bluuebunny/crossref_metadata_2025_split huggingface dataset:
ROSIGLITAZONE: POTENTIAL BENEFICIAL IMPACT ON CARDIOVASCULAR DISEASE
Authors: Viberti GC 
Published: April 2023

SUMMARYRosiglitazone, a potent member of the thiazolidinedione class of oral antidiabetic agents, reduces hyperglycaemia by improving insulin sensitivity – an important underlying factor in the development of both type 2 diabetes and its related cardiovascular complications. Rosiglitazone has now been available in clinical practice for more than three years, so there is a large body of evidence supporting its efficacy and safety as an antihyperglycaemic agent in patients with type 2 diabetes. Given the significant burden imposed on patients and healthcare resources by diabetes‐related cardiovascular disease (CVD), there is growing interest in the thiazolidinediones in terms of their potential to ameliorate CVD risk factors as a result of their insulin‐sensitising action and thus improve cardiovascular outcomes in individuals with type 2 diabetes. As reviewed below, rosiglitazone has a beneficial impact on a number of factors associated with insulin resistance and CVD, including microalbuminuria, hypertension, dyslipidaemia, visceral fat, elevated plasminogen activator inhibitor‐1 levels and increased concentrations of C‐reactive protein. These thiazolidinedione compounds are not problem‐free and the long‐term implications of some of rosiglitazone side‐effects such as weight gain, changes in LDL‐cholesterol concentration and fluid retention remain to be resolved. Large‐scale clinical outcome studies should give a clearer picture for rosiglitazone and related thiazolidinediones in relation to the extent of their impact on diabetes disease progression and incident cardiovascular events.
OBSTRUCTIVE SLEEP APNOEA SYNDROME PRESENTING IN A NEUROLOGY OUTPATIENT CLINIC
Authors: Larner AJ 
Published: April 2023

SUMMARYThe various neurological guises in which obstructive sleep apnoea syndrome (OSAS) may present are illustrated by reporting four previously undiagnosed patients seen by one consultant neurologist in general neurological outpatient clinics. Presenting features were episodes of loss of consciousness (2), stroke, and excessive daytime somnolence; morning headache and cognitive decline were also observed. Two patients had been involved in road traffic accidents. Diagnoses suggested by the referring doctors included epilepsy, stroke and narcolepsy. Since OSAS is associated with increased morbidity and mortality, yet is frequently amenable to treatment, neurologists should be familiar with the heterogeneous presentations of this condition.
INCONTINENCE IN ADULT FEMALES WITH CYSTIC FIBROSIS: A NORTHERN IRELAND SURVEY
Authors: Moran F , Bradley JM , Boyle L , Elborn JS 
Published: April 2023

SUMMARYThe objectives of this survey were to establish the prevalence, onset, severity and impact of incontinence and attitudes towards the availability of advice and treatment in female adults with cystic fibrosis (CF) in Northern Ireland. All female patients (n=59) at the Northern Ireland Regional Adult CF Centre were posted a questionnaire on incontinence. Leakage of urine occurred in 14/46 respondents. Leakage of urine occurred when chest was bad in 8/14 patients and when chest was good or bad in 3/14 patients. Patients reported that their bladder problem affected their ability to perform airway clearance or cough (13/14), and exercise (4/14). The main reason given for the patients who did not seek help for their incontinence (10/14) was that they were too embarrassed. This study highlights that patients with CF are reluctant to seek treatment for incontinence despite the impact this condition can have.
MANAGEMENT OF LOCALLY ADVANCED PROSTATE CANCER: A EUROPEAN CONSENSUS
Authors: Boccon‐Gibod L , Bertaccini A , Bono AV , Dev Sarmah B , Höltl W , Mottet N , Tunn U , Zamboglou N 
Published: April 2023

