bluuebunny/crossref_metadata_2025_split huggingface dataset:
Weight change, perceived health status and mortality in middle-aged British men
Authors: Wannamethee G , Shaper A G 
Published: December 2008

Summary
The association between weight change over a 5-year period, the subsequent perception of health and the mortality during a 4-year follow-up period has been examined in a prospective study of 7735 middle-aged British men. There were 357 deaths from all causes. Self-assessment of health status was considered as a potential guide to whether weight loss was intended or involuntary. Irrespective of weight change those who reported poor or fair health had a more than two-fold increase in death rate compared to those who reported good or excellent health. Considerable weight gain (&gt; 10%) was associated with high rates of cardiovascular disease regardless of health perception, although this was most marked in those who perceived poor or fair health. Moderate weight gain was of little importance except in those who regarded their health as poor or fair. Weight loss was associated with increased death rates from cancer regardless of health perception, although the rates were highest in those who perceived poor or fair health.
This study emphasizes that weight loss is a potentially serious symptom even in men who report good health. Assessment of weight change and of perception of health status are both of value and could be used in standard health enquiries to monitor health status in individuals and the community.
Post-traumatic external nasal neuralgia—an often missed cause of facial pain?
Authors: Golding-Wood D G , Brookes G B 
Published: December 2008

Summary
Pain about the bridge of the nose is often a diagnostic dilemma. There is an important recognizable subgroup who may, as a consequence of involvement of the external nasal nerve in nasal injury, exhibit neuralgic pain after a latent interval. Temporary relief by anaesthesia can be achieved and cure is possible by division of the anterior ethmoidal nerve. This rare cause of facial pain is presented using two illustrative cases.
Immune responsiveness in chronic fatigue syndrome
Authors: Milton J D , Clements G B , Edwards R H T 
Published: December 2008

Summary
We have endeavoured to find immunological indications of chronic virus infection in patients with chronic fatigue syndrome (myalgic encephalomyelitis) and to investigate immune responsiveness to viruses in such patients in comparison with normal subjects and patients with muscular dystrophy. Levels of circulating IgM immune complexes were elevated (above the 95% normal control range) in 10 (17%) of 58 patients with chronic fatigue syndrome, which was not significantly different from the normal controls or from dystrophy controls (by Mann Whitney U test). Levels of IgG complexes were only increased in 10% of patients.
Lymphocyte proliferation in response to concanavalin A (Con A), assessed by increase in 3H-thymidine incorporation, did not differ between 14 patients and 18 normal subjects. The proliferative response to Coxsackie B virus antigen did not differ between chronic fatigue patients and normal subjects when expressed either as an increase in counts or as a stimulation index. Adjustment of the counts in relation to the proliferation response to Con A, as an indication of the overall proliferative response of the cell preparation, did not reveal any hidden difference. IgM antibodies to Coxsackie B viruses were not found in any of 20 patients and in 1 of 20 dystrophy controls. Significant levels of neutralizing antibodies to Coxsackie B viruses 1–5 were found in 6 out of 19 (32%) patients compared with 4 out of 17 (24%) dystrophy controls, which does not differ from currently expected normal incidence. Antibody titres to other respiratory viruses were also not notably different between the patient and control groups.
In conclusion we can find no evidence for a definable viral aetiology for the chronic fatigue syndrome, neither in terms of a persistent infection nor an altered ability to respond to virus.
Patent foramina ovale in elderly stroke patients
Authors: Vella M A , Sulke A N , Rodrigues C A , McNabb W R , Lewis R R 
Published: December 2008

Summary
Fifty elderly patients who had suffered cerebrovascular incidents from no obvious cause and 33 age-matched controls were investigated for the presence of a patent foramen ovale by contrast 2-dimensional echocardiography at rest and after the Valsalva manoeuvre. Right-to-left shunting was found in only one patient and in none of the controls. This finding is in contradistinction to young adult stroke patients in whom the prevalence of a haemodynamically significant patent foramina ovale is high. Paradoxical embolism is an uncommon cause of stroke in the elderly.
Life-threatening hypercalcaemia in association with Addisonian crisis
Authors: Miell J , Wassif W , McGregor A , Butler J , Ross R 
Published: December 2008

