bluuebunny/crossref_metadata_2025_split huggingface dataset:
ADENOMYOEPITHELIOMA OF THE BREAST
Authors: Parks RW , Clarke MAR , Cranley B 
Published: April 2023

SUMMARYAdenomyoepithelioma is a rare disorder characterised by simultaneous proliferation of ductal epithelium and myoepithelial cells. It is more common in salivary glands or skin, and only rarely found in breast tissue. Adenomyoepithelioma of the breast was first described in 1970 by Hamperl.1 Since then, approximately 55 cases have been described in the literature; the largest review, by Tavassoli in 1991, reported 27 of these cases.2 Because of the small number of cases reported, the natural history of adenomyoepithelioma of the breast remains uncertain. We report a further case which was treated by local excision, and follow‐up for two years has revealed no evidence of local recurrence or metastatic spread.
COMPARISON BETWEEN REAGENT STRIPS USED FOR DETECTION OF URINARY TRACT INFECTION IN THE ELDERLY
Authors: Evans PJ , McNabb WR , Lewis RR 
Published: April 2023

SUMMARYA comparison was made between the accuracy of Ames and Boehringer reagent strips for detecting urinary tract infections in 100 elderly patients (50 acutely ill patients admitted to hospital and 50 attending the day hospital). The results for urinary nitrite, blood and protein for both strips were documented. Nitrite provided the highest sensitivities and specificities. In the acute hospital patients, the sensitivities were 83% and 89% for the Ames and Boehringer strips respectively, while for the day hospital patients the sensitivities were 90% for both strips. Specificities were 100% for both strips in each group of patients. There was thus little difference between the accuracy of the Ames and Boehringer reagent strips in detecting urinary tract infection.
AN AUDIT OF PATIENTS ADMITTED FOR HOME INTRAVENOUS THERAPY DIRECTLY FROM THE EMERGENCY DEPARTMENT
Authors: Montalto M 
Published: April 2023

SUMMARYThe Hospital in the Home Unit (HHU) provides home intravenous therapy to acute inpatients. The aim of this audit was to assess the practice of accepting patients for home intravenous therapy directly from the emergency department by describing the frequency and type of clinical conditions managed, and recording the outcome and adverse events of such admissions. Consecutive patient admissions to the HHU directly from the emergency department over a 15‐month period were included. The policy of accepting patients for home intravenous therapy from the emergency department will continue. Care with diagnosis and HHU assessment is required. Complications should be expected, and a reliable on‐call service is essential.
PRIMARY THYROID CARCINOMA AND THYROTOXICOSIS
Authors: Plengvidhya N , Rathanavijitrasilp A , Sangruchi T , Nitiyanant W , Vannasaeng S , Piraphatdist T , Vichayanrat A 
Published: April 2023

SUMMARYA 60‐year‐old man noticed rapid enlargement of a long‐standing thyroid goitre, with dysphagia and difficulty in breathing. Thyrotoxicosis was diagnosed. Chest X‐ray revealed multiple pulmonary metastases. He underwent near‐total thyroidectomy. The histopathology revealed an undifferentiated thyroid carcinoma with some areas of papillary carcinoma and its follicular variant. Postoperative 131l total body scan showed residual thyroid tissue in the neck and one functioning metastasis in the right rib, posteriorly. The patient's condition deteriorated rapidly and he died from pneumonia. The autopsy showed widespread metastases of undifferentiated thyroid carcinoma. Only the right rib contained the follicular variant of papillary carcinoma.
MEDIAL ORBITAL WALL BLOWOUT FRACTURE WITH MEDIAL RECTUS MUSCLE ENTRAPMENT
Authors: Cumberworth VL , Valentine PWM , McEwan J , Dawkins RS 
Published: April 2023

