bluuebunny/crossref_metadata_2025_split huggingface dataset:
Responses of primary health care professionals to UK national guidelines on the management and referral of women with breast conditions
Authors:   The BRIDGE Study Group
Published: August 2002

Abstract Rationale, aims and objectives To explore the responses of primary health care professionals to guidelines in general, and to the UK national guidelines on the management and referral of women with breast conditions in particular. Methods Qualitative study using practice‐based, semistructured group discussions with primary health care professionals. All practices were involved in a study evaluating the effect of the national breast symptom management guidelines on clinical practice. Discussion groups were conducted in the practice; fifteen of the 34 study practices were audio‐taped. Groups comprised the available partners and practice nurses at each practice. All members of each group were well known to one another. There was good attendance by all doctors, with 75% of male partners and 90% of female partners present at the meetings. Of the practice nurses 51% attended. In all, 86 professionals attended the meetings. Results A number of areas for comment arose consistently in each discussion. Guidelines in general were welcomed, although there was more support for evidence‐based than consensus‐based guidelines. The breast lump guideline was also welcomed, participants commenting that it was concordant with current practice. The breast pain guideline was more contentious, participants reflecting that it recommended more primary care management than was usual, and fell outside the experience and confidence of doctors or the expectations of patients. Participants felt it did not incorporate psychosocial factors into recommended management, despite this being an important part of primary care management. Conclusions There are concerns about consensus guidelines and doubts about the applicability of the breast pain guideline in this complex management area. The failure of these guidelines to address patient anxiety may limit their implementation.
Primary renal candidiasis: Fungal mycetomas in the kidney
Authors: Morris Burzin S , Chudgar Priya D , Manejwala Owais 
Published: August 2002

SUMMARYFungal infections of the urinary tract have a predilection for drainage structures rather than for the renal parenchyma. Of the causal factors, diabetes mellitus, immunosupressed states, AIDS and prematurity are those most commonly encountered. The case of a young, diabetic man whose chief clinical presentation was dysuria is described. On further examination he was found to harbour fungal balls in the right kidney. Radiological manifestations of acute pyelonephritis were also present. Although primary renal candidiasis is often commensurate with systemic fungaemia, he displayed none of the clinical features of disseminate infection and, hence, was treated conservatively with oral antifungal agents. Fortuitously, spontaneous passage of fungal particulate matter in urine was later reported.
Ultrafast MRI of the fetus
Authors: Glastonbury Christine M , Kennedy Anne M 
Published: August 2002

SUMMARYDuring the last decade there has been increasing interest in MRI for the evaluation of ultrasound‐detected fetal abnormalities. Motion artefacts previously precluded detailed imaging, but this is now possible using single‐shot rapid acquisition sequences. These ultrafast techniques with subsecond images capture ‘snap‐shot’ views of the fetus. By virtue of the infinitely long relaxation time (TR) these images are heavily T2‐weighted so that fluid around and within the fetus delineates the anatomy.Currently, fetal MRI has shown to be most beneficial in the investigation of cerebral abnormalities suspected from sonography, and in the detection of subtle associated anomalies. It clearly has a role in the evaluation of complex somatic abnormalities, and is helpful in the evaluation of fetuses prior to surgery.We present a pictorial review of our experience with single‐shot fast spin‐echo (SSFSE) imaging, demonstrating normal anatomy of the fetal brain and body. In addition we present cerebral and somatic abnormalities to illustrate cases where we have found fetal MRI to be a useful adjunct to sonography.
MRI appearances of the sphenoid sinus at the late follow‐up of trans‐sphenoidal surgery for pituitary macroadenoma
Authors: Connor SEJ , Deasy NP 
Published: August 2002

SUMMARYWe aimed to demonstrate the appearances of the sphenoid sinus on MRI performed later than 2 years post‐ transsphenoidal surgery (TSS). We retrospectively reviewed 47 patients in whom follow‐up MRI scans had been performed at least 2 years post‐TSS. We specifically reviewed the clinical and imaging of those patients in whom the sphenoid sinus was filled with signal abnormality or masses were present arising from the sinus roof and classified them as tumour or indeterminate abnormalities on imaging criteria. We documented other clinicoradiological details. Twelve of 47 patients demonstrated sphenoid sinus filling or sinus roof masses and in six of 12 patients it was possible to classify them as tumourous using imaging and clinical criteria. The indeterminate and non‐tumourous sphenoid sinus abnormalities most frequently had a T1‐weighted signal similar to subsellar tumour and displayed rim enhancement and thus could not be reliably distinguished from tumourous abnormality on the basis of signal or enhancement characteristics. The presence of a well‐defined surgical defect in the sella floor was associated with resolution of abnormality on MRI follow‐up. We concluded MRI findings of sphenoid sinus filling or sinus roof masses are present in approximately 26% of scans performed longer than 2 years post‐TSS. Half of these are of indeterminate origin and follow‐up is required to discriminate tumour from non‐ tumour with certainty. A well‐defined surgical defect in the sella floor is, however, suggestive of a non‐tumourous abnormality.
Renal parenchymal malakoplakia: An unusual cause of unilateral, diffuse renal enlargement
Authors: McKeen SK , Tie MLH 
Published: August 2002

