bluuebunny/crossref_metadata_2025_split huggingface dataset:
5. THE SURGICAL MANAGEMENT OF EARLY BREAST CANCER
Authors: Young AE 
Published: April 2023

SUMMARYDefinitive surgical treatment should never be undertaken without a histological confirmation of the diagnosis. For operable disease primary treatment is normally breast‐conserving surgery or mastectomy, in association with axillary surgery. Patients with larger technically operable tumours may be treated with primary chemotherapy to try to shrink the tumour so that less radical surgery can be undertaken. The objective of surgery is clearance of local and regional disease with a margin of clear tissue, and to achieve an acceptable cosmetic outcome. Clinical assessment of the axilla is unreliable and because of the prognostic significance of the axillary nodal status this has to be determined histologically. Patients with single tumours ≤4 cm are suitable for conservation therapy but this will depend on breast size. After excision with clear margins and subsequent radiotherapy the breast recurrence rate should not exceed 5–10% at 10 years. Patients wiill require mastectomy because of disease extent, breast size, or for personal reasons. The usual operation is a total mastectomy with axillary clearance but small islands of breast tissue may persist subcutaneously as potential sites for future disease. Good breast‐conserving surgery is invariably better than reconstruction but, in the event of a mastectomy, reconstruction is offered either as an immediate or a delayed procedure. Complications of any form of surgery include haematoma, wound sepsis and wound flap necrosis. Specific complications are collections of serous fluid in the axilla or in the wound itself (seroma), shoulder stiffness and cording caused by distal thrombosis of lymphatics or veins after axillary dissection. The intercostobrachial nerve is often divided during surgery, causing numbness of the inner upper arm. Some degree of lymphoedema of the arm occurs in 10–15% of patients treated with axillary surgery. It is usually mild and may become rare as more patients have sentinel node biopsies.
DEVELOPMENT OF A NURSE‐LED CHRONIC PAIN CLINIC IN UK PRIMARY CARE
Authors: Glasgow ACA , Glasgow JA 
Published: April 2023

SUMMARYWe describe the development of an innovative, nurse‐led chronic pain clinic in primary care. Benefit of the structured intervention was seen in terms of overall patient pain (as measured by the short form McGill‐Melzack pain scale) with no overall impact on drug costs. A significant proportion (54%) of patients taking non‐steroidal anti‐inflammatory drugs were deemed to be at risk of gastropathy and in need of gastroprotection as defined by the clinic protocol. Areas worthy of further study are discussed.
A SYSTEMATIC REVIEW OF THE EVIDENCE FOR RAPID ACCESS CHEST PAIN CLINICS
Authors: McManus RJ , Mant J , Davies MK , Davis RC , Deeks JJ , Oakes RAL , Hobbs FDR 
Published: April 2023

SUMMARYTo determine the impact of rapid access chest pain clinics (RACPC) on patient management, a systematic search (1966–2000) was performed of electronic databases, recent conference abstracts, citations of all identified studies, and by contact with other researchers. Studies of any design were included. Assessment of eligibility, methodological quality of studies and data abstraction was conducted independently by two reviewers. Outcome measures were sought in terms of admission rate of patients without acute coronary syndrome detection rate of acute coronary syndrome unrecognised by the GR timing of specialist assessment of patients with stable angina and speed and accuracy of detection of those with non‐cardiac chest pain. Nine relevant studies were found, but all had methodological flaws when considered as evaluative studies. All clinics described reviewed patients within 24 hours of referral. Only three studies made comparisons with control groups, none of which were randomised, and a further three provided follow‐up data only. Limited data were found for all four outcome measures, indicating possible benefits of RACPCs. However, all findings could be explained by potential biases in the original studies. In conclusion, the evidence base for the introduction of rapid access chest pain clinics is poor. The introduction of these clinics should include a randomised prospective evaluation of their worth.
ALZHEIMER'S DISEASE AND VASCULAR FACTORS: FACTS AND THEORIES
Authors: Pansari K , Gupta A , Thomas P 
Published: April 2023

