bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ophthalmic complications of HIV/AIDS
Authors: Ah-Fat F G , Batterbury M 
Published: December 2008

Summary
As a result of improved treatment and patient survival, ophthalmic complications are now being seen with increasing frequency in AIDS, occurring in up to 75% of patients during the course of the disease. The eye may be involved by an AIDS-related microvasculopathy, which gives rise to cotton wool spots, and by opportunistic infections caused by a wide range of organisms, including cytomegalovirus, herpes simplex virus, varicella zoster, Toxoplasma gondii, Mycobacterium avium-intracellulare, Treponema pallidum, Pneumocystis carinii and various fungal agents. Opportunistic infections may be the presenting sign of disseminated infection. The eye may also be involved by neoplasms such as Kaposi’s sarcoma and lymphoma, and by intracranial disease. Ocular involvement may lead to blindness if untreated and prompt ophthalmological referral is essential. This article reviews the range of ocular diseases seen in HIV and AIDS, current therapeutic options and outcome.
Endobronchial inflammatory pseudotumour exacerbating asthma
Authors: Jayne D , Bridgewater B , Lawson R A M 
Published: December 2008

Summary
Primary pulmonary tumours are rare in the paediatric population. Of the benign tumours, the most common is the inflammatory pseudotumour (plasma cell granuloma). It can present as a variety of non-specific symptoms which may delay diagnosis. It usually occupies a peripheral pulmonary location and gives rise to symptoms due to its local mass effect and destructive invasion. We report the case of an endobronchial inflammatory pseudotumour presenting as an exacerbation of asthma in a 10-year-old girl. Appropriate investigation lead to pre-operative diagnosis and early complete surgical resection. A good prognosis is anticipated.
Direct injection of anti-cancer drugs into endobronchial tumours for palliation of major airway obstruction
Authors: Çelikoğlu S I , Karayel T , Demirci S , Çelikoğlu F , Çağatay T 
Published: December 2008

Summary
Patients with tracheal or major airway obstruction due to inoperable carcinomas are at a high risk of developing respiratory failure or post-obstructive pneumonia, or both. This often leads to death in days or weeks. In such cases there is usually an urgent need to restore the airway. This report details the short-term results and techniques used for the treatment of airway obstruction by direct intratumoural injection of several anti-cancer drugs. A total of 93 patients with nearly complete extrinsic obstruction of at least one major airway were treated by injection of anti-cancer drugs directly into the endobronchial tumours or infiltrated bronchial mucosa through a flexible fiber-optic bronchoscope. At every session of treatment 1–3 ml each of 50 mg/ml 5-fluorouracil, 1 mg/ ml mitomycin, 5 mg/ml methotrexate, 10 mg/ml bleomycin and 2 mg/ml mitoxantrone were injected separately at different sites without pre-mixing. Local intratumoural chemotherapy relieved the obstruction in 81 of the 93 patients. Endoscopically visible tumours were reduced in size, and infiltrative changes were also improved. Obstruction was not relieved in 12 patients. The therapy was well tolerated and had no systemic side-effects, and no serious complications. Intratumoural chemotherapy can be considered a new life-saving palliative method in patients with life-threatening airway obstruction.
Advanced colonic carcinoma in children
Authors: Khan A M , Doig C M , Dickson A P 
Published: December 2008

Summary
We report two cases of colorectal carcinoma in children with a delay in diagnosis due to the low index of suspicion of this pathology as the cause of presenting symptoms. We conclude that any child presenting with unexplained rectal bleeding and abdominal pain should be investigated with endoscopy and barium enema.
Prognosis and management of Crohn's disease in the over-55 age group
Authors: Walmsley R S , Gillen C D , Allan R N 
Published: December 2008

