bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of cigarettes and nicotine in the onset and treatment of ulcerative colitis
Authors: Birtwistle J 
Published: December 2008

SummaryEpidemiological evidence suggests that ulcerative colitis is a disease of nonsmokers, while Crohn’s disease is a disease of smokers. The relative risk of developing ulcerative colitis is not only greater in nonsmokers, in addition there appears to be a rebound effect in smokers who quit, with the heaviest (ex-)smokers increasing their relative risk of the disease the most. This factor poses an ethical dilemma for health professionals giving advice on stopping smoking, which may thus have a serious detrimental effect on the health of some patients. Nicotine is believed to be the pharmacological ingredient of tobacco that is responsible for this beneficial effect and several clinical trials using nicotine have demonstrated it to be an effective therapeutic agent in the treatment of ulcerative colitis. Although the aetiology of ulcerative colitis is unclear, current research using nicotine-based products has produced some interesting clues, together with the possibility of some form of therapeutic treatment based on nicotine administration.
Nonvalvular myocardial involvement in metastatic carcinoid disease
Authors: Davis G , Birbeck K , Roberts D , Naqvi N 
Published: December 2008

Summary
A patient with the unusual post mortem finding of myocardial metastatic carcinoid tumour without classical valvular or endocardial carcinoid disease is described. This rare occurrence may represent an aggressive type of carcinoid tumour, with metastatic disease occurring before the development of classical fibrous valvular and endocardial pathology.
Continuing education for medical professionals: a reflective model
Authors: Brigley S , Young Y , Littlejohns P , McEwen J 
Published: December 2008

Summary
The Royal Colleges and their Faculties have moved continuing professional development up the agenda of doctors in the UK. The low educational value and failure to change professional practice of much continuing medical education has led to criticism of its emphasis on formal, didactic teaching and academic knowledge. The ubiquitous scientific or technical bias in medical education makes questionable assumptions about the nature of professional knowledge, how professionals learn, and the linkage of theory and practice in professional work. Given its narrow conception of professional knowledge, it is hardly surprising that the effectiveness of continuing medical education has proven difficult to evaluate.
These points of criticism suggest that a more systematic and coherent approach to continuing education is required. The adoption of the concept of continuing professional development, which draws on learning by reflective practice, marks an important step in this direction. Continuing professional development emphasises self-directed learning, professional self-awareness, learning developed in context, multidisciplinary and multilevel collaboration, the learning needs of individuals and their organisations, and an inquiry-based concept of professionalism. It also involves a widening of accountability to patients, the community, managers and policymakers, and a form of evaluation which is internal, participatory and collaborative rather than external and scientific in character.
Selenium-induced thyroid dysfunction
Authors: Hofbauer L C , Spitzweg C , Magerstädt R A , Heufelder A E 
Published: December 2008

Summary
Administration of the anti-oxidative trace element selenium is currently being evaluated for its benefits in patients with inflammatory diseases. However, little is known about the risks of selenium. We report on a patient in whom, along with standard therapy, administration of large intravenous doses of selenite for sepsis secondary to pneumonia resulted in development of marked hypothyroidism. In addition, severe iodine deficiency was noted, and supplementation with iodine led to normalisation of thyroid function.
Neutrophilic dermatoses: pyoderma gangrenosum and Sweet's syndrome
Authors: Lear J T , Atherton M T , Byrne J P H 
Published: December 2008

