bluuebunny/crossref_metadata_2025_split huggingface dataset:
OUTCOME IN CHILDREN UNDER 5 YEARS OF AGE WITH CONSTIPATION: A PROSPECTIVE FOLLOW‐UP STUDY
Authors: Elshimy N , Gallagher B , West D , Stringer MD , Puntis JWL 
Published: April 2023

SUMMARYConstipation in the pre‐school child is common and causes considerable distress to children and their parents. There is a lack of information regarding prognosis in this group of patients although some are clearly at risk of developing long‐term difficulties with defaecation. We have previously reported characteristics of children under 5 years of age referred to hospital over a one‐year period with idiopathic constipation. We now report outcome data after 18 months of follow‐up in 41 of the original cohort of 42 children. We have also summarised what we regard as good practice in managing constipation in this age group. Eighteen months after initial outpatient assessment, the symptoms of constipation were reported to have resolved in 36 (88%), although seven of these were still needing regular laxative treatment. It was our subjective impression that the five children who apparently did not improve came from families that had a greater degree of psychosocial problems and where compliance with treatment was suspect. This study shows that with simple treatment measures and ongoing support, an optimistic prognosis can be given to families from the outset. The minority of pre‐school children who do not improve may benefit from a more intensive psychological approach to management. (Int J Clin Pract 2000; 54(1): 25‐27)
TREATMENT OF STATUS EPILEPTICUS WITH MIDAZOLAM IN THE CRITICAL CARE SETTING
Authors: Hanley DF , Pozo M 
Published: April 2023

SUMMARYStatus epilepticus (SE) is a potentially life‐threatening condition that requires prompt and aggressive treatment. Prolonged status seizures are associated with significant physiological sequelae and neurological deficits. Although systemic events such as hyperthermia and anoxia contribute to neuronal damage, SE in and of itself can induce cell death. In general, the sooner it is brought under control, the more favourable is the prognosis. Benzodiazepines, as a group, are the most frequently used anticonvulsants in the management of status seizures. Midazolam, a water‐soluble benzodiazepine, is a potent anticonvulsant that offers many advantages over typical benzodiazepines. Because of its stability in aqueous media, midazolam dissolves in common diluents such as normal saline or dextrose water. Consequently, midazolam both intravenously (i.v.) and intramuscularly (i.m.) is well tolerated locally and is associated with less venoirritation than benzodiazepines or antiepileptics that require organic solvents. The water solubility of midazolam also allows rapid and reliable absorption of the drug from the i.m. injection site. Because it is rapidly metabolised and its metabolites are pharmacologically inactive, midazolam has a short duration of action. Most patients regain full conscious state and can be evaluated soon after the cessation of treatment. Midazolam by continuous i.v. infusion and by the i.m. route has been successfully used in the treatment of SE. Although some respiratory and haemodynamic side‐effects have been associated with midazolam, no clinically significant side‐effects were observed with its use for the indication of SE. It is suggested that midazolam is a safe and rapidly effective treatment option in the management of SE in the critical care setting.(Int J Clin Pract2000;54(10):30‐35)
THE ROLE OF ALPHA1‐BLOCKERS IN COMBINATION THERAPY FOR HYPERTENSION
Authors: Zusman RM 
Published: April 2023

SUMMARYAntihypertensive monotherapy provides adequate blood pressure control in less than 50% of patients with hypertension (BP>140/90 mmHg), especially those with stage 2‐3 disease. This article reviews clinical studies that demonstrate that add‐on therapy with an alpha1‐blocker (doxazosin, terazosin or prazosin) is an effective and well‐tolerated regimen for improving blood pressure control in patients with inadequately controlled hypertension. Furthermore, alpha1‐blockers have therapeutic benefits that go beyond blood pressure management. They have a small but positive effect on the serum lipid profile and they have favourable or benign effects on conditions that frequently coexist with hypertension, such as type 2 diabetes mellitus and benign prostatic hyperplasia. (Int J Clin Pract 2000; 54(1): 36‐41)
GIANT PILOMATRICOMA SIMULATING CARCINOMA OF THE MALE BREAST
Authors: Ismail W , Pain S , Al‐Okati D , Al Sewan M 
Published: April 2023

