bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperventilation with coincidental cardiac arrhythmias: a diagnostic pitfall in patients with presyncope
Authors: Wilkes N P , Chambers J B , Jackson G , Jewitt D E 
Published: April 2023

SummaryFive patients with presyncope had cardiac arrhythmias which were at first assumed to be causative. Symptoms persisted despite antiarrhythmic therapy, including insertion of a permanent pacemaker system in one case. A further interview in each patient revealed symptoms suggesting hyperventilation. Monitoring of end‐tidal pCO2 confirmed unequivocal hypocapnia preceding a typical attack and not associated with rhythm change.The symptoms of hyperventilation should be part of the routine history in any patient with presyncope.
Interparietal hernias: analysis of six cases with literature review
Authors: Etawo U S , Elechi E N 
Published: April 2023

SummarySix cases of interparietal hernia in five females and one male, age range 48–70 years, average 52 years, are presented together with a review of the literature.Two of the cases had emergency surgical repair for strangulated hernia with one postoperative death. There were no deaths in the four patients who had elective hernia repairs.The incidence of interparietal hernia in this study is 2.5 per cent with the interstitial variety accounting for 83 per cent of the cases. Each interparietal hernia resulted from a direct inguinal hernia. The differential strengths of the various layers of the anterior abdominal wall, the strongest being the aponeurosis of the external oblique muscle, are believed to be a factor causing the interstitial burrowing of these hernias.
Malnutrition in cirrhotic patients: anthropometric measurements as a method of assessing nutritional status
Authors: Loguercio C , Sava E , Marmo R , Blanco C Del Vecchio , Coltorti M 
Published: April 2023

SummaryThis study was undertaken to evaluate by anthropmetric measurements the nutritional status of cirrhotic patients at different stages of the disease and to establish intra‐ and inter‐observer variability in the determination of these parameters.In 60 healthy controls and 108 cirrhotics (63 ‘well compensated’ and 45 ‘decompensated’; groups A and B+C on the Child‐Pugh classification respectively) two independent experienced observers measured biceps, triceps, subscapular and overiliac skinfold thicknesses and arm circumference three times. Each observer was unaware of the results obtained by the other.No significant intra‐ or inter‐observer variability was found.The study indicates that skinfold thickness measurements are a reliable and reproducible method of assessing the nutritional status of cirrhotics. It was found that more than 50 per cent of the decompensated patients were malnourished, with skinfold values significantly lower than those of the controls.In comparison with skinfold thickness and arm circumference, parameters such as body weight and lean body mass are unreliable, and other indices such as muscle and/or fat arm area do not add any significant information to the evaluation of the nutritional status of cirrhotics.
Diphtheritic polyneuritis in an elderly woman: clinical and neurophysiological follow‐up
Authors: Roche S , Stone S , Allen CMC , Lange L S 
Published: April 2023

SummaryA 71‐year‐old English lady initially presented with a bulbar paralysis and, six weeks later, developed a generalised sensori‐motor neuropathy. Corynebacterium diphtheriae mitis was cultured from her throat swab. Despite a good clinical recovery at one month, nerve conduction velocity was at its lowest. As far as the authors are aware, this is one of the few cases of neurophysiological and clinical follow‐up in a British subject with diphtheritic peripheral neuropathy. This case emphasises the importance of giving antitoxin early.
Haemophilus aphrophilus endocarditis
Authors: Webb C H , Hogg G M 
Published: April 2023

SummaryWe report a case of Haemophilus aphrophilus endocarditis involving mitral and tricupsid valves in a boy with congenital heart disease. He had received dental treatment without antibiotic cover. Prolonged high‐dose ampicillin with gentamicin was necessary for cure. Short courses of ampicillin alone may not successfully treat H. aphrophilus.
Granular cell tumour (myoblastoma): two cases and a review of the literature
Authors: Payne‐James J J , Watkins R M 
Published: April 2023

SummaryGranular cell tumour is a rare neoplasm consisting of nests or ribbons of polyhedral cells with granular eosinophilic cytoplasm and small, dense nuclei. It may occur at various sites throughout the body. Two cases, one of the tongue and one of the rectum, are reported and the pathology and management of this uncommon neoplasm are discussed.
Acute appendicitis secondary to metastatic carcinoma of the breast
Authors: Maddox P R 
Published: April 2023