Summary
Pyoderma gangrenosum and Sweet's syndrome are classified as neutrophilic dermatoses as they exhibit intense dermal inflammatory infiltrates composed of neutrophils with little evidence of a primary vasculitis. They share several characteristics and respond to immunosuppressives. Aetiology is felt to represent a manifestation of altered immunologic reactivity. Patients with both conditions concurrently have been described. Diagnosis is based on clinical and histopathological findings. However, clinically the typical forms of the two conditions are quite distinct: pyoderma showing cutaneous ulceration with a purple undermined border and Sweet's syndrome having tender, erythematous, nonulcerated plaques and nodules. Approximately 50% of cases of pyoderma are associated with a specific systemic disorder. These include inflammatory bowel disease, rheumatoid arthritis, non-Hodgkin's lymphoma and myeloproliferative disorders. Many associations with Sweet's syndrome have been described, including acute myeloid leukaemia, myeloma and adenocarcinomas, and haematological malignancy. There is overlap between the two conditions with lesions categorised as Sweet's syndrome being clinically more characteristic of atypical pyoderma and vice versa. We believe that pyoderma and Sweet's syndrome represent a continuum of spectrum of disease. The reason for the clinical differences between the conditions is unclear and merits further investigation but may be explained by varying levels of intensity and extent of the inflammatory process. This review will describe the pathogenesis, clinical features, diagnosis, associations and treatment of the two conditions.
Tropical liver abscess
Authors: Yeoh K G , Yap I , Wong S T , Wee A , Guan R , Kang J Y 
Published: December 2008

Summary
Forty-one consecutive cases of liver abscesses seen at the National University Hospital, Singapore from 1988 to 1994 were reviewed. Twenty-seven cases (65%) were pyogenic, six (15%) amoebic, two (5%) tuberculous and six (15%) indeterminate. The predominance of pyogenic abscesses is in marked contrast to previous studies from the region a decade ago in which amoebic abscesses were the commonest type. The commonest pathogen causing pyogenic abscess was Klebsiella pneumoniae. Two cases were due to Mycobacterium tuberculosis, and this organism needs to be actively looked for in smears and cultures of aspirated material. As the majority of organisms isolated were resistant to ampicillin, empirical antibiotic treatment for suspected pyogenic abscess should include gentamicin or a cephalosporin. Percutaneous needle aspiration of the abscess was performed for 85% of pyogenic abscesses and surgery was necessary in only two cases because of complications. We found that percutaneous aspiration of liver abscess is helpful to confirm the diagnosis, provides a better bacteriological culture yield, gives a good outcome, and may uncover clinically unsuspected conditions like malignancy and tuberculoma which may mimic the presentation of liver abscesses. We recommend routine cytological examination of aspirated abscess material as well as stains and cultures for acid-fast bacilli.
Signs and symptoms in patients with salivary gland hypofunction
Authors: Longman L P , Higham S M , Bucknall R , Kaye S B , Edgar W M , Field E A 
Published: December 2008

Summary
Salivary gland hypofunction can have a devastating effect on oral health and may be an indicator of systemic disease such as Sjögren's syndrome. This prospective study investigates the oral and non-oral signs and symptoms in 120 patients with objective evidence of salivary gland hypofunction (ie, an unstimulated whole salivary flow of &lt; 0.2 ml/min). Patients were questioned about symptoms associated with decreased oral function; non-oral symptoms were also noted. The underlying cause of salivary gland hypofunction was established on the basis of clinical and laboratory findings and further investigations.
Eighty-five per cent of patients reported symptoms of decreased oral function in addition to oral dryness. Non-oral signs and symptoms were reported by 106 patients. Fifty-three per cent of patients were diagnosed as having Sjögren's syndrome. The prevalence of the following non-oral signs and symptoms were significantly higher in patients with Sjögren's syndrome, than in those without; a history of dry/irritated eyes, salivary gland swelling, dry skin and reduced lacrimal flow. Salivary gland hypofunction is associated with a wide range of oral and non-oral signs and symptoms. Several of these are of potential value as triggers for the clinician to identify patients with Sjögren's syndrome, and should serve to prompt referral for specialist investigation.
Haematuria
Authors: Rockall A G , Newman-Sanders A P , al-Kutoubi M A , Vale J A 
Published: December 2008

