bluuebunny/crossref_metadata_2025_split huggingface dataset:
IDEAL PAIN RELIEF FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Johnson RC , Hedges AR , Morris R , Stamatakis JD 
Published: April 2023

SUMMARYIn a previous report the effectiveness of intraperitoneal bupivacaine in reducing pain following laparoscopic cholecystectomy was demonstrated. Other methods of pain relief are commonly used but none has been compared following laparoscopic cholecystectomy. In two further studies we have compared the analgesic effect of intraperitoneal bupivacaine against wound infiltration with bupivacaine, and against intraperitoneal bupivacaine with the addition of a non‐steroidal anti‐inflammatory drug (NSAID) in patients undergoing laparoscopic cholecystectomy. Two consecutive studies were performed. In the first, patients in group 1 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity; patients in group 2 were given 20 ml of 0.25% bupivacaine injected into the trocar wounds. In the second study, patients in group 1 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity; patients in group 2 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity and a diclofenac suppository (100 mg) one hour before surgery. Postoperative pain was assessed with a visual analogue pain scale. There was no difference in pain scores in the two groups in either study. Intraperitoneal bupivacaine is as effective as wound infiltration. The addition of an NSAID makes no difference in the reduction of postoperative pain following laparoscopic cholecystectomy.
A COST MINIMISATION ANALYSIS OF CARDIAC FAILURE TREATMENT IN THE UK USING CIBIS TRIAL DATA
Authors: Malek M , Cunningham‐Davis J , Malek L , Paschen B , Tavakoli M , Zabihollah M , Davey P 
Published: April 2023

SUMMARYThe clinical benefits of beta‐blockers in heart failure are currently subject to intense debate and are being investigated. The economic impact of beta‐blockade, however, has largely remained unexplored. The Cardiac Insufficiency Bisoprolol Study (CIBIS), while failing to show statistically significant reduction in mortality over conventional therapy, demonstrates that the administration of bisoprolol adjuvant to standard therapy leads to a significant reduction in hospital admission. The present study is a cost minimisation analysis based on CIBIS data for the UK and is restricted to direct costs only. The costs of bisoprolol medication and inpatient treatment of heart failure are considered. The ‘base case’ analysis and the sensitivity analyses carried on all cosidriver parameters show that administering bisoprolol to heart failure patients adjuvantly to the standard therapy is at least cost neutral. Additional drug costs incurred by bisoprolol are compensated by the inpatient treatment costs of heart failure avoided. All other non‐quantifiable clinical benefits such as improvement of New York Heart Association functional class are positive extras to patients and the National Health Service.
HANDLING AND ACCEPTABILITY OF THE EASI‐BREATHE DEVICE COMPARED WITH A CONVENTIONAL METERED DOSE INHALER BY PATIENTS AND PRACTICE NURSES
Authors: Price DB , Pearce L , Powell SR , Shirley J , Sayers MK 
Published: April 2023

SUMMARYThis study compared the handling and acceptability of the Easi‐BreatheTM, a breath‐actuated metered dose inhaler (MDI), with that of a conventional MDI. A total of 104 patients and 14 practice nurses took part in interviews at a central location. An additional 100 practice nurses were interviewed in a telephone study. Significantly more patients (86%) found Easi‐Breathe easier than a conventional MDI to use correctly (p<0.001). Overall, more patients preferred Easi‐Breathe (82% vs 18%; p<0.001), ease of use and confidence in successful dose delivery being the main reasons for their preference. Nurses thought that Easi‐Breathe was easier for the vast majority of patients (97%) to use correctly, as well as being easier to teach and to use correctly in a crisis (p<0.001). Overall, 79% of nurses preferred the Easi‐Breathe to the conventional MDI (p<0.001), ease of use and ease of teaching being the main reasons for their preference.
RECENT ADVANCES IN THE NON‐SURGICAL MANAGEMENT OF ATRIAL FIBRILLATION
Authors: Kamalvand K , Sulke N 
Published: April 2023