SummaryA patient developing acute appendicitis and intestinal obstruction secondary to metastatic breast carcinoma is described. This rare occurrence may become more common with improved survival in cases of advanced breast malignancy.The intrinsic nature of malignant metastases in the appendix, with or without concurrent immunosuppressive chemotherapy, leads to a late presentation of appendicitis with a high incidence of perforation, associated with an increased mortality and morbidity.It is suggested that appendicectomy should be undertaken as a routine in patients with carcinoma of the breast when oophorectomy or laparotomy is to be performed.
THYMOPENTIN PROPHYLACTIC TREATMENT IN PATIENTS WITH RECURRENT RESPIRATORY INFECTIONS
Authors: Sundal E 
Published: April 2023

SUMMARY Present immunological methods do not regularly detect abnormalities in patients with chronic bronchitis, and no single parameter appears to be closely associated with the clinical findings. Of the many tests performed in the cited studies, the Merieux multitest procedure seems to offer the best findings in further studies, followed by determination of the OKT4/OKT8 ratio.The theoretical background for the use of an immunologic approach to prevent frequent recurrences of infections is discussed in depth, with particular emphasis on the pharmacologic efficacy profile of thymopentin. The safety of this drug is remarkably unproblematic.The present survey of 11 clinical studies shows that thymopentin treatment reduces the incidence of recurrent respiratory tract infections. The most frequently used dosing regimen is 50 mg SC three times a week for 6 weeks, which may be repeated after 3–6 months. The clinical effect appears long‐lasting, ie, 3–4 months after discontinuation of treatment.
BLOOD COAGULATION AND FIBRINOLYTIC ACTIVITY IN HYPOTHYROIDISM
Authors: Erem C , Kavgaci H , Ersöuz HÖ , Hacihasanoglu A , Ukinç K , Karti SS , Deger O , Telatari M 
Published: April 2023

SUMMARYThe influence of hypothyroidism on haemostasis is controversial; both hypocoagulable and hypercoagulable states have been reported. Hypothyroidism has been associated with atherosclerosis; a hypercoagulable state in addition might represent a risk factor for thromboembolic disease. The aim of the present study was to investigate the markers of endogenous coagulation and vascular endothelial cell function and to evaluate the relationship between serum lipid profile, thyroid hormones and haemostatic parameters in hypothyroid patients. We investigated various haemostatic parameters in 20 patients with hypothyroidism and compared them with 20 euthyroid controls. The relationship between serum thyroid hormones and the haemostatic parameters was examined. The plasma levels of fibrinogen, AT III and PAI‐1 were significantly increased in hypothyroid patients compared with the control group, whereas factors VIII and X activity was decreased. We showed that free T3 levels correlated with factor IX activity. Free T4, FT3 and TSH did not correlate with fibrinogen, vWF, AT III, t‐PA, or PAI‐1. aPTT correlated inversely with t‐PA activity and positively with protein C activity Anti‐Tg correlated inversely with FV. There was a positive correlation between triglycerides and protein C. Protein S correlated inversely with high density lipoprotein cholesterol. We found a hypofibrinolytic state in patients with hypothyroidism. Our results suggest that the risk of developing thrombosis and ultimately myocardial infarction via high PAI‐1 levels may be increased in patients with hypothyroidism, a result in line with recent epidemiological data. However, thyroid hormones may play a role at different levels of the complex haemostatic system.
NON‐VASCULAR CLAUDICATION: A CLINICAL CONUNDRUM
Authors: Fasih T , Pickin M , Cuschieri RJ 
Published: April 2023

SUMMARYThis is a prospective study of patients referred to our department with symptoms of claudication unlikely to be of vascular origin. After clinical assessment these patients were referred to an orthopaedic physician. Of 1070 patients referred, 33 patients were diagnosed with a non‐vascular problem. Of these, 21 were cases of spinal stenosis with or without nerve root irritation, seven had a combination of spinal pathology and peripheral vascular disease, and five were diagnosed with intervertebral disc prolapse (n=3), diabetic neuropathy (n=1) and chronic fatigue syndrome (n=1). The prognosis for patients with non‐vascular claudication in respect of the development of premature vascular events is likely to be different from vascular claudicants and they should be counselled appropriately Furthermore, the potentially less favourable outcome following reconstruction must be clearly explained to patients with a non‐vascular contribution to their symptoms before any therapeutic vascular intervention. Failure to do this is likely to have significant medicolegal implications.
THE RETURN OF THE LEECH
Authors: Abdelgabar AM , Bhowmick BK 
Published: April 2023

