bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ventriculoperitoneal Shunt Dysfunction in Adults Secondary to Conditions Causing a Transient Increase in Intra-abdominal Pressure: Report of Three Cases
Authors: Miele Vincent J. , Bendok Bernard , Bloomfield Stephen M. , Ondra Stephen L. , Bailes Julian E. 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Ventriculoperitoneal (VP) shunts function because of the pressure differential between the intracranial space and the peritoneal cavity. The pressure in the peritoneal cavity is the lower of the two in a properly functioning shunt; thus, cerebrospinal fluid flows distally. Although not reported in the literature, adult constipation, ileus, or small bowel obstruction can alter this pressure balance and cause dysfunction. If not recognized as a transient, easily treated phenomenon, patients may be subjected to unnecessary shunt revisions. This study analyzed the occurrence of shunt malfunction in three adults secondary to transient increases in intra-abdominal pressure.

CLINICAL PRESENTATION:
Three patients with clinical symptoms and radiographic evidence of VP shunt malfunction at presentation were found to have transient conditions causing a significant increase in intra-abdominal pressure. These patients' records were evaluated with an emphasis on risk factors, treatments, and outcomes.

INTERVENTION:
After resolution of the patients' abdominal issues, clinical signs and symptoms of VP shunt dysfunction resolved within 24 hours. Radiographic evidence of the resolution of shunt failure also was observed.

CONCLUSION:
Shunt malfunction or dysfunction consumes many person-hours and healthcare dollars. This study provides anecdotal evidence that transient and easily reversible increases in the intra-abdominal pressure of adults with VP shunts can result in dysfunction. Although it may not be practical to delay shunt revision while attempting to correct constipation, ileus, or small bowel obstruction, clinicians treating patients with these abdominal conditions should be aware that they could cause transient VP shunt failure. It would seem prudent that patients with VP shunts be started on a prophylactic bowel regimen before surgical procedures to decrease the risk of this somewhat preventable result.
Primary End-to-end Anastomosis of Anterior Cerebral Artery Dissecting Aneurysm: Technical Case Report and Review of The Literature
Authors: Al-Khayat Hisham , Kopitnik Thomas A. 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Subarachnoid hemorrhage caused by an isolated dissection of the anterior cerebral artery (ACA) is an extremely rare problem. The optimal treatment for patients with this clinical scenario varies and is controversial in the literature. We report a patient with a hemorrhage from a distal ACA dissecting aneurysm at presentation 2 years after an arteriovenous malformation resection, who was treated effectively with excision of the diseased segment and direct revascularization of the ACA. We report this as the first case of delayed hemorrhagic arterial dissection after arteriovenous malformation resection treated with early revascularization. We review this rare topic and present our perspective on the method of treatment of ACA dissection.

CLINICAL PRESENTATION:
A 32-year-old woman was transferred to the University of Texas Southwestern Medical Center and admitted with subarachnoid and intraventricular hemorrhage. Angiography revealed the source of the hemorrhage to be a dissecting aneurysm of the pericallosal artery.

INTERVENTION:
The patient underwent surgery on the third day after hemorrhage for excision of the dissecting aneurysm and in situ primary anastomosis of the pericallosal artery. Exposure and anastomosis of the pericallosal artery was facilitated by partial resection of the genu of the corpus callosum.

CONCLUSION:
On the basis of our experience and review of the literature regarding this topic, an optimal treatment for a dissecting aneurysm with hemorrhage involving the pericallosal portion of the ACA at presentation is excision of the diseased segment followed by revascularization. This treatment should prevent rehemorrhage from the aneurysm and avoid iatrogenic ischemic complications to the ACA territory that would be likely with trapping of the aneurysm without revascularization.
Percutaneous Ventral Decompression for L4–L5 Degenerative Spondylolisthesis in Medically Compromised Elderly Patients: Technical Case Report
Authors: Lee Ho-Yeon , Ahn Yong , Kim Dong Yun , Shin Song-Woo , Lee Sang-Ho 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE:
To evaluate the efficacy of percutaneous ventral decompression for the treatment of elderly and medically compromised patients with degenerative lumbar spondylolisthesis (DLS).

CLINICAL PRESENTATION:
We present three cases of elderly and medically compromised patients with DLS. Each patient had one or more of the following disorders: diabetes, hypertension, or congestive heart failure. The mean age of the patients was 74.3 years (range, 66–84 yr). All three patients had compressive central canal stenosis on magnetic resonance imaging at the level of DLS. Their symptoms were bilateral buttock pain, leg pain, and back pain.

TECHNIQUE:
Percutaneous ventral decompression without violation of the posterior bony structure was performed under local anesthesia. After the surgery, the symptoms were relieved in all three patients. There was no further progression of spondylolisthesis or neurological complications during the follow-up period.