SUMMARYAtrial fibrillation is the commonest clinical arrhythmia, and is associated with significant morbidity and mortality. The treatment of choice is to restore and maintain sinus rhythm. Although certain antiarrhythmic drugs are more effective than placebo in maintaining sinus rhythm, recurrence of atrial fibrillation post cardioversion remains common. The use of antiarrhythmic drugs can be associated with serious adverse effects due to their negative inotropic and proarrhythmic effects. Radiofrequency ablation of the AV junction is a safe and effective palliative treatment option in patients who have failed drug therapy. Ventricular rate control without the need for permanent pacing can be achieved by AV nodal modification using radiofrequency energy. There is also interest in the role of catheter ablation as a possible curative procedure for atrial fibrillation. Atrial pacing can reduce the incidence of atrial fibrillation in certain subgroups of patients. Finally, low energy intracardiac atrial defibrillation has been shown to be feasible in humans.
EFAVIRENZ IN THE MANAGEMENT OF HIV INFECTION
Authors: Gazzard BG 
Published: April 2023

SUMMARYEfavirenz, which is likely to be licensed in the UK and throughout Europe shortly, represents a major advance in the treatment of HIV infection. It belongs to the non‐nucleoside reverse transcriptase (NNRTI) class of drugs and, as such, it should only be prescribed with other potent therapies to avoid the development of resistance. However, in the pivotal head‐to‐head comparison of efavirenz with lamivudine and zidovudine, treatment over a 24‐week period proved superior to treatment with a standard regimen containing indinavir. The results from prolonged follow‐up of this study are eagerly awaited but it is clear that a combination of efavirenz with nucleoside analogues provides a potent proteinase inhibitor‐sparing regimen which may have less toxicity. Additional data also indicate that the combination of a proteinase inhibitor (indinavir) with efavirenz provides an extremely potent regimen which is well tolerated and produces complete inhibition of plasma HIV viraemia over prolonged periods of follow‐up. In common with many other currently available potent anti‐HIV therapies, the optimum use of this drug is being determined by ongoing clinical studies but it is clear that ease of administration (once‐daily), freedom from serious side‐effects and potency when used in combination are likely to represent a very considerable advance in the management of HIV infection.
NISOLDIPINE COAT‐CORE AND HEART RATE RESPONSE DURING TREATMENT OF HYPERTENSION
Authors: Zannad F 
Published: April 2023

SUMMARYNisoldipine coat‐core (nisoldipine CC), an extended‐release once‐daily formulation, is an effective treatment for mild‐to‐moderate hypertension, providing sustained blood pressure control over the 24‐hour dosing interval. Nisoldipine CC is highly vascular selective. It causes neither reflex tachycardia nor symptomatic bradycardia; it lacks significant negative inotropy at therapeutic doses; and it does not affect circadian variation in blood pressure or heart rate. Data suggest that the lack of reflex sympathetic activation in response to the blood pressure‐lowering effect of nisoldipine CC is due to the smooth onset of action of nisoldipine CC, causing resetting of the baroflex. The neutral heart rate profile of nisoldipine CC confers potential therapeutic advantages over several other calcium channel blockers, in particular, the short‐acting agents, in the treatment of hypertension.
MYOMECTOMY IN PREGNANCY: INCARCERATED PEDUNCULATED FIBROID IN AN UMBILICAL HERNIA SAC
Authors: Ehigiegba AE , Selo‐Ojeme DO 
Published: April 2023

SUMMARYWe describe a rare case of a 31‐year‐old woman at 28 weeks of pregnancy presenting with an incarcerated pedunculated fibroid in an umbilical hernia sac. She had a successful myomectomy and hernia repair and proceeded to have spontaneous vaginal delivery at term. Incarceration of a pedunculated fibroid presents a diagnostic puzzle which can be successfully treated by myomectomy.
TELEPHONE FOLLOW‐UP OF RELATIVES AFTER SUDDEN DEATH: A SURVEY OF RELATIVES' VIEWS
Authors: Stone G , Huggon A‐M , Nayeem N 
Published: April 2023