SUMMARYWe report a case of left medial rectus palsy due to entrapment by a fracture of the lateral wall of the ethmoidal sinus following a road traffic accident and discuss the presentation and management of this unusual complication.
THE SIGNIFICANCE OF URINARY N‐ACETYL‐ß‐D‐GLUCOSAMINIDASE FOR PREDICTING EARLY STAGE DIABETIC NEPHROPATHY
Authors: Kato H , Takashima T , Kishikawa H , Emura S , Ohmori K 
Published: April 2023

SUMMARYWe studied urinary N‐acetyl‐ß‐D‐glucosaminidase (NAG) in the early stage of diabetic nephropathy in 27 non‐insulin‐dependent diabetes mellitus (NIDDM) patients with a microalbumin level below 20 mg on 24‐hour urine sample. Microalbumin and NAG excretion were measured in 24‐hour urine samples collected on three separate occasions within seven days of admission. Creatinine clearance was determined simultaneously. There was a significant negative correlation between the creatinine clearance and 24‐hour urinary NAG (r=‐0.38, p<0.05). Elevation of urinary NAG may indicate decreased renal function during early stage NIDDM nephropathy.
THE IMPACT OF DIRECT ACCESS ENDOSCOPY, HELICOBACTER PYLORI NEAR PATIENT TESTING AND ACID SUPPRESSANTS ON THE MANAGEMENT OF DYSPEPSIA IN GENERAL PRACTICE
Authors: Asante MA , Patel P , Mendall M , Jazrawi R , Northfield TC 
Published: April 2023

SUMMARYDirect access endoscopy services, Helicobacter pylori infection and more effective acid suppression therapy have influenced the management of dyspepsia in the past decade. Three hundred and ten GPs in south London were surveyed via postal questionnaire to determine the impact of these factors on the management of dyspepsia in general practice. Ninety‐one per cent of GPs prescribed simple antacids as initial treatment for simple dyspepsia and referred only if symptoms did not improve. When acid suppresants were used, 41% used H2 antagonists compared with 11% for proton pump inhibitors (p=0.0001). Risk factors for underlying malignancy were the most frequent reason for hospital referral at first consultation. Long outpatient waiting times result in about 90% of GPs choosing direct access endoscopy as the route of referral for all patients with dyspepsia, while only 36% would refer patients with sinister symptoms to direct access endoscopy if waiting times were similar to that of outpatients. H. pylori near patient testing did not seem to influence the management of dyspepsia in general practice.
MECHANISMS OF HYPOPHOSPHATAEMIA IN ALCOHOLIC PATIENTS
Authors: Elisaf  , Siamopoulos KC 
Published: April 2023

SUMMARYThe aim of our study was to determine the possible pathophysiological mechanisms of hypophosphataemia in a group of 127 patients admitted to hospital for alcohol‐related causes. Blood and fresh urine specimens were taken to determine acid‐base and electrolyte parameters. Thirty‐seven patients (29.1%) had hypophosphataemia (serum phosphorus <0.77 mmol/l) with a range of serum phosphorus of 0.32‐0.74 mmol/l. In 17 hypophosphataemic patients inappropriate phosphaturia (FEP04 >20%, TmPO4/GFR<0.80 mmol/l) was evident, possibly due to hypomagnesaemia, metabolic acidosis, metabolic alkalosis, or a proximal tubular defect in phosphate transport. The causes of hypophosphataemia in the remaining 20 patients were alcohol withdrawal syndrome, respiratory alkalosis and diarrhoea. Patients with hypophosphataemia were more often found to have hypomagnesaemia and respiratory alkalosis than normophosphataemic patients. In conclusion, hypophosphataemia is frequently observed in alcoholic patients due to various pathophysiological mechanisms, such as inappropriate phosphaturia, increased phosphorus entry into cells and increased gastrointestinal loss of phosphate.
THE MEDICAL MANAGEMENT OF STROKE
Authors: Bath PMW 
Published: April 2023