CONCLUSION:
Percutaneous ventral decompression is an alternative method of treating DLS in elderly and medically compromised patients, especially when general anesthesia is not recommended.
Menopause health care provision: the views of women, general practitioners and practice nurses
Authors: Roberts Paula-J , Sibbald Bonnie 
Published: August 2004

Objective. To investigate the views of women, general practitioners and practice nurses about current and future menopausal health care, including both health service provision and education. Study design. Questionnaires were sent to a random sample of 1,000 women aged 40-65 and all general practitioners and practice nurses in the Wigan and Bolton area. Main outcome measures. Responses to questions about knowledge and views about the menopause, hormone replacement therapy and health care. Results. Completed questionnaires were returned from 59% (587/998) of women, 64% (181/281) of general practitioners and 82% (147/180) of practice nurses. Only 39% (219/555) of women, 63% (113/179) of general practitioners and 27% (39/144) of practice nurses were satisfied with their knowledge about the menopause/HRT. Ninety-four per cent (170/181) of general practitioners and 100% (143/143) of practice nurses felt the role of the practice nurse in menopause care could be developed in the future. Only 48% (66/139) of general practitioners wanted a practice based menopause/HRT clinic as opposed to 83% (109/131) of practice nurses and 82% (404/496) of women. Twenty-six per cent (41/161) of general practitioners wanted a community menopause clinic in the area as opposed to 73% (99/136) of practice nurses and 75% (351/467) of women. Conclusions. Women, general practitioners and practice nurses want better menopause care provision. There is a need for further education of both women and health professionals and a great deal of support for extending the role of the practice nurse. General practitioners' views on clinic based care are discussed.
Menopause research and audit
Authors: McMillan John 
Published: August 2004

This review begins by outlining some of the history behind the World Medical Association's Declaration of Helsinki. The Helsinki distinction between therapeutic and non-therapeutic research will be described and how this relates to a hypothetical HRT trial is considered. Then the ethical significance of research when it is combined with professional care is discussed. The concept of clinical equipoise is one relevant to menopause research when it involves randomising treatments to participants. Other important considerations mentioned include minimal risk and scientific merit. The final section of the review suggests that the distinction between clinical audit and research is one likely to become increasingly important and that many of the more significant issues associated with audit will relate to confidentiality.
The past, the present and the future o oestrogen and progestogen therapy for cardiovascular disease in postmenopausal women
Authors: Archer David F 
Published: August 2004

The overwhelming body of evidence indicating that oestrogen or hormone replacement therapy may be beneficial as primary prevention in cardiovascular disease in women leads one to continue to actively counsel women who have or do not have cardiovascular risk factors that oestrogen will be indeed cardioprotective. A lack of significant data other than the HERS trial, which is the only prospective randomised trial of secondary intervention, leads one to be reluctant to intervene with oestrogen plus progestin in women who have had a cardiac event. Can oestrogen be used more than one year after the acute event is a question that can only be answered by future research. The data from the HERS trial would suggest that, if oestrogen is used, its effect on preventing subsequent cardiovascular events is low. The reason for this is that other agents used to prevent recurrent cardiovascular events such as statins have a greater efficacy. The use of other agents, most notably statins initially, with a later addition of oestrogen, should be considered. It should be remembered that oestrogen can have other positive effects on the skeleton and the central nervous system. Markers of cardiovascular risk such as C-reactive protein, homocysteine, and lipids, can be useful in counselling women who are at increased risk for coronary heart disease. The measurement of C-reactive protein, homocysteine, and a lipid profile in postmenopausal women now appears to be useful and should be incorporated into the physician's evaluation. These results should be factored into a treatment plan. The use of statins for prevention and active treatment after cardiovascular events in women is changing the prescribing habits of obstetricians and gynaecologists in the USA. Physicians treating and counselling older women now should be comfortable with including lipid altering agents in their armamentarium. The information on the selective oestrogen receptor modulator raloxifene and alternative therapies such as soy protein and isoflavones are limited and, at the present time, do not lend themselves to making definitive statements as to their efficacy in long-term cardiovascular prevention and/or treatment as secondary interventions.
The treatment of hyperlipidaemia in postmenopausal women
Authors: Seed Mary , Mandeno R , Le Roux C 
Published: August 2004