SUMMARYWe present the case of a 65‐year‐old man with a large calcifying epithelioma in the right breast. The case is unusual not only for the size of the tumour but also for its location in a male breast. Despite its large size (12 × 10 × 7 cm), the tumour did not show any clinical, radiological or histological evidence of malignancy or aggressive behaviour. One year after surgery there was no recurrence or metastatic disease. The possibility of malignancy, recurrence or metastasis of these large tumours, as well as the necessity of follow‐up and investigations, are emphasised. (Int J Clin Pract 2000; 54(1): 55‐56)
EICOSAPENTAENOIC ACID TREATMENT IN SCHIZOPHRENIA ASSOCIATED WITH SYMPTOM REMISSION, NORMALISATION OF BLOOD FATTY ACIDS, REDUCED NEURONAL MEMBRANE PHOSPHOLIPID TURNOVER AND STRUCTURAL BRAIN CHANGES
Authors: Puri BK , Richardson AJ , Horrobin DF , Easton T , Saeed N , Oatridge A , Hajnal JV , Bydder GM 
Published: April 2023

SUMMARYThe administration of the omega‐3 fatty acid eicosapentaenoic acid (EPA) to a drug‐naive patient with schizophrenia, untreated with conventional antipsychotic medication, led to a dramatic and sustained clinical improvement in both positive and negative symptoms. This was accompanied by a correction in erythrocyte membranes of abnormalities in both n‐3 and n‐6 highly unsaturated fatty acids and with reduced neuronal membrane phospholipid turnover, as evidenced by serial 31‐phosphorus cerebral magnetic resonance spectroscopy. Using recently developed techniques of image segmentation, subvoxel registration and quantitation, analysis of serial high‐resolution 3D cerebral MRI scans showed that, in the year before EPA treatment, cerebral atrophy was taking place and that this atrophy was reversed by six months of EPA treatment. These results demonstrate that EPA can reverse both the phospholipid abnormalities previously described in schizophrenia and cerebral atrophy. They provide strong further evidence in support of the membrane phospholipid model of schizophrenia. (Int J Clin Pract 2000; 54(1): 57‐63)
CARDIAC REHABILITATION: FROM HELLERSTEIN TO THE MILLENNIUM
Authors: Bethell HJN 
Published: April 2023

SUMMARYIn the 1950s, Herman Hellerstein set out his ideas for the comprehensive rehabilitation of patients recovering from acute cardiac events, using a multidisciplinary team. His approach has been adopted by most developed countries, with varying speeds and enthusiasm. His original ideas have hardly been improved on. However, changes in the demographics and epidemiology of heart disease have led to changes in the patient groups included in cardiac rehabilitation today and, despite falling death rates from coronary disease, the numbers who might benefit from this treatment have grown steadily. Unfortunately, only a minority of patients with heart disease who would benefit are offered rehabilitation. The provision of cardiac rehabilitation in most countries is seriously deficient, and suggestions are made for improving this situation to fulfil Hellerstein's vision. (Int J Clin Pract 2000; 54(2): 92‐97)
CARCINOMA OF THE BREAST AND HORMONE REPLACEMENT THERAPY FOR OSTEOPOROSIS
Authors: Crawshaw A 
Published: April 2023

SUMMARYThe benefits of hormone replacement therapy for postmenopausal women, especially in the prevention and treatment of osteoporosis, are well known. It is still not clear whether oestrogen replacement therapy can be given safely to women with breast cancer. The incidence and survival of breast cancer is rising in the UK and increasing numbers of young women with breast cancer treated systemically experience an early menopause and are at prolonged risk of osteoporosis. This review discusses the risk/benefit analysis of oestrogen replacement therapy for breast cancer patients, and alternative therapies: SERMs, phyto‐oestrogens and bisphosphonates. A schedule for monitoring osteoporosis for breast cancer patients with a therapeutic early menopause is suggested. (Int J Clin Pract 2000; 54(2): 99‐103)
CHEST PAIN: PANIC ATTACK OR HEART ATTACK?
Authors: Potokar JP , Nutt DJ 
Published: April 2023

