bluuebunny/crossref_metadata_2025_split huggingface dataset:
Colorectal liver metastases
Authors: Burke D , Allen-Mersh T G 
Published: December 2008

Summary
Each year in the UK, between 12-14,000 people develop liver metastases from colorectal cancer. These metastases will contribute to the death of the patient in about 80% of cases. Treatments aimed at these tumours are best administered when the tumour is small. Current investigative methods allow tumours as small as 0.5 mm to be detected, and should be offered to all colorectal cancer patients at risk of developing liver metastases. Surgery remains the only curative treatment for these tumours, but, unfortunately, only 20% of those who have tumour excision will survive five years. In those patients unsuitable for surgery, chemotherapy with fluoropyrimidines produces the best tumour response. This may be administered systemically or regionally, via a catheter placed within the hepatic artery. The latter approach reduces systemic toxicity, but may produce hepatotoxicity. The results of other forms of systemic chemotherapy currently undergoing clinical trials are awaited. The vast majority of patients will benefit from suitable palliative treatment delivered either locally or systemically. With the wide range of treatments now available for liver metastases, these patients are best assessed in a unit with a special interest in the problem.
Narcolepsy-cataplexy and loss of sphincter control
Authors: Vgontzas A N , Sollenberger S E , Kales A , Bixler E O , Vela-Bueno A 
Published: December 2008

Summary
We describe the case of a 34-year-old man who presented intermittent faecal incontinence as a manifestation of cataplexy. The patient’s sleep history was positive for the full narcoleptic tetrad (sleep attacks, cataplexy, sleep paralysis and hypnagogic hallucinations) while extensive neuropsychiatric work up was negative for any neurologic or psychiatric illness. Repeat polysomnograms (including a polysomnogram with a full seizure montage) were positive for pathologic sleepiness, but there was no evidence of a seizure disorder. The course of the patient’s symptomatology and the favourable response of his symptoms to stimulants and imipramine support the theory that his intermittent loss of sphincter control is part of his narcolepsy-cataplexy.
The management of diabetes in pregnancy
Authors: Hadden D R 
Published: December 2008

Summary
The aim of the diabetes specialist is to provide a service to the pregnant diabetic woman so that she will present to her obstetrician with such well-controlled plasma glucose levels that her pregnancy will proceed without any diabetes-related problem, and she will be delivered of a normal baby, of normal size, at the normal full-term gestation, by the normal route. There are some problems in achieving this aim. The exact definition of hyperglycaemia in pregnancy is still a matter of dispute. Screening methods to identify the problem differ widely. Many centres have developed joint diabetes/antenatal clinics, but there are practical problems with such an approach. Pre-pregnancy counselling, and discussion of contraceptive measures is an important task for the diabetologist and requires up-to-date knowledge. Control of plasma glucose requires alteration of insulin doses as pregnancy proceeds. Mothers with retinal, renal or cardiac problems will need special care. The medical problems which develop, and the management of blood glucose during labour and delivery, mean that the diabetes team must be very adjacent to the obstetric service, and a centralised approach offers many advantages. The postpartum state, and the long-term outcome for both mother and baby, remain both an interest and a responsibility for the obstetric physician.
Syncope: driving advice is frequently overlooked
Authors: MacMahon M , O’Neill D , Kenny R A 
Published: December 2008

Summary
Consecutive referrals to a syncope clinic were asked about the frequency of enquiries about driving status by referring general practitioners and/or hospital specialists. Although 40% were drivers, only 13% of patients had been previously asked about driving, and 12% of drivers had experienced symptoms whilst driving. This represents an important oversight on the part of referring doctors.
Cutaneous and pharyngeal diphtheria imported from the Indian subcontinent
Authors: Hart P E , Lee P Y , Macallan D C , Wansbrough-Jones M H 
Published: December 2008

Summary
We report the case of a 32-year-old woman who presented upon returning from India with cutaneous ulcers on the feet and pharyngitis. Microbiological testing showed the causative organism to be a toxigenic strain of Corynebacterium diphtheriae. She was treated successfully with penicillin and diphtheria antitoxin. This case emphasises the importance of maintaining a high index of suspicion for such rare but significant infectious diseases.
An unusual cutaneous manifestation of ulcerative colitis: thrombotic skin gangrene
Authors: Singh S , Noshirwani K 
Published: December 2008