SUMMARYThe management of stroke, so long a ‘Cinderella’ condition, is changing rapidly as new developments appear for acute treatment, rehabilitation and secondary prevention. Most patients with acute stroke now need rapid assessment at hospital following the onset of symptoms. Those needing admission should be managed on an acute stroke unit for stabilisation, CT scanning and other investigation, and diagnosis, and then referred, as appropriate, to a specialist stroke rehabilitation unit. Aspirin is now the recognised treatment for acute ischaemic stroke (once primary Intracerebral haemorrhage has been excluded), and can be continued for secondary prevention. Attention should be paid to risk factors to prevent recurrence, especially treatment of hypertension, atrial fibrillation, and severe ipsilateral carotid stenosis. Patients with mild cerebrovascular disease should be managed in a specialist stroke/TIA clinic. Stroke is no longer an untreatable or unpreventable condition, and It is vital that hospitals design appropriate systems to manage patients in an interdisciplinary environment.
OSTEOPETROSIS IN CHILDREN
Authors: Al‐Rasheed SA , Al‐Mohrij O , Al‐Jurayyan N , Al‐Herbish A , Al‐Mugeiren M , Al‐Salloum A , Al‐Hussain M , El‐Desouki M 
Published: April 2023

SUMMARYOver a 10‐year period, 28 Arab children with autosomal recessive osteopetrosis were seen in two hospitals in Riyadh, Saudi Arabia. Eighteen (64%) had osteopetrosis associated with metabolic acidosis probably due to a renal tubular defect; nine (32%) had a malignant infantile form of osteopetrosis and one had a mild form with delayed onset. Parental consanguinity was 56% and 40% among patients with and without acidosis respectively. Somatic and psychomotor retardation and recurrent bone fractures were common in both groups. Dental caries, cerebral calcification and optic atrophy were more frequent in patients with acidosis, while anaemia, hepatosplenomegaly and deafness were more common in patients without acidosis. To guarantee optimal rehabilitation, children with this progressive disease require an early multiteam approach.
A STUDY OF CHEST INFECTIONS IN HIV SEROPOSITIVE PATIENTS IN KUALA LUMPUR
Authors: Wood E , Cheong I , Lee C 
Published: April 2023

SUMMARYA retrospective study of 144 adults with HIV infection was conducted to investigate the prevalence of upper and lower respiratory tract infections (URTIs and LRTIs). The patients were divided into two groups: those with acquired HIV through intravenous drug abuse (IVDA), and those who had acquired HIV through ‘other’ risk behaviours. LRTIs were more prevalent than URTIs overall, and LRTIs were significantly more common (p<0.001) in IVDAs than in the other‐risk group. Tuberculosis (40%) and bacterial pneumonias (33%) comprised the majority of LRTIs among IVDAs, while Pneumocystis carinii pneumonia (40%) was the commonest LRTI in the other‐risk group. Analysis of CD4 T‐lymphocyte counts indicated that HIV‐seropositive IVDAs are at greater risk of developing chest infections at higher CD4 counts than other‐risk patients. The IVDAs were also found to have a much higher rate of co‐infection with hepatitis C and B, which may be a factor accelerating the progression from HIV infection to AIDS. The mean time averaged for the two groups from known seroconversion to development of respiratory tract infection is only 1.37 years, which suggests HIV‐infected patients are presenting late for treatment in Malaysia.
PAEDIATRIC XANTHOGRANULOMATOUS PYELONEPHRITIS
Authors: Goodman TR , McHugh K , Lindsell M 
Published: April 2023

SUMMARYXanthogranulomatous pyelonephritis (XGP) is a well recognised but rare type of chronic pyelonephritis classically occurring in middle‐aged women. It is increasingly being recognised in children in whom it can be mistaken for Wilms' tumour. Awareness of the possibility of this condition occurring in children may allow early recognition and possible treatment. Two cases of XGP in children are described and the literature reviewed.
INTRAVENOUS CONSCIOUS SEDATION WITH MIDAZOLAM IN PAEDIATRIC PATIENTS
Authors: Rosen DA , Rosen KR 
Published: April 2023