SUMMARYChest pain is a common presentation to both primary and secondary care physicians but is often non‐cardiac in origin. Patients presenting with chest pain may be experiencing a panic attack. Panic disorder is a disabling psychiatric condition with serious consequences, such as impaired social functioning and increased risk of suicide. Comorbidity of panic disorder with other psychiatric conditions is common and often leads to increased severity of anxiety symptoms and a poorer prognosis. The cost of misdiagnosing non‐cardiac chest pain is high. It is important for physicians to be able to recognise panic attacks and to distinguish them from cardiac disease, thus avoiding unnecessary use of healthcare resources. This review discusses the prevalence and diagnosis of panic attack and panic disorder in patients presenting with chest pain to primary care physicians and cardiologists. Treatment options for panic disorder are considered, particularly the selective serotonin reuptake inhibitors, which are emerging as the first‐line choice for the treatment of panic disorder. (Int J Clin Pract 2000; 54(2): 110‐114)
THE ROLE OF TIROFIBAN IN ACUTE CORONARY SYNDROMES
Authors: Gomma A , Collinson J , Purcell H , Flather M 
Published: April 2023

SUMMARYPlatelet activation and aggregation play an important and essential role in the formation of intracoronary thrombus in acute coronary syndromes (ACS). ACS still carries unacceptably high rates of morbidity and mortality despite intensive antianginal therapy and the wide use of aspirin and heparin. Two glycoprotein IIb/IIIa receptor inhibitors are now licensed for concomitant use with heparin and aspirin in ACS. Glycoprotein IIb/IIIa receptor inhibitors block the final step for platelet aggregation and fibrinogen binding, thus preventing thrombus formation. Tirofiban is a potent, synthetic, non‐peptide and specific glycoprotein IIb/IIIa receptor inhibitor. In three major international trials involving over 7200 patients (PRISM, PRISM‐PLUS and RESTORE), tirofiban was shown to be well tolerated and to reduce the risk of ischaemic complications in patients with unstable angina, non‐Q‐wave myocardial infarction and high‐risk patients undergoing revascularisation when used in combination with aspirin and heparin. These and ongoing studies are discussed. (Int J Clin Pract 2000; 54(2): 121‐124)
MISTAKEN FIRST IMPRESSIONS: A RESPONSE
Authors: Lewis MB , Ellis HD 
Published: April 2023

SUMMARYIn this journal, Cummins et al1 reported an experiment that examined clinicians' predictions of causes of death from subjects' pre‐morbid photographs. They found that clinicians performed at chance. The validity of two of their other conclusions are challenged. First, that clinicians routinely form impressions of how a person will die from their appearance. Second, that certain health professionals use common judgements to form these impressions. These claims are found to be based upon non‐falsifiable hypothesis and inappropriate statistics; hence, an experiment employing pictures of feet (or any arbitrary personal detail) would have led the authors to the same conclusions. (Int J Clin Pract 2000; 54(2): 126‐127)
PERNICIOUS ANAEMIA AND NEUROPHYSIOLOGICAL STUDIES IN ARABS
Authors: Moussa NA , Awad MO , Yahya TM 
Published: April 2023

SUMMARYWhile pernicious anaemia is a disease predominantly affecting people of north European descent, there is increasing awareness of its occurrence in other ethnic populations. We document herein details of six Arabs who had pernicious anaemia and significant neurophysiological abnormalities. All the patients made a complete haematological and symptomatic recovery following parenteral administration of hydroxycobalamin. The diagnosis of pernicious anaemia should be considered in Arab patients of all ages who have macrocytic anaemia, or symptoms of peripheral neuropathy. We caution against the empirical use of folic acid and vitamin B12 in the management of patients with chronic anaemia. (Int J Clin Pract 2000; 54(3): 152‐154)
THE WHYS AND WHEREFORES OF GETTING PATIENTS TO GIVE UP SMOKING
Authors: Pracy JP , Chevretton EB 
Published: April 2023

SUMMARYSmoking‐related diseases are responsible for the majority of premature deaths in industrialised societies. It is 50 years since the link between smoking and lung cancer was first established, since when a gradually increasing number of smoking‐related illnesses have been identified. The treatment of patients suffering smoking‐related illnesses consumes a large proportion of health care budgets. The ever‐increasing costs of health care, in part due to the advent of new therapeutic techniques, could be offset by a concerted effort to reduce the number of people smoking. Various strategies, particularly if used in combination, have been shown to produce acceptable smoking cessation rates. At present there appears to be a reluctance on the part of governments to fund a concerted, co‐ordinated programme to encourage and assist people to stop smoking. In the absence of such support it is important for all health professionals to provide sensible advice and support to help their patients to stop smoking. (Int J Clin Pract2000;54(3): 155‐159)
THE CURRENT MANAGEMENT OF CYSTIC FIBROSIS
Authors: Lees CM , Smyth RL 
Published: April 2023