Summary
The course, prognosis and management of 62 patients with Crohn's disease aged 55 years or over at diagnosis has been reviewed. The distal ileus was the commonest site of disease in the older patient, where the characteristic presentation was acute after initially mild symptoms. Early local resection was often required, particularly where there was diagnostic doubt or suspicion of caecal malignancy. Recurrence rates were much lower in the older patient than after resection in younger patients. Medical treatment played a minor role in the management of patients with distal ileal disease, in part because stricture formation was present at diagnosis and the acute nature of symptoms at presentation led to early surgical treatment. Colonic Crohn's disease was usually confined to the distal or left side of the colon and initially could be difficult to distinguish from diverticular disease. Extensive colonic Crohn's disease was rare. The apparently limited disease was not necessarily associated with a good prognosis, since disease at this site sometimes progressed rapidly, necessitating urgent surgical resection.
Medical treatment (corticosteriod therapy, with or without azathioprine) was usually effective initially for treatment of symptomatic colonic Crohn's disease, but sustained remission was rare. Those patients with persistent symptoms were restored to good health with surgical treatment but at a price, in that nearly half eventually required a permanent stoma.
Painless stress fractures in diabetic neuropathic feet
Authors: Gill G , Benbow S , Tesfaye S , Kaczmarczyk E , Kaye L 
Published: December 2008

Summary
We describe two patients with diabetes mellitus and associated neuropathy, who presented with painless foot swelling and no history of trauma. X-Rays revealed recent underlying fractures-in one of a metatarsus, and the other of a proximal phalanx. These were assumed to be ‘stress’ fractures unassociated with pain because of the severe sensory neuropathy. Though spontaneous fractures in neuropathic feet have been previously described, they almost always occur in association with Charcot joints, and are usually painful. The differential diagnosis of acute swelling in the foot of a diabetic patient with sensory neuropathy should include stress fracture.
Permanent cardiac pacing in elderly patients with recurrent falls, dizziness and syncope, and a hypersensitive cardioinhibitory reflex
Authors: Crilley J G , Herd B , Khurana C S , Appleby C A , de Belder M A , Davies A , Hall J A 
Published: December 2008

Summary
The study was designed to assess the outcome of treatment with permanent dual-chamber pacing of elderly patients with falls, dizziness and syncope associated with the demonstration of a hypersensitive cardioinhibitory reflex. Questionnaires were sent to patients (and their general practitioners) who had been referred to a regional pacing centre with recurrent falls, dizziness or syncope diagnosed as likely to be secondary to cardioinhibitory carotid sinus syndrome or predominantly cardioinhibitory vasovagal syndrome. After pacemaker insertion, 84% of patients had no further syncope over a mean follow-up period of 10 (range 1.5 to 30) months. Minor symptoms persisted in only 40% of all patients. Symptoms were unchanged in 22%. It was concluded that permanent dual-chamber pacing is an effective treatment for elderly patients with recurrent falls, dizziness and syncope in whom a hypersensitive cardioinhibitory reflex is found. Good results were obtained in this group with a simple diagnostic work-up.
Diagnostic difficulties in periodic Cushing's syndrome
Authors: Walker A B , Leese G P , Vora J P 
Published: December 2008

Summary
A 22-year-old black woman presented with symptoms suggestive of Cushing's syndrome three years after chemotherapy for a presumed teratoma with cervical lymphadenopathy. Initially, the absence of clinical signs and the demonstration of two normal 24 h urinary free cortisols appeared to exclude the diagnosis, but an ectopic adrenocorticotropin-producing thymic carcinoid was subsequently removed surgically. Cushing's syndrome due to ectopic adrenocorticotropin production can be difficult to diagnose, particularly if there is periodic hormonogenesis.
Tumour seeding following percutaneous endoscopic gastrostomy placement in head and neck cancer
Authors: Thorburn D , Karim S N , Soutar D S , Mills P R 
Published: December 2008

SummaryWe report the case of a patient with advanced squamous carcinoma of the supraglottic larynx and hypopharynx who developed metastatic gastric deposits occurring at the site of a percutaneous endoscopic gastrostomy tube, inserted 10 months previously by the pull technique. We review seven previous reports of tumour deposits occurring at the site of placement of a percutaneous endoscopic gastrostomy in patients with head and neck cancer, and consider alternative methods of enteral feeding in such patients.
A double-blind, multicentre, placebo-controlled study of tiludronate in Paget's disease of bone
Authors: Fraser W D , Stamp T C , Creek R A , Sawyer J P , Picot C 
Published: December 2008