SUMMARYThe report of the Working Group on Bereavement Care in A&E departments recommended both the provision of follow‐up for relatives and the audit of bereavement care as examples of good practice. In our adult A&E department follow‐up contact is made by support workers, who have often been involved with the family at the time of death, making telephone contact four to five days later. This paper describes the role of the support workers and the results of a questionnaire sent to relatives to seek their views on this telephone follow up. In a six‐month period 98 families had relatives who died in A&E; 38 (39%) of them returned completed questionnaires. The telephone call was thought to be helpful by 37 (97%) of the respondents. The commonest reasons given were: ‘It showed you cared’ (95%) and 'It enabled me to ask questions' (46%). We have found that the experience and, more importantly, availability of the support workers allows a level of consistency and continuity in follow‐up care which can otherwise be difficult to achieve.
ATRIAL FIBRILLATION, THROMBOEMBOLISM AND ANTITHROMBOTIC THERAPY
Authors: Li‐Saw‐Hee FL , Lip GYH 
Published: April 2023

SUMMARYAtrial fibrillation is the commonest sustained disorder of cardiac rhythm and is associated with increased risk of stroke and thromboembolic events. Warfarin (dose‐adjusted to a target INR of 2.0‐3.0) has been well established to reduce this risk of stroke by 68% (95% CI 50‐79%), while aspirin provides a risk reduction of 21% (95% CI 0‐38%). Nevertheless, warfarin confers a risk of bleeding and the inconvenience of regular monitoring checks, while aspirin seems effective only for certain low‐risk subgroups. Thus there have been strenuous efforts to improve thromboprophylaxis in atrial fibrillation, by using low‐intensity anticoagulation regimens, combination antiplatelet therapy and refinement of risk stratification strategies. Attempts at using a low‐intensity, fixed‐dose warfarin regimen have, however, been disappointing. For now, a strategy of risk stratification should be adopted to identify highest risk patients with atrial fibrillation who would benefit from anticoagulation.
EVIDENCE‐BASED MEDICINE AND OSTEOPOROSIS: A COMPARISON OF FRACTURE RISK REDUCTION DATA FROM OSTEOPOROSIS RANDOMISED CLINICAL TRIALS
Authors: Meunier PJ 
Published: April 2023

SUMMARYThe goal of osteoporosis therapy is to prevent fractures, and many therapies are available for this disease. Regarding proven fracture benefit, however, the quality of the randomised clinical trial evidence varies substantially among therapies. The purpose of this paper is, therefore, to review the published osteoporosis randomised clinical trial literature and to assess the quality of the evidence. Although more than 35 randomised trials for different therapies were reviewed, only alendronate and vitamin D plus calcium have clearly demonstrated a fracture benefit, with alendronate providing the greatest relative risk reduction. Quality clinical trial fracture data for calcitonin, etidronate, fluoride, hormone replacement therapy, parathyroid hormone, calcitriol (and other vitamin D preparations), vitamin D and calcium monotherapy, and selective oestrogen receptor modulators are either lacking or inconclusive or published only as abstracts.
UNILATERAL ADRENAL MEDULLARY HYPERPLASIA: ANOTHER FORM OF CURABLE HYPERTENSION?
Authors: Bailey J , Vanherle AJ , Giuliano A , Schröder S 
Published: April 2023

SUMMARYA case of unilateral adrenal medullary hyperplasia is presented in a 49‐year‐old caucasian female without multiple endocrine neoplasia association. The patient presented with episodic hypertension and paroxysms suggesting an underlying phaeochromocytoma. Biochemical supported this diagnosis but no discrete tumour was found on preoperative localising studies or at the time of surgery. The patient underwent a unilateral adrenalectomy with confirming adrenal medullary hyperplasia with complete resolution of her symptoms for six months.
PREDICTORS FOR EXTRAINTESTINAL INFECTION OF NON‐TYPHOIDAL SALMONELLA IN PATIENTS WITHOUT AIDS
Authors: Chiu CH , Lin TY , Ou JT 
Published: April 2023