SUMMARYCystic fibrosis (CF) is one of the commonest lethal inherited conditions among Caucasians. It affects multiple organ systems and exhibits a range of clinical problems of varying severity. Life expectancy has improved in recent years as treatment regimes have become more intensive, but current treatments are expensive, often time consuming and may affect quality of life. This review summarises the treatments currently used in the management of patients with CF, and the evidence for these. (Int J Clin Pract 2000; 54(3): 171‐179)
AFELIMOMAB
Authors: Vincent JL 
Published: April 2023

SUMMARYTumour necrosis factor‐α (TNF‐α) is well established as a key mediator in the inflammatory response seen in various disease processes including sepsis. TNF‐α is involved in virtually all features of septic shock and multiple organ failure. Anti‐TNF‐α strategies are thus appealing and have been effective at reducing inflammation and morbidity in certain conditions including rheumatoid arthritis and Crohn's disease. Afelimomab is the F(ab')2 fragment of a murine anti‐TNF‐α antibody, and has been evaluated in clinical trials in septic patients. The results suggest that the drug is well tolerated, and may be of benefit in certain groups of patients with sepsis. A large, randomised, clinical trial of afelimomab in patients with severe sepsis has recently been completed and the results are eagerly awaited. More work is necessary to identify a means of selecting which patients are most likely to benefit from this type of therapy in sepsis. (Int J Clin Pract 2000; 54(3): 190‐193)
SOLITARY PLASMACYTOMA OF THE PAROTID GLAND
Authors: Hari CK , Roblin DG 
Published: April 2023

SUMMARYExtramedullary plasmacytoma involving the parotid gland is a rare occurrence. This report describes a case of solitary extramedullary plasmacytoma arising from the parotid gland of a 60‐year‐old woman. The importance of thorough follow up for these patients is stressed, as the possibility of multiple myeloma is higher in this group. (Int J Clin Pract 2000; 54(3): 197‐198)
OSTEOID OSTEOMA OF THE SCAPULAR NECK: A CASE REPORT
Authors: Ruiz AL , Mcmullan MG , Yeates HA , Craig BF 
Published: April 2023

SUMMARYOsteoid osteoma localised in the scapula are very rare. We report the case of an 11‐year‐old girl, who presented with an osteoid osteoma at the neck of the glenoid. This was excised en bloc after being located accurately by computed tomography. This case report demonstrates the difficulty in the approach to the excision of this unusually located lesion. (Int J Clin Pract 2000; 54(3): 199‐200)
CHRONIC HEPATITIS C BETA‐INTERFERON‐INDUCED SEVERE HYPERTRIGLYCERIDAEMIA WITH APOLIPOPROTEIN E PHENOTYPE E3/2
Authors: Homma Y , Kawazoe K , Ito T , Ide H , Takahashi H , Ueno F , Matsuzaki S 
Published: April 2023

SUMMARYThe mechanisms of hypertriglyceridaemia and changes in plasma lipoprotein subfractions by β‐interferon treatment were studied in a hepatitis C patient with apo E phenotype E3/2. Plasma levels of triglyceride (TG) were increased by treatment with 6 × 106 β‐interferon and reached 8.06 mmol/l at 4 weeks of treatment. Low energy and low fat diet reduced them to half the maximal level. Plasma levels of LDL1 (1.019<d<1.045)‐C, LDL2 (1.045<d<1.063)‐C, HDL2‐C and HDL3‐C were 0.39, 0.31, 0.21 and 0.28 mmol/l, respectively, which are low, but the plasma levels of IDL, which is a remnant of TG‐rich lipoproteins, was normal at 7 weeks of treatment. The distribution of plasma lipoprotein subfractions returned to normal after interferon treatment was discontinued. The mass and activity of lipoprotein lipase (LPL) were reduced to half the baseline level by interferon treatment. The activity of hepatic triglyceride lipase (HTGL) which transforms IDL to LDL was normal. The patient's apo E phenotype was E3/2; with that phenotype the removal of TG‐rich lipoproteins and IDL through the receptors of the remnant and LDL is impaired. But the IDL plasma level was normal, probably because of normal HTGL activity and high LDL‐receptor activity. Lymphocyte LDL‐receptor activity was double that of the control. We conclude that interferon caused the low mass and activity of LPL which in turn caused the hypertriglyceridaemia. And no retention of the remnant of TG‐rich lipoproteins in this patient with apo E3/2 and low levels of LDL subfractions was due to the active removal of them through LDL‐receptors as well as the impaired production of them by suppression of LPL by interferon. (Int J Clin Pract 2000; 54(4): 212‐216)
MANAGEMENT OF BREAST PAIN
Authors: Faiz O , Fentiman IS 
Published: April 2023