SUMMARYMedicinal leeches (Hirudo medicinalis) have been used in medicine for thousands of years to treat a wide range of ailments. Nowadays, leeches are used successfully for only a few conditions, notably in the field of reconstructive or microsurgery, to salvage tissue flaps and skin grafts whose viability is threatened by venous congestion. The anticoagulant properties of hirudin, contained in leech saliva, may lead to wider therapeutic applications in the prevention and treatment of thromboembolic disease. Optimal care is needed when applying leeches, because their use can be complicated by serious bacterial infections.
REVIEW OF CLINICAL EXPERIENCE WITH ATOSIBAN AND THE TRACTOCILE EFFICACY ASSESSMENT SURVEY IN EUROPE (TREASURE) STUDY PROTOCOL
Authors: Husslein P , Quartarolo JP 
Published: April 2023

SUMMARYA phase IV multinational, multicentre study has been designed – the Tractocile Efficacy Assessment Survey in Europe (TREASURE). The aim is to assess atosiban in the clinical setting, which is associated with fewer restrictions than in phase III trials. Atosiban is to be compared with ‘usual care’ in women eligible for treatment, and will also be evaluated as deferred or immediate treatment in women who have not yet fulfilled the diagnostic criteria for pre‐term labour. Exploring the use of atosiban beyond the normal indications may allow the identification of additional subpopulations of women who will benefit from early treatment. TREASURE will offer data on new diagnostic tools, investigate respiratory distress syndrome according to severity and record the use of antenatal steroids. It is hoped that additional information concerning the subtle differences in clinical practice will broaden our understanding of how to manage pre‐term labour and offer the chance to revise treatment guidelines. (Int J Clin Pract 2003; 57(2): 121–127)
ACUTE DISSEMINATED ENCEPHALOMYELITIS: A RIDDLE WRAPPED IN A MYSTERY INSIDE AN ENIGMA
Authors: John L , Khaleeli AA , Larner AJ 
Published: April 2023

SUMMARYThe difficulties in establishing a diagnosis of acute disseminated encephalomyelitis (ADEM) are illustrated in this case report, which attempts to raise awareness of the condition among general physicians, since they are the practitioners most likely to see such acute neurological presentations. Clinical and investigative features which raise the index of suspicion for the diagnosis of ADEM are outlined.
COX‐LOX INHIBITION: CURRENT EVIDENCE FOR AN EMERGING NEW THERAPY
Authors: Smelly MM , Hawkey CJ 
Published: April 2023

SUMMARYSafe and effective drug treatment is an important objective of all doctors. In the treatment of arthritis, non‐steroidal anti‐inflammatory drugs offer effective treatment but safety is significantly limited, largely due to gastrointestinal toxicity. Attention has recently focused on exploiting increased knowledge of metabolism of arachidonic acid to allow the development of safer anti‐inflammatory drugs. Dual inhibitors of cyclo‐oxygenase and lipoxygenase are planned. These drugs may inhibit formation of both prostaglandins and leukotrienes. This review outlines the salient features of cyclo‐oxygenase and lipoxygenase metabolism of arachidonic acid. The role of the eicosanoids in mediating inflammation and gastrointestinal integrity is delineated. Evidence is presented regarding action of licofelone, one COX/LOX inhibitor that is currently in advanced stages of clinical trials. This review examines the hypothesis that licofelone is an effective anti‐inflammatory agent that does not cause peptic damage.
RELAPAROTOMY: A FIVE‐YEAR REVIEW OF INDICATIONS AND OUTCOME
Authors: Ching SS , Muralikrishnan VP , Whiteley GSW 
Published: April 2023