SUMMARYRenal parenchymal malakoplakia is usually described as a multi‐ or unifocal process. We report an unusual case presenting with unilateral diffuse renal enlargement consistent with an early stage in the evolution of this disease.
False negative biliary scintigraphy in gangrenous cholecystitis
Authors: Grant Robyn L , Tie Mark LH 
Published: August 2002

SUMMARYGangrenous cholecystitis is a serious complication of acute cholecystitis and is associated with increased morbidity and mortality rates. We report a case in which the diagnosis was suggested by ultrasound, but cholecystectomy delayed due to atypical clinical presentation and a false negative radionuclide biliary scan.
CT and MRI appearances of methotrexate leucoencephalopathy
Authors: Wilks Michael J , Tie Mark LH , Pozza Christopher H 
Published: August 2002

SUMMARYMethotrexate is a well recognised cause of diffuse symmetrical leucoencephalopathy. The widespread use of the drug in chemotherapeutic regimes necessitates awareness of this complication. A case report and a brief literature review is presented.
Spinal angiolipoma: Report of three cases and review of MRI features
Authors: Garg Ajay , Gupta Vipul , Gaikwad Shailesh , Deol P , Mishra Nalin Kant , Sharma Mehar Chand , Vaish Sandeep 
Published: August 2002

SUMMARYWe report three cases of spinal angiolipoma, two intramedullary and one epidural, and review their MRI features. Diagnoses were established preoperatively in all cases. Specific MRI features including the importance of postgadolinium fat‐saturated T1‐weighted images and presence of vascular flow‐voids are discussed with histopathological correlation. A characteristic morphological appearance of intramedullary angiolipoma has been suggested.
Gadolinium‐enhanced computed tomographic aortography
Authors: Chryssidis S , Davies RP , Tie MLH 
Published: August 2002

SUMMARYRadiographic contrast agents using gadolinium have a better safety profile and photoelectric effect than iodinated contrast, allowing use where iodinated contrast is contraindicated. A case of gadolinium‐enhanced computed tomographic aortography (CTA) for suspected thoracic dissection is reported. Aortic enhancement was sufficient for confident exclusion of an intimal flap. The findings were later confirmed by MRI. Vascular enhancement diminished below the diaphragm and tissue enhancement was minimal. Gadolinium diethylenetriamine penta‐acetic acid (Gd‐DTPA) may be used for CTA of the thoracic aorta, where the use of iodinated contrast is contraindicated. Multi‐slice CT may expand the role of gadolinium enhancement in the future.
Beginning angiography: A step‐by‐step guide
Authors: Heng Robert C , Bell Kevin W 
Published: August 2002

SUMMARYProcedures in radiology are still very much learnt as an apprenticeship. While there is no substitute for hands‐on practice and the one‐to‐one teaching of an experienced consultant, it has been our experience that learning is significantly facilitated by the availability of simple, easy‐to‐follow, relevant notes for pre‐reading, especially in the difficult and potentially hazardous area of angiography. However, we have had surprising difficulty in finding an introductory text that is suitable for the teaching of angiography to new, never‐seen‐it‐before trainees. We have therefore developed a short, simple, illustrated manual within our department for introducing angiography to first‐year registrars, which we present in this article. We hope trainees will find it of use for providing an overview of the principles and the basic techniques involved prior to beginning formal training in this challenging and rewarding specialty.
Relevance of VacA and mucosal pathological changes in Chinese patients with upper gastrointestinal diseases before and after Helicobacter pylori eradication
Authors: CHEN Xiao Yu , VAN DER HULST Rene , VAN DER ENDE Arie , PAN Zhi Jun , XIAO Shu Dong , TYTGAT Guido NJ , TEN KATE Fiebo JW 
Published: August 2002

