 
Published: December 2008

Summary
We describe two patients with angioma serpiginosum who had both undergone a variety of haematological tests for investigation of purpura, but in whom careful examination of the skin demonstrated abnormal blood vessels rather than extravasated blood. Recognition of vascular disorders which simulate purpura may avoid unnecessary investigations.
Myxoedema presenting with seizures
Authors: Bryce Gillian M , Poyner Fiona 
Published: December 2008

Summary
The case of a 32 year old female who presented with her first epileptic fit and took over 36 hours to recover is described. Investigations led to a diagnosis of hypothyroidism as the cause. Following treatment with thyroxine she has remained well with no further fits for over 2 years. Hypothyroidism should be considered as a possible underlying cause of epilepsy especially when there is a prolonged recovery time after a fit.
Deficiency of 17 α-hydroxylase associated with absent gonads
Authors: Malcolm P N , Wright D J , Edmonds C J 
Published: December 2008

SummaryA phenotypic female presented initially at the age of 17 years with amenorrhoea and delay of sexual development. Karyotype was male, 46 XY, and as gonads were absent, a diagnosis of congenital anorchia was made. The patient was treated with oestrogen.At the age of 23 years, she re-presented with tall stature and hypertension. She then had normal female habitus but absent pubic and axillary hair. Re-investigation showed that sex steroids and cortisol were absent and established the diagnosis as 17 α-hydroxylase deficiency. Treatment with hydrocortisone rapidly corrected the hypertension. Ultrasound examination confirmed the absence of gonads but showed that a small uterus was present.Measurement of serum cortisol is important for recognition of such patients, but further measurements of sex steroids, particularly progesterone, are needed to prove the diagnosis.We have found no previous reports of absent gonads in 17 α-hydroxylase deficiency. The association remains unexplained.
An audit of training in public health medicine
Authors: Rous Elizabeth , Guy Margaret , Hayward Peter , Bramleby Peter 
Published: December 2008

Summary
Postgraduate training is one of the core functions of every specialty. The Trainee Members Committee of the Faculty of Public Health Medicine audited the quality of training in public health medicine according to guidelines set by the Education Committee of the Faculty. The survey identified several weaknesses in training which need to be remedied by Faculty Members. This audit model would prove useful to other specialties and the benefit of trainee involvement in the Committee structure of the Faculty is highlighted.
Renal impairment associated with an acute paracetamol overdose in the absence of hepatotoxicity
Authors: Campbell Norman R C , Baylis Barry 
Published: December 2008

Summary
This report describes a paracetamol overdose in which renal impairment occurred without biochemical evidence of hepatotoxicity. We are aware of only one similar case. However, it is possible this scenario may be seen more frequently with close biochemical follow-up.
Primary disseminated fusarial infection
Authors: Madhavan M , Ratnakar C , Veliath A J , Kanungo Reba , Smile S Robinson , Bhat Sanjay 
Published: December 2008

Summary
Among the fungal pathogens the species Fusariam solani causing systemic infection is very rare and generally causes systemic infection only in an immuno-compromised host. We report a systemic infection caused by F. solani in a non-immunocompromised adult male, to our knowledge the first such case report.
Localized scleroderma and hemiatrophy in association with antibodies to double-stranded DNA
Authors: Adebajo A O , Crisp A J , Nicholls A , Hazleman B L 
Published: December 2008

Summary
Localized scleroderma involves primarily skin but also muscle, bone and synovium. Further associations and transitional forms have been reported. We report here two cases showing associations between localized scleroderma and vasculitis, mononeuritis multiplex, juvenile chronic arthritis and hemiatrophy. In particular our cases both possess antibodies to double-stranded DNA, a finding not previously reported.
Femoral hernia appendix causing small intestinal obstruction
Authors: Wyatt J P , Varma J S 
Published: December 2008

Summary
An 88 year old woman presented with a painful, irreducible right femoral hernia and small intestinal obstruction. At laparotomy, some distal small intestine was found to have twisted around an uninflamed appendix which was acting as a 'band', with its tip fixed in the femoral hernia sac. Although the association between the appendix and femoral hernia is well recognized, the production of small intestinal obstruction by this particular mechanism has not been previously reported.
Treatment of Raynaud's phenomenon with triiodothyronine corrects co-existent autonomic dysfunction: preliminary findings
Authors: Gledhill R F , Dessein P H , Van der Merwe C A 
Published: December 2008