This review summarises current evidence for therapeutic options for hyperlipidaemia in post menopausal women. The two situations in which treatment is recommended are: 1. Primary prevention, which requires assessment of total risk factors for coronary heart disease. a) Statins. AFCAPS/TEXCAPS is the only randomised controlled trial (RCT) to include women. Fewer coronary heart disease (CHD) events, but no difference in mortality was found. b) Hormone replacement therapy (HRT). While there are numerous reports of positive observational epidemiological studies for HRT, there are no completed RCTs. There is little evidence for statin use in women except for familial hypercholesterolaemia. HRT is therefore not only appropriate for its multiple effects on lipoproteins, vascular function and insulin sensitivity but also for prevention of osteoporosis. 2. Secondary prevention, to achieve target total and low density lipoprotein (LDL) cholesterol. a) Statins. The major measurable effect of these drugs is to reduce total and LDL cholesterol. In the RCTs 4S, CARE and LIPID, where 20% of subjects were female, CHD events, but neither CHD mortality nor total mortality were significantly reduced in women. b) HRT. Data available from two RCTs using conjugated equine oestrogens and medroxyprogesterone acetate show no benefit. Other studies of HRT have been observational and positive. The effects of treatment on lipoproteins with statins, HRT and the combination have been investigated. In secondary prevention for hyperlipidaemic women to achieve cholesterol <5 and LDL<3 mmol/L statins will be first choice, with HRT a possible addition for its other benefits on cardiovascular risk factors. Choice of HRT medication. The route of administration will affect specific risk factors, eg, oral oestrogen reduces Lp(a) and LDL, increases HDL, while the transdermal route is less effective at reducing Lp(a) and LDL but does not increase triglyceride. Both routes reduce fibrinogen, factor VII and adhesion molecules and improve blood flow. The choice of progestogen will also affect cardiovascular risk factors. The most important lipid risk factors in women are HDL, triglyceride and Lp(a). The risk associated with raised triglyceride and LDL is offset by high HDL. Thus, in women with risk factors in primary prevention, theoretically oral HRT with a non-androgenic progestogen is likely to be of most benefit. However, since long-term adherence to therapy is important in reducing cardiovascular risk, the individual's choice of route and type of HRT is paramount.
Urinary incontinence in men over 50
Authors: Edlund Christer , Peeker Ralph , Fall Magnus 
Published: August 2004

Although urinary incontinence (UI) in men is an increasing problem, it has not been investigated to the same degree as that in women. In an urbanised environment, with diverse demands on health professionals, incontinence remains a problem difficult to solve not only for the individual patient but also in terms of a public health strategy, since costs related to urinary incontinence are impressive. The prevalence of UI is increasing since this complaint is much more common in the elderly - and this section of the population is increasing in Western societies. Greater public awareness and education are further increasing demands for effective therapy for the male population.
Statins and menopausal health
Authors: Mueck Alfred O , Seeger Harald 
Published: August 2004

Cardiovascular disease is associated with high morbidity and mortality. Cholesterol-lowering statins can reduce health risks both in men and women. While this benefit has thus far been attributed to the lipid-lowering effects of these drugs, the importance of their direct actions on vascular tissue is gaining more recognition. Furthermore, recent studies suggest that statins might also be effective in preventing osteoporosis and Alzheimer's disease. Equally interesting are experimental results showing that statins may inhibit growth of certain malignancies such as the breast. When statins are combined with hormone replacement therapy (HRT), even greater beneficial effects on the lipid profile can be obtained. To our knowledge we have investigated for the first time direct vascular effects by combining statins with HRT. We were able to identify significant beneficial effects on endothelial function and vascular smooth muscle proliferation. In the context of current discussions on the benefits and risks of HRT in treating patients with pre-existing cardiovascular disease, it appears particularly important that interventional studies should be conducted to evaluate the therapeutic relevance of statin/HRT combinations. At present, this is the most important conclusion drawn from the data collected thus far on the combination of these two drug types. There is some evidence suggesting drug-specific effects, particularly adverse reactions and statin interactions, which should be considered when using this combination therapy.
'Two week wait' standards for suspected gynaecological malignancy. On target, but missing the point?
Authors: Morrison Joanne 
Published: August 2004

Objective: To assess the two-week rapid access referral system for UK general practitioners introduced in April 2000 for women suspected of having a gynaecological cancer. Study design: An audit of details of women referred between 1st April 2000 and 31st March 2003 via the two-week rapid access system to one gynaecological consultant who performs gynaecological oncology surgery at the John Radcliffe Hospital, Oxford. Main outcome measures: Information on waiting times, clinical indication (postmenopausal bleeding, suspicious pelvic mass, vulval lesions, or "other" symptoms including postcoital vaginal bleeding, suspicious lesions of the cervix or vagina), and subsequent diagnosis were recorded. Data on all other women in whom a diagnosis of a gynaecological malignancy was made during the same period following referral to the same consultant's routine gynaecological outpatient clinic were also collected. Results: The target time of two weeks to see a consultant was met for 94% of women referred via the rapid access system. The response time declined slightly with increasing numbers of referrals. However, the majority of women with a gynaecological malignancy were not referred via the rapid access system. Conclusions: To accommodate the two-week rapid access referrals and achieve UK government targets, there was a reduction in appointments for routine outpatient referrals. However, as the majority of women with gynaecological malignancy presented via traditional referral routes, there is a danger that their diagnoses are being delayed.
No increased risk of endometrial hyperplasia with fixed long-cycle oestrogen-progestogen therapy after five years
Authors: Erkkola Risto , Kumento Ulpu , Lehmuskoski Sirpa , Mattila Leena , Mustonen Mika 
Published: August 2004