SUMMARYThis report summarises the findings of a European Consensus Group review of current standards of care in locally advanced prostate cancer defined as (a) untreated cancer extending clinically beyond the prostatic capsule in patients with no evidence of lymph node invasion or distant metastases, and (b) residual disease remaining after local treatment with positive surgical margins, seminal vesicle invasion, persistent prostate‐specific antigen (PSA) and/or secondary PSA relapse. There was no overall consensus as to the standard of care in clinically apparent locally advanced prostate cancer. It was agreed, however, that hormonal therapy (e.g. with a gonadotrophin releasing hormone analogue [GnRHa]) represents a valid treatment in these patients. Treatment practices and regimens vary considerably between European countries, but GnRHa is widely used, either alone or in combination with antiandrogens. Hormonal therapy alone is a valid option, though the optimal modality, timing and duration of treatment remain to be defined. Adjuvant therapy with a GnRHa has been shown to improve survival in patients undergoing external beam radiotherapy. It is a viable option after prostatectomy in patients with persistent or secondary relapsing PSA. It was determined that optimal treatment will be different according to PSA, clinical staging and Gleason score, and the treatment of locally advanced disease should be individually tailored after discussion between physician and patient. In many instances, patients prefer and expect some form of treatment in preference to watchful waiting. Treatment nomograms such as the Kattan nomograms provide precise, comprehensive and invaluable tools for everyday use and may be used to predict outcomes and guide treatment decisions.
AUSCULTATORY PERCUSSION: AN ADDED DIMENSION IN PHYSICAL DIAGNOSIS
Authors: Brunk SF 
Published: April 2023

SUMMARYThe combination of both auscultation and percussion in the diagnostic examination improves both auscultation and percussion and, in so doing, increases the skill of palpation. Auscultatory percussion (AP) is easy to learn, easy to use and requires little time to perform. The size of normal organs and the size of abnormal masses as determined by AP are usually similar to measurements determined by X‐rays and CT scans. Abnormalities found by AP need to be evaluated and confirmed by other diagnostic procedures. AP brings increased precision to physical diagnosis and is felt to be a valuable addition to medical practice.
EFFICACY AND SAFETY OF BUPROPION SR FOR SMOKING CESSATION: DATA FROM CLINICAL TRIALS AND FIVE YEARS OF POSTMARKETING EXPERIENCE
Authors: Ferry L , Johnston JA 
Published: April 2023

SUMMARYBupropion SR was introduced for smoking cessation in the US in 1997. This review assesses the efficacy and safety of bupropion SR for treatment of tobacco dependence based on data from clinical trials and five years of postmarketing experience. Through June 2001, there were approximately 32 million patient exposures to bupropion (9 million for smoking cessation) in clinical practice, and more than 8000 patients have been studied in clinical trials for tobacco dependence. In clinical trials, bupropion SR was more effective than placebo at improving initial and long‐term abstinence rates and preventing relapse. Bupropion SR is generally well tolerated. The most common adverse event in clinical trials or clinical practice is insomnia, which can also be a symptom of nicotine withdrawal. The two main risks of treatment with bupropion SR are major motor seizure and hypersensitivity reaction. Clinical trials data suggest that the incidence of seizure is approximately 0.1%, and that of serious cases of hypersensitivity approximately 0.12%. Benefit‐risk assessment, assuming a 30% one‐year quit rate demonstrates that for every 10,000 smokers treated with bupropion SR, 19 lives are saved and 86 cases of smoking‐attributed morbidity are averted in a five‐year period while the risk of experiencing one of the two potentially serious adverse events during treatment is 0.22%. These data further establish both the efficacy and safety of bupropion SR and its use in preventing the adverse health effects of chronic tobacco use.
BILATERAL RENAL ARTERY STENOSIS AFTER ABDOMINAL RADIOTHERAPY FOR HODGKIN'S DISEASE
Authors: Saka B , Bilge AK , Umman B , Yilmaz E , Nisanci Y , Erten N , Karan MA , Tascioglu C 
Published: April 2023

SUMMARYA 49‐year‐old woman was admitted with fatigue, dyspnoea, pretibial oedema and decreased daily urination. Seven years ago she was treated with doxorubicin, bleomycin, vinblastine and dacarbazine, alternating with mechlorethamine, vincristine, procarbazine and prednisone and 80 Gy abdominal radiotherapy for Hodgkin's disease. Two years later, malignant hypertension was diagnosed. Angiotensin‐2 antagonist and p‐blocker treatment was given. After increased serum creatinine levels were determined, renal angiography was performed and total obstruction in the left renal artery and near total obstruction in the right side was observed. She was admitted to our clinic with oliguria, and acute renal failure was diagnosed. Balloon angioplasty and stent implantation was performed to the right renal artery. After a polyuric period, serum creatinine reduced to near normal levels. Angiotensin‐2 antagonist treatment worsened the course in this patient. Patients with resistant hypertension occurring years after abdominal radiotherapy should be evaluated for renal artery stenosis.
THE EFFECT OF VITAMIN D3 ON INSULIN SECRETION AND PERIPHERAL INSULIN SENSITIVITY IN TYPE 2 DIABETIC PATIENTS
Authors: Borissova A‐M , Tankova T , Kirilov G , Dakovska L , Kovacheva R 
Published: April 2023