SUMMARYIntravenous midazolam has been widely used in paediatric patients for conscious sedation in procedures such as endoscopy, oesophageal manometry, biopsy, bone marrow aspiration and lumbar puncture. Its advantages include quick onset and short duration of action, and haemodynamic stability which may be associated with improved patient acceptance. The pharmacokinetic profile of midazolam compares favourably with that of diazepam, permitting more controlled sedation with a quicker recovery time. Midazolam has been associated with shorter recovery room stays and less vomiting in children who undergo outpatient surgery. The safety and tolerability profile of midazolam in paediatric patients is comparable or superior to that observed in adults. Patients who are haemodynamically unstable, as well as pre‐term and term infants are at greater risk of hypotension while receiving sedation. Thus, the availability of IV midazolam for use in children provides an important additional option for providing IV conscious sedation.
CEREBRAL PTOSIS REVISITED
Authors: Nagaratnam N , Singh‐Grewal D , Chen E , Davies D 
Published: April 2023

SUMMARYWe studied nine patients with cerebral ptosis and gaze deviation following an acute stroke. The brains of all nine showed an extensive lesion in the fronto‐parieto‐temporal regions. In five the stroke was left hemispheric. The assumption is that cerebral ptosis may have a bihemispheric representation and results from damage to the connections rather than to a specific area.
A COMPARISON OF A COMMUNITY MENTAL HEALTH CENTRE‐BASED PSYCHIATRIC SERVICE WITH ONE BASED IN AN OUTPATIENT DEPARTMENT AT THE SAME HOSPITAL
Authors: Singh MB , Puri BK 
Published: April 2023

SUMMARYReferrals and response to referrals of two psychiatric services with similar catchment areas of the same hospital, one with a Community Mental Health Care (CMHC) centre and the other based at an outpatient department, were compared over a five‐month period. While the service with a CMHC had an increased number of referrals, which may reflect the aims of the CMHC of making mental health services more accessible and less stigmatised, most referrals were from general practitioners and therefore likely to be appropriate. In spite of its increased workload, the time from referral to assessment for the CMHC‐based service was significantly shorter than for the outpatient‐based service.
ANTIPLATELET DRUGS IN SECONDARY PREVENTION OF STROKE
Authors: Diener H‐C 
Published: April 2023

SUMMARYStroke is a leading cause of long‐term disability and death in developed countries. The primary medical strategy for secondary prevention of stroke is antiplatelet therapy. Although the clinical value of acetylsalicylic acid (ASA) is well recognised for preventing secondary stroke, several questions remain. What is the optimal dose of ASA to prevent stroke? Would combining ASA with another antiplatelet drug increase efficacy? Do new agents currently under development offer additional benefits? Many of the recent clinical trials address these questions. This review article summarises the results of these trials in the context of evolving strategies for stroke prevention, including the management of recurrent transient ischaemic attacks (TIAs), side‐effects of ASA, and economic issues.
CONTRACEPTION: A REVIEW
Authors: Kubba AA 
Published: April 2023

SUMMARYRecent years have seen a dual development in contraception: on the one hand, advances in technology have widened the choice for women; on the other, the right of women to informed and free choice has been reaffirmed. The need to provide contraceptive users with impartial and up‐to‐date advice was highlighted by the pill scare of 1995. The extreme safety of the pill when used by low risk women was confirmed in several reports. However, interest in long‐acting systemic non‐oral methods continues to increase as providers seek methods with minimal compliance requirement and therefore higher efficacy which, in the case of the hormone releasing intrauterine system (IUS) and injectable progestogens, approach the efficacy of female sterilisation. Globally the intrauterine device (IUD) had topped the league of reversible contraceptives for many years but had had mixed fortunes in some developed countries, especially the US. A revival of the IUD is on the way, mainly because of the impressive performance of the IUS and the recent introduction of a frameless device, the GyneFix.
OBSTRUCTIVE SLEEP APNOEA SYNDROME: CARDIOPULMONARY AND DIFFUSE MANIFESTATIONS
Authors: Lalloo MT 
Published: April 2023