SUMMARYComplications from abdominal surgery may necessitate reoperation and can be associated with significant morbidity and mortality. This review aims to analyse the incidence and outcome of relaparotomy for various indications. In a retrospective review of case notes of patients who had undergone one or more relaparotomies during the same hospitalisation between 1996 and 2000, 55 patients required relaparotomy. Indications included bleeding, infection, anastomotic leakage, wound dehiscence, necrotising pancreatitis, bowel necrosis, bowel obstruction and miscellaneous indications. Relaparotomy for dehiscence and obstruction carried minimal risk; for bleeding and infection entailed moderate risks; and for anastomotic leak had the highest mortality rate. The mortality rate increased in older age groups, multiple system and organ failure and multiple relaparotomies. The overall mortality rate was 38%. Twenty‐nine per cent of patients had MRSA infection contributing to sepsis and multiple system and organ failure. Reintervention had brought to evidence technical errors, which could be corrected, and resulted in patient salvage in some cases. The mortality rate of relaparotomy has remained unchanged compared with data published previously, despite improvements in surgical techniques and critical care. Timely relaparotomy is valuable in the identification and treatment of complications following abdominal surgery.
UNUSUAL PERIANAL TUMOURS MASQUERADING AS ABSCESSES
Authors: Bracey EECL , Mathur P , Dooldeniya M , Joshp A , Dawson PM 
Published: April 2023

SUMMARYTumours of the perianal region and anal canal are uncommon and can present in a variety of ways. Acute anorectal sepsis is a common condition that usually presents as a painful lump close to the anal margin. Tumours in the perianal region may mimic the symptoms and signs of anorectal sepsis, thereby leading to a delay in diagnosis and management. We report three patients who presented to our department with symptoms and signs suggestive of perianal abscess but which on further investigation were discovered to be due to unusual perianal tumours. Only one of the tumours was found to be malignant – a primary perianal mucinous adenocarcinoma; the other two were benign, a leiomyoma and an aggressive angiomyxoma. A high index of clinical suspicion is required to the diagnosis of perianal tumours when assessing patients with painful perianal lumps, particularly those with a long history and those of ethnic origin. Every effort should be made to establish a preoperative diagnosis so that correct treatment can be delivered.
TESTICULAR TORSION: A TWIST TO THE TALE
Authors: Shergill IS , Gupta S , Arya M , Patel HRH 
Published: April 2023

SUMMARYTesticular torsion is a surgical emergency that requires prompt exploration if testicular viability is to be maintained. Although rare, it is essential to be aware that it may occur despite previous fixation (orchidopexy). Testicular torsion occurring after previous orchidopexy is rare, but recognition of this possibility is essential to prevent testicular infarction and subsequent orchidectomy During scrotal exploration a wide variety of methods for orchidopexy exist. We present a case of testicular torsion despite previous fixation and discuss the merits of various techniques available for orchidopexy.
TILT‐INDUCED PSEUDOSYNCOPE
Authors: Luzza F , Pugliatti P , Di Rosa S , Calabro D , Carerj S , Oreto G 
Published: April 2023

SUMMARYUsing the head‐up tilt test (HUTT) we evaluated 986 consecutive patients affected by unexplained syncope. In 266 patients the test induced bradycardia and/or hypotension resulting in syncope or presyncope, thus allowing a diagnosis of neurally mediated syncope. In three other patients (0.3% of the entire population and 1% of the all positive tests) HUTT provoked loss of consciousness despite no significant change in heart rate and/or blood pressure. In all three cases unconsciousness was prolonged and no pathological finding was present except lack of response. This phenomenon has been defined as ‘pseudosyncope’ and related to psychiatric illness. Pseudosyncope induced by HUTT reproduced the clinical events, so the test outcome was considered a true positive response. Our experience suggests that HUTT may contribute to the recognition of psychiatric disorder in some patients affected by unexplained syncope.
HOSPITAL‐ACQUIRED URINARY TRACT INFECTION
Authors: Kalsi J , Arya M , Wilson P , Mundy A 
Published: April 2023

SUMMARYNosocomial urinary tract infections (UTIs) account for up to 40% of all hospital‐acquired infections. The associated morbidity and mortality are a major drain on hospital resources. Patients with indwelling urinary catheters, patients undergoing urological manipulations, long‐stay elderly male patients and patients with debilitating diseases are at high risk of developing nosocomial UTIs. The organisms responsible usually originate from patients' endogenous intestinal flora, but occasionally from a moist site in the hospital environment. Nosocomial pathogens causing UTIs tend to have a higher antibiotic resistance than simple UTIs. Infection control policies are important in limiting the number of hospital‐acquired UTIs. Other important points include catheterisation using an aseptic technique and sterile equipment and the use of closed drainage systems. UTIs should be treated only after a urine sample has been sent and the advice of a microbiologist sought. In the future catheters impregnated with antibiotics, and the use of newer materials, may lead to further reductions in the incidence of nosocomial UTIs.
THE ROLE OF CILOSTAZOL (PLETAL™) IN THE MANAGEMENT OF INTERMITTENT CLAUDICATION
Authors: Bradbury AW 
Published: April 2023