SUMMARYAlthough Alzheimer s disease is classified as a neurodegenerative dementia, in Alzheimer s dementia there is increasing evidence of an association with vascular risk factors and vascular pathology. These observations are supported by epidemiological and pathological studies. Vascular factors may play a significant role in the pathogenesis of Alzheimer s dementia. Further research is needed to explore this relationship. Modification of vascular risk factors could make a significant impact towards prevention and treatment of Alzheimer s disease, which is a distressing and prevalent condition in the community. This article considers the relationship of these vascular risk factors and potential mechanisms associated with the aetiopathogenesis of Alzheimer s dementia.
USE OF INTERNET MEDICAL WEBSITES AND NHS DIRECT BY NEUROLOGY OUTPATIENTS BEFORE CONSULTATION
Authors: Larner AJ 
Published: April 2023

SUMMARYWith increasing personal access to the internet, and the mass of medical information available in cyberspace, many patients may access information before an outpatient consultation. Since this information may shape individual health beliefs and expectations, yet is acknowledged to be of very variable quality, it may be important for practitioners to know about their patients' self‐directed findings. Medical information may also be gained from the NHS Direct telephone helpline. This study measured the frequency of use of the internet and of NHS Direct by questioning consecutive new referrals attending general neurology outpatient clinics over a three‐month period. A comparison was made between patients' searches and their final diagnosis. Patients' views on the use of the information received were sought.
INTRACARDIAC THROMBUS TRAVERSING A PATENT FORAMEN OVALE: IMPENDING PARADOXICAL EMBOLISM DEMONSTRATED BY TRANSOESOPHAGEAL ECHOCARDIOGRAPHY
Authors: Rinaldi CA , Stewart AJ , Blauth CI 
Published: April 2023

SUMMARYParadoxical embolism is a rare but potentially catastrophic complication of deep venous thromboses and pulmonary embolism. We describe a patient in whom transoesophageal echocardiography demonstrated a large clot traversing the atrial septum which was successfully removed by surgery.
INCORRECTLY ALIGNED FLY LEADS INSIDE THE ECG MACHINE CAUSING ‘ISCHAEMIC’ CHANGES
Authors: Butler J , Pooviah PK , Joglekar M , Hasan M 
Published: April 2023

SUMMARYWe describe a case in which a young woman was inappropriately diagnosed as having ischaemic heart disease after presenting with exertional neck pain and an abnormal ECG. Diffuse Q‐wave and T‐wave inversion changes were later attributed to erroneous placement of fly leads inside the ECG machine at a recent service. Clinicians should be aware of this uncommon cause of incorrect lead connections, which can result in unnecessary investigations and treatment.
INFILTRATING FIBROMATOSIS OF THE BREAST: A POTENTIAL PITFALL
Authors: Kouriefs C , Leris ACA , Mokbel K , Wells C , Carpenter R 
Published: April 2023

SUMMARYMammary fibromatosis is a rare condition. It presents a big dilemma for the clinician, because it mimics breast cancer clinically, radiologically and sometimes cytologically. We report a case of fibromatosis of the breast and highlight the diagnostic difficulties and management.
HEALTHCARE EXPENDITURE IN PATIENTS TREATED WITH VENLAFAXINE OR SELECTIVE SEROTONIN REUPTAKE INHIBITORS FOR DEPRESSION AND ANXIETY
Authors: Wan GJ , Crown WH , Berndt ER , Finkelstein SN , Ling D 
Published: April 2023

SUMMARYWe compared healthcare expenditure over a six‐month period following initiation of therapy with either venlafaxine (immediate and extended‐release) or a selective serotonin reuptake inhibitor (SSRI) in depressed patients with or without anxiety. Patients beginning treatment for a new depressive episode were identified retrospectively using the administrative data of the MEDSTAT MarketScan® database for the period 1994–1999. Before beginning therapy, patients prescribed venlafaxine had more non‐mental illnesses (0.85vs0.76; p<0.01) and hospitalisations for mental illness (0.53vs0.29; p<0.05) than patients prescribed SSRIs. In the six months after initiating treatment, venlafaxine was associated with lower hospitalisation expenditure for non‐mental illness ($177vs$526; p<0.01) than SSRIs, although total healthcare expenditure was not significantly different. Venlafaxine was associated with a 50% decrease in the odds of hospitalisation for non‐mental illness compared with SSRIs, with significantly lower inpatient expenditure.
ABOLITION OF WOLFF‐PARKINSON‐WHITE PATTERN DURING EPISODES OF ANGINA
Authors: Mourad D , Al‐Bawi AM , Cherian G 
Published: April 2023