Summary
Ulcerative colitis has a number of associated skin lesions. We report the case of a patient with active ulcerative disease presenting with rapidly progressive necrotic skin lesions, identified as thrombotic and requiring skin grafting. Thrombotic cutaneous gangrene is a rare but potentially serious manifestation of uncontrolled ulcerative colitis.
The homeless
Authors: Abdul-Hamid W , Cooney C 
Published: December 2008

Summary
The medical literature on homeless people tends to concentrate on their biographic characteristics or clinical problems without enough attention being given to the social and environmental contexts which they have to survive. This article summarises the literature on the role of social factors in the causation and outcome of health problems of the homeless and emphasises the importance of addressing the social context in effecting intervention. Services that deal with the social needs of the homeless will be more successful in meeting their needs and reducing their distress.
Mixed pulmonary infection with Nocardia, Candida, methicillin-resistant Staphylococcus aureus, and group D Streptococcus species
Authors: Vassallo J , Galizia A C , Cuschieri P 
Published: December 2008

Summary
A 67-year-old man on prednisolone and azathioprine for ulcerative colitis, developed severe pneumonia due to Nocardia otitidis caviarum, methicillin-resistant Staphylococcus aureus, a group D Streptococcus and Candida albicans. The patient responded well to aggressive antimicrobial therapy.
Polyarteritis nodosa and drug abuse: is there a connection?
Authors: Samuels N , Shemesh O , Yinnon A M , Fisher D , Abraham A S 
Published: December 2008

Summary
Drug abuse has been controversially linked to polyarteritis nodosa. A 28-year-old man with a history of drug abuse with inhaled heroin presented with an enigmatic illness consisting of refractory fever, bilateral pleural effusions, migratory polyarthritis, and a leukaemoid reaction. An abdominal angiography confirmed the diagnosis of polyarteritis nodosa, and treatment with both prednisone and cyclophosphamide resulted in significant clinical and laboratory improvement.
Treatment of hyperemesis gravidarum with the 5-HT3 antagonist ondansetron (Zofran)
Authors: Tincello D G , Johnstone M J 
Published: December 2008

Summary
Ondansetron is a 5-hydroxytryptamine receptor antagonist which is known to be a highly effective anti-emetic drug for chemotherapy-associated nausea and vomiting and for postoperative nausea. We report here a case where ondansetron was used in severe hyperemesis gravidarum to avoid parenteral nutrition. The drug was used intermittently in every trimester with no apparent adverse effects on mother or infant.
Interferon-alpha in childhood haematological malignancies
Authors: Simkó R , Nagy K 
Published: December 2008

SummaryThe application of cytostatics has brought about a breakthrough in the treatment of childhood haematological malignancies in the past 20 years. Chemotherapy appears to be least successful in the rare, low and very high mitotic index diseases, which often have an enormous tumour-burden. The suitability of chemotherapy in minimal residual leukaemia is also of some doubt. In these situations a ‘conservative’ treatment may be more appropriate. Because interferon-alpha has a distinct mechanism of action, and a broad-spectrum haematopoietic inhibitory activity, it is relatively nontoxic and noncancerogenic, and it may have a role in the treatment of malignant haematological disorders, either as a mono- or combination therapy. The exact indications and dosages for interferon in childhood malignancies are far from clear. Up to now, it has proved to be most efficacious in small tumour masses, providing a theoretical basis for application in minimal residual disease. Controlled clinical data, however, are not yet available. It remains to be determined whether or not interferon can be added to current chemotherapy protocols without a significant reduction of dose. Hopefully, a deeper understanding of the activities of interferon will allow us to plan better trials with combination treatments.
Bladder cancer
Authors: Leung H Y , Griffiths T R , Neal D E 
Published: December 2008