OBJECTIVE:  To investigate the influence of VacA activity on gastric mucosa prior to and after Helicobacter pylori eradication in Chinese patients with peptic ulcers and chronic gastritis.METHODS:  Seventy‐four dyspeptic patients with H. pylori infection were enrolled. The status of H. pylori infection was evaluated by culture and histo­pathology before and 4−6 weeks after H. pylori eradication therapy. Histological specimens were examined and graded semiquantitatively according to the updated Sydney classification.RESULTS:  Helicobacter pylori with VacA was found in 59 of 74 patients (80%), and its prevalence in patients with peptic ulcers and chronic gastritis was similar. Helicobacter pylori eradication rates in patients with VacA+ and VacA− strains were similar. Before eradication, the degrees of acute or chronic inflammation, epithelial damage, atrophy, intestinal metaplasia (IM) and the number of lymphoid follicles were similar in patients with VacA+ and VacA−H. pylori. Four to 6 weeks after the eradication of H. pylori infection, the degrees of acute and chronic inflammation, and epithelial damage in the antrum decreased significantly, particularly in patients with VacA+H. pylori (P < 0.0001). The number of lymphoid follicles in the antrum also decreased more in patients with VacA+H. pylori than in those with VacA−H. pylori (P= 0.051). However, there was no difference in the extent of atrophy and IM between these two groups.CONCLUSIONS:  There is no specific correlation between VacA+/VacA−H. pylori strains and mucosal clinicopathological features in Chinese patients with upper gastrointestinal diseases before and after eradication therapy. Successful eradication of H. pylori infection does not improve atrophic and IM lesions of the gastric mucosa.
HLA‐DR genotypes in Chinese patients with ulcerative colitis
Authors: PENG Zhong Sheng , HU Pin Jin , GUO Yun Wei , CHEN Min Hu , CUI Yi , LIU Si Cun 
Published: August 2002

OBJECTIVE:  To study HLA‐DR genotypes and to analyze the relationship between HLA‐DR genotypes, antineutrophil cytoplasmic antibodies (ANCA) and clinical classification of ulcerative colitis (UC) in Chinese patients.METHODS:  Eighty UC patients and 123 healthy subjects were enrolled in the study. Serum ANCA was detected by using indirect immunofluorescence and HLA‐DR was genotyped by using the polymerase chain reaction with sequence‐specific primers (PCR‐SSCP).RESULTS:  The positive rate of ANCA in UC patients was 55%, but 0.0% in the controls. The HLA‐DR2 and DR15 positive rates in the UC patients were 58.8 and 40%, respectively, which were significantly greater than 30.1 and 17.9% in the controls (P < 0.05). In the UC patients, the DR15‐positive rate was significantly higher, but the DR16‐positive rate was significantly lower in the ANCA‐positive group than in the ANCA‐negative group (52.3 vs 25.0%; 9.1 vs 30.6%, P < 0.05). The HLA‐DR2 and DR15‐positive rates in chronic persistent UC patients were significantly greater than those in the incipient or chronic recrudescent type of UC (84.2 vs 50.0 or 51.4%; 63.2 vs 29.2 or 35.1%, P < 0.05).CONCLUSIONS:  In Chinese UC patients, the positive rates of HLA‐DR2 and ANCA were significantly higher compared with healthy controls. The increase in the DR2‐positive rate was associated with the increase in the DR15‐positive rate in ANCA‐positive UC patients, and was associated with the increase in the DR16 gene positive rate in ANCA‐negative UC patients. In general, HLA‐DR genotypes are related to the clinical classification of ulcerative colitis.
Overexpression of peroxisome proliferator‐activated receptor γ and retinoid X receptor α in gastric carcinomatous tissue
Authors: YAO Li Ping , WU Kai Chun , WU Han Ping , SONG Bao Hua , QIAO Tai Dong , FAN Dai Ming 
Published: August 2002

