bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOCTORS' KNOWLEDGE OF SOCIO‐LEGAL ASPECTS OF PATIENT CARE
Authors: Benbow SJ , King D , Barrett JA 
Published: April 2023

SUMMARYDoctors' knowledge of socio‐legal aspects of patient care is poor. To quantify this a questionnaire on certain socio‐legal topics was sent to 400 general practitioners and 250 hospital doctors. The responses were compared to a group of social workers. Both hospital doctors and general practitioners did badly on all topics considered. Social workers' knowledge was significantly better overall, (P<0.01).Our results confirm the lack of knowledge amongst a broad spectrum of doctors. We suggest that this may be related to a lack of emphasis on these aspects in both undergraduate and postgraduate education.
OFLOXACIN VERSUS TRIMETHOPRIM AND CO‐TRIMOXAZOLE IN THE TREATMENT OF UNCOMPLICATED URINARY TRACT INFECTION IN GENERAL PRACTICE
Authors: Spencer RC , Cole TP 
Published: April 2023

SUMMARYA large‐scale, randomised, multicentre single‐blind clinical trial was conducted to assess the comparative efficacy and tolerance of ofloxacin, trimethoprim and co‐trimoxazole in the treatment of uncomplicated urinary tract infection in general practice.A total of 1,069 patients from 76 centres across the UK were enrolled in the study, and randomised to one of the following treatment groups: ofloxacin (200 mg od), trimethoprim (200 mg bd) or co‐trimoxazole (trimethoprim 160 mg and sulphamethoxazole 800 mg bd). Each patient received five days of medication. Clinically, ofloxacin was as effective as trimethoprim and co‐trimoxazole. However, the bacteriological cure rate was significantly better for ofloxacin, with eradication of the initial causative pathogen by the end of treatment in 92% of patients in the ofloxacin group, compared with 81% for trimethoprim and co‐trimoxazole (P = 0.0002). There was also a lower relapse rate for ofloxacin. Ofloxacin was well tolerated: adverse events were reported by 67 (12.4%) patients in the ofloxacin group, compared with 48 (18.7%) patients in the co‐trimoxazole group and 37 (13.6%) patients in the trimethoprim group. Ofloxacin can therefore be considered a suitable alternative for the treatment of uncomplicated urinary tract infection.
ECTOPIC PREGNANCY: EPIDEMIOLOGY, ADVANCES IN DIAGNOSIS AND MANAGEMENT
Authors: Dimitry E S , Rizk B 
Published: April 2023

INTRODUCTIONEctopic pregnancy was first clearly described by Abulcasis, a famous Arabic writer on surgical topics.1 Although maternal deaths from ectopic pregnancy have declined, it is still the leading cause of death in the first trimester and accounts for 6–11% of all maternal deaths. From 1982 to 1984, 14 women died in England and Wales from this condition.2 The presence of ectopic pregnancy subjects women to the uncertainties of intra‐abdominal bleeding, laparotomy, extended hospital stay and fetal loss. Furthermore, they could face reduced future fertility.3
CONSERVATIVE THERAPY FOR TENNIS ELBOW
Authors: Ernst E 
Published: April 2023

SUMMARYTennis elbow is a common overuse syndrome. It is accompanied by degenerative changes in the enthesis of the extensor carpi radialis brevis muscle. It may be best diagnosed clinically by eliminating other possible causes of lateral elbow pain. Physical methods should always be selected as initial treatment. Immobilisation is the initial advice that most doctors give: ultrasound has been shown to be effective in a placebo‐controlled, double‐blind trial, and low energy laser has been found to reduce objective but not subjective symptoms.Other forms of physical treatment like electrotherapy, thermotherapy and massages can be tried, even though proof of their efficacy needs to be established more firmly. When physical treatments have failed, steroid injections can help. If symptoms still persist, then surgery is called for. There are still many open questions surrounding the syndrome of tennis elbow. Research into this common soft tissue disease should be intensified.
WHICH CALCIUM CHANNEL BLOCKER FOR ISCHAEMIC HEART DISEASE?
Authors: Tan K , Lewis S 
Published: April 2023