Summary
Cardiovascular autonomic function was assessed in 9 subjects with Raynaud's phenomenon. The underlying diseases were systemic lupus erythematosus (n = 5), systemic sclerosis (n = 3) and rheumatoid arthritis (n = 1). Five standard non-invasive tests, 3 of heart rate and 2 of blood pressure, were employed. Compared with age and sex matched controls (n = 25), the number of values abnormal was 24 of 45 (53%) overall and between one and 4 (median, 2) individually. Significant differences were present for 3 tests, two of heart rate and one of blood pressure.
The subjects were given triiodothyronine, 60 to 80 micrograms per day, for vasospastic attacks. Autonomic function was reassessed between weeks 4 and 9 (9 subjects) and between weeks 12 and 18 (8 subjects) after introduction of triiodothyronine. Test results showed a considerable improvement. At the second reassessment, the number of values abnormal was now 5 of 40 (12.5%) overall and nil (n = 4) or one (n = 4) individually. Significant differences remained for one heart rate test only. Adverse side effects to triiodothyronine occurred in a single subject and were readily controlled.
Evidence of somatic neuropathy was present electrophysiologically in all 9 subjects and clinically in 8. Triiodothyronine may have corrected autonomic dysfunction by increasing blood flow to ischaemic peripheral nerves or by acting on the autonomic system more directly.
Further study of triiodothyronine in autonomic insufficiency appears merited.
Mitral stenosis in the Maroteaux-Lamy syndrome: a treatable cause of dyspnoea
Authors: Marwick Thomas H , Bastian Bruce , Hughes Clifford F , Bailey Brian P 
Published: December 2008

Summary
The case is reported of a young woman with the Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI) who presented with rapidly progressive dyspnoea due to mitral stenosis. Mitral valve replacement was performed and the appearance of the valve was typical of mucopolysaccharide infiltration. Dyspnoea in patients with the Maroteaux-Lamy syndrome may be due primarily to cardiac valve involvement, and in this setting, valve surgery is safe and effective.
Colonoscopy in patients aged 80 years or older and its contribution to the evaluation of rectal bleeding
Authors: Bat Leon , Pines Amos , Shemesh Eliahou , Levo Yoram , Zeeli Doron , Scapa Eitan , Rosenblum Yosef 
Published: December 2008

Summary
Colonoscopies performed in patients aged 80 years or older at the Sheba Medical Center were analysed according to the primary indication for the procedure: 101 colonoscopies were performed because of rectal bleeding of at least 2 months duration, and 335 for all other indications. Carcinoma of the large bowel was found in 29 (28.7%) bleeders, with the rectum being the most frequently involved site (12 patients). Among the non-bleeders, the prevalence of cancer was significantly lower (33 cases, 9.8%; P less than 0.001), and rectal carcinoma was less common (five patients, P = 0.04), but proximal tumours were more frequent. Of patients with cancer who had operations, the majority (72%) had a tumour confined to the bowel wall (Dukes A or B). The rate of adenomas was similar for both groups (34% vs 29%). The non-bleeders complained more frequently of abdominal pain or a change in bowel habits as compared to the bleeders, but both groups had similar rates for anaemia and weight loss.
In all, 47% of these octogenarians with cancer, and 26% with adenomas were referred for colonoscopy because of rectal bleeding. This procedure was found to be safe in old age, as we recorded only four (0.9%) non-fatal complications among our series, a similar figure to the overall incidence of complications at our Institute. In conclusion, our data indicate that rectal bleeding in octogenarians warrants a complete colonic investigation, preferably by total colonoscopy.
Recurrent intra-cranial granulomata presenting as space-occupying lesions in a patient with common variable immunodeficiency
Authors: Misbah S A , Spickett G P , Esiri M M , Hughes J T , Matthews W B , Thompson R A , Chapel H M 
Published: December 2008

