bluuebunny/crossref_metadata_2025_split huggingface dataset:
The tight pants syndrome--a sporting variant
Authors: Jowett N I , Robinson C G 
Published: December 2008

Summary
Tight neoprene ‘warm pants’ are increasingly utilised by sportsmen to prevent muscular injury. However, they may impede venous flow from the legs. We describe a case of extensive proximal deep vein thrombosis with subsequent pulmonary embolism in a fit young man with previous hip trauma.
Adult respiratory distress syndrome due to mycoplasma pneumonia
Authors: Shah D C , Muthiah M M 
Published: December 2008

Summary
A previously fit 48-year-old man was admitted with an acute respiratory failure due to mycoplasma pneumonia that was confirmed by raised mycoplasma titre on complement fixation test. It was also associated with disseminated intravascular coagulopathy. The patient made a full recovery but required intermittent positive pressure ventilation.
The diabetic patient with hypertension
Authors: Leese G P , Savage M W , Chattington P D , Vora J P 
Published: December 2008

Summary
Hypertension and diabetes co-exist more commonly than would be expected from their individual prevalences. Elevated blood pressure is most commonly due to coexisting essential hypertension, or diabetic renal disease. Early stages of diabetic renal disease can be identified by detecting microalbuminuria. Standard measures of blood pressure are not necessarily raised, but 24-hour ambulatory measures frequently identify a loss of nocturnal drop in blood pressure. Treating hypertension aggressively is important in slowing the inexorable decline in glomerular filtration rate. In diabetes there appears to be no ‘J’-shaped relationship between blood pressure and cardiovascular events, thus removing any concern about attaining low blood pressures as long as the patient is asymptomatic. Morbidity and mortality in these patients is usually associated with cardiovascular events, and it is important to assess the effect of drugs on left ventricular hypertrophy and metabolic parameters. Many drugs are effective at lowering blood pressure, but angiotensin-converting enzyme inhibitors may have an additional renoprotective action. alpha-Adrenergic antagonists may improve lipid profiles and calcium antagonists are probably lipid neutral, making these drugs useful alternatives. Dihydropyridine calcium antagonists (eg, nifedipine) may augment protein-uria, and hence non-dihydropyridine calcium antagonists (eg, verapamil, diltiazem) would be preferred. beta-Blockers and thiazide diuretics have the disadvantage of causing a deterioration in glycaemic and lipid profiles, but can be useful on occasions.
Contract learning, clinical learning and clinicians
Authors: Parsell G , Bligh J 
Published: December 2008

Summary
Current trends in education and training emphasise that learners, whether they are school children, students or adults, need to acquire generic skills and personal characteristics which will enable them to become independent self-directed learners. This will enable them to continue the process of learning throughout their lives. Recent recommendations for the reform of undergraduate medical education, for training of hospital doctors and general practitioners, and the higher profile now being given to continuing medical education, reflect the strength of this particular educational current sweeping through all levels of medical education. Learning contracts, developed through negotiation between a teacher and a learner, are especially effective educational tools for stimulating independent learning. This paper examines the theoretical basis of contract-learning and its relevance to clinical settings.
Polymicrobial brain abscess involving Haemophilus paraphrophilus and Actinomyces odontolyticus
Authors: Simpson A J , Das S S , Mitchelmore I J 
Published: December 2008

Summary
A case of brain abscess involving Haemophilus paraphrophilus and Actinomyces odontolyticus is presented. This combination of organisms has not previously been described. All brain abscess specimens should routinely be processed rapidly and cultured for a prolonged period to ensure recovery of fastidious organisms which may have implications for antibiotic therapy.
Accreditation of residency training in the US
Authors: Armbruster J S 
Published: December 2008

