bluuebunny/crossref_metadata_2025_split huggingface dataset:
RESEARCH AND THE PROBLEMS OF LITTER AND MEDICAL WASTES ON THE UK COASTLINE
Authors: Philipp R , Pond K , Rees G 
Published: April 2023

SUMMARYRecent research has shown that recreational water and bathing beach quality are associated with injury, infection and personal well‐being. Continued surveillance is essential to audit the environmental and associated health trends. In the Coastwatch UK project and since 1989, annual surveys each autumn have been undertaken during a two‐week study period, into the extent of littering of the UK coastline. The Public Health Laboratory Service also collects data on the use of hepatitis B immunoglobulin. In these studies it is now possible to examine time trends. The findings are not reassuring. They help to justify present concern about the health effects of discarded litter and medical waste and fears that environmental degradation could lead to loss of income from tourism. In response, some health and local authorities have started public education programmes, supplying litter bins on or near bathing beaches, emptying them regularly and undertaking beach cleansing during the summer months. The UK government is also introducing new legislation that will require 6 mm fine mesh wire screens on all shore‐based sewage outlets around the UK coastline. Continued monitoring is needed to assess the effectiveness of these interventions. The need for greater personal responsibility is particularly identified.
REACTIVE ARTHRITIS: IS IT A USEFUL CONCEPT?
Authors: Beutler AM , Schumacher HR 
Published: April 2023

SUMMARYReactive arthritis (ReA) is one of the most common arthritides affecting young adults. In most cases it follows urogenital or enteric bacterial infection, but its pathogenesis is not fully understood. It is generally considered a sterile arthritis which appears to involve immune response to bacterial organisms and genetic host susceptibility associated with the presence of HLA‐B27 antigen. New findings suggest that in some ReA cases, viable bacteria are present inside the joints, and these organisms may cause the disease and trigger the inflammatory response. ReA manifests clinically as a rheumatoid factor negative oligoarthritis associated with enthesopathy and certain mucosal and skin lesions. Laboratory findings in ReA are non‐specific. Although concepts of its pathogenesis are still evolving, so‐called ReA remains an important condition to be distinguished from rheumatoid arthritis. Prognosis is generally better. Treatments with known effects in some cases include non‐steroidal antiinflammatory drugs, intra‐articular corticosteroids, oral tetracyclines and sulphasalazine. The occasional chronic and severe ReA may be very difficult to treat.
PLACENTAL CHORIOANGIOMA: A CASE REPORT AND LITERATURE REVIEW
Authors: Esen UI , Orife SU , Pollard K 
Published: April 2023

SUMMARYWe report on a large asymptomatic placental chorioangioma, identified as an area of reduced echogenicity on ultrasound at 36 weeks' gestation. Despite the large size, it was not associated with the usual maternal or fetal complications expected with a chorioangioma of that size, possibly because of thrombosis and tumour degeneration.
SCHISTOSOMIASIS OF THE APPENDIX IN THE UK
Authors: Jones HJS , Ibrahim AEK , Deroda JK 
Published: April 2023

SUMMARYSchistosomiasis is endemic in many parts of the world but is rare in the UK. It usually affects the bladder or intestine, resulting in bleeding and fibrosis. However, schistosomal eggs are frequently found in the appendix and these can be symptomatic. The present case describes appendiceal infestation accompanied by acute appendicitis.
TUMOUR PRESENTING AS A RETROSTERNAL ABSCESS FOLLOWING MEDIAN STERNOTOMY
Authors: Martin IR , Jowett NI 
Published: April 2023

SUMMARYA 73‐year‐old lady, who underwent coronary artery bypass grafting eight months previously, presented with rigors and chest pain. The upper sternum was tender, swollen and erythematous, suggesting a retrosternal abscess. Radiological investigation supported the clinical diagnosis. Local infections following median sternotomy are uncommon, most being early and superficial. Late infections are very uncommon, and should suggest alternative pathology. Following open surgical drainage, histology showed the mass to be a poorly differentiated adenocarcinoma. The primary tumour was never found.
CEREBRAL VENOUS THROMBOSIS OCCURRING DURING AN ECTOPIC PREGNANCY AND COMPLICATED BY INTRACRANIAL HYPERTENSION
Authors: McDonnell GV , Patterson VH , Mckinstry S 
Published: April 2023