Summary
A patient with profound panhypogammaglobulinaemia due to common variable immunodeficiency developed two discrete intra-cranial space-occupying lesions, 10 years apart, requiring craniotomy. Histological examination revealed the intra-cranial masses to be granulomata of unknown aetiology on both occasions.
Primary pulmonary hypertension and functional hyposplenism
Authors: Fahy Gerard , Robinson Killian , Deb Binayak , Graham Ian 
Published: December 2008

SummaryPrimary pulmonary hypertension is a rare disease of unknown case. Functional hyposplenism is characterized by the appearance of abnormal circulating erythrocytes despite the presence of a spleen and is associated with a variety of disease states. A case of primary pulmonary hypertension associated with functional hyposplenism is described in this report.
The late presentation of postero-lateral congenital diaphragmatic hernias
Authors: Heaton N. D. , Adam G. , Howard E. R. 
Published: December 2008

SummaryFour patients presenting after the neonatal period with a combination of respiratory and gastro-intestinal symptoms and signs which point to the diagnosis of congenital postero-lateral diaphragmatic hernias are discussed. Late presentation is more common than previously acknowledged. Early correct diagnosis and treatment are associated with an excellent clinical outcome.
Is bed rest useful after diagnostic lumbar puncture?
Authors: Spriggs D A , Burn D J , French J , Cartlidge N E F , Bates D 
Published: December 2008

SummaryA randomized study of 110 patients undergoing their first diagnostic lumbar puncture was performed to compare the effect of immediate mobilization with 4 hours bed rest on the incidence of post lumbar puncture headache. There was no difference between the mobile (n = 54) and bed rest (n = 56) groups in the incidence of post lumbar puncture headache (32% versus 31%, respectively). We conclude that bed rest following lumbar puncture may be an unnecessary imposition on the patient, as well as on nursing staff.
Cerebellar manifestations of prostatic carcinoma
Authors: McLoughlin J , Gingell J C , Harper G , Hinchliffe A 
Published: December 2008

Summary
We present two patients known to have prostate cancer who presented with acute cerebellar signs. The neurological deficit of the first patient was due to a paraneoplastic cerebellar manifestation and progressed, despite evidence of response of the primary prostate tumour to hormonal manipulation. The second case, resulting from a solitary cerebellar metastasis, was amenable to surgical intervention and subsequent hormonal manipulation. This latter patient has experienced no recurrent neurological signs after a period of 7 years follow-up. This is the first report of a paraneoplastic cerebellar deficit and, to our knowledge, only the sixth case of parenchymatous cerebellar metastasis of prostatic origin to appear in the literature.
The value of urinary red cell shape in the diagnosis of glomerular and post-glomerular haematuria. A meta-analysis
Authors: Offringa M , Benbassat J 
Published: December 2008

Summary
The proportion of dysmorphic red cells (DRC) in the urinary sediment and their mean corpuscular volume (MCV) have been claimed to discriminate between glomerular and postglomerular sources of haematuria. To determine the diagnostic value of urinary DRC and MCV, we searched the literature and critically reviewed 21 published studies using a predetermined set of criteria for evaluation.
All studies originated from referral centres. Interobserver variability in identifying urinary DRC was reported in four studies and found to be unacceptably large in one. Although reproducible over different samples of the same individual, urinary MCV was unreliable in cases of low-grade haematuria because of interfering debris. Weighted averages and 95% confidence limits of the sensitivity and specificity of the DRC proportion for glomerular disease were 0.88 (0.86-0.90) and 0.95 (0.93-0.97), respectively; those of a low MCV were 1.00 (0.98-1.00) for sensitivity and 0.87 (0.80-0.91) for specificity. Sensitivity and specificity values derived from in-patients were slightly higher than those in referred outpatients. No studies of urinary DRC or MCV in patients with incidentally detected microhaematuria in the primary care setting were found.
We conclude that at present the diagnostic value of urinary DRC and MCV is limited. In referral centres, that is, in patients with a high probability of postglomerular haematuria, the test cannot rule out urological lesions, because its specificity for glomerular disease may be as low as 0.80. In the primary care setting, that is, in unselected patients with incidentally detected low-grade haematuria, the accuracy of the test has not been studied but may be even lower. The use of urinary DRC or MCV as an indicator of the source of haematuria is in need of further experimental development and confirmation.
'Pseudo-Alzheimer's' and primary brain tumour
Authors: O'Mahony D , Walsh J B , Coakley D 
Published: December 2008