Summary
In the US, accreditation and certification of residency training are functions of separate public sector agencies. Accrediting decisions are made directly by 26 Residency Review Committees, which represent the primary medical specialties and function under the authority of the Accreditation Council for Graduate Medical Education. The accrediting bodies may consider only educational issues and are prohibited by the government from controlling physician supply. Only the programme, not the institution in which it is conducted, is accredited. The US residency is a structured educational programme that is expected to provide comparable experience to all enrolled residents. Length of training may vary from two to six years depending on the specialty. Additional training may be obtained in subspecialty programmes, which are subsets of the primary specialty residencies and are also reviewed for accreditation. These have increased in significant number in recent years as subspecialisation has proliferated in the US.
Purtscher’s retinopathy
Authors: Buckley S A , James B 
Published: December 2008

Summary
Purtscher’s retinopathy presents to the clinician as loss of vision in a patient with a history of a possible precipitating event such as recent major trauma, pancreatitis, childbirth or renal failure. The ophthalmological picture is one of ischaemia at the posterior pole with white patches of oedema and haemorrhages concentrated around the optic disc. The most probable pathological cause is embolisation of the peripapillary terminal arterioles supplying the superficial peripapillary capillary net. The nature of the embolic particles remains uncertain. Complement-mediated aggregates, fat, air, fibrin clots and platelet clumps may all be involved in what is most likely to be a multifactorial process. There is at present no recognised treatment for the condition.
The use of liver grafts infested with Clonorchis sinensis for orthotopic liver transplantation
Authors: Yeung C K , Ho J K , Lau W Y , Lee K H , Li A K 
Published: December 2008

Summary
In the Orient, millions are known to have Clonorchis sinensis (biliary trematodiasis) infestation. When these infested livers become available as donor organs, there are potentially serious implications that the transplant team would need to consider. We report the use of two such infested livers, one from a cadaveric donor and the other from a live related donor, for orthotopic liver transplantation. The parasite was encountered not only during organ procurement, but also caused early postoperative blockage of the hepatico-jejunostomy splintage tube and cessation of bile flow in the second recipient. Upon follow-up for four and two years, respectively, no other ill effect has been observed in either patient. Repeated examination of stool for ova of C sinensis in both patients during follow-up visits had been negative, indicating that all the parasites probably had been killed by the cold perfusion. In view of the severe shortage of liver grafts and the lack of serious morbidity associated with the use of these infested livers, we have adopted the policy to include these livers for future transplantation. Special considerations and precautions are, however, required during the perioperative period and on long-term follow-up.
‘Relapse’ of chronic active hepatitis--not always what it seems
Authors: Muller A F , Toghill P J , Smith P 
Published: December 2008

Summary
Immune chronic active hepatitis is a disease notorious for its unpredictability. In a patient with chronic hepatitis who has already suffered relapses a search for a second cause of jaundice is not usually necessary. This report emphasises the essential role of liver biopsy.
Developing the role of the tutor/facilitator
Authors: Wetzel M S 
Published: December 2008

Summary
The effective training of facilitator/ tutors is crucial to the success of a problem-based learning approach to medical education. New skills are needed to accomplish the change from giver of information to facilitator of learning, coach, and guide. This paper outlines considerations for the design of a tutor training programme and describes the Harvard Medical School programme in detail.
The role of the radiologist in surgical management: an audit of clinico-radiological conferences
Authors: Dennison A R , Kerrigan D D , Oakley N , Paraskevopoulos J A , Peck R , Collins M C , Johnson A G 
Published: December 2008

Summary
A prospective analysis of the radiological findings and final diagnoses of 342 patients discussed at joint surgical/radiological conferences over a seven-month period was undertaken in an attempt to define the role of the radiologist in the clinical management of surgical patients. Although the diagnosis had already been correctly made on clinical or radiological grounds in 38% (130/342) of patients presented at the X-ray conferences, careful review of the films resulted in an immediate firm diagnosis in a further 9% (31/342), or promoted further radiological investigations which were responsible for an eventual definitive diagnosis in 20% of the remainder (32/169). The input of the radiologist in selecting the most appropriate additional investigation was particularly valuable in the management of more complex clinical problems.
Congestive cardiac failure following laxative withdrawal
Authors: Riley J A , Brown A R , Walker B E 
Published: December 2008