SUMMARYThe aim of this study was to evaluate the effect of vitamin D3 supplementation on insulin secretion and insulin resistance. Ten females with type 2 diabetes being treated with oral hypoglycaemic agents and with normal serum and urine calcium levels were enrolled in the study. The study was conducted in March, when levels of vitamin D are lowest in our region. The level of plasma 25(OH)D was measured (normal range in winter 25–120 nmol/l). The first (FPIS) and second (SPIS) phases of insulin secretion were studied during IVGTT Peripheral insulin resistance was measured. A group of 17 age‐ and BMI‐matched females with normal glucose tolerance served as a control group. The diabetic patients were treated with cholecalciferol 1332 IU daily for one month. The mean plasma 25(OH)D level was 35.3±15.1 nmol/l at baseline, 70% of patients being vitamin D deficient. After one month of treatment with vitamin D3, the plasma 25(OH)D level increased by a mean of 75.8%; 70% of the patients achieved normal vitamin D levels. FPIS increased significantly by 34.3%, while the change in SPIS of 20.4% was not significant (p>0.8). We found a significant correlation between the change in FPIS and the change in 25(OH)D level after vitamin D3 supplementation (p<0.018). The results showed a decrease of 21.4% in insulin resistance after one month, but the change was not significant. Bearing in mind that the main defects in type 2 diabetes mellitus are reduced FPIS and insulin resistance, and the favourable effect vitamin D3 had on them, we suggest vitamin D3 deficiency may at least partly contribute to the impairment of insulin secretion and probably of insulin action. Our results suggest that vitamin D3 supplementation could be an element in the complex treatment of type 2 diabetes mellitus during the winter.
MANAGEMENT OF PSYCHOSIS IN PARKINSON'S DISEASE
Authors: D'Souza C , Gupta A , Alldrick MD , Sastry BSD 
Published: April 2023

SUMMARYPsychosis is one of the most disabling complications associated with Parkinson's disease (PD) and occurs in up to 30% of PD patients treated chronically with antiparkinsonian drugs. Visual hallucinations, with or without delirium and paranoid delusions, are the most frequent symptoms. Psychosis complicating PD can be more disabling than the motor symptoms of PD; it frequently poses a serious threat to the patient's ability to maintain independence and is the single greatest risk factor for nursing home placement. Choosing an antipsychotic drug for a PD patient is a common clinical dilemma. The conventional antipsychotic drugs are poorly tolerated in PD because of their predictable and at times profound worsening in parkinsonian motor symptoms. The recent availability of atypical antipsychotic drugs that can control psychotic symptoms without compromising motor function has led to significant advances in therapeutic strategies in the management of PD psychosis in the community. This article reviews data on the use of atypical antipsychotics in patients with PD and the current recommendations on their use in the management of PD psychosis.
ETORICOXIB IN THE TREATMENT OF CHRONIC PAIN
Authors: Duncan MR , Capell HA 
Published: April 2023

SUMMARYFor the many patients who suffer chronic pain, we seek the most effective anti‐inflammatory drug with the least side‐effect profile and the greatest long‐term safety. Etoricoxib, a selective COX2 inhibitor, has been shown to be as effective as non‐selective non‐steroidal anti‐inflammatory drugs in the management of chronic pain in rheumatoid arthritis and osteoarthritis, for periods of up to one year. Data on etoricoxib efficacy in chronic low back pain is beginning to emerge. The side‐effect profile of etoricoxib suggests it is well tolerated with similar adverse effects to non‐selective NSAIDs. Larger studies are awaited, to see whether superior gastrointestinal tolerability can be proven. Further work will be required to show that etoricoxib is safe in patients with pre‐existing cardiovascular or gastrointestinal comorbidity, and the potentially confounding role of aspirin still needs to be elucidated. However, etoricoxib shows promise as a new and effective COX2 inhibitor in clinical practice.
SMALL INTESTINAL METASTASIS FROM RENAL CELL CARCINOMA EXHIBITING RARE FINDINGS
Authors: Nozawa H , Tsuchiya M , Kobayash T , Morita H , Kobayashi I , Sakaguch M , Mizutani T , Tajima A , Kishida Y , Yakumaru K , Kagami H , Sekikawa T 
Published: April 2023