Summary
A 35 year old woman was admitted with acute radial artery occlusion necessitating two operations and thrombolytic therapy. Subsequently a diagnosis of primary hypothyroidism was made and she was commenced on thyroxine replacement therapy. Her condition, however, continued to deteriorate with the development of an Addisonian crisis heralded by, and complicated by, severe, life-threatening hypercalcaemia. This case highlights the importance of considering Addison's disease in any patient whose condition deteriorates after the introduction of thyroxine replacement, and illustrates the often forgotten association of hypercalcaemia and hypoadrenalism.
Fatal splenic sequestration crisis in adult sickle cell-beta thalassaemia
Authors: van Rhee F , Balsitis M , French E A 
Published: December 2008

Summary
Fatal acute splenic sequestration crisis in an adult patient with sickle cell-beta+ thalassaemia is described. To our knowledge fatal splenic sequestration in adult sickle cell-beta thalassaemia has not been previously reported.
Rhabdomyolysis associated with cranial diabetes insipidus
Authors: Kung A W C , Pun K K , Lam K S L , Yeung R T T 
Published: December 2008

Summary
Rhabdomyolysis has been reported to be associated with hyperosmolality in diabetic ketoacidosis and non-ketotic hyperosmolal state. Whether the rhabdomyolysis was due to hyperosmolality per se or whether hyperglycaemia also played a role is not clear. We hereby report a case of cranial diabetes insipidus with hypernatraemia and hyperosmolality complicated by rhabdomyolysis. None of the known risk factors, such as coma, hypokalaemia, hypophosphataemia, diabetic ketoacidosis or non-ketotic hyperosmolality, were present in this patient. We believe that severe hyperosmolality per se is an important predisposing factor for non-traumatic rhabdomyolysis, and serum muscle enzymes should be closely monitored in the management of patients with diabetes insipidus.
The diagnosis of femoral hernia
Authors: Corder Allan P 
Published: December 2008

SummaryThe accuracy of diagnosis of femoral hernia in referrals to a district general hospital over a period of 5 years has been studied and related to clinical outcome. A correct diagnosis was made in only 36 of 98 cases (60 urgent, 38 routine) before admission to hospital. A correct pre-operative diagnosis was ultimately made in 85 cases. Four patients, all urgent admissions with incarcerated bowel, died within 30 days of operation. In none of these cases was a correct diagnosis made before admission to hospital. The median length of post-operative stay of urgent admissions was 7 days (range 4-50) when a correct initial diagnosis was made and 10 days (range 4-50) when the initial diagnosis was incorrect (P = 0.07, Mann-Whitney test). When strangulated small bowel was found at operation, 70% of those with an incorrect initial diagnosis (n = 23) required resection, as compared with 20% of those with a correct initial diagnosis (n = 10, P = 0.014, χ2 with Yates' correction).Femoral hernias are frequently incorrectly diagnosed before hospital admission and this is associated with worsened outcome in urgent cases.
Elevated serum parathyroid hormone related protein and 1,25-dihydroxycholecalciferol in hypercalcaemia associated with adult T-cell leukaemia-lymphoma
Authors: Johnston S R D , Hammond P J 
Published: December 2008

Summary
Hypercalcaemia occurs in up to 80% of patients with adult T-cell leukaemia-lymphoma (ATLL) associated with human T-cell leukaemia virus-1 infection. Elevated serum levels of 1,25-dihydroxycholecalciferol, implicated in the pathogenesis of hypercalcaemia in lymphoma, and of parathyroid hormone-related protein (PTHrP), which is associated with hypercalcaemia of several solid malignancies, were demonstrated in a patient with ATLL hypercalcaemia. Treatment with bisphosphonates reduced the serum calcium but had no significant effect on the serum PTHrP levels. This case supports recent in vitro evidence for enhanced PTHrP expression in ATLL tumour cells and suggests that more than one tumour cell product may be involved in the pathogenesis of ATLL hypercalcaemia.
Fatal haematemesis due to benign retrosternal goitre
Authors: Parker D R , el-Shaboury A H 
Published: December 2008

Summary
The development of a goitre in the retrosternal space may result in many different symptoms due to local compression. We describe a case in which such a goitre resulted in full-thickness ulceration of the oesophagus, which presented as a fatal haematemesis. We believe that such a complication has not been previously reported.
Massive haemorrhage due to ulcerative colitis presenting as melaena
Authors: Aristodemou Aristi , Ryder S , Jacyna M R 
Published: December 2008