Objective: The aim of this study was to evaluate the long-term endometrial safety of long-cycle sequential oestrogenprogestogen hormone replacement therapy (HRT). Study design: A prospective, longitudinal, single group study was undertaken in postmenopausal women, aged 45-66 years, treated with up to 21 3-month cycles (five years) of sequential oestrogen-progestogen HRT. Treatment consisted of 70 days of 2 mg/day oestradiol valerate (E2V), followed by 14 days of E2V combined with 20 mg/day medroxyprogesterone acetate (MPA), followed by seven days placebo. Endometrial biopsies were assessed at baseline, at 12 months in women with an endometrial thickness >6 mm and in all participants at 24, 36, 48 and 60 months. Mammography was performed at baseline and at 24-month intervals thereafter. Adverse events were assessed throughout the study. Results: Of 132 women enrolled, 94 completed five years of treatment (540 women years). Endometrial changes (oestrogen effect II) were apparent in most women from 24-60 months (95, 83.3% women at 24 months). One case of simple hyperplasia was found (at 60 months), and none of complex hyperplasia or endometrial cancer. The pattern and frequency of adverse events were consistent with other sequential oestrogen-progestogen HRT regimens. Conclusions: The incidence of hyperplasia over five years (0.19%, upper 95% CI 0.88) was well within the acceptable rates defined by the European Union Committee for Proprietary Medicinal Products (CPMP).
Hormone replacement therapy and the bladder
Authors: McCully Keri S , Jackson Simon 
Published: August 2004

Lower urinary tract symptoms are a common, distressing and embarrassing problem for women of all ages, but become increasingly more common with advancing age. Oestrogen preparations have been used for many years to manage urinary symptoms, but there is still controversy over the efficacy of these preparations. The purpose of this review is to provide a critical overview of the epidemiological evidence when considering hormone replacement therapy for treatment of urinary symptoms in women. Various studies have demonstrated that oestrogen replacement can improve, or even cure, urinary stress and urge incontinence. High dose oestrogen can reduce the total number of voids in 24 hours, including nocturnal voids. Vaginal oestriol significantly reduces the risk of recurrent infections in postmenopausal women with a history of recurrent urinary tract infections. Data on combining oestrogen with a progestogen are limited, but suggest it may negate the benefit and more research is still required in this area to clarify their role.
Red clover isoflavones and menopausal health
Authors: Ronald Barentsen 
Published: August 2004

Summary Menopausal symptoms such as hot flushes and night sweats can be very disrupting. While hormone replacement therapy is an effective therapy, concerns about side effects and breast cancer risk have stimulated interest into alternative therapies such as phytoe-strogens. These are oestrogen-like compounds made by plants. Two major sources of phytoestrogens are soy and red clover. Data on randomised controlled trials of red clover for the control of menopausal symptoms are presented. The conflicting data are encouraging and suggest that phytoestrogens are a treatment modality that needs pursuing.
Shared decision-making, health choices and the menopause
Authors: Salkovskis Paul M , Wroe Abigail L , Rees Margaret CP 
Published: August 2004

Summary The growing influence of the mass media on public understanding of health care matters has increased both information and misinformation in patients seeking help with menopausal symptoms. The use of shared decision-making strategies provides the opportunity to engage the patient in taking some responsibility for their own treatment. It also allows the identification and correction of any distortions in the perceived balance of evidence for and against any particular treatment. Shared decision-making balances the need to respect patients’ values and autonomy with the drive towards evidence-based medicine and clinical cost-effectiveness. Although ways of achieving such a balance are much discussed, the current need is for research which can identify effective strategies that allow the principles of “shared decision-making” and “evidence-based patient choice” to be validated and applied in clinical practice. Previous research focused on hormone replacement therapy indicates that the patient's decision is the outcome of the way they balance the pros and cons of taking (or not taking) it, and that their satisfaction with the decision is strongly associated with the perception that they have been given information about the full range of treatment available. It therefore seems likely that patients will respond more positively to consultations which include discussion of hormone replacement therapy alongside alternative strategies such as natural remedies and dietary/lifestyle changes. Psychological factors influencing treatment choice and the decision making process are discussed, and clinical and research implications for clinical practice in the menopause clinic examined.