SummaryMany serious and potentially treatable diseases of the urinary tract may have haematuria as their only manifestation. However, asymptomatic microscopic haematuria detected by dipstick testing may be seen in up to 16% of screening populations. The great majority of such cases will have no sinister underlying cause, particularly in those under 40 years of age, and so the schedule of further investigations, some of which may be invasive, time-consuming and expensive, needs to be rationalised. In addition, the increasing popularity of ‘fast track’ clinics for the investigation of haematuria enhances the need for a clear strategy of investigation. Analysis of the epidemiology of asymptomatic haematuria and its causes combined with a consideration of the risk-benefit profile of the available investigations, makes it possible to set out an algorithm for the initial management of this common finding. Careful clinical assessment and basic laboratory tests for renal function, analysis of the urinary sediment and cytological examination of the urine are followed by ultrasound and plain radiography of the urinary tract. Flexible cystoscopy under local anaesthetic is central to the algorithm in patients of all ages. The importance of a nephrological opinion and consideration of renal biopsy, especially in younger patients with other evidence of glomerular disease, is stressed. The role of intravenous urography in excluding pathology of the upper urinary tract, especially in patients over the age of 40, is also considered.
Cardiac tamponade
Authors: Ball J B , Morrison W L 
Published: December 2008

Summary
Cardiac tamponade is a cardiological emergency requiring prompt treatment in order to avoid a fatal outcome. It can complicate a number of medical conditions and it is important, therefore, that all practitioners are aware of its presentation, diagnosis and management. These are outlined. We suggest that, with certain specific and important exceptions, percutaneous catheter pericardiocentesis is to be recommended in the management of cardiac tamponade. We include a review of 51 consecutive cases treated at our own institution. Catheter pericardiocentesis was successful in 49 (96%) cases and 36 (80%) patients did not require any further intervention. There were no major and only two minor complications which required no additional treatment. We review previous literature concerning percutaneous pericardiocentesis. Using recommended procedures, pericardiocentesis is successful in 90–100% of cases and major complications are rare.
Malakoplakia and colorectal adenocarcinoma
Authors: Bates A W , Dev S , Baithun S I 
Published: December 2008

Summary
We report a case of malakoplakia in association with colonic adenocarcinoma. Tumour-associated malakoplakia in the gastrointestinal tract is a rare finding, generally confined to the colon. It may be locally aggressive, with invasion of pericolic tissues, but is always located adjacent to the tumour. This contrasts with the often more diffuse, multifocal distribution of colonic malakoplakia in association with other pathologies.
Parkinson's disease
Authors: Playfer J R 
Published: December 2008

Summary
Parkinson's disease is a common disabling disease of old age. The diagnosis of idiopathic Parkinson's disease is based on clinical signs and has poor sensitivity, with about 25% of patients confidently diagnosed as having the disease actually having other conditions such as multi-system atrophy and other parkinsonism-plus syndromes. Benign essential tremor and arteriosclerotic pseudo-parkinsonism can easily be confused with Parkinson's disease. The cause of Parkinson's disease remains unknown. Speculative research highlights the role of oxidative stress and free radical mediated damage to dopaminergic cells. Parkinson's disease is the one neurodegenerative disorder in which drugs have been demonstrated to be of value. There is now a wide variety of drugs and formulations available, including anticholinergics, amantidine, L-dopa, dopamine agonists including apomorphine, selegiline and soon to be available catechol-O-methyltransferase inhibitors. Disabling side-effects of treatment, fluctuations, dyskinesias and psychiatric problems require strategic use of the drugs available. There is an increasing potential for neurosurgical intervention.
Learning contracts in higher professional training: a user's guide
Authors: Brambleby P , Coates R 
Published: December 2008

Summary
If the doctor undergoing higher professional training is to make best use of the attachment to a training location, and that training location is to make the most efficient use of the contribution of the trainee, then a written framework such as a learning contract can meet the needs of both. The first stage is to list the learning needs of the individual trainee and to match them with the work experience offered by the training location. Next, the work programme for the coming six to 12 months should be formalised in a learning contract, spelling out the tasks to be performed and the expected training benefit. This is then reviewed at agreed intervals and a written appraisal made. At the end of the attachment the trainee, trainer and any outside accrediting or auditing body, has a written account of what was expected, what was achieved, and the performance of trainee and trainer.
Octreotide scanning for carcinoid tumours
Authors: Critchley M 
Published: December 2008

Summary
The somatostatin analogue octreotide may be used in the diagnosis of carcinoid and other neuroendocrine tumours. Radionuclide scanning following intravenous injection of 111Indium-labelled octreotide (111In-DTPA-pentetreotide) provides a sensitive, non-invasive method of localising somatostatin-positive tumours. The technique may also be used to identify patients who may respond to ‘cold’ octreotide therapy and to monitor therapeutic efficacy.
The role of ultrasound in the diagnosis of a large, rapidly growing, thyroid mass
Authors: King A D , Ahuja A T , King W , Metreweli C 
Published: December 2008