SummaryBladder cancer is the fourth most common cancer in England and Wales. The most common presenting symptom is macroscopic haematuria. The management options for superficial and invasive bladder cancer depend on the stage at presentation. Most superficial bladder cancers are managed by transurethral resection and cytoscopic follow-up. The prognosis for patients with invasive bladder cancer is less good. The role of chemical, radiotherapeutic and surgical intervention are discussed.
Spontaneous healing of osteitis fibrosa cystica in primary hyperparathyroidism
Authors: Gibbs C J , Millar J G , Smith J 
Published: December 2008

Summary
A 24-year-old man with primary hyperparathyroidism and osteitis fibrosa cystica developed acute hypocalcaemia. Spontaneous healing of his bone disease was confirmed radiographically and by correction of the serum alkaline phosphatase. Hypercalcaemia associated with a raised serum parathyroid hormone recurred 90 weeks after the initial presentation. During the fourth neck exploration a parathyroid adenoma was removed, resulting in resolution of his condition. Haemorrhagic infarction of an adenoma was the most likely cause of the acute hypocalcaemic episode.
Expanding the role of the nurse in the Accident and Emergency department
Authors: Neades B L 
Published: December 2008

SummaryIn response to the increasing demands upon the Accident and Emergency department and supported by changes within the scope of professional practice of the qualified nurse, Accident and Emergency nurses have expanded their role within the multidisciplinary team. The article reviews the development of this expanded role for the nurse within the Accident and Emergency team and discusses its implications.
Wernicke-Korsakoff syndrome
Authors: Zubaran C , Fernandes J G , Rodnight R 
Published: December 2008

SummaryAlcohol abuse is one of the most serious problems in public health and the Wernicke-Korsakoff syndrome is one of the gravest consequences of alcoholism. The pathology is often undiagnosed in its less evident presentations, therefore an accurate diagnostic approach is a critical step in treatment planning. Treatment is based on restoration of thiamine, although this is insufficient to prevent the psychological decline of a great number of patients. The cognitive impact of the pathology is derived from the interaction of alcoholic neurotoxicity, thiamine deficiency and personal susceptibility. In this article, the literature concerning Wernicke-Korsakoff syndrome is reviewed.
Warwickshire consultants' ‘training the trainers’ course
Authors: Whitehouse A 
Published: December 2008

Summary
To train junior hospital doctors more quickly and effectively as envisaged by the Calman reforms, consultants will need to develop their adult education skills. This paper describes a course set up and attended by a mixed group of Warwickshire consultants to improve their understanding of these skills. The course organisation and content is described and the ‘learner-centred education’ model, educational supervision techniques, giving feedback on performance, goal setting, learning contracts and other topics covered are explained. A 12-month interval questionnaire evaluation by attendants shows that the principles taught in the course were being widely applied a year later. Thus, at a modest cost, consultants can receive a valuable basic training in adult education.
Malignant change in a chronic skin lesion induced by an intravenous cannula
Authors: Nkere U U , Banjar A 
Published: December 2008

Summary
A cutaneous wound subjected to continuous irritation has an increased potential for malignant degeneration. The types of trauma that may give rise to the initial injury are diverse and have been well documented. We report a case of one such lesion in a 65-year-old man who had a persistent right forearm wound for over three years. The wound arose from the site of venous cannula puncture. Malignant transformation occurred in a manner comparable to that seen in other chronic lesions (Marjolin's ulcer).
Reversible acute renal failure induced by losartan in a renal transplant recipient
Authors: Ostermann M , Goldsmith D J A , Doyle T , Kingswood J C , Sharpstone P 
Published: December 2008

Summary
A 56-year-old man who received a live-related renal transplant in 1988 was started in 1995 on the selective angiotensin II antagonist losartan (Dupont-Merke) to treat worsening hypertension. Two months later because of pulmonary oedema, loop diuretics were started. Within two weeks, serum creatinine had increased from 245 to 571 mumol/l, and the patient became oliguric. A systolic bruit was noted over the graft. Renal angiography showed a 90% stenosis of the transplant renal artery. Losartan was withdrawn, with prompt improvement in renal function. A successful percutaneous transluminal angioplasty performed a few days later resulted in further improvement in renal function accompanied by a significant diuresis.
Ursodeoxycholic acid in the treatment of liver diseases
Authors: Saksena S , Tandon R K 
Published: December 2008