SUMMARYTo identify the risks and predictors for extraintestinal infection (EII) in patients with non‐typhoidal salmonellosis, we undertook a study of 398 patients with cultures positive for non‐typhoidal Salmonella seen at Chang Gung Memorial Hospital and Chang Gung Children's Hospital between November 1993 and October 1994. Salmonella choleraesuis was the most invasive serotype observed. S. panama, S. typhimurium and S. schwarzengrund were the commonest causes of EII among those serotypes usually causing gastroenteritis. Pre‐existing underlying disease, particularly immunosuppressive disease, was the most important risk factor that may have predisposed adult patients to have EII. Old age (≥60 years) and isolation of invasive serotypes were also frequently associated with EII in adult patients. The characteristics of paediatric patients with a high probability of having EII were: <3 years of age, abnormal blood test results (a leucocyte count ≥15,0007mm3 or <5000/mm3, immature leucocytes ≥10% of total leucocytes, and a C‐reactive protein concentration ≥50 mg/l); and isolation of invasive serotypes. This information can be an aid to early diagnosis and treatment of EII caused by non‐typhoidal Salmonella.
THE EFFICACY AND SAFETY OF TELMISARTAN COMPARED TO ENALAPRIL IN PATIENTS WITH SEVERE HYPERTENSION
Authors: Neutel JM , Smith DHG , Reilly PA 
Published: April 2023

SUMMARYThis 8‐week, open‐label study compared the efficacy and safety of once‐daily telmisartan, either alone or in combination with hydrochlorothiazide (HCTZ) and amlodipine, with a similar enalapril regimen in patients with severe hypertension. Clinically relevant reductions in supine systolic blood pressure/DBP were observed with telmisartan (14.6/13.2 mmHg) and enalapril (13.0/12.9 mmHg) monotherapy. Incremental reductions were seen with up‐titration of monotherapy (telmisartan 8.1/7.4 and enalapril 9.2/7.7 mmHg), and the addition of HCTZ (telmisartan 14.9/8.7 and enalapril 8.0/6.7 mmHg), and amlodipine (telmisartan 8.0/6.5 and enalapril 10.5/6.4). After 8 weeks of treatment, supine DBP control was achieved in 55% and 35% of the patients on the telmisartan and enalapril regimens, respectively. Both treatment regimens were well tolerated. Telmisartan, a new angiotensin receptor blocker, is a safe and effective drug to use in combination for the treatment of patients with severe hypertension and proved at least as effective as the enalapril combination.
A SURVEY OF PATIENT SATISFACTION AFTER DAY CASE SURGERY
Authors: Wong LS , Kaukuntla HK , Lam FT , Fraser IA 
Published: April 2023

SUMMARYA prospective survey of patients attending day case surgery was undertaken to determine patient satisfaction. In an eight‐week prospective study, patients undergoing procedures in the day surgical unit were asked to fill in two questionnaires, the first before surgery and the second two weeks after surgery. One hundred and eighty‐nine patients were recruited into the study; of these, 98 (52.4%) returned correctly completed forms. Most of the patients believed the information given them before surgery was adequate and the standard of care in the day unit was high. Only five patients needed to see their general practitioner because of continued problems. Twenty‐one patients felt they were discharged too early. Our current practice in day case surgery inevitably leads to some patients being discharged early. Facilities must be provided for some patients to stay longer in the day unit. Day case surgery did not result in an unacceptable increase in the workload for GPs, nor did it compromise the quality of patient care.
MANAGEMENT OF WOMEN WITH A FAMILY HISTORY OF BREAST CANCER
Authors: Curry P , Fentiman IS 
Published: April 2023