OBJECTIVE:  To investigate the expression of peroxisome proliferator‐activated receptor γ (PPAR‐γ) and retinoid X receptor α (RXR‐α) in chronic gastritis, gastric mucosal dysplasia and gastric carcinoma and to identify any correlations between PPAR‐γ and RXR‐α expression in this progression sequence.METHODS:  Immunohistochemical methods (avidin− biotin−peroxidase complex) were used to examine the expression of PPAR‐γ and RXR‐α in 53 patients with gastric carcinoma, 18 with gastric mucosal dysplasia and 30 with chronic atrophic gastritis. Thirty‐one patients with chronic non‐atrophic gastritis acted as controls.RESULTS:  The positive rates of PPAR‐γ and RXR‐α in gastric carcinoma were 41.5 and 54.7%, 27.8 and 38.9% in gastric mucosal dysplasia, 10.0 and 20.0% in chronic atrophic gastritis, and 6.5 and 16.1% in chronic non‐atrophic gastritis, respectively. The expression of PPAR‐γ and RXR‐α increased during the progression from chronic non‐atrophic gastritis to chronic atrophic gastritis, then to gastric carcinoma. Compared with chronic gastritis, the expression of PPAR‐γ and RXR‐α in gastric mucosal dysplasia and gastric carcinoma was significantly increased (P < 0.05, P < 0.01). In gastric carcinoma, the expression of PPAR‐γ and RXR‐α was not associated with tumor cell differentiation or metastasis in the lymph nodes (P > 0.05). There was a positive correlation between the expression of PPAR‐γ and RXR‐α in gastric carcinoma (r= 0.54, P < 0.01).CONCLUSIONS:  Overexpression of PPAR‐γ and RXR‐α protein is apparent in human gastric cancer. This might be an early event in carcinogenesis, and both PPAR‐γ and RXR‐α may play independent and/or synergistic roles in the progression of gastric carcinoma.
Combined lamivudine and famciclovir therapy for patients with chronic hepatitis B
Authors: XU Ke Cheng , LI Shao Bai , WENG Shao Ji , LEI Chun , YE Ping 
Published: August 2002

OBJECTIVE:  No single antiviral drug is able to eradicate hepatitis B virus (HBV) infection. It has been shown in vitro that lamivudine and panciclovir (the active metabolite of famciclovir) act synergistically to inhibit HBV replication. To study the therapeutic efficacy of combined lamivudine and famciclovir therapy in patients with chronic hepatitis B.METHODS:  Twenty‐one patients with chronic hepatitis B, who had been given lamivudine monotherapy for more than 6 months without improve­ment, had increased serum alanine aminotransferase (ALT) and HBV‐DNA levels, and were positive for hepatitis B surface antigen (HBsAg); 17 were positive for HBeAg. The diagnosis was verified by histology in 12 HBeAg‐positive cases. All patients were given combined therapy with lami­vudine (100 mg q.d.) and famciclovir (500 mg t.i.d.) orally for 4 months, and then with lamivudine alone for 5−10 months.RESULTS:  Serum HBV‐DNA levels were initially 1 × 108.19 ± 1.18 copies/mL,
then decreased to 1 × 105.25 ± 1.18 copies/mL
at the end of the combined treatment and 1 × 105.25 ± 1.82 copies/mL
in the follow‐up period (P < 0.01).
Serum ALT decreased from 225 ± 110 U/L before
the trial to 79 ± 50 U/L
at the end of the combined treatment and 81 ± 48 U/L
in the follow‐up period (P < 0.01).
In 17 HBeAg‐positive patients, eight (47.1%) had HBeAg/anti‐hepatitis
B e antigen (HBeAg) seroconversion with a significant decrease of HBV‐DNA
(<1 × 104 copies/mL)
and normal ALT (P < 0.01). Of
four HBeAg‐negative patients, three had decreased levels of HBV‐DNA,
to below 1 × 104 copies/mL,
which was associated with a significant decrease in ALT. Two patients
had recurrent flare‐ups in the follow‐up period, but both HBV‐DNA
and ALT were lower than the pretreatment levels. In 10 patients who
underwent a second liver biopsy, improvements in inflammatory activity
and fibrosis were seen in eight (80%) and four (40%)
cases, respectively (P < 0.05).CONCLUSIONS:  The combination treatment of lamivudine and famciclovir has synergistic or additive anti‐HBV effects, and may be an alternative therapy for patients with active chronic hepatitis B.
Esophageal motility in patients with sliding hiatal hernia and reflux esophagitis
Authors: YE Ping , LI Zhao Shen , XU Guo Ming , LU Ren Hua , ZOU Duo Wu , YIN Ning 
Published: August 2002