SUMMARYIntermittent claudication affects 5% of the middle‐aged population in developed countries and is associated with a significant reduction in health‐related quality of life and cardiovascular morbidity and mortality The mainstay of treatment is best medical therapy (BMT) comprising smoking cessation, antiplatelet agents, lipid‐lowering, advice to exercise, and correction of other modifiable vascular risk factors. Although BMT is highly effective in reducing cardiovascular risk and may also improve walking distance, many patients remain unacceptably symptomatic despite it. Until recently, the only available adjuvant therapies were supervised exercise programmes, angioplasty and surgery Many patients are unable to comply with the first, and the last two are associated with limited durability and risk. The advent of cilostazol (Pletal™) adds evidence‐based pharmacotherapy to the vascular specialist's armamentarium for the first time. Here cilostazol and its role in the management of intermittent claudication are discussed.
MATRIX METALLOPROTEINASE PROFILE IN PATIENTS WITH CREUZTFELDT‐JAKOB DISEASE
Authors: Kettlun A , Collados L , García L , Cartier LA , Wolf ME , Mosnaim AD , Valenzuela MA 
Published: April 2023

SUMMARYPreliminary findings suggest that abnormalities in matrix metalloproteinase (MMP) activity may be found in the cerebrospinal fluid (CSF) of patients with Creutzfeldt‐Jakob disease (CJD). In this study of 16 subjects with CJD and 16 age‐, and sex‐matched controls, we determined the presence of MMP‐2 and MMP‐9 in their active and proenzyme forms, the relative levels of MMP‐3 and four inhibitors of MMP activity (TIMP‐1, TIMP‐2, TIMP‐3 and TIMP‐4), and the concentration of 4‐3‐3 protein. The methodology used involved zymography and immunological techniques. The results indicate that, compared with controls, CJD patients have a significantly higher positive frequency of pro‐MMP‐9 and of the active form of MMP‐2, along with significantly higher levels of TIMP‐1 and TIMP‐2, classical inhibitors of MMP‐9 and MMP‐2, respectively. We also found a positive correlation between 14‐3‐3 protein concentration and that of TIMP‐1 and TIMP‐2 levels (correlation coefficients of 0.793 and 0.798, respectively). These results suggest that abnormalities in MMP and TIMP profiles may be helpful in the biochemical characterisation of CJD.
THE REALITY OF TREATING DYSLIPIDAEMIA IN PATIENTS WITH CORONARY HEART DISEASE: A PRIMARY CARE SURVEY
Authors: Wright DJ , Grayson AD , Jackson M , Dainty C 
Published: April 2023

SUMMARYManagement of hyperlipidaemia in patients with ischaemic heart disease is suboptimal despite the proven benefit of statin therapy. Significant improvement in management has been shown in the EUROASPIRE II study. It is unclear, however, whether such changes have also occurred in primary care. We aimed to evaluate the use of statin therapy by performing a cross‐sectional survey of 300 patients with CHD aged >30 years from three general practices. A total of 249 (83%) of the 300 patients had their cholesterol measured and 141 (47%) were on statin therapy; 129 (43% of total) achieved a target cholesterol of <5 mmol/l, of whom 85 (64%) were on statin therapy. Of the remaining 120 patients whose cholesterol exceeded 5 mmol/l, 56 (47%) were on statin therapy. Thus 60% (85/141) of those on statin therapy achieved adequate control compared with 40% (44/108) without statins (p<0.008). Those patients with CHD diagnosed on objective evidence were more likely to receive statin therapy (55.5%). Many patients with CHD are still not receiving appropriate secondary prevention. Those on statin therapy are more likely to achieve target levels <5 mmol/l. The average doses of statins vary and are lower than the evidence‐based doses used in previous large‐scale studies, which may help explain the persistence of failed treatment. (Int J Clin Pract 2003; 57(6): 488–491)