SUMMARYThrombosis of the cerebral dural sinuses and veins has been described since the early 19th century.1,2 Clinically the process is characterised by diverse symptomatology and physical findings and in spite of advances in diagnostic radiological techniques it remains an under‐recognised condition. It has been most commonly associated with sepsis, trauma, pregnancy, the puerperium and many other hypercoagulable states. We describe an apparently unique case of sagittal sinus thrombosis occurring during an ectopic pregnancy. This was subsequently complicated by intracranial hypertension in spite of clinical improvement and magnetic resonance imaging (MRI) evidence suggesting a return of venous patency. The clinical presentation, radiological features and management is discussed.
SELF‐EXPANDABLE OESOPHAGEAL STENTS IN THE MANAGEMENT OF BENIGN PEPTIC OESOPHAGEAL STRICTURES IN THE ELDERLY
Authors: Foster  
Published: April 2023

SUMMARYSelf‐expandable oesophageal stents are being increasingly used in the management of malignant oesophageal strictures. Most benign peptic oesophageal strictures can be successfully managed using endoscopic oesophageal dilatation combined with long‐term Proton pump inhibition therapy. Although endoscopic oesophageal dilatation can be performed on an outpatient basis, it often requires repeated hospital visits. There is a small risk of oesophageal perforation, while cardiorespiratory complications may be encountered during the use of intravenous sedation in an elderly population. The use of self‐expandable Strecker stents in three elderly patients with benign peptic oesophageal strictures is described.
LONG‐TERM POTASSIUM SUPPLEMENTATION LOWERS BLOOD PRESSURE IN ELDERLY HYPERTENSIVE SUBJECTS
Authors: Fotherby MD , Potter JF 
Published: April 2023

SUMMARYFollowing a randomised cross‐over trial of the effect of a four‐week 60 mmol/day potassium supplement versus placebo on blood pressure (BP), eight of the original 18 hypertensive subjects continued with a 48 mmol daily potassium supplement for four months. For these eight subjects 24‐h potassium excretion during placebo, one month of 60 mmol and four months of 48 mmol daily potassium supplementation phases was 56 ± 23, 102 ± 28 and 90 ± 35 mmol/24 hours, respectively, and mean 24‐h BP following each phase was 160 ± 16/89 + 11, 147 ± 13/83 ± 12 and 145 ± 14/81 ± 9 mmHg respectively, a significant fall in mean 24‐h SBP between four months of potassium supplement and placebo period of 15 ± 13 mmHg (95% CI: 4, 26 mmHg, p=0.02), although the fall in 24‐h DBP was not significant (8 ± 11 mmHg, 95% CI: 0, 17 mmHg, p=0.08). Modest increases in dietary potassium intake could have significant effects on lowering BP in the large proportion of elderly subjects with hypertension.
IMMUNE MODULATION AND SEPSIS
Authors: Karzai W , Reinhart K 
Published: April 2023

SUMMARYThe pathogenesis of sepsis involves not only microbial toxins but also activated host inflammatory mediators. Therefore, besides conventional antibiotic or surgical treatment of infection and supportive intensive therapy, modulating host inflammatory mediators as a conjunctive therapeutic option has been explored in the past decade. Although successful in animal models of sepsis, inhibiting host inflammatory response in human sepsis has failed to improve survival or otherwise show efficacy. Studies are needed which better describe the circumstances under which these therapies may ultimately prove successful.
CONTROVERSY AND CONSENSUS IN THE MANAGEMENT OF UPPER GASTROINTESTINAL DISEASE IN PRIMARY CARE
Authors: Whitaker MJ , Brun J , Carelli F ,   International Gastro Primary Care Group
Published: April 2023

SUMMARYApproximately 5% of all primary care consultations in the UK are for upper gastrointestinal (GI) diseases, the most common of which is dyspepsia, with a prevalence of between 25 and 50% in the western world. The exact definition of dyspepsia is elusive, which has resulted in confusion about diagnosis and treatment, highlighting the need for management guidelines. The International Gastro Primary Care Groups (IGPCG) has developed, by consensus, practical guidelines to help GPs manage patients with upper GI symptoms. After a detailed history is taken, alarm symptoms identified and organic disease excluded, the predominant symptom should be identified. This strategy, as outlined in the IGPCG upper GI disease management plan, can help the GP in the selection of the most appropriate treatment for each patient. This plan is flexible enough to be used in a wide variety of healthcare systems and will evolve as new evidence becomes available.
KOCH'S OR CROHN'S?
Authors: Kapoor VK 
Published: April 2023

