bluuebunny/crossref_metadata_2025_split huggingface dataset:
Iatrogenic profound hypoalphalipoproteinaemia: an unrecognised cause of very low HDL cholesterol
Authors: Murphy M J , Duncan A , Vallance B D , Packard C J , O’Reilly D S 
Published: December 2008

Abstract
A significant reduction in plasma high density lipoprotein (HDL) cholesterol is a recognised consequence of treatment with probucol. By contrast, fibrate therapy in general has the opposite effect. We report two cases where the combination of probucol and a fibrate led to profoundly reduced plasma levels of HDL cholesterol associated with very low levels of apolipoprotein A-I (apoA-I). In the first, bezafibrate was added to probucol, and in the second, probucol added to a combination of simvastatin and fenofibrate. In both cases, plasma levels of HDL and apoA-I returned towards normal after discontinuation of one or both drugs, indicating that the reduction was reversible.
Renal dysfunction associated with liver transplantation
Authors: Jindal R M , Popescu I 
Published: December 2008

AbstractIt has been known for some time that a variety of liver diseases affect kidney function, but renal dysfunction associated with orthotopic liver transplantation has received scant attention. Although the mechanisms mediating these abnormalities are incompletely defined, advances in the understanding of renal pathophysiology after liver transplantation have made it possible to develop new treatment strategies. Aggressive and early intervention to diagnose and treat renal complications associated with liver transplantation should be the goal for transplant centres.
The management of acute myocardial infarction
Authors: Saltissi S , Mushahwar S S 
Published: December 2008

Abstract
Greater understanding of the underlying pathophysiology of acute myocardial infarction (AMI) has led to more aggressive management and lower mortality, both in-hospital and long term. AMI results mainly from thrombotic occlusion of the infarct-related coronary artery. The ensuing necrosis evolves over a 6-12 h period providing a time window for interventions designed to reduce eventual infarct size. The most appropriate interventions are those which restore coronary artery patency and hence myocardial blood flow as soon as possible. Occasionally, disruption of the occluding thrombus and compression of the underlying atheromatous lesion is best achieved by direct percutaneous transluminal coronary angioplasty. For the vast majority however, revascularisation by drug therapy is more appropriate. As soon as possible, all patients without contraindications should be offered oral aspirin and intravenous thrombolysis, usually with streptokinase but occasionally with tissue plasminogen activator. Patients in whom these agents are contraindicated should be considered for intravenous beta-blockade using atenolol or metoprolol to reduce myocardial demand and hence infarct size. Patients with large infarcts, impaired ventricular function, left ventricular failure or hypertension should be considered for early angiotensin-converting enzyme inhibitor therapy. Other agents may be valuable symptomatically, but have no proven role in reducing infarct size or mortality. After the first 24 h, the main aims of management are to assess the likelihood of later ischaemic events or death (risk stratification) and hence to choose appropriate long term secondary prophylaxis.
The prevalence of drivers in acute geriatric wards
Authors: Morgan R , Turnbull C J , King D 
Published: December 2008

Abstract
An audit of 150 patients on five acute geriatric wards found that 28 (19%) still drove. Forty-three (28%) used to drive but had given up, whilst 79 (53%) (76 of whom were female) had never driven. Former drivers gave the main reason for stopping as cost. No driver could recall being advised about driving by a doctor. Twenty-two drivers (79%) had a significant clinical condition that could affect driving, ranging from blackouts to arthritis. It is recommended that all elderly patients should be asked if they drive and any clinical conditions they might have that would adversely affect their driving be sought. Appropriate advice should be given by doctors to their elderly patients in order to safeguard them and the public from road traffic accidents.
Endoscopic balloon dilatation of duodenal strictures in Crohn’s disease
Authors: Kelly S M , Hunter J O 
Published: December 2008

