bluuebunny/crossref_metadata_2025_split huggingface dataset:
SEVERE HYPERKALAEMIA WITH NORMAL ELECTROCARDIOGRAM
Authors: Bandyopadhyay S , Banerjee S 
Published: April 2023

SUMMARYElevated serum potassium without associated electrocardiograph and biochemical changes makes the diagnosis of pseudohyperkalaemia likely. One of the common causes of this is thrombocytosis with in vitro leak of cellular potassium due to increased fragility of the platelets. We report a case where the diagnosis of essential thrombocytosis was made during investigation of persistent hyperkalaemia in an apparently healthy female.
THE EFFICACY OF ACETAZOLAMIDE ON VISUAL FUNCTIONS IN A PATIENT WITH CHOROID METASTASIS OF BREAST CARCINOMA
Authors: Sari R , Camci C , Kutlu R , Totan Y , Sevinc A , Buyukberber S 
Published: April 2023

SUMMARYBreast carcinoma is the most frequent cancer in women and is the second leading cause of death. Choroid metastasis of breast carcinoma can be found either at presentation or in remission. It is frequently encountered in disseminated breast cancer with multiple organ metastasis. It has been proposed that the oedema‐reducing effect of acetazolamide is due to stimulated ion and fluid removal from the retina to the choroid. A 40‐year‐old female patient on adjuvant chemotherapy for breast cancer was found to have an isolated choroid metastasis. Clinical and radiological remission was achieved after orbital radiotherapy, chemotherapy and acetazolamide treatment. In this case report, we emphasise the possible beneficial effect of acetazolamide in patients with choroid metastasis.
COMPARISON OF ALENDRONATE, CALCITONIN AND CALCIUM TREATMENTS IN POSTMENOPAUSAL OSTEOPOROSIS
Authors: Dursun N , Dursun E , Yalçin S 
Published: April 2023

SUMMARYThe present study was planned to assess the safety, tolerability and efficacy on bone mineral density (BMD), pain, quality of life and fracture risk of alendronate, calcitonin and calcium treatments. A total of 151 postmenopausal women with lumbar spine BMD 2 SD or more below the young adult mean were randomly assigned to one of three groups: 51 patients received oral alendronate 10 mg and calcium 1000 mg (alendronate group), 50 patients intranasal salmon calcitonin 100 IU and oral calcium 1000 mg (calcitonin group), and 50 patients oral calcium 1000 mg (calcium group) daily for one year. BMD was assessed by dual energy X‐ray absorbtiometry, pain by a visual analogue scale, and quality of life by the Nottingham health profile. Significant increases in BMD at all sites were obtained in the calcitonin and alendronate groups, but not in the calcium group. Pain and quality of life improved significantly in both the calcitonin and alendronate groups, but not in the calcium group. New vertebral fractures were seen in 31.58% of the alendronate, 37.5% of the calcitonin, and 40% of the calcium groups, representing no statistical difference. No serious side‐effects were seen in any of the patients during follow‐up.
VALSARTAN ALONE AND AS PART OF COMBINATION THERAPY IN GENERAL PRACTICE IN BRAZIL
Authors: Madi JC , Oigman W , Franco R , Armaganijan D ,   Group of Investigators from the Brazilian Multicentre Evaluation
Published: April 2023

SUMMARYThe objective of this study was to assess the efficacy and tolerability of valsartan (Diovan®) when given alone or as part of a combination regimen in normal clinical practice, in general practice patients in Brazil. In an open, multicentre post‐marketing surveillance (PMS) study, 7256 hypertensive patients were evaluated. Therapy with valsartan either as monotherapy or in combination with 12.5 mg chlorthalidone was observed for up to six months. Assessments at baseline and study endpoints included analysis of adverse events and measurement of systolic and diastolic blood pressure (BP). A total of 3855 patients (53%) received valsartan as monotherapy (mostly as 80 mg once daily), 1162 (16%) received 80 mg valsartan + 12.5 mg chlorthalidone, and 347 (4.8%) received valsartan together with other antihypertensive agents; 858 patients were not evaluable because of inadequate records. A control group of 1034 patients received other antihypertensives. Overall tolerability was high, with 98.5% of patients receiving valsartan alone, 97.7% of those receiving valsartan + chlorthalidone and 92.4% of those receiving other antihypertensives giving tolerability ratings of ‘excellent’ or ‘good’. In this large PMS study, valsartan alone and in combination with chlorthalidone was associated with excellent safety and tolerability in general practice patients in Brazil with primary hypertension, irrespective of age, sex or concomitant diseases.
THE INCIDENCE OF CHLAMYDIA TRACHOMATIS IN WOMEN WITH URETHRAL SYNDROME
Authors: Mutlu B , Mutlu N , Yücesoy G 
Published: April 2023