SUMMARYAbdominal tuberculosis is not uncommon in the UK, especially in Asian immigrants. It resembles Crohn's disease clinically and radiologically, and it may be difficult to differentiate between them, even at laparotomy or histology. The distinction is important, however, for proper management of the two conditions. Every effort must be made to exclude abdominal tuberculosis before the patient is diagnosed as having Crohn's disease and is treated with steroids.
SPONTANEOUS REGRESSION OF CANCER OR MISDIAGNOSIS? FOUR CASE REPORTS
Authors: Charlton RC 
Published: April 2023

SUMMARYFour case reports regarding possible spontaneous regression of cancer are given. This is a rare but previously documented occurrence, with the literature suggesting possible causal factors for cancer regression or an indefinite period of dormancy. These include genetic, hormonal, immunological and psychological factors. However, the literature makes no reference to potential misdiagnosis, either clinically or histologically. The effect of being diagnosed as having terminal cancer is profound and even after regression or resolution of the disease, there are inevitable psychological sequelae.
RUPTURED HEPATOMA PRESENTING WITH PERITONITIS AND ACUTE LACTIC ACIDOSIS
Authors: Kelly J , Al‐Fallouji M 
Published: April 2023

SUMMARYA case is reported in which a large hepatoma presented with rupture and acute severe lactic acidosis. Spontaneous rupture is a rare but recognised mode of presentation of hepatoma. Malignancy has also occasionally been associated with acute lactic acidosis, though the association with hepatoma has not previously been reported.
NEW PATIENTS PRESENTING TO THEIR GP WITH DYSPEPSIA: DOES HELICOBACTER PYLORI ERADICATION MINIMISE THE COST OF MANAGING THESE PATIENTS?
Authors: McIntyre A‐M , Macgregor S , Malek M , Dunbar JA , Hamley JG , Cromarty JA 
Published: April 2023

SUMMARYFifty‐seven patients newly presenting to their GP with dyspepsia agreed to take part in a pharmacist‐led clinic which tested and treated for Helicobacter pylori. Of these patients, 63% (36/57) tested positive and received eradication therapy. For 78% (28/36), eradication was successful with the first course of treatment, 89% (25/28) remaining symptom‐free over the six‐month follow‐up. Eradication was successful for a further 17% (6/36) after a second attempt; again, these patients remained free of symptoms over the follow‐up period. Thus, of the initial patients, 54% (31/57) were successfully treated, with no further symptoms. Such results had significant consequences on the expected direct cost of management per patient from a GP viewpoint. Using decision analysis it was found that H. pylori eradication for patients presenting with dyspepsia for the first time could result in considerable cost savings per patient in the long term.
EFFECT OF DOXAZOSIN ON THE SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA: RESULTS FROM THREE DOUBLE‐BLIND PLACEBO‐CONTROLLED STUDIES
Authors: Mobley DF , Kaplan S , Ice K , Gaffney M , Dias N 
Published: April 2023

SUMMARYThe urinary symptoms characteristic of benign prostatic hyperplasia (BPH) can have a considerable impact on patients' quality of life. Symptom score assessment is now used in BPH, although a number of different instruments are available. Controlled clinical trials with selective α1 adrenoceptor antagonists such as doxazosin, prazosin and terazosin have shown these agents to be effective in the treatment of BPH. The effects of doxazosin on the severity and bothersomeness of BPH symptoms were determined in three multicentre, double‐blind, placebo‐controlled clinical studies, involving a total of 609 normotensive and hypertensive patients. Doxazosin was initiated at a dosage of 0.5 or 1 mg once daily, with a final dose range of up to 12 mg once daily. The duration of active treatment was 12 to 14 weeks. Significant improvements were seen in symptom severity and bothersomeness with doxazosin compared with placebo, in both patient populations. The onset of symptomatic improvement was rapid, occurring within two weeks of treatment initiation, and efficacy was sustained throughout the treatment period. A long‐term, open label extension of these studies has demonstrated sustained efficacy during 48 months of follow‐up. Since symptom relief is the primary goal of therapy in BPH, and since doxazosin's effects are rapid in onset and sustained in duration, it appears that doxazosin is an effective agent for the treatment of symptomatic BPH in both normotensive and hypertensive men.
SELECTIVE ENDOSCOPY IN MANAGEMENT OF INGESTED FOREIGN BODIES OF THE UPPER GASTROINTESTINAL TRACT: IS IT SAFE?
Authors: O'Sullivan ST , McGreal GT , Reardon CM , Hehir DJ , Kirwan WO , Brady MP 
Published: April 2023