SUMMARYObstructive sleep apnoea syndrome mainly affects males over 40 and is thought to occur as a result of soft tissue laxity in the buccal and pharyngeal musculature. It is associated with changes in blood oxygen saturation and may lead to pulmonary hypertension and cardiac arrhythmias. Investigations should include routine haematological tests and, if possible, polysomnography. The main aim of therapy is to reverse as many risk factors as possible, i.e. alcohol consumption, obesity and smoking. Nasal continuous positive airway pressure is a useful tool in treatment but patient compliance may be poor, so surgery may be indicated. The surgical intervention of choice is uvulopalatopharyngoplasty, which is of most benefit to the patient with an upper airway laxity with an obstruction only at this level.
TREATMENT OF PAIN WITH SUSTAINED‐RELEASE TRAMADOL 100, 150, 200 MG: RESULTS OF A POST‐MARKETING SURVEILLANCE STUDY
Authors: Nossol S , Schwarzbold M , Stadler Th 
Published: April 2023

SUMMARYIn a post‐marketing‐surveillance study the use of a sustained‐release tramadol preparation (Tramal® long 100, 150, 200 mg) was investigated in 3153 patients. The intention was to comply with the legal obligation to carry out product surveillance and to collect data on prescribing behaviour. We focused our attention on drug safety and efficacy. Tramal long was used mainly for severe and very severe pain. The most frequently reported causes of pain were diseases of the locomotor system (49.9%), tumours (24.3%), traumas and fractures (10.1%), and neurogenic (9.3%). The mean daily dose was 235.7 mg, usually divided into two doses. The analgesic effect was described as very good or good by 82.5% of the patients. Adverse events occurred in 6.5% of the patients, mostly in the form of typical opioid side‐effects such as nausea (3.4%), dizziness (1.5%) and vomiting (1.1%). Severe or unknown side‐effects were not reported.
SAVED BY A HERNIA: AN UNUSUAL PRESENTATION OF OVARIAN CANCER
Authors: Matthews SJ , Mcclelland HR 
Published: April 2023

SUMMARYA lump in the groin of a 75‐year‐old woman co‐existed with a single ovarian cyst. It was eventually diagnosed as a solitary necrotic omental metastasis from a cystadenocarcinoma of the ovary which had herniated through the femoral canal.
SUDDEN ONSET DEAFNESS: TWO CASES ASSOCIATED WITH PREGNANCY
Authors: Lavy JA 
Published: April 2023

SUMMARYSudden onset sensorineural deafness is an otological emergency; subsequent recovery of hearing has been shown to correlate with early treatment. There have been few documented reports of this occurring in pregnancy, although the increased thrombogenic risk of the pregnant state is a proposed aetiological factor. The wide variation in outcome is demonstrated by these two cases, which are presented to raise awareness of this condition.
FIBROUS CONTRACURE OF THE ELBOW FOLLOWING CANNULATION OF THE ANTECUBITAL FOSSA VEIN
Authors: Saab M , Kurdy NMG , Birkinshaw RI 
Published: April 2023

SUMMARYA case of flexion contracture of the elbow resulting from thrombophlebitis is described. Thrombophlebitis is a recognised complication following cannulation of the antecubital fossa vein. In severe cases a tender fibrous band is palpable. There are no previous reports of a contracture deformity occurring from such a fibrous band. This case therefore presents an unusual clinical manifestation of thrombophlebitis not previously described.
ENT MANIFESTATIONS OF PSEUDOMONAS AERUGINOSA INFECTION IN HIV AND AIDS
Authors: Hern JD , Ghufoor K , Jayaraj SM , Frosh A , Mochloulis G 
Published: April 2023