Summary
A multicentre, randomised, placebo-controlled, dose-ranging study was conducted to investigate the therapeutic activity and sustained efficacy of tiludronate (200 mg, 400 mg and 600 mg once daily) taken orally for 12 weeks in patients with Paget's disease. Serum alkaline phosphatase concentrations were compared with baseline at weeks 12 and 24; treatment success was defined as a 50% reduction compared with baseline. Changes in the hydroxyproline: creatinine ratio were also measured. Pain was assessed using the Huskisson Visual Analogue Scale and by questionnaire. Patients completing at least 11 weeks of treatment were followed-up 18 months later by postal questionnaire. Significantly greater numbers of patients in the tiludronate groups successfully responded to treatment compared with the placebo group. A dose-response was observed; the percentage of patients responding to treatment being 31% (200 mg), 52% (400 mg) and 82% (600 mg) at week 12 and 45% (200 mg), 70% (400 mg) and 82% (600 mg) at week 24. Tiludronate treatment also significantly reduced hydroxyproline: creatinine ratios compared with placebo, again showing a dose response. Dose-related gastrointestinal symptoms were the commonest adverse events, occurring in 2.4%, 11.0%, 5.5% and 18.9% of patients receiving placebo and tiludronate 200, 400 and 600 mg daily, respectively. The response to oral tiludronate was sustained for more than 18 months in some patients and there was evidence of a reduction in the longer term complications of the disease. These results show that oral tiludronate is an effective, well-tolerated treatment for Paget's disease; the 400 mg once daily dose appears to offer the optimum balance of efficacy and tolerance.
Abnormal movements associated with severe hyponatraemia
Authors: Nagaratnam N , Icao E , Peric H 
Published: December 2008

Summary
An elderly woman with severe hyponatraemia manifested transient choreoathetoid movements of the upper extremities and dyskinetic movements of the face and mouth. She showed more than one type of hyponatraemia and a precise diagnosis was not possible. The movements were abolished with treatment of the hyponatraemia with no recurrence or sequelae.
Quality of life as an outcome measure
Authors: Bulpitt C J 
Published: December 2008

Summary
It is important to identify unknown and unquantified benefits and risks of therapeutic intervention that are reflected in the quality of life. This is especially important when the benefit: risk analysis is not clearly in favour of treatment. Quality of life is defined and target areas identified. The steps in the measurements of quality of life are discussed, including the validity, repeatability and sensitivity to change of existing methods; their acceptability, analytical problems; the presentation of the results; and the use of the results in economic evaluations. The Sickness Impact Profile, the Nottingham Health Profile and the Quality of Well-Being scale are compared for the assessment of patients with angina. The advantages and disadvantages of each is discussed together with the results from a double-blind trial of treatment in angina where the Sickness Impact Profile was employed. Generic and disease-specific instruments are compared. The advantages and disadvantages of economic evaluations employing quality-of-life outcomes are discussed. Methods should be employed that withstand rigorous scientific evaluation. Both a health profile and a summary statistic such as a Health Status Index should be measured. If different treatments are to be compared, a randomised controlled trial should be employed. If the more expensive treatment is likely to be superior then costs should be collected and a cost-utility analysis performed.
Crohn's disease presenting with acute colonic perforation
Authors: Roy M K , Delicata R J , Carey P D 
Published: December 2008

Summary
Crohn's disease is well known for its multiple intestinal complications. The chronic nature and fibrous inflammation which invariably accompanies this disease explains the relative rarity of free intestinal perforation. The true incidence of free bowel perforation is difficult to assess but 1–2% is the anticipated occurrence during the course of illness. We present a case of Crohn's disease which presented for the first time with acute colonic perforation, an extremely rare entity, and review the current world literature.
Diffuse soft tissue emphysema as a complication of anorexia nervosa
Authors: Hatzitolios A I , Sion M L , Kounanis A D , Toulis E N , Dimitriadis A , Ioannidis I , Ziakas G N 
Published: December 2008

SummaryWe describe a case of a young woman with anorexia nervosa with a 35% weight loss, amenorrhea and behavioural disturbances complicated by spontaneous diffuse soft tissue emphysema (subcutaneous, pneumomediastinum, epidural and retroperitoneal).
Cryptosporidiosis in persons with HIV infection
Authors: Ramratnam B , Flanigan T P 
Published: December 2008