SUMMARYDuring a four‐year period, 308 patients presented following ingestion of foreign bodies. Ingestion was accidental in 272 cases (88.3%) and deliberate in the remainder. Symptoms at presentation included dysphagia, odynophagia, nausea and vomiting, chest pain and pharyngeal discomfort. Sixty‐eight patients were asymptomatic. A policy of expectant management and selective endoscopy was employed. Following initial assessment 202 patients (65.6%) were discharged without treatment, 30 (9.7%) of whom were later reviewed as outpatients and did not require admission. Forty‐nine patients (16%) were admitted for treatment; 27 had oesophagoscopy, five bronchoscopy and two had foreign body extraction with direct laryngoscopy. In nine patients who were endoscoped, no foreign body was identified. Twenty‐seven others were referred to the otorhinolaryngology service in another hospital. There were no deaths in the group and morbidity was 1.2%. We conclude that a policy of selective endoscopy is safe and effective in the management of patients following ingestion of foreign bodies.
AN INVESTIGATION OF INTERFACE PRESSURES IN LOW AIR LOSS BEDS
Authors: Ryan DW , Allen V , Murray A 
Published: April 2023

SUMMARYProspective randomised trials indicate that the low air loss bed is a successful method of treatment for pressure sores. To study the properties of these beds interface pressures were measured in two different low air loss beds. Ten healthy volunteers had eight readings at six different body sites taken supine and sitting. Occipital and heel pressures for both products exceeded 4.7 kPa, the accepted capillary closing pressure, while pressures at other sites were below this. These findings suggest that pressure relief alone is not the sole reason for the clinical acceptance of low air loss beds in the treatment of pressure sores.
DIFFICULTIES AND DILEMMAS IN THE MANAGEMENT OF CONGENITAL ANOMALIES IN TWIN PREGNANCY
Authors: Edozien LC , Mayers FN , Gowland  
Published: April 2023

SUMMARYBoth the incidence of twin pregnancy and the demand for prenatal diagnosis are increasing. Unfortunately, biochemical screening and ultrasound scanning are less reliable for prenatal diagnosis in twin pregnancies than in singletons. Amniocentesis and chorionic villous biopsy are usually diagnostic in singleton pregnancies but may be marred by sampling errors in twin gestations. Where a congenital anomaly has been diagnosed in a twin pregnancy, difficult decisions may have to be made, especially if one twin is unaffected. In these cases, special skills are required to ensure that adequate information, psychological support and optimal medical care are provided.
THE MEDICAL TREATMENT OF PATIENTS PRESENTING WITH INTERMITTENT CLAUDICATION SECONDARY TO ATHEROSCLEROSIS
Authors: Sandison AJP , Taylor PR 
Published: April 2023

SUMMARYPeripheral vascular disease affects a large number of elderly people but is symptomatic in only a few cases. Most of these will not be considered for surgical or radiological revascularisation procedures unless their disease affects the suprainguinal vessels. The traditional advice to stop smoking and keep walking is important but, in addition, thought should be given to the secondary prevention of cardiovascular disease in these patients. Thorough assessment and modification of their risk factors, including their lipid status, should be performed and aspirin should be prescribed to all patients who can tolerate it.
CHEMISTRY SET POISONING
Authors: Mucklow ES 
Published: April 2023

SUMMARYA prospective survey of chemistry set poisoning (CSP) was undertaken using the monthly postal enquiry report system of the British Paediatric Surveillance Unit (BPSU). Fourteen cases were reported, with one fatality and uneventful full recovery in the other 13. The packaging of the chemicals was unsatisfactory in all cases: it was not child resistant and had no proper closures. Risk factors were lack of supervision 64.3%, emotional factors 28.6%, genuine accident 7% and unidentified 7%. An additional retrospective survey of CSP reported to the National Poisons Information Service centres over the same period added a further 19 cases of CSP, making a total of 33 cases, 14 (42%) being due to copper sulphate and four (12%) to cobalt chloride, respectively. This survey showed CSP to be a significant problem, with an incidence of 0.3 cases per 100,000 children. Six recommendations were made concerning child‐resistant containers, toxic hazard warnings, size and content of the lettering, health education programmes targeted at the most vulnerable groups, and lastly, a legal restriction on the chemicals that can be included in these sets, so that the most toxic are excluded.
LOCALLY APPLIED TRANSDERMAL NITRATE PATCHES FOR THE TREATMENT OF ISCHAEMIC REST PAIN
Authors: Fletcher S , Wright M , Wilkinson A , Farr M , Sellars L 
Published: April 2023