OBJECTIVE:  To study the radiographic and esophageal motility changes that are characteristic of patients with both sliding hiatus hernia (HH) and reflux esophagitis.METHODS:  Thirty patients were diagnosed with HH by using gastroscopy. These patients were divided into two groups according to the severity of their esophagitis: group HH1 (grades A and B, n= 18); group HH2 (grades C and D, n= 12). Sliding HH was confirmed by barium meal examination. Radiographic techniques were used to test for spasms and strictures, the coarseness of the mucosa, and to study the types of reflux and clearance. Esophageal pH (24‐h), lower esophageal sphincter pressure and the frequency and amplitude of esophageal peristalsis during reflux were also studied.RESULTS:  Radiography revealed that the mucosa was coarse in all cases. Eighty percent of patients had sucking reflux and 36.7% had passive clearance. The percentages of total, supine and upright acid exposure times were greater in patients with HH than those in the controls (P < 0.01), but the difference between the HH1 and HH2 groups was not significant. Lower esophageal sphincter resting pressure was less in the HH group than that in the control group (P < 0.05). However, there were no differences in the length of the sphincter among groups. During episodes of acid reflux, the frequency and amplitude of peristalsis, and the percentage of normal primary esophageal peristalsis were all lower in HH patients than in the controls, and the duration of peristalsis was increased relative to that of the controls (P < 0.05).CONCLUSIONS:  Sucking reflux and passive clearance are very important in HH. Esophageal acid exposure time does not correlate with the severity of esophagitis. Lowered lower esophageal sphincter resting pressure, decreased frequency and amplitude, and increased duration of esophageal peristalsis during the episode of reflux may play an important role in the pathogenesis of sliding HH.
Developing a general practice library: a collaborative project between a GP and librarian
Authors: Pearson David , Rossall Hannah 
Published: August 2002

AbstractThe authors report on a self‐completed questionnaire study from a North Yorkshire based general practice regarding the information needs of its clinicians. The work was carried out with a particular focus on the practice library, and the findings identified that a new approach to maintaining and developing the library was needed. The literature regarding the information needs of primary care clinicians and the role of practice libraries is considered, and compared to those of the clinicians at the practice. Discussion follows on how a collaborative project was set up between the practice and a librarian based at the local NHS Trust library in order to improve the existing practice library. Difficulties encountered and issues unique to the project are explored, including training implications presented by the implementation of electronic resources. Marketing activities implemented are discussed, how the library will operate in its new capacity, and how ongoing support and maintenance of the library will be carried out. It is concluded that although scepticism still exists regarding librarian involvement in practice libraries, collaboration between clinicians and librarians is an effective approach to the successful development and maintenance of a practice library, and recommendations are therefore made for similar collaborative work.
The influences of stimulus wavelength and eccentricity on short‐wavelength pathway isolation in automated perimetry
Authors: Cubbidge R. P. , Wild J. M. 
Published: August 2002

SummaryThe aim of the study was to determine whether the suggested stimulus and background parameters employed in commercially available short‐wavelength sensitive perimetry (SWAP) are clinically appropriate. Threshold versus intensity curves were measured using a modified Humphrey Field Analyser. The reduction in background luminance was achieved using aperture stops in order to avoid changes in the chromaticity of the background. Short‐wavelength thresholds were determined for 440, 450 and 460 nm stimuli and were corrected for pre‐receptoral absorption. Short‐wavelength sensitive pathway isolation was approximately 1.5 log units and decreased with increases in eccentricity and in stimulus wavelength. It would seem that the use of a 450 nm narrowband stimulus filter would offer a compromise between both the physiological requirements and the physical properties of the stimulus. Such an approach would reduce some of the inherent between‐subject normal variability associated with SWAP.
Changes in the static accommodation response with age
Authors: Kalsi M. , Heron G. , Charman W.N. 
Published: August 2002

SummaryA transverse study of the monocular, steady‐state accommodation response/stimulus curves for 49 normal subjects with ages between 17 and 49 years shows that the slope of the curve reduces only slowly with age up to about 40 years and then declines rapidly as complete presbyopia is approached. Such behaviour appears to result from the accommodation system changing its characteristics with age to make optimal use of the available objective amplitude of accommodation and the depth‐of‐focus of the eye.
Sighting dominance, handedness, and visual acuity preference: three mutually exclusive modalities?
Authors: Pointer Jonathan S. 
Published: August 2002

SummaryIt is tempting, even perhaps for the clinician, to assume prima facie that an individual's handedness is indicative of other lateral asymmetries, including ocular (sighting) dominance and preferred monocular acuity. An analysis of new data relating to these three modalities, as collated from counter‐balanced groups of normally sighted male and female children and adults examined in optometric practice, confirms the general fallacy of this assumption and considers why it is such a persistent misconception. The degree of association between the three modalities in right‐preferent individuals is revealed as statistically no greater than chance. On the basis of this study, estimates of right‐sided hand, eye and/or acuity congruency are derived for the information of the clinician in the prescribing environment of the consulting room.