Summary
We report the case of a 60-year-old woman who presented with weakness and hypokalaemia due to excessive use of laxatives. When the laxatives were withdrawn, she developed severe congestive cardiac failure requiring treatment with a diuretic and angiotensin-converting enzyme inhibitor. There was no underlying cardiac abnormality, and these drugs were eventually stopped with no recurrence of the cardiac failure. The possible mechanisms of heart failure following laxative withdrawal is discussed.
Myocardial infarction following sternal surgery
Authors: Aggarwal R K , Morrison W L 
Published: December 2008

Summary
We report a case of myocardial infarction in a 32-year-old man undergoing sternal surgery. Thrombotic occlusion of the right coronary artery with no underlying atheromatous disease was demonstrated angiographically and successfully treated with intracoronary thrombolysis.
Homocystinuria: what about mild hyperhomocysteinaemia?
Authors: van den Berg M , Boers G H 
Published: December 2008

Summary
Hyperhomocysteinaemia is associated with an increased risk of atherosclerotic vascular disease and thromboembolism, in both men and women. A variety of conditions can lead to elevated homocysteine levels, but the relation between high levels and vascular disease is present regardless of the underlying cause. Pooled data from a large number of studies demonstrate that mild hyperhomocysteinaemia after a standard methionine load is present in 21% of young patients with coronary artery disease, in 24% of patients with cerebrovascular disease, and in 32% of patients with peripheral vascular disease. From such data an odds ratio of 13.0 (95% confidence interval 5.9 to 28.1), as an estimate of the relative risk of vascular disease at a young age, can be calculated in subjects with an abnormal response to methionine loading. Furthermore, mild hyperhomo-cysteinaemia can lead to a two- or three-fold increase in the risk of recurrent venous thrombosis. Elevated homocysteine levels can be reduced to normal in virtually all cases by simple and safe treatment with vitamin B6, folic acid, and betaine, each of which is involved in methionine metabolism. A clinically beneficial effect of such an intervention, currently under investigation, would make large-scale screening for this risk factor mandatory.
Acute renal failure due to sulphadiazine crystalluria in AIDS patients
Authors: de Sequera P , Albalate M , Hernandez J , Vazquez A , Abad J , Ramiro E , Fernández Guerrero M , Caramelo C , Casado S , Ortiz A 
Published: December 2008

Summary
We report two AIDS patients who developed acute renal failure while receiving sulphadiazine for cerebral toxoplasmosis. Renal ultrasound revealed diffuse bilateral echogenic shadowing material. ‘Sheaves of wheat’ crystals, typical of sulphadiazine crystalluria, were present in the urine. One patient required a percutaneous nephrostomy. Hydration and urine alkalinisation resulted in rapid improvement of renal function and ultrasonographic findings. Sulphadiazine-induced crystalluria and acute renal failure is increasingly frequent. Awareness of its existence may lead to prevention and early conservative treatment.
Diagnosis and management of heart failure in the elderly
Authors: King D 
Published: December 2008

SummaryHeart failure is common in the elderly and is associated with a significant morbidity and mortality. It accounts for about 5% of adult medical admissions and the expenditure of 1% of the total National Health Service budget. Clinical presentation in old age may be with the classical symptoms of heart failure but often, due to multiple pathology and low functional ability, presentation is atypical. Both nonspecific symptoms and signs of heart failure, are often a delayed presentation in this population, make diagnosis difficult. Treatment of the failing heart in an older person is similar to the young however, diligence is required when prescribing due to age-related pharmacokinetic changes and co-existent morbidity. This may result in polypharmacy and an increase in drug interactions which themselves may have deleterious consequences. However, knowledge of the aetiology of heart failure in old age and the possible atypical presentation as well as available treatments, will result in better management and improved quality of life and reduced mortality in the elderly heart failure population.
The knowledge of hospital patients about vascular diseases and their risk factors
Authors: Gariballa S E , Peet S M , Fotherby M D , Parker S G , Castleden C M 
Published: December 2008