Abstract
Endoscopic balloon dilatation of oesophageal and colonic strictures is now widely performed. Duodenal strictures due to Crohn’s disease represent a difficult clinical problem as surgical intervention is a major undertaking and recurrences are common. We describe endoscopic balloon dilatation in three patients with obstructive symptoms from duodenal strictures due to Crohn’s disease. The procedure appeared safe, was well tolerated and resulted in an excellent symptomatic response. This method is particularly suitable for short duodenal strictures and avoids the need for surgical intervention in this difficult group of patients.
Systemic lupus erythematosus presenting as effuso-constrictive pericarditis
Authors: McMechan S R , McClements B M , McKeown P P , Webb S W , Adgey A A 
Published: December 2008

Abstract
We describe a 62-year-old woman in whom systemic lupus erythematosus presented as life-threatening effuso-constrictive pericarditis. Surgical drainage of the pericardium was required and the patient made a satisfactory recovery. At six-months follow-up, while taking hydroxychloroquine and a non-steroidal anti-inflammatory agent, she remains well.
Developing comprehensive stroke services: an evidence-based approach
Authors: Langhorne P 
Published: December 2008

AbstractThe recent interest in the development of services for stroke patients reflects an increasing optimism about stroke management and the recognition that properly organised care can improve outcomes after stroke. A comprehensive stroke service should provide early assessment and investigation of stroke disease in both in-patient and out-patient settings, acute care for stroke in-patients to manage their medical and surgical problems, and rehabilitation for patients with persisting functional problems. Other components may include out-patient, day hospital or domiciliary rehabilitation facilities and continuing care and support facilities for patients discharged from hospital. This article discusses the evidence to support different components of a comprehensive stroke service and emphasises the need for flexible approaches to different local conditions.
Venepuncture: the medicolegal hazards
Authors: McConnell A A , Mackay G M 
Published: December 2008

Abstract
Venepuncture is commonly regarded as a trivial procedure allocated to the most junior medical staff. The result of this policy is that junior doctors are required to perform a minimally invasive procedure on consenting patients without any structured venepuncture training or assessment. Consequently, inexperienced doctors may perform multiple and sometimes unnecessary, venepunctures, which could damage essential venous access, eg, in the diabetic or renal patient. We review the medicolegal position and suggest that structured venepuncture training is essential and argue that unskilled treatment may be regarded by the Courts as demonstrating the mens rea of assault in the form of recklessness.
Massive haemorrhage due to colitis secondary to nonsteroidal anti-inflammatory drugs
Authors: Sacanella E , Muñoz F , Cardellach F , Estruch R , Miró O , Urbano-Márquez A 
Published: December 2008

Abstract
A case of massive haemorrhage due to colitis induced by nonsteroidal anti-inflammatory drugs in a 74-year-old man is reported.
Guidelines for the management of thrombophilia. Department of Haematology, The Royal London Hospital, Whitechapel, London, UK
Authors: Cavenagh J D , Colvin B T 
Published: December 2008

Abstract
Although there are numerous risk factors for venous thromboembolic disease, the term ‘thrombophilia’ refers only to those familial or acquired disorders of the haemostatic system that result in an increased risk of thrombosis. The inherited thrombophilias include antithrombin III deficiency, resistance to activated protein C (factor V Leiden), protein C and protein S deficiencies as well as some rare forms of dysfibrinogenaemia. It is possible that other inherited conditions might also predispose to thrombosis. In contrast, when using the above definition, the antiphospholipid syndrome is the only genuine acquired thrombophilic state. Patients who have thromboembolic disease at a young age with no provoking event or who have a positive family history or whose thrombosis involves an unusual site should be investigated for thrombophilia. The management of a patient identified as having a laboratory abnormality associated with thrombophilia will depend on a variety of factors such as the patient’s individual and family thrombotic history, the site of the thrombosis and the presence of other prothrombotic risk factors. The use of prophylactic anticoagulation during pregnancy and the puerperium requires particularly careful consideration in thrombophilic women. As more becomes known about the thrombophilias it will become possible to formulate more exact guidelines as to the management of these conditions.
Subclinical thyroid disease
Authors: Elte J W , Mudde A H , Nieuwenhuijzen Kruseman A C 
Published: December 2008