SummaryWe present a patient with known ulcerative colitis who presented with massive lower gastrointestinal bleeding in the form of melaena. Extensive investigations indicated that the source of blood loss was only from the colon, was attributable to the colitis, and settled when the colitis was treated with steroids. Melaena may be due to blood loss from the colon.
Craniospinal intradural arachnoid cyst
Authors: Bhatia Sanjay , Thakur Rup Chand , Devi B Indira , Radotra B D , Kak V K 
Published: December 2008

Summary
A patient with an uncommonly situated congenital intradural arachnoid cyst is reported. The cyst extended from the cervical spinal canal into the posterior cranial fossa and was posterolateral to the spinal cord. The patient's initial complaint was urinary hesitancy. The location of the cyst is unique and the presenting complaint rare.
Biliary tract invasion and obstruction by hepatocellular carcinoma: report of five cases
Authors: Lai S T , Lam K T , Lee K C 
Published: December 2008

Summary
Major biliary tract obstruction caused by tumour invasion is a rare manifestation of hepatocellular carcinoma. The authors had the opportunity to diagnose and treat five such cases, three of whom had features of acute cholangitis. The prevalence of both hepatocellular carcinoma and recurrent pyogenic cholangitis is high in patients from the Far East. The former may first present under the guise of the latter. Gastroenterologists and surgeons should be aware of hepatocellular carcinoma when managing these patients who present with obstructive jaundice, gross hepatomegaly and cholangitis.
Significance of a low serum ferritin level in elderly in-patients
Authors: Joosten E , Dereymaeker L , Pelemans W , Hiele M 
Published: December 2008

Summary
Iron deficiency, defined as a serum ferritin level less than or equal to 50 micrograms/l was found in 28 (11%) of 252 consecutive elderly in-patients (mean age 81 years). Sixteen among them were anaemic and only five had a microcytic anaemia. In a separate study, 15 anaemic and 13 non-anaemic iron-deficient elderly in-patients were investigated in order to evaluate the prevalence of gastrointestinal symptoms and lesions in both groups. In nine of the anaemic and seven of the non-anaemic patients a potential cause for the iron deficiency was established. Most anaemic and non-anaemic patients lacked the symptoms described as suggestive of underlying gastrointestinal pathology. Thus, a ferritin level less than or equal to 50 micrograms/l justifies a gastrointestinal investigation if the general condition allows for it as well in anaemic as in non-anaemic elderly hospitalized patients. Therefore, serum ferritin should be part of the routine biochemical investigation of elderly in-patients.
Pancreatitis associated with diclofenac
Authors: Khan Izhar H , Edward Neil 
Published: December 2008

Summary
A 34 year old female developed acute pancreatitis after commencing diclofenac for a painful arthropathy. The possible role of prostaglandin inhibition in non-steroidal analgesic drug-induced pancreatitis is discussed and the suggestion is made that serum amylase should be measured in patients who develop abdominal pain, following ingestion of non-steroidal anti-inflammatory
Butterfat absorption—a valuable screening test in malabsorption
Authors: Harper G D , Wheeler D C , Wicks A C B 
Published: December 2008

Summary
The diagnosis of intestinal malabsorption is difficult to make without the use of specific tests such as endoscopic retrograde cholangiopancreatography (ERCP) or duodenal biopsy which are invasive and potentially hazardous. Faecal fat estimation or C14 Triolein breath tests have limitations as screening tools are time consuming and expensive. The butterfat absorption test (BFAT) is, in contrast, a simple, quick and cheap test for fat malabsorption. We have assessed the performance of this test in a blinded retrospective study of all such procedures performed in a teaching hospital over an 8 year period.
One hundred and fourteen cases of suspected malabsorption had one or more butterfat tests. These were divided into absorbers and malabsorbers without knowledge of the butterfat test results.
We found the butterfat test to have a sensitivity of 88% and a specificity of 94% using a cut-off of 20 light-scattering intensity units to discriminate normal from abnormal tests. At this level, predictive values are 91% for a positive result and 92% for a negative. These results are similar to those reported with the C14 Triolein breath test and adjusted faecal fats.
We conclude that the butterfat test is a simple, cheap and effective screening test in the diagnosis of malabsorption.
Hyperosmolar non-ketotic diabetic coma and rhabdomyolysis
Authors: Trump Dorothy , O'Hanlon Shaun , Rinsler Michael , Sharp Patrick 
Published: December 2008