SUMMARYFive to ten per cent of breast cancer results from an inherited germ line mutation. The main susceptibility genes are BRCA1 and BRCA2, but others include Cowden's disease, Li Fraumeni syndrome and ataxia‐telangiectasia. For those with BRCA1 or BRCA2 mutations the lifetime probability of breast cancer is between 0.40 and 0.73. Genetic testing needs to be offered to young women with breast cancer before considering testing their relatives. The efficacy of surveillance in women with genetic susceptibility has yet to be proved. The value of tamoxifen as a preventive agent in women with genetic susceptibility has yet to be confirmed. Prophylactic bilateral mastectomy will probably reduce the risk of breast cancer but this may not be absolute because of the difficulty of removing all breast tissue. New approaches may enable the selective destruction of mammary epithelium without disturbance to breast architecture.
A SUSTAINED RELEASE FORMULATION OF ISOSORBIDE‐5‐MONONITRATE WITH A RAPID ONSET OF ACTION
Authors: Arthur RMF , Mehmel H 
Published: April 2023

SUMMARYThe clinical efficacy of a combined immediate‐release and sustained‐release preparation of isosorbide‐5‐mononitrate for angina pectoris is observed within a few minutes of administration. The preparation reduces the number of silent and painful ischaemic episodes and increases work and exercise capacity. The pharmacokinetic profiles accord with the circadian variation in cardiovascular disease. Drug levels fall significantly at night and tolerance to the haemodynamic and antianginal effects is not seen. Once‐daily administration is appreciated by patients. The preparation also shows promise in treating heart failure.
5‐FLUOROURACIL‐INDUCED ERYTHEMA MULTIFORME
Authors: Lo SK , Yip D , Leslie M , Harper P 
Published: April 2023

SUMMARYErythema multiforme is an immunologically mediated skin reaction to a foreign antigen and can occur with many drugs. We report the first two cases of erythema multiforme induced by 5‐fluorouracil (5‐FU). The first case was in a man with inoperable gastric carcinoma being treated by continual infusion who developed the classic rash involving the neck and upper chest, along with mouth ulceration and plantar‐palmar erythrodysaesthesia. Histological confirmation was made by skin biopsy and the lesions resolved spontaneously. They recurred on restarting 5‐FU. The second case was in a woman being given adjuvant bolus 5‐FU and folinic acid for Duke's C colon cancer who developed the rash during the first cycle. Again, the lesions settled spontaneously but recurred more severely on the second cycle. When treatment was changed to the specific thymidylate synthase inhibitor, raltitrexed, the course was completed uneventfully.
LEFT‐SIDED HEPATIC HYDROTHORAX WITH ASCITES
Authors: Alagiakrishnan K , Patel PJ 
Published: April 2023

SUMMARYHydrothorax has long been recognised as a complication of cirrhosis, but It is seen in only a few patients, mostly on the right side. We report an unusual case of massive left‐sided hydrothorax complicating cirrhosis with ascites, where pleuro‐peritoneal communication was demonstrated on the left side by radionuclide scanning.
PERCUTANEOUS ETHANOL INJECTION THERAPY IN 47 CIRRHOTIC PATIENTS WITH HEPATOCELLULAR CARCINOMA 5 CM OR LESS: A LONG‐TERM RESULT
Authors: Lin SM , Lin D‐Y , Lin C‐J 
Published: April 2023