Abstract
Thyroid disease can roughly be divided into functional and anatomical disorders. Subclinical disease is by definition not accompanied by symptoms or signs and usually goes unrecognized for the bearer (and the observer). In this communication an overview will be given of existing literature and some own results concerning subclinical hypothyroidism, subclinical thyrotoxicosis and thyroid incidentalomas. Apart from definitions, data on prevalence, clinical effects, prognostic significance and the need for and response to therapy will be discussed.
Pulmonary embolism--the role of thrombolytic therapy in its management
Authors: More R S , Chauhan A 
Published: December 2008

AbstractIn massive pulmonary embolism where there may be evidence of right ventricular dysfunction and acute pulmonary hypertension, anticoagulation therapy alone may prove inadequate. In such situations use of thrombolytic agents produces an improvement in haemodynamics compared to anticoagulants alone, although studies to date have been too small to address the issue of mortality benefit. It would appear that all age groups gain benefit from the use of thrombolytics. Studies that have compared thrombolytic agents and anticoagulants are discussed. In addition, the issues of the choice of thrombolytic agent and the different modes of delivery of therapy are addressed.
Do accident and emergency senior house officers know the British guidelines on the management of acute asthma?
Authors: Ulahannan T , Hardern R D , Hamer D W 
Published: December 2008

Abstract
Avoidable deaths from asthma continue, even in hospital. Since the management of acute severe asthma is often initiated in the Accident and Emergency department, it is crucial that staff there have adequate knowledge. An anonymous questionnaire, containing items based on chart 6 of the UK guidelines, was completed by 66 Accident and Emergency Senior House Officers from the Yorkshire region. The study aim was to establish these doctors’ levels of knowledge about the recommended management of acute asthma in Accident and Emergency. The median score was 10 (out of a possible 24) and the interquartile range 8-13. Further efforts are required to implement these guidelines so that the best patient outcomes can be achieved.
Metformin treatment in NIDDM patients with mild renal impairment
Authors: Connolly V , Kesson C M 
Published: December 2008

Summary
Metformin is contraindicated in patients with renal failure because of the risk of lactic acidosis. This study assessed the complications of metformin treatment in patients with non-insulin-dependent diabetes mellitis with normal and raised serum creatinine. Subjects using metformin with serum creatinine above the upper reference range (120 mu mol/l) were identified (n = 17) from a hospital diabetes register; those with abnormal liver function, cardiac failure, peripheral vascular disease or recent severe illness were excluded. Reference plasma lactate levels were established, mean 1.742 mu mol/l (SD 0.819) using age-matched non-diabetic subjects. Age-matched patients treated with metformin with normal serum creatinine levels formed the control group (n = 24). Details of gastrointestinal disturbance were recorded, and plasma lactic acid and vitamin B12 levels measured. The median total daily dose of metformin in both groups was 1700 mg. The mean plasma lactate in subjects with serum creatinine 80-120 mu mol/l (2.640 mmol/l (SD 1.434) p &lt; 0.02) was higher than non-diabetic control levels while diabetic subjects with serum creatinine 120-160 mumol/l had a mean of 2.272 mmol/l (SD 0.763) p &lt; 0.05. There was no significant difference between the two groups taking metformin, nor any significant difference in the reporting of gastrointestinal symptoms between the groups on metformin (11.76% vs 12.5%). Plasma lactic acid levels are higher in diabetic subjects taking metformin compared with healthy volunteers but, within the diabetic groups, the small elevation of serum creatinine was not associated with higher plasma lactate levels.
Telling relatives that a family member has died suddenly
Authors: Marrow J 
Published: December 2008

Summary
Persons dying suddenly are very likely to be taken to the nearest Accident and Emergency Department. The task of informing and counselling bereaved relatives therefore frequently falls to the staff of these Departments. Adequate preparation is important in allowing such situations to be dealt with in a sensitive and appropriate manner. Advice on coping with different aspects of sudden death is given and some common reactions discussed. Special problems are also considered (eg, the death of a child, criminal violence, communication difficulties). Aftercare must also not be forgotten and staff should receive training in the care of the bereaved.
Gastric cancer
Authors: McCulloch P 
Published: December 2008