Summary
Primary brain tumour may present in the elderly purely as a dementing illness before the onset or detection of sensorimotor neurological symptoms or signs. Although neurological examination may indicate no definite signs, close attention to accepted DSM-IIIR and NINCDS-ADRDA diagnostic criteria for primary degenerative dementia and 'probable' Alzheimer's disease respectively will suggest a process other than a degenerative one. This was the case in two patients with primary brain tumour presenting clinically with dementing illness similar to but distinct from Alzheimer's disease.
Yersinia enterocolitica endocarditis on a prosthetic valve
Authors: Pras E , Arber N , Pinkhas J , Sidi Y 
Published: December 2008

Summary
Yersinia entercolitica endocarditis has rarely been described before. This is the first report of prosthetic valve Yersinia enterocolitis endocarditis, complicated by infected brain embolization. The patient, however, completely recovered after 6 weeks of combined therapy with ceftriaxone and gentamicin.
Naproxen-associated vasculitis
Authors: Jahangiri Marjan , Jayatunga A P , Bradley J W P , Goodwin T J 
Published: December 2008

Summary
Three cases of digital vasculitis attributable to naproxen ingestion are reported. The vasculitic changes were reversed by withdrawal of the drug. These three cases emphasize the need to consider drug sensitivity as a cause of unexplained digital vascular lesions.
Leg ulceration in venous disease
Authors: Shami S K , Shields D A , Scurr J H , Smith P D 
Published: December 2008

Summary
We have given a brief summary of the scale of the problem caused by venous ulceration in the UK, and have then reviewed the various theories of causation, including a historical survey, and presented the evidence for and against the two main current theories of fibrin cuffs and white cell trapping. We also outline previous hypotheses of the aetiology of venous ulceration, including arteriovenous microanastomoses, stasis and oedema. The contribution of superficial venous incompetence in the pathogenesis of ulceration is also examined.
A randomized trial of one versus three doses of Augmentin as wound prophylaxis in at-risk abdominal surgery
Authors: Bates Tom , Roberts Jonathan V , Smith Kevin , German Karl A 
Published: December 2008

Summary
In a randomized prospective trial of prophylactic antibiotics in at-risk abdominal surgery, one dose of intravenous Augmentin (amoxycillin 250 mg and clavulanic acid 125 mg) on induction has been compared with three 8 hourly doses in 900 patients. Wound infection rates which included minor and delayed infections were very similar in those given one dose: 48/449 (10.7%) compared with those given three doses: 49/451 (10.9%) 95% confidence limits - 4.25% + 3.9%.
There were more septic and sepsis-related deaths in those patients given one dose (14 deaths) than in those given three doses (7 deaths) P &gt; 0.1 95% CL - 0.4% + 3.0%. However, there were more very elderly patients in the one dose group: 64% of the deaths were aged over 80 and all but one had an emergency operation. There was no difference in the other outcome measures studied which included non-fatal deep sepsis, length of postoperative hospital stay, duration of postoperative fever or the use of antibiotics for postoperative infection.
One dose of a suitable intravenous antibiotic gives prophylaxis against wound infection in at-risk abdominal surgery which is at least as effective as multiple doses. However, there may be a risk of overwhelming systemic sepsis in very elderly patients having emergency surgery.
Pyrexia of unknown origin: changing spectrum of diseases in two consecutive series
Authors: Barbado F J , Vázquez J J , Peña J M , Arnalich F , Ortiz-Vázquez J 
Published: December 2008

Summary
Comparison was made of the aetiology and methods of diagnosis in two series of patients meeting the classic criteria of pyrexia of unknown origin during 1968-1981 and during 1982-1989 seen in the Department of Internal Medicine at La Paz University Hospital, Madrid, Spain. There was a statistically significant decrease in the percentage of infections and an increase in neoplasms and connective tissue disorders in the second series. The percentage of patients diagnosed by laparatomy was similar in both series but the diagnosis yield at laparotomy was greater in the second period. Pyrexia of unknown origin continues to be a condition which can defy clinical expertise in in spite of advances in diagnostic techniques.