Summary
Rhabdomyolysis is a rare but potentially fatal complication of hyperosmolar states. We report a case of severe hyperosmolar non-ketotic diabetic coma causing rhabdomyolysis in a young man. Despite very high levels of creatine kinase there was no detectable myoglobinuria. Creatine kinase estimation should be a standard investigation in all patients presenting with a hyperosmolar state.
A model for rational introduction of new and expensive medicines
Authors: Bell E , McCartney C 
Published: December 2008

Abstract
The reported impact of human monoclonal IgM antibody (HA1A) on the mortality rate from Gram-negative bacteraemia aroused considerable interest in its use in Glasgow Royal Infirmary. However, the commercial preparation of HA1A was extremely expensive. With this in mind, the Infirmary’s Drugs and Therapeutics Committee introduced a system whereby the commercial preparation of HA1A could be introduced in a controlled fashion, thereby establishing a model which would encourage targeting the prescription of new, highly expensive treatments to appropriate patients. This model provides the clinician with a set of objective criteria to be met before prescribing such a preparation, thus preventing unnecessary increases in the hospital drug budget and justifying using expensive resources.
Lower limb intra-arterial thrombolysis
Authors: Golledge J , Galland R B 
Published: December 2008

Abstract
In the UK, approximately 5000 patients present annually with acute lower limb ischaemia. The aetiology is usually thromboembolic disease, other causes include aortic dissection and arterial trauma. Over the past two decades thrombosis has replaced embolism as the principal cause of acute ischaemia, and now accounts for approximately 59% of cases. As a consequence, intra-arterial thrombolysis is being increasingly used as first-line treatment for this condition.
Crescentic glomerulonephritis and eosinophilic interstitial infiltrates in a patient with hypereosinophilic syndrome
Authors: Richardson P , Dickinson G , Nash S , Hoffman L , Steingart R , Germain M 
Published: December 2008

Abstract
Crescentic glomerulonephritis with immune complex deposition and acute eosinophilic interstitial nephritis developed in a patient with the hypereosinophilic syndrome. Acute renal failure ensued but was rapidly reversed by high-dose oral prednisone. Confounding factors and unusual findings are described with a review of recent literature. This mode of presentation has not previously been reported.
Factors associated with high risk of marginal hyperthermia in elderly patients living in an institution
Authors: Vassallo M , Gera K N , Allen S 
Published: December 2008

Abstract
The elderly, the very young, and the sick are known to be adversely affected by high environmental temperatures. In a retrospective open case-note review of 872 patients in a large institution during a hot summer we identified characteristics in the elderly that increase the risk of marginal hyperthermia. Women were more likely to be affected than men (25.6% vs 16.9%). We found an age-related increase in marginal hyperthermia, 15.7% of those below 60 years developed a hyperthermia compared to 18.9% in those between 70-79 years (non-significant), 28.3% in those between 80-89 years (p = 0.01) and 50% in those above 90 years (p &lt; 0.01). There was also a direct relationship between the incidence of hyperthermia and the ambient temperature (29% in the warmer wards, compared to 17.2% in cooler ones; p &lt; 0.01) and with the level of dependence (42.3% of the bedridden group, p &lt; 0.01, and 20.4% of the semi-dependent, p &lt; 0.01, compared to 11.1% of the mobile group). These factors were more significant as predictors of risk than the diagnosis. Identifying high risk patients early and taking appropriate measures to avoid hyperthermia and dehydration is important to try to decrease mortality during heatwaves.
Antiphospholipid syndrome in a patient with rapidly progressive fibrosing alveolitis
Authors: Kelion A D , Cockcroft J R , Ritter J M 
Published: December 2008