SUMMARYA 70‐year‐old woman presented with unstable angina following a myocardial infarction. At cardiac catheterisation she had inferoapical dyskinesia, blocked right and circumflex arteries and an 80% stenosis of the left anterior descending artery. When free of angina, the ECG showed a Wolff‐Parkinson‐White (WPW) pattern consistent with a posterior free wall accessory pathway. However, during some episodes of angina at rest, she reverted to normal conduction and back again to the WPW pattern after the angina subsided with sublingual nitrate. The disappearance of the WPW pattern during angina can be explained by transient ischaemia blocking conduction in the accessory pathway.
MASSIVE UPPER GASTROINTESTINAL HAEMORRHAGE DUE TO INTRAGASTRIC RUPTURE OF A SPLENIC ARTERY ANEURYSM
Authors: Moawad M , Ray S , Joseph JV 
Published: April 2023

SUMMARYMost cases of splenic artery aneurysm are asymptomatic, being found incidentally at the time of investigations (e.g. ultrasound, computed tomography, angiography) or laparotomy for other conditions. Rupture of a splenic artery aneurysm with erosion into the stomach is a rare cause of massive upper gastrointestinal haemorrhage. This case report is, to our knowledge, only the second case of splenic artery aneurysm presenting with massive upper gastrointestinal haemorrhage due to erosion into the stomach in a nulliparous woman.
NEVER FORGET THE RISKS OF IMMUNOSUPPRESSION
Authors: Mackillop LH , O'Donnell J , Ayliffe W , Jayawardene SA 
Published: April 2023

SUMMARYIt has been widely reported in the literature that malignant neoplasms are a recognised complication of immunosuppression following organ transplantation. These days, immunosuppressive drugs are being used for many conditions outside the transplant setting. A case of a de novo astrocytoma in a patient on long‐term immunosuppression for psoriatic arthritis is described
ETHNIC DIFFERENCES IN PERIPHERAL VASCULAR DISEASE
Authors: Makin A , Silverman S , Lip GYH 
Published: April 2023

SUMMARYThe wide variation in the way coronary artery disease (CAD) affects different ethnic groups and the associated risk factor profiles of these groups have been extensively studied, but ethnic differences in the clinical manifestations of peripheral vascular disease (PVD) have been relatively neglected. The aim of the present review is to provide an overview of PVD in different ethnic groups and to explore possible pathophysiological factors accounting for these differences. Atherosclerotic PVD is generally less prevalent in Indo‐Asians and Afro‐Caribbeans than in Caucasians, despite the ‘classical’ risk factors being as prevalent, if not more so, suggesting the possibility of as yet unidentified risk factors in these groups. Angiographic and microscopic evidence suggests that patients of African or Afro‐Caribbean origin suffer from a different pattern of PVD, which primarily affects the distal arteries. In contrast, Indo‐Asians tend to suffer from thromboangiitis obliterans (Buerger's disease) far more frequently than other ethnic groups; thus, their arterial disease appears to present much earlier and with greater severity. However, if this sub‐category of patient is excluded, they seem to suffer much less from ‘simple’ atherosclerotic disease than their Caucasian counterparts. Despite a higher prevalence of diabetes among Indo‐Asians, the prevalence of intermittent claudication is considerably less in this ethnic group.
INVASIVE LOBULAR CARCINOMA OF THE BREAST PRESENTING SUCCESSIVELY WITH COLONIC AND GASTRIC METASTASES
Authors: Basu S , Last A , Shinkfield M 
Published: April 2023

SUMMARYInvolvement of the gastrointestinal tract by metastases from invasive lobular carcinoma of the breast is well recognised. We report a unique case where, four years after the initial management of the primary breast disease, the patient developed colonic metastases followed by a disease‐free interval of two years and then presented with gastric metastases. The patient responded successfully to first‐ and second‐line chemotherapeutic agents on both occasions and is currently being maintained on third‐line hormonal therapy.
18. GENETICS OF BREAST CANCER
Authors: Irving M , Elmslie F , Berg J 
Published: April 2023