SUMMARYThe objective of this study was to discover the incidence of Chlamydia trachomatis in women with urethral syndrome. A total of 102 patients included in this study were divided into two groups: group 1 comprised 63 women suffering from painful urination and frequency, with no organisms seen on Gram stain or isolated in routine urine culture; group 2 consisted of 39 women with no complaints. Chlamydia antigen was found to be positive in 24 patient samples (38%) in group 1 and in four patient samples (11%) in group 2. The difference between the two groups was statistically significant (p=0.0435). There was also a weak correlation between Chlamydia antigens and finding more than 10 polymorphonuclear leucocytes in the Gram stains (r=0.02364).
3. FIXED AND MODIFIABLE RISK FACTORS FOR BREAST CANCER
Authors: Fentiman IS 
Published: April 2023

SUMMARYLikely pathogenesis of breast cancer is in two phases, initiation and promotion. Initiating factors include ionising irradiation, dietary factors and possibly alcohol consumption causing DNA mutations uncorrected by repair mechanisms. Subsequent promotional factors include exposure to oestrogens, reduced by late menarche, early pregnancy and lactation and increased by nulliparity, oral contraceptive use and hormone replacement therapy. Only 5% of breast cancers result from inherited genetic mutations of BRCA1 and BRCA2, but individuals with such mutations have a high risk (66–80%) of developing the disease. Most patients with benign breast problems are not at increased risk of breast cancer, but those with atypical epithelial hyperplasia have an increased risk and should be kept under surveillance or asked to participate in trials of prevention.
PERCUTANEOUS ENDOSCOPIC GASTROSCOPY TUBE MIGRATION: A RARE CAUSE OF A COMMON SURGICAL PROBLEM
Authors: Hussien M , Eawzy M , Carey D 
Published: April 2023

SUMMARYPercutaneous endoscopic gastroscopy (PEG) is now the preferred method for long‐term enteral nutrition for patients with inadequate oral intake. It is usually replaced by a Foley catheter when it becomes non‐functional because of blockage or wear and tear. PEG tube migration is an unusual complication which may not be noticed by the patient or the medical staff and may present as delayed small bowel obstruction. We report on a patient who developed such a complication and the missing PEG tube was replaced by a Foley catheter when it was thought the original tube had fallen out. The use of catheters with an external stop device is recommended to prevent this rare complication.
ABNORMALITIES OF THYROID HORMONAL FUNCTION TESTS IN HOSPITALISED ELDERLY PATIENTS: A PROSPECTIVE STUDY
Authors: Gupta A , Habubi N , Thomas P 
Published: April 2023

SUMMARYWe measured thyroidal hormonal function tests in unselected sick and hospitalised elderly patients with a new immunoassay technique. Our results show a significant percentage of subjects with thyroid hormonal dysfunction.
PATENT FORAMEN OVALE IN ELDERLY STROKE PATIENTS
Authors: Lewis RR , Hussain A , Rashed KA , Cooke RA , McNabb WR , Chambers J 
Published: April 2023

SUMMARYThe aim of this study was to determine the incidence of echocardiographically detectable patent foramen ovale (PFO) in elderly patients who have strokes from cerebral infarction, as well as to assess the association between PFOs and other risk factors for stroke disease. Forty‐three patients aged ≥65 years admitted consecutively with cerebral infarction shown on computerised tomography of the brain were assessed using transoesophageal echocardiography. A PFO was present in 8 (19%) of the 43 patients. Four patients (50%) in this PFO group had stroke risk factors. Two were in atrial fibrillation and, of the six patients in sinus rhythm, a risk factor was present in two, both of whom had diabetes mellitus. A PFO was not detected in 35 patients. Twenty‐nine (83%) of the patients in this group had risk factors, with 18 having two or more. Seven patients were in atrial fibrillation. Of the 28 patients in sinus rhythm, risk factors were present in 22 (78%).
METHANOL‐INDUCED OPTIC NEUROPATHY: TREATMENT WITH INTRAVENOUS HIGH DOSE STEROIDS
Authors: Sodhi PK , Goyal JL , Mehta DK 
Published: April 2023