SUMMARYPatients with severe peripheral vascular disease may suffer considerable pain which can be difficult to control with conventional analgesics. We sought to assess the analgesic effect of transdermal nitrate patches in such patients. A prospective trial was performed in 15 patients with ischaemic rest pain due to atherosclerotic peripheral vascular disease. Pain control and oral analgesic requirement were assessed. Fourteen of the 15 had a good or moderate response to the nitrate patches with a subsequent reduction in oral analgesic requirement. The patients with primarily small vessel disease had the greatest improvement in pain control. We conclude that topical nitrates may be used to provide rapid and safe analgesia for patients with ischaemic rest pain.
ACUTE PSEUDO‐OBSTRUCTION OF THE COLON FOLLOWING LEFT‐SIDED TOTAL HIP REPLACEMENT: AN ANALYSIS OF FIVE PATIENTS
Authors: Breusch SJ , Lavender CP 
Published: April 2023

SUMMARYWe report five cases of acute large bowel pseudo‐obstruction following left‐sided total hip replacement. All five cases presented with a similar sequence of clinical symptoms and physical signs. Acetabular trauma and heat generation from bone cement may lead to an imbalance of the autonomic nervous supply of the colon. We discuss a possible explanation for this phenomenon. We conclude that this condition is probably more common after total hip replacement than is currently diagnosed.
LATE PRESENTATION OF SOLITARY JEJUNAL METASTASIS FROM RENAL CELL CARCINOMA
Authors: Hession PR , Campbell RSD 
Published: April 2023

SUMMARYHaematogenous metastases to the small bowel are a rare occurrence, usually from malignant melanoma or bronchogenic carcinoma. There are occasional reports of other primary tumours presenting with small bowel involvement as the first evidence of metastases. We describe a case of intraluminal jejunal metastasis from a renal cell carcinoma, occurring 10 years after the original nephrectomy.
CENTRAL RETINAL VEIN OCCLUSION ASSOCIATED WITH THE POLYCYSTIC OVARIAN SYNDROME
Authors: Salzmann J , Jagger J 
Published: April 2023

SUMMARYWe report a case of central retinal vein occlusion (CRVO) in a young woman with polycystic ovarian syndrome (PCOS). CRVO in young patients is a rare condition, frequently associated with a severe underlying systemic disorder. This is the first report of CRVO associated with documented PCOS. We discuss the therapeutic dilemma.
SURGICAL NUTRITIONAL TEAM AND ITS IMPACT ON TOTAL PARENTERAL NUTRITION IN THE NATIONAL UNIVERSITY HOSPITAL, SINGAPORE
Authors: Png DJC , Ong CL , Chan S 
Published: April 2023

SUMMARYThe Surgical Nutrition Advisory Team (SNAT) of our hospital, formed in October 1992, decided to study the impact of such a team on the six months before and after its formation on catheter care and nutritional support in total parenteral nutrition. Our study showed that with a dedicated nutritional team, catheter sepsis was reduced from 35.1% to 15.4%. The median lifespan of central catheters was increased from 7 to 11 days. Mechanical complications were reduced from 11% to zero. Better patient selection resulted in more severely malnourished patients receiving preoperative nutrition and fewer postoperative patients being started on total parenteral nutrition. Better monitoring of nutritional requirements, electrolyte and metabolite levels and consequently faster correction of abnormal blood levels, were also obtained.
ANTIDEPRESSANTS IN THE ELDERLY
Authors: Chiu HFK 
Published: April 2023

SUMMARYAntidepressants are effective in the treatment of depression but their use in the elderly merits special attention. In general, the tertiary amine tricyclic antidepressants (TCAs) tend to produce significant side‐effects in the elderly. In contrast, nortriptyline, desipramine and lofepramine are better tolerated than other TCAs. The newer antidepressants including the selective serotonin reuptake inhibitors are useful alternatives in the treatment of depression in the elderly. As pharmacokinetic studies show that higher steady‐state plasma levels of tertiary amine antidepressants may be found in the elderly than in the younger population, a lower dosage is recommended. However, the need for a lower dose in the elderly is less certain for the secondary amine TCAs. The optimum duration of continuation and maintenance antidepressant therapy requires further study. For delusional depression, there is evidence to support the superiority of ECT and combination antipsychotic/antidepressant treatment over antidepressant alone. The ultimate choice of antidepressant will be a balance of efficacy, safety, acceptability and cost.