SUMMARYIt is well known that breast cancer often occurs in clusters within families. This clustering can be attributed to mutations in the breast cancer susceptibility genes, BRCA1 and BRCA2, in 16% of familial cases. Women with a family history of breast cancer, in whom no mutation is identified, are still at increased risk of developing the disease. This review addresses methods for estimating and stratifying risk of developing breast cancer based on family history. It also indicates how to identify patients likely to carry mutations in BRCA1 or BRCA2 and gives recommendations for intervention for women with a family history of breast cancer.
SUMATRIPTAN NASAL SPRAY FOR MIGRAINE: A REVIEW OF STUDIES IN PATIENTS AGED 17 YEARS AND YOUNGER
Authors: Hämäläinen M , Jones M , Loftus J , Saiers J 
Published: April 2023

SUMMARYThis review considers the epidemiology, clinical manifestations and functional consequences of migraine in children and adolescents and surveys the studies establishing the efficacy and tolerability of sumatriptan nasal spray in this patient population. Although therapeutic advances in paediatric and adolescent migraine have lagged behind those in adult migraine, the first systematic studies of migraine medications in young patients have brought about progress in the past five years. These studies show that therapeutic approaches suitable for adult patients are not always applicable to paediatric and adolescent patients. Because of the unique characteristics of paediatric and adolescent migraine, it has been difficult to demonstrate in young patients the efficacy of oral sumatriptan and other triptan tablets, which are the medications of choice for adult migraine. With sumatriptan, this finding has proven to be a consequence of the form in which the drug was administered rather than the inherent properties of the drug. The availability of sumatriptan nasal spray allows the benefits of migraine‐specific therapy to be extended to children and adolescents. In both well‐controlled, single‐episode studies and long‐term, multiple‐episode studies, sumatriptan nasal spray has been effective and well tolerated for the acute treatment of migraine in children and adolescents. Except for unpleasant taste, which is not significantly distressing to patients, sumatriptan nasal spray has a tolerability profile similar to that of placebo in young patients.
MANAGEMENT OF HYPERTHYROIDISM IN TRINIDAD AND TOBAGO
Authors: Teelucksingh S , Akong J , Klijn C , Ramdass M , Naraynsingh V 
Published: April 2023

SUMMARYA questionnaire study of current practices regarding the investigation and treatment of hyperthyroidism was undertaken in Trinidad and Tobago between December 1999 and March 2000. The study evaluated the choice of laboratory tests requested and the therapeutic choices for a standard patient with hyperthyroidism. In addition, clinical scenarios based upon variations of the standard case (by altering age, gender, goitre size and duration of disease) were also tested. Two hundred and ninety‐six questionnaires were sent; 134 (45%) were returned, of which four were excluded for incomplete data. Ninety five per cent of respondents requested biochemical confirmation but the range of tests varied widely. Thyroid scintigraphy was requested by 36% and thyroid ultrasound by 35%. Medical treatment (75%) with antithyroid drugs was the most popular choice for treatment of the standard patient. This did not change significantly if the patient was male. On the other hand, radioiodine (62%) was more popular in the treatment of chronic/relapsing hyperthyroidism (p<0.005). In the elderly, medical management was still the most popular choice (57%) but the choice of radioiodine therapy was significantly increased compared with that in the standard patient (36% vs 19%) (p<0.005). In a young female with a large goitre and chronic disease, surgical intervention (61%) was the treatment of choice, especially among surgeons and general practitioners; radioiodine was chosen by 28% of respondents (mostly internists). There is need for clear guidelines in investigating thyroid disease but therapeutic choices are well informed and consistent with accepted practice elsewhere. In particular there is a fairly liberal attitude towards radioiodine use in hyperthyroidism.
FROM ADRENALINE TO FORMOTEROL: ADVANCES IN β‐AGONIST THERAPY IN THE TREATMENT OF ASTHMA
Authors: Campbell LM 
Published: April 2023

SUMMARYLong‐acting β2‐agonists (formoterol and salmeterol) represent the latest advance in a series of improvements in β2‐agonist asthma therapy since the introduction of isoprenaline. Traditional inhaled short‐acting β2‐agonists (salbutamol and terbutaline) provide rapid as‐needed symptom relief and short‐term prophylactic protection against bronchoconstriction induced by exercise or other stimuli. Where symptoms are not adequately controlled by corticosteroids alone, inhaled selective long‐acting β2‐agonists are used additionally for maintenance. Salmeterol and formoterol are well tolerated, provide effective long‐term symptom control and reduce the incidence of exacerbations; any development of tolerance or masking of underlying inflammation with continual use does not appear to be clinically relevant. Formoterol is both rapid acting (as fast as salbutamol) and long acting (similar to salmeterol). Increasing clinical evidence suggests that inhaled formoterol is a convenient and well‐tolerated treatment that is effective both for regular maintenance and as‐needed relief of symptoms.
FOLK REMEDIES STILL IN USE: A CASE OF SOFT PALATE AND UVULAR OEDEMA DUE TO ECBALIUM ELATERIUM
Authors: Koussidis GA , Mountantonakis S , Petrichou CC 
Published: April 2023