Summary
Ursodeoxycholic acid is a dihydroxy bile acid with a rapidly expanding spectrum of usage in acute and chronic liver diseases. The various mechanisms of action of this hydrophilic bile acid include direct cytoprotection, detergent action on dysfunctional microtubules, immunomodulation and induction of hypercholeresis. Its efficacy in primary biliary cirrhosis and primary sclerosing cholangitis as an adjunct to medical therapy has been well established. Newer indications include its use in the management of chronic hepatitis, cirrhosis, post liver transplant rejection, graft-versus-host disease and acute viral hepatitis, where it not only relieves symptoms of cholestasis but also arrests ongoing hepatocyte necrosis.
The journal club
Authors: Valentini R P , Daniels S R 
Published: December 2008

Summary
As the body of medical literature continues to expand, physicians must develop the necessary skills to keep up with the vast amount of information available. The journal club provides a forum to allow residents to remain current with the literature while also teaching them the methods to evaluate it critically. Those readers wishing to start a journal club or revive an existing one should begin by designating a leader and defining the conference goals. Emphasizing the importance of this conference in the educational process while allowing it to be structured to optimise resident interest and attendance will help to ensure its success. Periodic evaluation of this conference will allow the organisers to assess the concordance of the resident's goals with those of the faculty. Formal evaluation will also provide an objective assessment of the knowledge gained by the house-staff through participation in journal club.
The assessment of acute calf pain
Authors: Banerjee A 
Published: December 2008

Summary
Acute calf pain can be due to a variety of causes. The identification of patients requiring screening for deep vein thrombosis can be achieved from the history and physical examination. For emergency department use, initially noninvasive assessment with ultrasound scanning can not only demonstrate thrombosis but also other lesions, including popliteal cysts and masses producing venous compression. This is a cost-effective strategy suitable for the assessment of the ambulatory patient. Some subgroups of patients with proven deep vein thrombosis may require further investigation for the predisposing cause.
Pneumonitis induced by sulphasalazine
Authors: Peters F P J , Engels L G J B , Moers A M J 
Published: December 2008

Summary
We describe a 65-year-old woman with eosinophilic pneumonitis induced by sulphasalazine. Laboratory findings revealed peripheral eosinophilia. The chest X-ray showed bilateral infiltrations, which disappeared after sulphasalazine was discontinued.
Generic inhaled salbutamol versus branded salbutamol. A randomised double-blind study
Authors: Williamson I J , Reid A , Monie R D , Fennerty A G , Rimmer E M 
Published: December 2008

Summary
Generic substitution of salbutamol lags behind that of other drugs in Scotland and a negative perception by both patients and doctors may explain this. The aim of this study was to assess whether, in clinical practice, there was any difference in efficacy between branded salbutamol (Ventolin) and a generic preparation. Asthmatic patients using a Ventolin metered-dose inhaler at least twice a day for symptom relief were entered into a double-blind cross-over study, comparing Ventolin, blinded Ventolin and a generic salbutamol in random order for two weeks each. Daily peak flows, inhaler use and bronchodilator response were recorded. At the end of each treatment period patients rated their inhaler against their usual Ventolin on a 5-point scale. Forty patients were entered into the study; 90% received 1000 micrograms or more of inhaled steroids per day. Eleven patients dropped out during the run-in phase. In the remaining 29 patients, no significant difference between treatments could be found in any of the objective parameters measured. Fifty-five per cent of patients said they could detect a difference between the inhalers, and 45% noted a difference between their usual Ventolin and the open or blinded Ventolin. This study showed clinical equivalence between a generic and branded salbutamol. Patients' own assessment of their relief inhaler seems to be influenced by factors other than efficacy. The study highlights that careful encouragement is required when changing to a generic product and has particular implications for the forthcoming conversion to CFC-free products.
Haemopoietic growth factors
Authors: Ketley N J , Newland A C 
Published: December 2008