SUMMARYTo elucidate the long‐term results of percutaneous ethanol injection (PEI) for hepatocellular carcinoma (HCC), 47 cirrhotic patients with HCC ≤5 cm after PEI were analysed. Thirty‐two of the patients were male. The age range was 37‐68 years. Thirty‐nine patients were seropositive either for hepatitis B surface antigen or antihepatitis C virus antibody. There were a total of 61 tumours, including solitary tumours in 35 patients, double tumours in 10 and triple tumours in two. The size of the main tumour was ≤3 cm in 29 patients and more than 3 cm in 18 patients. Seventeen, 27 and three patients were in Child's class A, B and C respectively; 5‐10 ml 95% ethanol was injected into the tumour every three to seven days until the echogenicity of the tumour changed to a hyperechoic or heterogeneous one. A booster PEI was given in 34 (56%) lesions with viable tumour, which was detected by dynamic computed tomography. The one, two, three and and four‐year survival rates were 85%, 75%, 61% and 39% respectively for all patients. Good liver reserve significantly improved the survival rate (p<0.01, Child's class A and B vs Child's class C). The one, two, three and four‐year recurrence rates were 24%, 55%, 69% and 79% for all patients. HCC recurred more frequently in patients with multiple tumours (p<0.02).
TRANSPORT AND LOCALISATION OF m‐THPC IN VITRO
Authors: Kessel D 
Published: April 2023

SUMMARYThe hydrophobic photosensitising agent meta‐tetrahydroxyphenylchlorin (m‐THPC) must be formulated with an appropriate vehicle before administration. Studies were carried out with murine leukaemia cells in vitro to assess the role of formulation in drug pharmacokinetics. The rate‐limiting step in m‐THPC accumulation was the slow conversion of drug aggregates to monomers upon dilution into growth media. Only non‐viable cells with damaged membranes showed a rapid drug uptake, otherwise m‐THPC accumulation was a slow process. It was found that m‐THPC was localised mainly at mitochondrial loci. Subsequent irradiation resulted in the release of cytochrome c into the cytosol, triggering a rapid activation of caspase‐3, which led to an apoptotic response. Plasma distribution of m‐THPC involved binding to lipoprotein species, with only a slight appearance of the drug in the albumin fraction.
A COMPARISON OF VALSARTAN AND CAPTOPRIL IN PATIENTS WITH ESSENTIAL HYPERTENSION IN INDONESIA
Authors: Prabowo P , Arwanto A , Soemantri D , Sukandar E , Suprihadi H , Parsudi I , Sulaiman Markum M , Kabo P , Atmoko R , Prodjosudjadi W 
Published: April 2023

SUMMARYAdult Indonesian outpatients were randomised to receive either valsartan 80 mg once daily or captopril 25 mg twice daily for 8 weeks. The main criterion for tolerability was the incidence of adverse events. The primary efficacy variable was the change in mean sitting diastolic blood pressure (SDBP) from baseline to endpoint. No valsartan patients experienced dry cough, which was reported by 22 captopril patients (21.6%). Both drugs reduced mean SDBP and SSBP, with a trend in favour of valsartan. The percentage of valsartan patients whose BP normalised was higher than in captopril patiente at week 4 (37% and 22%) and week 8 (45% and 34%), the difference being statistically significant at week 4 (p<0.05). Valsartan 80 mg once daily is as effective as captopril 25 mg twice daily in reducing blood pressure in Indonesian patiente, and has a better tolerability profile in respect of dry cough.
ATRIAL FIBRILLATION IN A GENERAL HOSPITAL: HOW WELL ARE WE DOING?
Authors: Bhattacharyya A , Sharma SC 
Published: April 2023

SUMMARYAtrial fibrillation (AF) is an important risk factor for ischaemic stroke, and anticoagulation is now indicated in many patients, particularly those with congestive cardiac failure, hypertension, a history of transient ischaemic attacks or embolic stroke. In a retrospective study (and audit), we examined 280 cases of AF (acute, paroxysmal non‐sustained and chronic sustained) admitted to a general hospital in the UK. The commonest underlying medical condition was ischaemic heart disease (57%), while the commonest presenting feature was congestive cardiac failure (60%). Pharmacological cardioversion was preferred against electrical cardioversion for reverting to sinus rhythm. Fifty‐six patients (20%) received warfarin, 55 patients (20%) were on aspirin, and the remaining 169 (60%) received neither warfarin nor aspirin. More awareness is needed among physicians managing AF particularly in relation to anticoagulation.