SUMMARYSmall intestinal metastasis from renal cell carcinoma (RCC) has only rarely been described. We report two patients who developed small bowel metastases from RCC showing different clinicopathological characteristics. Both patients underwent hemilateral nephrectomy for RCC and developed lung metastases metachronously or simultaneously. One patient developed occlusive ileus caused by multiple polypoid tumours composed of sarcomatoid tissue in the jejunum shortly after nephrectomy. The other patient presented melaena due to bleeding from a Borrmann 2‐like tumour in the jejunum six years after nephrectomy. Clinically, his disease was slow‐growing. Sarcomatoid histology and Borrmann 2‐like tumour in this report are rare findings in metastatic tumour of RCC in the small bowel.
EFFICACY AND TOLERABILITY OF ONCE‐DAILY ORAL THERAPY WITH TELITHROMYCIN COMPARED WITH TROVAFLOXACIN FOR THE TREATMENT OF COMMUNITY‐ACQUIRED PNEUMONIA IN ADULTS
Authors: Pullman J , Champlin J , Vrooman PS 
Published: April 2023

SUMMARYA randomised, double‐blind study of adults with community‐acquired pneumonia (CAP) resulted in clinical cure rates of 90.0% for telithromycin and 94.2% for trovafloxacin. Bacteriological eradication rates were also comparable for both treatments. All high‐risk patients (i.e. ≥65 years old [n=25], Pneumonia Severity Index score; ≥lll [n=16], pneumococcal bacteraemia [n=4]) were clinically cured. In infections caused by Mycoplasma pneumoniae and Chlamydophila (Chlamydia) pneumoniae, clinical cure rates were 93.3% (14/15) for telithromycin and 100% (16/16) for trovafloxacin. Possibly drug‐related, treatment‐emergent adverse events (TEAEs) were considered mild and occurred in 47.2% of telithromycin and 33.0% of trovafloxacin patients. The most frequently reported, possibly drug‐related, TEAEs were diarrhoea and nausea for telithromycin and diarrhoea and headache for trovafloxacin. Serious TEAEs occurred in 1.9% of telithromycin and 1.8% of trovafloxacin subjects and were considered not drug related. No deaths occurred during the study. Telithromycin and trovafloxacin were safe and comparable in efficacy in these patients with CAR
STEROIDAL CONTRACEPTIVE VAGINAL RINGS
Authors: Sarkar AW 
Published: April 2023

SUMMARYThe development of steroid‐releasing vaginal rings over the past three decades is reviewed to illustrate the role of this device as an effective hormonal contraceptive for women. Vaginal rings are made of polysiloxane rubber or ethylene‐vinyl‐acetate copolymer with an outer diameter of 54–60 mm and a cross‐sectional diameter of 4–9.5 mm and contain progestogen only or a combination of progestogen and oestrogen. The soft flexible combined ring is inserted in the vagina for three weeks and removed for seven days to allow withdrawal bleeding. Progesterone/progestogen‐only rings are kept in for varying periods and replaced without a ring‐free period. Rings are in various stages of research and development but a few, such as NuvaRing, have reached the market in some countries. Women find this method easy to use, effective, well tolerated and acceptable with no serious side‐effects. Though the contraceptive efficacy of these vaginal rings is high, acceptability is yet to be established.
DELAYED REPAIR OF A FRACTURED PENIS: A NEW TECHNIQUE
Authors: Naraynsingh V , Ramdass MJ , Thomas D , Maharaj D 
Published: April 2023

SUMMARYFracture of the penis can be managed conservatively or surgically. Conservative management is associated with a high morbidity, and early surgical repair of the fracture is usually recommended in order to prevent complications. Because a fractured penis is swollen throughout its length, it is difficult to identify the fracture site accurately, so a degloving technique is usually used to locate and repair the torn corpus cavernosum; this can lead to further trauma and complications. In cases where extensive swelling makes accurate clinical localisation difficult, delaying the repair for 7–12 days facilitates easy identification and repair of the torn corpus cavernosum. We report three cases where treatment was delayed until the swelling had subsided, when a simple direct repair was successfully carried out.
RENOVASCULAR HYPERTENSION SECONDARY TO SPONTANEOUS RENAL ARTERY DISSECTION AND TREATMENT WITH STENTING
Authors: Bilge AK , Nisanci Y , Yilmaz E , Umman B , Hunerel D , Ozsaruhan O 
Published: April 2023

SUMMARYRenovascular disease is the cause of less than 1% of patients with hypertension; within this group aneurysm and dissection in renal artery are even rarer causes. It may be not only iatrogenic or traumatic, but may also develop spontaneously from fibromuscular disease or atherosclerotic lesions. We present a 26‐year‐old male patient with recently developed and progressive hypertension in whom renal angiography showed aneurysmal dilatation and dissection of the right renal artery. With the implantation of two stents in the true lumen, normal renal blood flow and thrombosis of the aneurysmal sac was established. As a result, stent implantation to renal artery dissection is effective, reliable and easy and can be an alternative to surgical treatment.
CARDIAC METASTASIS FROM A RENAL CELL CARCINOMA
Authors: Cheng ASH 
Published: April 2023