Summary
The knowledge of 28 stroke patients on the nature, consequences, treatment and risk factors of stroke and ischaemic heart disease was examined using a questionnaire and compared with that of 26 patients with ischaemic heart disease and 41 controls without evidence of vascular disease. Information was also collected on the patients’ willingness to change their life-style, the information and advice they had received and their desire for more information. It was found that about half of the elderly stroke and heart disease patients had a reasonable knowledge of the condition and its related risk factors. Only eight (14%) patients remembered receiving information and advice in relation to their condition during their hospital stay compared with one (2%) control. There was a significant difference between the number of stroke and heart disease patients who wanted to know more about their condition compared with the control group (32 vs 14; p = 0.03). A quarter of the patients and half of the controls knew that fruit and vegetables were good for you and excessive fat and alcohol were less inducive to good health. Most patients with a risk factor were willing to exercise more, stop smoking, cut down on their drinking, or lose weight. These results suggest that elderly hospital patients have a reasonable basic knowledge about vascular diseases, but that a significant number want to know more and would be willing to change their life-style.
Continuous infusion of methylene blue for septic shock
Authors: Brown G , Frankl D , Phang T 
Published: December 2008

Summary
Nitric oxide has been determined to be a potential mediator of the haemodynamic changes associated with sepsis. The haemodynamic eects of nitric oxide can be partially antagonised by methylene blue, through inhibition of the enzyme, guanylate cyclase. The case report presented here demonstrates a beneficial haemodynamic eect of continuous infusion of methylene blue during sepsis. These findings could be extrapolated to other patients or prompt additional research.
Poliomyelitis
Authors: Kidd D , Williams A J , Howard R S 
Published: December 2008

Summary
1996 is polio awareness year. This paper reviews the clinical syndrome of acute paralytic poliomyelitis and its sequelae. We discuss epidemiological studies of the syndrome of late functional deterioration many years after the acute infection and the current hypotheses of the pathophysiology of such disorders. Recent evidence has suggested that potentially treatable factors may be implicated in the majority of such patients and it is therefore important to exclude such disorders before attributing late functional deterioration to progressive post-polio muscular atrophy.
Supporting relatives following a cot death
Authors: Phillips B M 
Published: December 2008

Summary
The incidence of sudden infant death syndrome or cot death has decreased by 60 to 70% in the last 10 years. The largest decrease has been following the Back to sleep campaign in 1991. The epidemiology of cot death now emphasises its association with poverty and smoking in the home. The compassionate reception of the ‘cot death’ baby and his family in the Accident and Emergency department is the first step in enabling families to come to terms with the grief that the death produces. Accident and Emergency staff can facilitate the early grieving process by an understanding of the family’s needs and the provision of appropriate information.
Intracardiac thrombus formation in cardiac impairment: the role of anticoagulant therapy
Authors: Lip G Y 
Published: December 2008

SummaryThe presence of intracardiac thrombus has been associated with many diseases and clinical states, although cardiac impairment is commonly also present. Despite this, there continues to be a lack of consensus on which patients with cardiac impairment should have anticoagulant therapy. This review discusses the relationship between thromboembolism and cardiac impairment secondary to ischaemic heart disease, and suggests possible mechanisms, methods of diagnosis and therapeutic strategies for anticoagulation in such patients. In particular, warfarin has been established as thromboprophylaxis in certain subgroups of patients with cardiac impairment secondary to ischaemic heart disease. A large-scale randomised controlled trial in ambulant patients with cardiac impairment to evaluate the effectiveness of anticoagulant therapy and antiplatelet therapy is, however, long overdue.
Comparative efficacy and safety of ciprofibrate and sustained-release bezafibrate in patients with type II hyperlipidaemia
Authors: Betteridge D J , O’Bryan-Tear C G 
Published: December 2008