Summary
Haemopoietic growth factors are involved in the production of the various blood cells from progenitors in the bone marrow, making them useful in a range of clinical situations. The genes for several of them have been cloned and their production engineered by recombinant technology, making them widely available. Myeloid growth factors are used to support patients in the aftermath of chemotherapy and bone marrow transplantation and have potential application in the treatment of infectious diseases. Erythropoietin is widely used for patients with anaemia due to failure of marrow production, having established its effectiveness in chronic renal failure. Thrombopoietin has recently been described and may provide a means to alleviate thrombocytopenia. Current indications and areas of recent reappraisal are addressed in this review.
Unsuspected thyrotoxicosis and hyperemesis gravidarum in Asian women
Authors: Chong W , Johnston C 
Published: December 2008

SummaryThis report describes three women with hyperemesis gravidarum caused by previously undiagnosed thyrotoxicosis. All three women were eight weeks pregnant and only one woman had typical features of thyrotoxicosis. Hyperemesis could not be controlled by anti-emetics. The patients were successfully treated with antithyroid drugs. Anti-thyroid treatment does not need to be continued once resolution of symptoms and thyrotoxicosis have occurred.
Supervised drug administration in patients with refractory hypertension unmasking noncompliance
Authors: Cronin C C , Higgins T M , Murphy M B , Ferriss J B 
Published: December 2008

Summary
Noncompliance with medication is common, particularly in asymptomatic conditions such as hypertension that require long-term treatment, and is often unsuspected. We describe two patients with refractory hypertension in whom noncompliance was confirmed by a precipitous fall in blood pressure when antihypertensive medications were given under direct supervision.
Genes and the development of vascular disease
Authors: Foy C A , Grant P J 
Published: December 2008

Summary
Clinical vascular disease occurs as the result of the chronic development of atherosclerosis, often with acute occlusive thrombus formation as the final event. Both atherosclerotic and thrombotic disorders are complex processes resulting from genetic and environmental interactions. We review genes currently implicated as risk factors and the approaches for identifying novel genetic risk factors.
Solitary ileocolic arteriovenous malformation: spongostan and silk therapeutic embolisation
Authors: Alcalde M , Jiménez G , Díaz P , García-Díaz M , Pascasio J M , Moro R , Zapata J , López-Santamaría A 
Published: December 2008

Summary
A debilitated patient with liver cirrhosis and poor haemostasis had a severe lower gastrointestinal haemorrhage. A superior mesenteric arteriogram revealed an early persistent and promiment draining vein in the ileocolic artery. Two fragments of Spongostan and silk were used to embolise the bleeding artery and the haemorhage ceased immediately. No infarction of the embolised area was observed and the bleeding was controlled.
Massive arterial bleeding from a single rectal vessel
Authors: Harrison J D , Calatayud A , Thava V R , Kirby R M 
Published: December 2008

Summary
We report a case of massive rectal haemorrhage arising from a single ectatic arterial vessel above the haemorrhoidal cushion in normal rectal mucosa. Use of an anal retractor enable identification of the bleeding vessel and avoided a major laparatomy.
Langerhans cell histiocytosis (histiocytosis X)
Authors: Lam K Y 
Published: December 2008

Summary
There has been a renewed interest in Langerhans cell histiocytosis in recent years due both to advances in basic research and to improvements in diagnostic and treatment approaches. In this article, we review the various aspects of the disease and the potential implications of these recent scientific researches for our understanding and management of the disorder.
Handbooks, learning contracts, and senior house officers: a collaborative enterprise
Authors: Parsell G 
Published: December 2008

Summary
Efforts to bring about improvements in hospital-based education and training for senior house officers over the last few years have raised issues which are gradually being addressed. One of these is the lack of understanding by many clinical teachers of educational principles and their application to senior house officer training. This study describes how volunteer consultants in five specialties in a North West District General Hospital worked together to develop an educational structure for senior house officers. An audit of education and training was carried out across the hospital to help identify problem areas. An education specialist worked with consultants to develop, implement and evaluate a handbook based on adult learning principles. The handbook incorporated a learning contract, formal review process and a curriculum of learning objectives for each specialty. In parallel, consultants created in-house videos which were used to raise awareness of clinical teachers in the hospital about these educational issues. Preliminary evaluation showed positive responses by both senior house officers and consultants to both the study and its outcomes.