Abstract
The antiphospholipid syndrome is a thrombotic disorder which can occur in a primary form or more classically in systemic lupus erythematosus. An association between cryptogenic fibrosing alveolitis and the antiphospholipid syndrome has not previously been reported. We describe a patient with severe cryptogenic fibrosing alveolitis who developed pulmonary embolism and myocardial infarction in the presence of antiphospholipid antibody. The case also illustrates that worsening respiratory function may represent superimposition of one lung pathology on another, and may not simply be a deterioration of the pre-existing disease.
Is this patient fit for thoracotomy and resection of lung tissue?
Authors: Thomas S D , Berry P D , Russell G N 
Published: December 2008

Abstract
Central to risk assessment for lung resection is the fact that surgery offers the only chance of long-term survival and cure in non-small carcinoma of the lung. The challenge is, therefore, to offer surgery to as many patients as possible, whilst avoiding the risk of death from postoperative respiratory failure. Risk assessment is based on careful evaluation of the patient’s existing cardiac and respiratory disease. The use of a cardiac risk index, such as that described by Detsky, will ensure that cardiac risk factors are recognised and, where possible, ameliorated prior to surgery. Pre-existing respiratory disease may be assessed by arterial blood gas analysis, exercise testing, whole and regional lung function tests. Criteria based on these tests have been proposed to aid patient selection prior to lung resection. However, these criteria take no account of the beneficial influence on outcome of modern anaesthesia and postoperative care. The elimination of postoperative pain, along with techniques such as minitracheostomy and incentive spirometry have allowed surgery to be offered to many patients who would have been deemed unsuitable by standard criteria. Patients with potentially resectable lung cancer must never be arbitrarily excluded from surgery on the basis of any single criteria or test. Referral for assessment by an experienced team consisting of a thoracic physician, surgeon and anaesthetist will maximise the number of patients offered surgery for this otherwise incurable disease.
Telling your patient he/she has multiple sclerosis
Authors: Ford H L , Johnson M H 
Published: December 2008

Abstract
It is difficult to tell a person that s/he has multiple sclerosis. The diagnosis is based on clinical findings and often cannot be made on first meeting. In many cases investigations do not help. When the diagnosis is made, the patient should be fully informed in the majority of cases. Guidelines have been developed for imparting the diagnosis. Early diagnosis will become increasingly important with the development of new treatments for multiple sclerosis.
The use of rheumatoid factors in clinical practice
Authors: Thomas M J , Adebajo A , Chapel H M , Webley M 
Published: December 2008

Abstract
Rheumatoid factor is a commonly requested test in the investigation of joint problems. Although the test has been found to be both sensitive and specific for rheumatoid arthritis in patients attending Rheumatology Clinics, when the test is applied to general hospital or community populations it performs poorly. Thus the setting in which rheumatoid factor tests are requested and awareness of the test’s limitations are critical for appropriate use and interpretation of results. We studied 295 consecutive requests for testing at four centres. The majority were performed for the investigation of joint problems but only 6% of these were positive, suggesting unselective requesting. Half of the results were used to make diagnoses and influence management. However, significant numbers of clinicians felt that the test result had either excluded or confirmed a diagnosis of rheumatoid arthritis suggesting that results were being over-interpreted and that clinical decisions made on this basis may have been inappropriate. We conclude that in this setting rheumatoid factor testing is of limited value and generates misleading information.
What should I do about my patient’s gall stones?
Authors: Dennison A R , Azoulay D , Oakley N , Baer H , Paraskevopoulos J A , Maddern G J 
Published: December 2008

Abstract
The problem of benign biliary disease is one that causes significant morbidity and social economic strain in the western world. The classical treatment, cholecystectomy, has been challenged by various medical and surgical techniques in a seemingly random nature. The development of the treatment of gall stone disease is reviewed by analysis of published studies over the last 20 years. The advantages and disadvantages are discussed as an overview and summary of the current management of gall stone disease in the light of our knowledge of its malignant potential.
Enterococcal endocarditis after extracorporeal shock wave lithotripsy for nephrolithiasis
Authors: Zimhony O , Goland S , Malnick S D , Singer D , Geltner D 
Published: December 2008

Abstract
We report a case of enterococcal endocarditis following extracorporeal shock wave lithotripsy (ESWL) for ureteral stone. Although endocarditis following ESWL is very rare, transient bacteraemia occurs during ESWL. This case is a reminder that enterococcal endocarditis may follow innovative genitourinary procedures without appropriate prophylaxis.