SUMMARYThe aim of this study was to find the potential benefit of intravenous high dose steroids in the treatment of patients with methanol optic neuropathy. Four patients complaining of diminution of vision after taking methylated spirit presented to us within a variable period of its consumption. The systemic features of methanol poisoning were absent in these patients. Raised blood levels of methanol confirmed the diagnosis of methanol optic neuropathy. All these patients received high doses of intravenous steroids for three days, followed by oral steroids, 1 mg/kg body weight, for 11 days. The administration of high doses of intravenous steroids led to an improvement of visual status in all four patients. Intravenous high dose steroids benefit the visual status of patients with methanol‐induced optic neuropathy, provided the interval between the consumption of methanol and starting treatment is short. Further studies should be undertaken to document the role of intravenous steroids in this context.
NON‐NEUROLOGICAL VARIABLES AND MORTALITY OF ACUTE STROKE
Authors: Sharma JC 
Published: April 2023

SUMMARYAcute stroke is associated with high mortality. While this is the direct consequence of the neurological injury, stroke patients develop a number of physiological abnormalities and complications in the acute phase. Extensive research has produced a plethora of information about these non‐neurological variables. Different patients have different abnormalities. Some of these variables have severe adverse effects on mortality, both acute and long term. Some of the variables are pre‐existing, while others are non‐modifiable. The body responds to cerebral tissue injury in a way that seems to lead to further damage to the brain and other vital systems, and patients usually have more than one variable needing attention. Acute stroke presents as a multisystem disease on the verge of multisystem failure. Although there is lack of evidence of the benefits of correcting the deranged variables, it makes clinical sense that non‐neurological variables should be identified, monitored and managed, with the aim of improving the outcome of acute stroke patients.
THE ECHINOCANDINS, FIRST NOVEL CLASS OF ANTIFUNGALS IN TWO DECADES: WILL THEY LIVE UP TO THEIR PROMISE?
Authors: Graybill JR 
Published: April 2023

SUMMARYThe echinocandins comprise a major development in systemic antifungal therapy. They rapidly and irreversibly inhibit glucan synthesis in the fungal cell wall, a distinct target from azole antifungals, flucytosine and polyenes. As such, the echinocandins appear effective against triazole and amphotericin B resistant fungi. The spectrum is still not fully understood because of problems with susceptibility testing, and because of limited studies in animal models. The primary target species for clinical studies include Candida and Aspergillus, but the class is likely to have broader use. Lack of nephrotoxicity and few drug interactions make this class attractive. The major limitations at present appear to be the lack of oral formulation and uncertainty regarding the extent of the spectrum. These drugs have the potential of being significant additions to the management of mycoses in the critically ill patient.
REPAIR OF CONCOMITANT INGUINAL AND FEMORAL HERNIAS UNDER LOCAL ANAESTHESIA
Authors: Elton C , Stoodley BJ 
Published: April 2023

SUMMARYWe describe the case of a 91‐year‐old patient with small bowel obstruction due to an obstructed groin hernia. It was decided to repair the hernia under local anaesthesia and sedation because of the patient's age and medical condition. At surgery, concomitant inguinal and femoral hernias were found and repaired. We discuss the technique of repairing groin hernias under local anaesthesia, especially in the elderly, and the previously reported incidence of concomitant hernias.
REFERRAL PATTERNS TO A DISTRICT GENERAL HOSPITAL GASTROENTEROLOGY OUTPATIENT CLINIC: IMPLICATIONS FOR ‘THE TWO‐WEEK TARGET’
Authors: Martin JP , Gabe SM , Pitcher MCL , Jacyna  
Published: April 2023

SUMMARYWe defined the pattern and appropriateness of GPs' new‐patient referrals to a large district general hospital gastroenterology department, and assessed the implications for workload in the context of the recently introduced ‘two‐week target’. Prospective data were collected on all new referrals over a two‐month period and 426 new appointments were included, from which data were available on 390. Only six referrals were deemed inappropriate. Sixty‐nine patients had a functional disorder, and GPs were less likely to diagnose this group at referral than the gastroenterologist was after the initial consultation. Nineteen per cent of all GP referrals were classified as urgent and 6% of these had a malignancy. Fifty per cent of patients with malignancy were not perceived as meriting an urgent referral by the GP Gastroenterology outpatient facilities are already overstretched and the implementation of the two‐week target will add considerable strain to the current resources, with little gain in identifying malignancy.
THE CURRENT PHYSIOTHERAPY MANAGEMENT OF PATIENTS WITH BRONCHIECTASIS: A UK SURVEY
Authors: O'Neill B , Bradley JM , McArdle N , Macmahon J 
Published: April 2023