SUMMARYA case of soft palate and uvular oedema due to nasal administration of juice produced from the fruit of the plant Ecbalium elaterium, widely known as squirting cucumber, is presented. The patient recovered after administration of subcutaneous adrenaline and methylprednisolone. Cucurbitacins have been implicated in the past as toxic constituents of plants from the Cucurbitaceae family. Either an allergic reaction or a direct toxic effect of the constituents is responsible for the occurrence. A few similar cases have been reported, mostly in eastern Mediterranean countries.
TWIN REVERSED ARTERIAL PERFUSION (TRAP) SYNDROME
Authors: Sen S , Esen UI , Sturgiss SN 
Published: April 2023

SUMMARYTwin reversed arterial perfusion (TRAP) syndrome is an extremely rare manifestation of feto‐fetal transfusion syndrome. This condition is seen in monozygotic twin pregnancies, where the affected twin is perfused retrogradely by the healthy twin. The affected twin presents with bizarre malformations such as acardia and acephalus. We present such a case, which was diagnosed prenatally. The pregnancy progressed uneventfully to term.
Defect mechanisms, oxygen vacancy trapping ability in rare‐earth doped BaTiO3 from first‐principles and thermodynamics
Authors: Cheng Xu , Zhen YiChao , Zhao Peiyao , Hui Kezhen , Xiao Mengjian , Guo Limin , Fu Zhenxiao , Cao Xiuhua , Li Longtu , Wang Xiaohui 
Published: April 2023

AbstractThe defect mechanisms of rare earth (RE) doped BaTiO3 have a strong impact on the electrical performance of the multilayer ceramics capacitors (MLCCs). Oxygen vacancy is the main reason for the device degradation over longtime use, while the effect of the doping strategy on controlling the oxygen vacancies is not yet quantitatively understood. In this work, the grand canonical thermodynamic defect model based on first‐principle calculations is applied to evaluate the defect mechanism of RE‐doped BaTiO3 under practical experimental condition. The charge compensation and prior site occupancy of RE are found not only associated with ionic size but also exhibit transitions with oxygen partial pressure and doping concentration. Furthermore, the oxygen vacancy trapping ability of RE ions is evaluated from the perspectives of thermodynamics and kinetics. The migration barrier among first nearest oxygen sites dramatically changed depending on the RE site occupancy. The large trapping ability is contributed by the relatively large negative binding energy of the defect complex and comparable RE concentrations substituted on Ba and Ti sites. The two conditions can be achieved in amphoteric ions doped systems, while in pure donor doped BT only one of these conditions can be satisfied. Although the self‐compensated defect complexes exhibit the highest binding energy, the trapping ability contributed by different defect complexes (, , REBa − RETi) is generally comparable in these systems. This feature of amphoteric RE ions accounts for the improvement of the lifetime and reliability of MLCCs.
In search of operational resilience: How and when improvisation matters
Authors: Essuman Dominic , Ataburo Henry , Boso Nathaniel , Anin Emmanuel Kwabena , Appiah Listowel Owusu 
Published: May 2023

AbstractThe need to improvise during supply chain disruptions to enhance operational resilience is ever more critical. Yet, managers appear to lack an understanding of how and when improvisation matters. We apply the conservation of resources theory to conceptualize how firms activate spontaneous and creative improvisation during supply chain disruptions and theorize how that relates to operational resilience in low and high supply chain disruption conditions. We test our arguments on primary data from a sample of 259 firms in Ghana. We find that creative improvisation has a positive relationship with operational resilience, and this relationship is stronger in high supply chain disruption conditions. Spontaneous improvisation, on the contrary, is unrelated to operational resilience in both low and high supply chain disruption conditions. These findings indicate that not all types of improvisation contribute to operational resilience, suggesting the need for a nuanced approach to theorizing and applying the improvisation concept in supply chains.