SUMMARYMastalgia is a common problem among premenopausal women, and those with severe and protracted symptoms merit treatment. A range of non‐hormonal and hormonal agents is available for symptom control among mastalgia sufferers but many are ineffective. Tamoxifen is the most effective and least toxic agent available for the treatment of severe chronic breast pain. Dosage with tamoxifen must be tailored to individual patient requirement and symptom control balanced against troublesome side‐effects. (Int J Clin Pract 2000; 54(4): 228‐232)
UPDATE ON VANCOMYCIN RESISTANCE
Authors: Perichon B , Courvalin P 
Published: April 2023

SUMMARYEnterococci can be responsible for severe infections such as endocarditis, meningitis and septicaemia and are one of the most important causes of nosocomial infections. Resistance in enterococci concerns many classes of antibiotics including, since 1986, glycopeptides. These antibiotics act by blocking cell wall formation, and resistance is due to synthesis of modified peptidoglycan precursors. Resistance can be acquired or intrinsic and strains may be resistant to vancomycin and teicoplanin, or to vancomycin only. Five types of glycopeptide resistance and their biochemical mechanisms have been described. Furthermore, strains that are dependent on vancomycin for growth have been isolated from clinical samples. Data suggest that resistance could originate in glycopeptide‐producing organisms or in enterococcal species intrinsically resistant to these antibiotics. (Int J Clin Pract 2000 54(4): 250‐254)
TRANSIENT PATHOLOGICAL Q WAVES IN SUSPECTED ACUTE MYOCARDIAL INFARCTION: ‘ELECTRICAL STUNNING’
Authors: Banerjee S , Hargreaves  
Published: April 2023

SUMMARYIn acute coronary syndromes the development of pathological Q waves is usually taken as evidence of established myocardial infarction (MI). We describe two patients with suspected acute Ml who developed transient pathological Q waves. Cardiac enzymes were normal and cardiac catheterisation showed severe proximal coronary disease. Recognition of ‘non‐infarction’ Q waves is important and may influence management of these patients. (Int J Clin Pract 2000; 54(4): 263‐264)
A CLINICAL COMPARISON OF SUMATRIPTAN NASAL SPRAY AND DIHYDROERGOTAMINE NASAL SPRAY IN THE ACUTE TREATMENT OF MIGRAINE
Authors: Boureau F , Kappos L , Schoenen J , Esperanca P , Ashford E 
Published: April 2023

SUMMARYA multinational, multicentre, randomised, double‐blind, double‐dummy, crossover study (368 patients treating two attacks) was conducted to compare the efficacy and tolerability of sumatriptan nasal spray (20 mg) with dihydroergotamine (DHE) nasal spray (1 mg plus optional 1 mg). At the primary efficacy time point of 60 minutes after dosing, significantly more patients obtained headache relief (change from moderate or severe to none or mild) after treatment with sumatriptan than with DHE (53% sumatriptan, 41% DHE, p<0.001). Significantly more patients reported relief of nausea after sumatriptan than after DHE at 60 minutes (64% sumatriptan, 49% DHE, p=0.006). A significant difference between the two treatments was first observed at 45 minutes with respect to both headache relief (38% sumatriptan, 31% DHE, p=0.037) and relief of nausea (55% sumatriptan, 40% DHE, p=0.014). There were no significant differences between the two treatments for other measures of efficacy. Both treatments were well tolerated, with only 10% of patients in each group reporting one or more adverse events. The most frequently reported adverse event after sumatriptan was a bad or bitter taste, which was reported by 5% of patients. After DHE, 4% of patients reported symptoms of the nasal cavity/sinuses and 3% reported nausea and/or vomiting as adverse events. lt is concluded that sumatriptan nasal spray is superior to DHE nasal spray in the relief of pain and nausea associated with acute migraine headache. (Int J Clin Pract 2000; 54(5): 281‐286)