SUMMARYThe purpose of this survey was to ascertain which physiotherapy techniques are currently used, how interventions are assessed and to determine the views of physiotherapists in the UK on the need for further research. Senior physiotherapists in 100 randomly selected hospitals providing respiratory care in the UK were sent a previously piloted questionnaire on their bronchiectasis practice. The response rate was 82%. A variety of physiotherapy treatment techniques and outcome measures are used, and there are no national guidelines on the physiotherapy management of patients with bronchiectasis. There is a clear need for research into the effectiveness of physiotherapy techniques in bronchiectasis including a cost‐benefit analysis which would enable targeting of resources and the development of evidence‐based practice guidelines.
CURRENT CLINICAL PRACTICE OF INDUCTION AND MAINTENANCE IMMUNOTHERAPY FOR METASTATIC RENAL CELL CARCINOMA
Authors: Little B , Young M , Ho KJ 
Published: April 2023

SUMMARYCurrent systemic treatment of metastatic renal cell carcinoma revolves around the use of interleukin‐2 and interferon‐α, often in combination with 5‐fluorouracil. This article looks at the currently reported response rates for these modalities. It also looks at current practice as regards maintenance treatment, i.e. the continued therapeutic regimen following the initial response to the induction immunotherapy cycles.
AMIODARONE‐INDUCED THYROTOXICOSIS: NOT A BENIGN CONDITION
Authors: Leung PM , Quinn ND , Belchetz PE 
Published: April 2023

SUMMARYAmiodarone is a heavily iodinated drug effective in the control of various tachyarrhythmias. Despite its undoubted benefit, treatment with amiodarone is not without risk, because a number of potentially serious side‐effects may develop during therapy. Thyrotoxicosis is most commonly recognised but its potential consequences tend to be underestimated, and its treatment can be challenging and difficult. We report several cases of amiodarone‐induced thyrotoxicosis which serve to highlight the potential severity of the condition.
USE OF A CUSTOMISED ENDOTRACHEAL TUBE FOR TRACHEOSTOMY IN THE LARGE NECK
Authors: Coatesworth AP 
Published: April 2023

SUMMARYPatients with huge necks who require a tracheostomy pose particular problems. This paper describes a technique to customise a standard endotracheal tube to make a long tracheostomy tube. This can be used as a short‐term emergency airway. It is recommended because it is cheap, simple, safe and potentially life saving.
RIEDEL'S THYROIDITIS: CLINICAL, PATHOLOGICAL AND IMAGING FEATURES
Authors: Papi G , Corrado S , Cesinaro AM , Novelli L , Smerieri A , Carapezzi C 
Published: April 2023

SUMMARYRiedel's thyroiditis (RT) is an extremely rare form of chronic thyroiditis, characterised by a fibroinflammatory process which partially destroys the thyroid, often involving surrounding tissues. We describe an unusual case of RT in a 38‐year‐old woman, and discuss its typical clinical, pathological, ultrasound, radionuclide scanning and magnetic resonance findings. We conclude that the diagnosis of RT is highly suggestive in the presence of a hard gland (or nodule), fixed to adjacent structures; ‘cold’ on Tc99 scan; hypoechoic with absence of vascular flow, invading the adjacent neck structures on ultrasound; hypointense in T1‐ and T2‐weighted MR images; and showing fibrous tissue fragments with inflammatory cells at cytological examination. Thyroidectomy has to be performed to confirm the diagnosis and to relieve pressure symptoms.
A COST‐EFFECTIVENESS EVALUATION OF AMLODIPINE USAGE IN PATIENTS WITH CORONARY ARTERY DISEASE IN SWEDEN
Authors: Doyle JJ , McGuire A , Arocho R , Arikian S , Casciano J , Svangren P , Casciano R , Kim R , Kugel H 
Published: April 2023

SUMMARYThe objective of this analysis was to calculate the cost‐effectiveness of amlodipine therapy in patients with coronary artery disease in Sweden. It is hypothesised that treatment with amlodipine will have an impact on overall cardiovascular disease treatment costs, resulting in a positive cost‐effectiveness profile. A Markov cohort simulation model was constructed to simulate event‐related and procedure‐related health economic outcomes of coronary artery disease populations on amlodipine versus those on placebo. Patient level data from the Prospective Evaluation of the Vascular Effects of Norvasc Trial was used to populate the model. The total number of adverse cardiovascular clinical outcomes experienced over a three‐year period was lower for patient on amlodipine than for those on placebo. The rate of hospitalisation per patient due to angina, coronary artery bypass graft, percutaneous transluminal coronary angioplasty, congestive heart failure, and myocardial infarction in the placebo cohort was 64.7%, while the rate in the amlodipine cohort was 46.9%. The cost per patient was Swedish kroner (SEK)26,600 for amlodipine patients and SEK27,400 for placebo patients. The use of amlodipine resulted in improved clinical outcomes as well as a slight savings in cost over a three‐year period.
ACCEPTABLE AGREEMENT BETWEEN TYMPANIC AND RECTAL TEMPERATURE IN ACUTE STROKE PATIENTS
Authors: Christensen H , Boysen G 
Published: April 2023