Summary
Cryptosporidium parvum is an ubiquitous protozoan parasite that is a major cause of diarrhoea in individuals infected with human immunodeficiency virus. The hallmarks of infection include profuse watery diarrhoea which may become chronic in the severely immunosuppressed individual. No uniformly effective therapy exists. Current treatment relies upon a trial of anti-retroviral and specific anti-cryptosporidial medications, adequate fluid and nutritional support, and anti-motility agents.
Hypopituitarism due to lymphocytic hypophysitis in a patient with retroperitoneal fibrosis
Authors: Alvarez A , Cordido F , Sacristán F 
Published: December 2008

Summary
We present a 78-year-old woman with clinical acute hypopituitarism in whom pathologic findings showed lymphocytic hypophysitis and retroperitoneal fibrosis. Lymphocytic hypophysitis should be included in the differential diagnosis of hypopituitarism at any age. The association with idiopathic retroperitoneal fibrosis suggest an autoimmune origin for this entity.
Adrenocorticotropin-secreting carcinoid tumour identified and treated 12 years after presentation with Cushing's syndrome
Authors: Vaidya B , Richardson D , Hilton C J , Kendall-Taylor P 
Published: December 2008

Summary
A case of Cushing's syndrome due to an adrenocorticotropin (ACTH) secreting bronchial carcinoid tumour is described. Endocrine assessment suggested ectopic ACTH syndrome, but imaging revealed no tumour. Bilateral adrenalectomy was performed, and computed tomographic scans of chest and abdomen were performed annually. A small nodule became apparent in the right lung 12 years after the presentation, which postoperatively was confirmed as the bronchial carcinoid tumour responsible for the ectopic ACTH syndrome.
How to pass the MRCP (UK) examination—ask a successful candidate!
Authors: Salter R , Smith S 
Published: December 2008

Summary
Recently successful MRCP (UK) candidates were asked to rate the value of clinical experience, reading, practice with past or simulated examination papers and commercially organised courses as preparation for parts 1 and 2 of the examination. With respect to part 1, practice with past and simulated papers was unanimously felt to be of crucial importance with examination-focused reading helpful. Clinical experience was deemed irrelevant and commercially organised courses a matter of individual choice. For part 2, clinical experience was felt to be of fundamental importance but needed to be practised in an ‘examination atmosphere’. Both general reading and practice with past and simulated papers were judged helpful and commercially organised courses were perceived to be of more value than for part 1. Trainees should be advised to seek advice on examination preparation from both ‘authoritative sources’ and their recently successful colleagues.
Complications associated with different insertion techniques for Hickman catheters
Authors: Ahmed Z , Mohyuddin Z 
Published: December 2008

Summary
A dependable central venous access is an essential prerequisite for the delivery of care to the cancer patients. This has become easier since the introduction of indwelling central venous catheters. However, pancytopenia, often encountered in haematological malignancies, does influence the morbidity associated with these catheters. In this study the effects of two different placement techniques of Hickman catheters were evaluated. A total of 177 Hickman catheters were inserted in patients suffering from haematological malignancies. In 112 patients the catheters were placed percutaneously into subclavian veins without prior tunnelling; in the other 65 patients these were introduced, after having been tunnelled, into cephalic/external jugular veins by a cut-down technique. The catheters remained in use in each patient for between 18 and 253 days. Excessive bleeding and haematoma formation occurred in a significantly higher proportion of patients from the cut-down group (61% and 41%, respectively) compared to patients from the percutaneous group (8% and 0%, respectively). These in turn had a profound impact on the incidence of infective complications. Catheter exit site infection, tunnel infection and septicaemia were observed in 26%, 18%, and 41%, respectively, of the patients from the cut-down group, while in patients from the percutaneous group, skin exit site infection was noted only in 7% and septicaemia in 19% of patients. It was concluded that the placement technique of these catheters exerts a significant influence on the immediate as well as delayed complications. The results indicate that the insertion technique requiring minimal dissection is more beneficial. It is therefore recommended that percutaneous insertion without tunnelling should be the technique of choice for catheter placement.
Cell and molecular mechanisms of pathogenesis and treatment of cancer
Authors: Rew D A 
Published: December 2008