SUMMARYRenal cell carcinomas are known to extend into the renal vein and inferior vena cava, but cardiac metastases are rare and usually clinically silent. In the case described here, there was evidence of right ventricular outflow obstruction, associated with a metastatic renal tumour in the right ventricular wall protruding into the ventricular cavity. The patient had presented years earlier with an ulnar neuropathy, for which the tumour may have been responsible. This case highlights the need to consider an underlying paraneoplastic syndrome in a patient presenting with neuropathy, because appropriate investigation could have led to early detection and possible cure of the renal lesion. When renal cell carcinoma is confined to the renal parenchyma, five‐year survival is up to 70%, but this falls to 5% in the presence of distant metastases.
SPREAD OF MELANOMA AFTER LYMPHATIC DRAINAGE: RELAUNCHING THE DEBATE
Authors: Vereecken P , Mathieu A , Laporte M , Petein M , Heenen M 
Published: April 2023

SUMMARYSecondary lymphoedema of the leg can result in disruption of lymphatic vessels following lymph node surgery. Evidence supports the use of complex decongestive physiotherapy (CDP) in such cases, despite the possibility of tumour recurrence due to this therapy in cancer patients. We present the case of a 52‐year‐old woman who developed in‐transit metastases and systemic evaluable disease one month after starting CDP for secondary lymphoedema of the leg. (lnt J Clin Pract 2003; 57(5): 444–445)
A ONE‐YEAR, RANDOMISED, PLACEBO (SALINE) CONTROLLED CLINICAL TRIAL OF 500–730 KDA SODIUM HYALURONATE (HYALGAN®) ON THE RADIOLOGICAL CHANGE IN OSTEOARTHRITIS OF THE KNEE
Authors: Jubb RW , Piva S , Beinat L , Dacre J , Gishen P 
Published: April 2023

SUMMARYThe primary objective of this study was to investigate structural changes, as measured by joint space narrowing (JSN), within the knee joint during treatment with intra‐articular sodium hyaluronate (HA) of molecular weight 500–730 kDa in patients with osteoarthritis (OA) of the knee. Patients received a weekly intra‐articular injection of either 20 mg2/ml HA or a 2 ml vehicle placebo (saline) for three weeks. This course was repeated twice more at four‐monthly intervals. Concomitant treatment with analgesics or NSAIDs was allowed. The primary efficacy measure was the reduction in mean joint space width (JSW) of the medial compartment at 52 weeks. A total of 408 patients were randomised and 319 completed the one‐year study (HA: n=160, placebo: n=159); 273 of the 319 were included in the primary analysis. Analysis of variance on these 273 patients did not show a statistically significant difference between the two treatment groups. However, there was a significant difference in response to treatment in terms of the baseline JSW (p=0.01), indicating that outcome of treatment may depend on‐baseline JSW. Therefore, a subgroup analysis by baseline JSW was conducted. This compared patients with a JSW >4.6 mm with those with a JSW <4.6 mm. In those with radiologically milder disease at baseline and receiving HA, the JSN was significantly reduced compared with placebo (p=0.02). In patients with radiologically more severe disease there was no difference in JSN between the two treatments. Although, in this one‐year study, no overall treatment effect was seen, those with radiologically milder disease at baseline had less progression of joint space narrowing when treated with HA.
ANTIHYPERTENSIVE EFFICACY OF MOXONIDINE IN PRIMARY CARE: A ‘REAL‐LIFE’ STUDY
Authors: Schachter M , Mitchell G , Niziol C , Abhyankar BA 
Published: April 2023

SUMMARYBoth clinical trials and everyday experience indicate that most hypertensive patients will need two or more drugs to reach target blood pressures. The current framework for the selection of drugs for combination therapy is based mainly on their interaction with the renin‐angiotensin system. However, this approach would not fully exploit the range of drugs now available. This study, based on current primary care practice, confirms that the centrally acting drug moxonidine has efficacy as an add‐on agent comparable to that of other drugs such as beta‐blockers and ACE inhibitors and that it can effectively be combined with these agents. It also shows that moxonidine is as well tolerated as the other drugs and much better than older centrally acting agents such as clonidine and methyldopa. The study reinforces the view that moxonidine can be considered as an effective and well‐tolerated drug for use in combination with any other class of antihypertensives.