SUMMARYMajor concerns remain about the reliability of tympanic thermometers. The aim of this study was to investigate the agreement between rectal and tympanic thermometry and compare this with the repeatability of each method in patients with acute stroke. Tympanic temperature readings were from 0.7°C below to 0.8°C above rectal readings. As to repeatability, we found second rectal readings to be between 0.3°C below and 0.4°C above first readings, and second tympanic readings to be between 0.4°C below and 0.5°C above first readings. The agreement between the two methods is acceptable in clinical practice. Tympanic thermometry is useful in serial measurements, whereas, for a single accurate measurement, rectal mercury thermometry remains the method of choice.
MULTIDOSE FLURBIPROFEN 8.75 MG LOZENGES IN THE TREATMENT OF SORE THROAT: A RANDOMISED, DOUBLE‐BLIND, PLACEBO‐CONTROLLED STUDY IN UK GENERAL PRACTICE CENTRES
Authors: Blagden M , Christian J , Miller K , Charlesworth A 
Published: April 2023

SUMMARYThe flurbiprofen 8.75 mg lozenge is a novel formulation that combines a demulcent effect with the analgesic activity of a non‐steroidal anti‐inflammatory drug. Previous controlled clinical studies have demonstrated the single‐ and multi‐dose efficacy of these lozenges over placebo. The current study reflected the treatment of sore throat in general practice, investigating multiple dose efficacy where patients also had access to concomitant antibiotics and rescue medication. The efficacy of flurbiprofen 8.75 mg lozenge over placebo was confirmed: there was a significant difference in pain relief obtained from flurbiprofen 8.75 mg versus placebo, along with a significant reduction of difficulty in swallowing from the time of first assessment and significantly greater reductions in throat soreness and difficulty in swallowing throughout the study period. Additionally, significant benefit over placebo was demonstrated where concomitant antibiotic use was introduced, indicating that flurbiprofen 8.75 mg lozenges can be co‐administered when antibiotic therapy is appropriate. No significant safety issues were identified.
EFFICACY OF A PROPRIETARY IBUPROFEN GEL IN SOFT TISSUE INJURIES: A RANDOMISED, DOUBLE‐BLIND, PLACEBO‐CONTROLLED STUDY
Authors: Machen J , Whitefield M 
Published: April 2023

SUMMARYThe efficacy of a novel, proprietary topical formulation of ibuprofen 5% gel (Ibugel™) was evaluated in a placebo‐controlled study in patients with soft tissue injuries. Patients received either active gel (n=40) or placebo gel (n=41) for a maximum of seven days. Pain and interference with physical activity were assessed daily using visual analogue scales. There was a significant difference (p<0.001) in favour of active treatment for the time to achieve clinically meaningful reduction in pain. By day 7, 75% of patients in the active gel group had a clinically meaningful reduction of pain compared with 39% of patients who received placebo. Despite differences between study centres, the data for interference with physical activity also showed an advantage for active treatment. By day 7, 79% of patients in the active gel group had a clinically meaningful reduction in interference with physical activity, compared with 44% of patients who received placebo.
10. SENTINEL NODE BIOPSY IN PRIMARY BREAST CANCER
Authors: Beechey‐Newman N 
Published: April 2023

SUMMARYSentinel node biopsy is a minimally invasive but accurate way of staging the axilla such that as many as 50% of women with primary breast cancer could avoid axillary clearance and the morbidity this carries with it. The methodology has yet to be perfected but identification of the sentinel node(s) with either dye or isotope, or with a combination of these, is a robust technique that is quick to learn and correctly predicts the status of the rest of the axilla in significantly more than 90% of patients. Improvements in the methodology and in patient selection will inevitably make sentinel node biopsy even more accurate. Studies to demonstrate the survival impact of replacing axillary clearance with sentinel node biopsy and selective axillary node treatment are required and are in their early stages.