Summary
Surgery remains the mainstay of treatment for most classes of human solid tumours, with the principal exception of lymphomas, but it is insufficient in many cases to guarantee cure. With few exceptions, recurrent and metastatic solid tumours continue to defy attempts to develop effective adjuvant therapies. Recent insights into tumour biology reveal an increasingly complex picture of cell and molecular processes which confer heterogeneity and resistance to treatment upon tumours. These insights may also yield new targets for more effective adjuvant therapies.
Variability in management of symptomless microhaematuria in schoolchildren
Authors: Benbassat J , Gergawi M , Offringa M , Bearman J E , Drukker A 
Published: December 2008

Summary
The evaluation of incidentally detected symptomless microhaematuria in schoolchildren is controversial. Some authors advocate varying numbers of immediate tests, while others recommend investigations only in cases who develop systemic symptoms or signs, or a decline in renal function. The objective of this study was to estimate the extent to which this uncertainty affects the declared habits of practising physicians. A sample of 16 family physicians, 42 primary care paediatricians and 26 full-time hospital-based paediatric nephrologists in Israel were asked to complete a survey using a written case of a hypothetical eight-year-old boy with incidentally detected symptomless microhaematuria. Responses were received from 16 (100%), 18 (43%) and 18 (69%), respectively. The mean number of requested tests, other than follow-up examination of the urine, were 1.5 (range 0–5) for family physicians, 2.5 (1–5) for primary care paediatricians and 5.3 (2–12) for paediatric nephrologists, at an average cost of NIS 408 (US$ 136), NIS 454 (US$ 151) and NIS 860 (US$ 286), respectively. There was also a marked variability within subspecialty groups, so that some family physicians recommended more tests at a higher cost than some of the paediatric nephrologists. There was a marked and unexplained variability within and among the three groups of respondents regarding the extent of the evaluation. The main reason for this variability is probably the uncertainty about the scientifically appropriate way to approach this condition in a symptomless child.
Liver cirrhosis
Authors: Williams E J , Iredale J P 
Published: December 2008

Summary
Liver fibrosis and its related complications continue to represent a significant worldwide healthcare burden. Over the past decade there has been considerable improvement in our understanding of the cellular mechanisms and pathophysiology underlying hepatic fibrosis. This greater insight into the relevant basic sciences may lead to the development of novel treatment strategies designed to block the fibrogenic cascade or even enhance matrix degradation. In addition, there have been significant advances in the management of the complications of cirrhosis, with specific treatments now available for some conditions. Perhaps most notably, liver transplantation is now a highly successful treatment for end-stage liver disease and should be considered in all patients with chronic liver disease.
Primary pulmonary hypertension associated with human immunodeficiency virus infection
Authors: Golpe R , Fernandez-Infante B , Fernandez-Rozas S 
Published: December 2008

Summary
Several cardiorespiratory diseases can complicate human immunodeficiency virus infection. Primary pulmonary hypertension is a rare clinical disorder which carries a bad prognosis. More than 90 cases of HIV-associated primary pulmonary hypertension have been reported to date. Although its pathogenesis remains unknown, some evidence suggests a possible role for the virus itself in its development. Genetic susceptibility may also be implicated. The clinical and histopathologic features of this entity do not differ from those of classic primary pulmonary hypertension. The diagnosis requires a high degree of clinical suspicion and a careful evaluation to rule out causes of secondary pulmonary hypertension. In addition to supportive measures, anticoagulation and vasodilators have been used to treat this disorder, although sufficient data regarding long-term results with these therapies are lacking.
The use of HMG Co-A reductase inhibitors following acute myocardial infarction in hospital practice
Authors: Khong T K , Missouris C G , Murda'h M , MacGregor G A 
Published: December 2008

Summary
Treatment with a HMG-CoA reductase inhibitor (statin) following a myocardial infarction has been shown to reduce the incidence of subsequent coronary revascularisation, myocardial infarction and cardiovascular death. The majority (89%) of patients admitted to the coronary care unit of our hospital received a fasting cholesterol check as part of a routine coronary care unit protocol. However, our survey shows that only 26% of patients surviving an acute myocardial infarction were on treatment with a statin at follow-up. Furthermore, those receiving statins were given smaller doses than those used in clinical trials. One way to ensure patients receive adequate treatment with statins, may be to include it as part of a coronary care unit protocol.