Summary
The value of ultrasound in the diagnosis of a large rapidly growing thyroid mass was assessed in a study of 42 patients with a large (&gt; 3 cm) rapidly growing (&lt; two months) solitary mass. Haemorrhage into a thyroid nodule was present in 31 patients and thyroid malignancy in 11. Ultrasound of haemorrhage into a thyroid nodule revealed a large cystic mass in all 31 patients containing internal debris (22), septations (three), or a combination of both (six). The malignant causes of a large rapidly growing mass were lymphoma (two), anaplastic carcinoma (four) and metastasis (five). Ultrasound of these thyroid malignancies revealed a mass with a smooth, well-defined margin and strikingly low homogeneous echogenicity in all cases. Patients with thyroid metastases had evidence of widespread metastatic disease elsewhere. Lymphoma was differentiated from anaplastic carcinoma on fine-needle aspiration cytology or surgical biopsy. Ultrasound was of value in differentiating between a benign haemorrhagic nodule and a malignant tumour. The various malignant tumours had similar appearances, however, and could not be distinguished on ultrasound.
Cranial and peripheral neuropathy due to Epstein-Barr virus infection
Authors: Gavin C , Langan Y , Hutchinson M 
Published: December 2008

Summary
A case of Epstein-Barr virus infection with neurological complications is described. An 18-year-old man developed cranial neuropathy and peripheral sensorimotor polyneuropathy three weeks after a sore throat. Though severely affected initially, he made a good recovery and no specific therapeutic intervention appears to have influenced his clinical course.
Dehydration in the terminally ill—iatrogenic insult or natural process?
Authors: Chadfield-Mohr S M , Byatt C M 
Published: December 2008

Summary
The question of whether terminally ill patients should artificially be given fluids has been debated since before palliative care became a recognised specialty. Arguments have been adduced from physiological, comfort, legal psychological, and emotional perspectives. Palliative care specialists agree that the priority is preventing the symptoms associated with dehydration, rather than the dehydration itself. However, the majority of terminally ill patients are cared for in settings outside hospices, and those admitted to hospital will tend to be exposed to a more technical approach. There are no randomised controlled trials in this area, and although an ethical minefield, we should not be afraid to manage individual patients according to the principles of palliative care where control of symptoms, not normalising of physiological variables, is the primary objective.
Testicular carcinoma
Authors: O'Callaghan A , Mead G M 
Published: December 2008

Summary
Testicular cancer is the commonest malignancy in young males and its incidence has more than doubled in the last 25 years. For clinical purposes, two tumour types are identified, seminoma and non-seminoma germ cell tumours (loosely known as teratomas). Stage I disease is confined to the testes and is managed surgically, with adjuvant chemotherapy or radiotherapy as appropriate. Cisplatin-based chemotherapy is the cornerstone of treatment for metastatic disease, with cure rates exceeding 80%. Early diagnosis and cure should be the aim in all patients. To this end, those with testicular symptoms should be evaluated promptly by ultrasound, and in young male patients presenting with the clinical picture of metastatic disease, germ cell tumour should top the list of differential diagnoses.
Chronic pancreatitis and pancreatic carcinoma
Authors: Evans J D , Morton D G , Neoptolemos J P 
Published: December 2008

Summary
The differential diagnosis between pancreatic cancer and chronic pancreatitis is very important as the management and prognosis of these two diseases is different. In most patients with pancreatic disease, the diagnosis can be established but there is a subgroup of patients in whom it is difficult to differentiate between these conditions because the clinical presentation is often similar and currently available diagnostic tests may be unable to distinguish between an inflammatory or neoplastic pancreatic mass. This paper reviews the aetiology, pathology and clinical features of these diseases and discusses the limitations of conventional diagnostic methods and how newer techniques may be of value in the differential diagnosis.
Moyamoya disease
Authors: Farrugia M , Howlett D C , Saks A M 
Published: December 2008