Summary
We are gaining a clearer insight into the causes and mechanisms of gastric carcinogenesis, and may be able to reduce the incidence in the future by Helicobacter pylori eradication, perhaps in conjunction with nutritional supplements. The work required to establish this kind of prevention programme still has a long way to go. Surveillance and early detection are a key area, and current hopes rest with an increasingly low threshold for gastroscopy together with improved awareness in both patients and general practitioners. Identification of a high-risk group for surveillance would be a major advance, and may become possible due to advances in molecular biology. In terms of treatment, surgery remains the mainstay, but for useful analysis of its’ efficacy, uniform and detailed pathological staging is vital. Pre-operative assessment has improved greatly in recent years, resulting in fewer nontherapeutic laparotomies, thanks to a combination of improved imaging techniques and laparoscopy. Limited endoscopic surgery is now feasible for very early disease. The extent of radical surgery remains controversial: a strong argument can be made for concentrating this kind of surgery in the hands of a limited number of specialist units who will have the numbers and the expertise to answer the outstanding questions. Chemotherapy has yet to prove its value, but there are hopes that the newest regimes may do this. Treatment results in the West remain unsatisfactory, but they have improved in the last two decades, and should be capable of considerable further improvement.
Cancer of the oesophagus
Authors: Hennessy T P 
Published: December 2008

Summary
Oesophageal cancer is the fourth most common tumour in developing countries, comprising mainly squamous cell tumours, although the incidence of adenocarcinoma has increased enormously over the last decades. Surgical resection has long been acknowledged as the mainstay of treatment, and developments in surgical technique are reviewed. The roles of radiotherapy and chemotherapy in the management of oesophageal cancer remain unclear, especially as the majority of studies to date have been uncontrolled trials. We present an analysis of 601 patients who underwent resection for carcinoma of the oesophagus between 1970 and 1994 in the Department of Clinical Surgery, St James’s Hospital, Dublin. The analysis shows clearly that, while peri-operative mortality continues to improve, conventional surgery offers little prospect of cure in the majority of cases. We have therefore embarked upon a prospective controlled trial of neoadjuvant chemoradiotherapy followed by surgery versus surgery alone in patients with adenocarcinoma or squamous cell tumours of the oesophagus. Preliminary results indicate that multi-modality treatment may have a valuable role to play in the treatment of carcinoma of the oesophagus.
Pre-operative computed tomography in abdominal aortic aneurysms
Authors: Fitzgerald E J , Spence L D 
Published: December 2008

Summary
Major additional pathology, in the abdomen or directly related to the aneurysm itself, which influenced surgical management was demonstrated in 39 (34.5%) of 113 patients with suspected abdominal aortic aneurysm who had undergone pre-operative assessment with computed tomography (CT). Major additional pathology within the abdomen was shown in 11 (9.7%) and related to the aneurysm itself in 26 (23%). Therefore, CT has a significant impact on operative management of such patients and should be routine in the pre-operative evaluation of abdominal aortic aneurysms. The current roles of CT angiography and magnetic resonance angiography are discussed.
Primary Sjögren’s syndrome, ulcerative colitis and selective IgA deficiency
Authors: Steuer A , McCrea D J , Colaco C B 
Published: December 2008

Summary
A 24-year-old man with primary Sjögren’s syndrome presented with xerophthalmia, xerostomia, and marked parotid swelling. He had a previous history of selective IgA deficiency and ulcerative colitis treated with sulphasalazine. Immunosuppression and withdrawal of sulphasalazine resulted in rapid resolution of the parotitis and disappearance of autoantibodies. A possible role for sulphasalazine in the induction of autoimmunity in this case is discussed.
Investigation of patients with polycythaemia
Authors: Pearson T C , Messinezy M 
Published: December 2008