Summary
The hypolipidaemic efficacy and safety of ciprofibrate were compared with a sustained-release formulation of bezafibrate (Bezalip Mono) in 174 patients with type II hyperlipidaemia. This multicenter, open, parallel-group study was conducted in general practice. A total of 83 patients received 100 mg ciprofibrate once daily and 91 received 400 mg bezafibrate once daily for eight weeks. Concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were measured at baseline (after stabilisation on a lipid-lowering diet) and after eight weeks. Safety was assessed from reports of adverse events and by measuring haematological and biochemical parameters. After eight weeks, ciprofibrate produced a significantly greater decrease in total cholesterol (-17.8% vs -12.5%), low-density lipoprotein cholesterol (-22.4% vs -17.2%), and triglycerides (-33.9% vs -26.1%). High-density lipoprotein cholesterol concentrations were increased significantly by both drugs (19.6% with ciprofibrate, 24.9% with bezafibrate) but the differences between drugs were non-significant. Both drugs were well tolerated, with headache the most widely reported adverse event.
A patient with hepatitis B, antimicrosomal antibodies, and autoimmune hypothyroidism
Authors: Catapani W R , Valente O , Aguiar C 
Published: December 2008

Summary
A 37-year-man with chronic hepatitis B was diagnosed as having antimicrosomal antibodies and subclinical hypothyroidism. The association of autoimmune manifestations with hepatitis B has been less frequently reported than with hepatitis C virus. It is discussed whether this patient illustrates a case of spontaneous development of antimicrosomal antibodies, only casually associated with the presence of hepatitis B virus, or there is a real causative relationship between both conditions.
Consultants' study leave--value for money?
Authors: Bennett J R 
Published: December 2008

Summary
The consultants in a single large acute hospital trust were given a personal allocation of £500.00 pounds for study leave and asked to supply reports on the purpose and value of that leave. The majority of consultants (82%) took leave during the 12-month period at an average cost of £182.80 pounds for each episode. Most was regarded of value and the majority was shared with other members of staff.
False aneurysm with median nerve palsy after iatrogenic brachial artery puncture
Authors: Yip K M H , Yurianto H , Lin J 
Published: December 2008

Summary
We report on a case in which a patient on oral anticoagulation for her aortic valve replacement, with an International Normalised Ratio of 2.13, developed a false aneurysm of the brachial artery after a routine arterial puncture, despite direct pressure to the aspiration site. The false aneurysm was complicated by the development of median nerve palsy.
Carcinoma of the sigmoid colon presenting as a scrotal swelling
Authors: Bryan N P , Jackson A , Raftery A T 
Published: December 2008

Summary
A case of adenocarcinoma of the sigmoid colon, presenting as a testicular mass, is described. At sigmoid colectomy widespread metastases were found and only palliative care could be offered thereafter. The incidence and age of such a presentation and manner of spread of the occult primary are discussed.
Regression of a large gastric MALT lymphoma with antibiotic treatment to eradicate Helicobacter pylori
Authors: Martin J , Boyle S , Jacyna M 
Published: December 2008

Summary
We report a case of a large low-grade gastric lymphoma of mucosa-associated lymphoid tissue (MALT), which regressed following the eradication of concurrent Helicobacter pylori infection. This case lends further support to a policy of H pylori eradication as a first line therapy for all these lesions, irrespective of size. The long-term prognosis of tumours treated in this way, however, needs further evaluation.
The role of cell migration and microchimerism in the induction of tolerance after solid organ transplantation
Authors: Jindal R M , Sahota A 
Published: December 2008

SummaryA new hypothesis has been proposed which states that microchimerism is the basis for the clinical tolerance seen in long-term survivors of solid organ transplants. Efforts to enhance microchimerism include simultaneous infusion of bone marrow of donor origin and transplantation of a solid organ. Studies are in progress to verify the phenomenon of microchimerism and its role in clinical tolerance.