Summary
Moyamoya disease is a rare cerebrovascular condition of uncertain aetiology commonly affecting young persons. The disease is mainly seen in Japanese patients. We report two cases of moyamoya disease in Caucasian women and review the postulated aetiological factors and associated conditions as well as the spectrum of invasive and non-invasive imaging modalities useful in the diagnosis and follow-up of the disease, with particular reference to the developing role of magnetic resonance imaging and angiography.
Rapid diagnosis of asymptomatic hereditary haemochromatosis by detection of the Cys282Tyr mutation in the HLA-H gene
Authors: Aslam S , Standen G R 
Published: December 2008

Summary
Hereditary haemochromatosis is an autosomal recessive disorder characterised by life-long excessive accumulation of iron. A candidate gene for hereditary haemochromatosis has recently been reported (HLA-H) and a specific missense mutation (Cys282Tyr) has been identified in 85% of patients with the disorder. We describe the rapid detection of this mutation using the polymerase chain reaction and restriction endonuclease digestion. The usefulness of this test for early diagnosis of hereditary haemochromatosis in asymptomatic family members is highlighted.
Association of sarcoidosis, low-grade B-lymphoma and epidermoid carcinoma
Authors: Romero J , Ramón y Cajal S , Vargas J A , Pérez-Maestu R , Salas C , Regueiro C A , Aragon G 
Published: December 2008

Summary
We report on a case of the so-called sarcoidosis-lymphoma syndrome in a 65-years-old man diagnosed as having sarcoidosis and, four years later, neurosarcoidosis. The diagnoses of epidermoid carcinoma of the skin and of stage IV monocytoid, small cell lymphocytic lymphoma were made five and seven years, respectively, after the initial diagnosis of sarcoidosis. It has been suggested that the increased mitotic activity of lymphocytes observed in sarcoidosis, favours their malignant transformation. Hypothetically, sarcoidosis might also influence the development of epidermoid carcinomas by depletion of circulating T4 lymphocytes and decreased resistance to oncogenic viruses that could lead to decreased tumour rejection in the epithelia exposed to carcinogenic stimuli.
Treatment of progressive renal failure and nephrotic syndrome with azathioprine and prednisolone
Authors: Baker L R I , Tucker B , Macdougall I C , Oommen R 
Published: December 2008

Summary
Four patients with idiopathic membranous glomerulonephritis, heavy proteinuria and progressive renal failure received azathioprine and prednisolone. Renal function improved in all four and proteinuria declined sharply in three. We suggest that treatment with azathioprine and prednisolone may be of benefit in this form of idiopathic membranous glomerulonephritis.
Tamoxifen for retroperitoneal fibrosis
Authors: Frankart L , Lorge F , Donckier J 
Published: December 2008

Summary
Retroperitoneal fibrosis, either idiopathic or associated with aortic inflammatory aneurysm, is a chronic fibrotic disease that causes progressive obstruction of ureters and vessels around the lower abdominal aorta. Treatment is often difficult (surgery) or hazardous (steroids). We report a case of a woman with retroperitoneal fibrosis associated with aortic inflammatory aneurysm, who was successfully treated with oral tamoxifen.
Exercise electrocardiogram and single vessel coronary artery disease
Authors: Chauhan A , Thuraisingham S I , Stone D L 
Published: December 2008

Summary
The aim of this study was to assess the efficiency of exercise tests in identifying ischaemia in the territories supplied by the three main coronary arteries. We prospectively analysed 578 patients with single vessel coronary disease (&gt; 50% stenosis in one vessel and completely normal other vessels). Patients with single vessel coronary artery disease were divided into three groups: patients with significant left anterior coronary artery disease (group 1, n = 234); patients with significant right coronary artery disease (group 2, n = 201); patients with significant left circumflex disease (group 3, n = 143). Our study, which is the largest prospective study of patients with angiographically documented single vessel coronary artery disease, suggests that the exercise electrocardiogram is a poor predictor of circumflex coronary artery ischaemia. In addition, the site of ST depression identified from the electrocardiogram was a poor predictor of the site of myocardial ischaemia. No single lead could distinguish between the three groups and the location of coronary stenosis could not be predicted by location of ST depression.