SUMMARYIn acquired immunodeficiency syndrome (AIDS), opportunistic infections occur which are usually related to defects in cell‐mediated immunity. However, there has also been an increase in the incidence of bacterial infections in this population, including infections caused by Pseudomonas species. This study reveals the wide range of ear, nose and throat manifestations which can be caused by Pseudomonas aeruginosa in patients with HIV and AIDS and illustrates the need for a high index of clinical suspicion combined with accurate microbiological data for treating these potentially life‐threatening infections. In addition, treatment using combination chemotherapy, such as ciprofloxacin and ceftazidime, is advised, as it has been shown that dual therapy results in a significantly lower mortality.
COMPARATIVE EFFICACY AND SAFETY OF THE NONSTEROIDAL ANTI‐INFLAMMATORY DRUGS NIMESULIDE AND DICLOFENAC IN PATIENTS WITH ACUTE SUBDELTOID BURSITIS AND BICIPITAL TENDINITIS
Authors: Wober W , Rahlfs VW , Büchl N , Grässle A , Macciocchi A 
Published: April 2023

SUMMARYThe efficacy and tolerability of nimesulide, a non‐steroidal anti‐inflammatory drug (NSAID) 100 mg twice daily were compared with diclofenac 75 mg b.i.d. in short term treatment of acute shoulder (acute subdeltoid bursitis and bicipital tendinitis) in adult patients. In this double‐blind (double‐dummy), randomised, parallel group study over two weeks, 122 patients were included. The Mann‐Whitney statistics revealed therapeutic equivalence of both treatments with a slight superiority for nimesulide. The tolerability of nimesulide, judged by investigators and patients and analysed statistically, was superior to that of diclofenac. Thus, the benefit‐risk relationship was better for the test drug than for the reference drug.
BIOCHEMICAL TESTING OF ADRENOCORTICAL FUNCTION
Authors: Rosalki SB 
Published: April 2023

SUMMARYDisturbed adrenal function may present in various ways. Here are outlined some of the functions of the adrenals and the clinical effects of adrenal disorder, followed by a more detailed consideration of the application of laboratory tests to the identification of adrenocortical hypo‐ and hyperfunction.
METASTATIC RENAL CELL CARCINOMA OF THE PAROTID GLAND PRESENTING AS A NECK MASS
Authors: Gangopadhyay K , Abuzeid MO , Martin JM , Saleem M 
Published: April 2023

SUMMARYMetastatic tumours in major salivary glands are uncommon, with a higher incidence of primary sites from the head and neck. Renal cell carcinoma often exhibits unusual behaviour causing both clinical and pathological confusion. Renal cell carcinoma initially presenting as a metastatic swelling in the parotid gland or elsewhere in the head and neck is rare. We report a case of renal cell carcinoma metastatic to the parotid gland where the neck swelling was the first sign of the tumour, with a comprehensive review of the literature.
TELEPHONE FOLLOW‐UP: AN EXTENSION OF THE SURGICAL OUTPATIENT DEPARTMENT
Authors: Scott NA , Hughes S , Wright S 
Published: April 2023

SUMMARYA total of 112 surgical patients took part in telephone follow‐up, conducted by non‐medical staff, after discharge home. Successful telephone follow‐up was achieved in 93% of patients at 6 weeks, 91% at 3 months and 79% at 12 months. Telephone follow‐up by non‐medical staff is a practical method of assessing patient outcome after surgery. Wider use of this technique would free up time in the surgical clinics, without compromising audits of outcome and purchaser demands for evidence of efficacy.
MANAGEMENT OF VULVAL PAIN – WHOSE RESPONSIBILITY?
Authors: Kundu A , Riley AJ 
Published: April 2023

SUMMARYVulval pain can be acute or chronic. Usually patients present to their general practitioner when the pain is acute but, when specialist advice is required, vulval pain can present a real dilemma over to whom to refer patients. Genitourinary medicine, gynaecology, dermatology and sexual dysfunction clinics all play an important part in the holistic management of this symptom. Consultation in a sympathetic environment with appropriate investigations and collaboration between different disciplines may provide a diagnosis and management.