SummaryPolycythaemia may complicate or be the presenting feature of a wide variety of different pathologies. Early diagnosis and treatment of primary polycythaemia will significantly reduce the morbidity and mortality associated with this condition. Patients with a raised packed cell volume are divided into those with a raised red cell mass (absolute polycythaemia), and those with a red cell mass within their normal range (apparent polycythaemia). A standard investigative approach of an absolute polycythaemia enables patients with primary and secondary polycythaemia to be identified, leaving a group termed idiopathic erythrocytosis. There are a number of physiological situations and pathological events associated with idiopathic erythrocytosis and apparent polycythaemia. Careful follow-up of both groups of these patients is essential to identify possible causative mechanisms.
Apneustic breathing provoked by limbic influences
Authors: Stewart J , Howard R S , Rudd A G , Woolf C , Russell R W 
Published: December 2008

Summary
We describe a 64-year-old man with cerebrovascular disease who had an acute stroke characterised by pseudobulbar palsy, facial weakness, and pyramidal signs. He developed frequent emotional outbursts followed by periods of apneusis. Between these episodes he breathed with a regular and unvarying rate and tidal volume. Autopsy showed extensive cortical, subcortical and pontine infarction. The respiratory pattern indicated a dissociation between voluntary and automatic pathways. The descending limbic pathways were preserved but an abnormal pattern of automatic breathing (ie, apneusis) occurred because of the presence of bilateral pontine infarction.
Cystic lymphangioma of the pancreas
Authors: Daltrey I R , Johnson C D 
Published: December 2008

Summary
Cystic lymphangioma of the pancreas is a rare condition. A 14-year-old girl presented with a cystic abdominal mass and abdominal pain. She was initially treated by biopsy and cyst drainage, and subsequently with partial excision of the cystic mass. The mass, which was a cystic lymphangioma involving the pancreas, recurred after each operation. Persisting symptoms led to a pylorus-preserving pancreatectomy and hepaticojejunostomy. Total excision is the only effective method of treating this benign tumour. The patient remains symptom free 2 1/2 years after pancreatectomy.
A new immunosuppressant: tacrolimus
Authors: James D G 
Published: December 2008

Summary
Tacrolimus is the new name for the Japanese immunosuppressant drug FK506. It blocks interleukin 2 transcription thereby inhibiting the CD4 Th-1 lymphocyte response to foreign antigens. It also selectively inhibits cytokine secretion of IL3, IL4 and interferon-gamma. It is metabolised by the cytochrome P-450 enzyme system. The results of two trials indicate that it is similar to cyclosporin in efficacy and toxicity.
The sleepwalking/night terrors syndrome in adults
Authors: Crisp A H 
Published: December 2008

Summary
A third of a million adults in the UK sleepwalk while a million suffer from night terrors. In both conditions the individual is unaware of the fullness of their surroundings and is totally focussed in their concern or activity. Doctors are only likely to become involved if the individual comes to harm or seeks help or if other people are inconvenienced or threatened. The constitutional basis of the disorder is beyond doubt, although the actual expression may be related to stressful life-events resulting from an individual’s personality, relationships and circumstances. Treatment may include the provision of a secure environment, counselling, and the use of benzodiazepines and serotonin re-uptake inhibitors.
The elderly and their medication: understanding and compliance in a family practice
Authors: Blenkiron P 
Published: December 2008

Summary
Eighty patients aged 75 years and over were interviewed in the surgery or at home to assess their level of knowledge, degree of compliance, and problems with their medicines. Regular medication was prescribed to 59 patients, who took a total of 206 drugs. The correct purpose of medication was stated in 72% of cases, the dosage regimen recalled accurately for 75%, and the correct name given for 64% of drugs. The elderly rated their compliance as ‘good’ (never miss doses) for 77% of drugs prescribed. This correlated poorly for individual patients with the level of correct compliance as assessed on computer records of repeat prescriptions, which nevertheless was accurate for 80% of medicines taken. A significant difficulty for the elderly was the removal of tops from medicine containers, occurring in 18 cases (31% patients), including half of those taking analgesics or nonsteroidal anti-inflammatory drugs. The widespread, legally enforced, use of child-resistant containers for the elderly frequently seems inappropriate. Further improvements in comprehension and compliance may occur with regular explanation and rationalisation of medication by the family doctor, when visiting the elderly at home.