SUMMARYCalcium channel blockers have been available since the early 1960s. Extensive research has been undertaken to evaluate their usefulness in the treatment of patients with ischaemic heart disease. We have reviewed the pharmacology of these drugs and the major clinical trials. In particular, we have examined the effect of calcium channel blockers on the progression of atheroma, and their role in the following clinical settings: following myocardial infarction, following non‐Q‐wave myocardial infarction, and in unstable angina.
ARE NON‐STEROIDAL ANTI‐INFLAMMATORY DRUGS ALWAYS NECESSARY? A GENERAL PRACTICE SURVEY
Authors: Swift G L , Rhodes J 
Published: April 2023

SUMMARYThe number of patients receiving long‐term ‘repeat prescriptions’ for non‐steroidal anti‐inflammatory drugs (NSAIDs) was examined in a General Practice; a group of them with osteoarthritis or musculoskeletal pain attempted to withdraw their NSAID treatment and substitute alternative analgesics.Thirty‐eight randomly selected patients, with conditions other than rheumatoid arthritis, were interviewed and alternative analgesics prescribed to replace their NSAID therapy. After one month, 22 had very satisfactory pain relief without their NSAID but 16 had resumed therapy, with four of them on a reduced dosage; three others wished to try an alternative analgesic again. Five initially with gastro‐intestinal symptoms were asymptomatic within a month of discontinuing their NSAID. After four months, 24 of the 38 had discontinued NSAIDs, including one who had an upper gastrointestinal haemorrhage during the study; two others were taking a reduced dosage.
HOME SWEET HEN — A GUIDE TO HOME ENTERAL NUTRITION
Authors: Park R H R , Galloway A , Russell R I , Ewing A B , Machattie G , Davidson L 
Published: April 2023

SUMMARYInitial experience of home enteral nutrition (HEN) was gained from malnourished patients with Crohn's disease.1–6 The rationale for HEN was to improve the patients' lifestyle by reducing the need for repeated admissions for nutritional support: this method is extremely useful in correcting nutritional problems. Over the past ten years the use of HEN has expanded to cover other clinical areas including correction of growth retardation secondary to gastrointestinal disease,7,8 cystic fibrosis,9,10 inborn errors of metabolism,11 congenital heart disease,12 and chronic renal failure,13 in addition to many types of neoplasia14 and chronic neurological diseases.14At the present time, approximately 150 patients receive HEN within the catchment area of the Greater Glasgow Health Board (population 940,000). Despite the increasing availability of HEN many clinicians and dietitians are still reluctant to consider HEN as a ‘routine adjunct’ to clinical management, claiming that it is too dangerous or complicated. The aims of this article are to explain our method of running a HEN service, offer advice on practical problems and discuss further developments and potential difficulties.
THE ROLE OF ECHOCARDIOGRAPHY IN THE DIAGNOSIS AND MANAGEMENT OF INFECTIVE ENDOCARDITIS
Authors: Cooke R A , Chambers J B 
Published: April 2023

SUMMARYThe echocardiographic appearance in suspected endocarditis must always be interpreted in the context of the clinical findings. Thus although echocardiography may contribute to the early diagnosis of infective endocarditis, it should rarely be used as a screening test. It is highly sensitive for the detection of complications such as abscesses or valvular regurgitation and can estimate their severity. Although transthoracic imaging will allow a complete study in many cases, the transoesophageal approach is superior for the detection of abscesses and the assessment of prosthetic mitral valves. Patients with large vegetations, particularly on the mitral valve, are at increased risk of embolism but there is no convincing evidence to support prophylactic surgery in these cases.
HALLUCINATIONS AS A PRESENTING FEATURE IN MALIGNANT HYPERTENSION
Authors: Rosbotham J , Ritter J M , Watson J P 
Published: April 2023

SUMMARYA 68‐year‐old man with malignant hypertension of renovascular origin presented with visual impairment and complex visual hallucinations. Four weeks after the hypertension had been controlled by drugs, the hallucinations ceased and electroencephalographic evidence of encephalopathy resolved.
PERFORATION OF AN ABDOMINAL VISCUS ASSOCIATED WITH A PNEUMOTHORAX
Authors: Lim A , Ling R , Diggory R , Copeland G 
Published: April 2023

SUMMARYPneumothorax is a very unusual presenting complication of a perforated abdominal viscus. We present two such cases. The importance of close scrutiny of chest radiographs taken for abdominal disease is stressed.
THE INCIDENCE OF DELAYED PNEUMOTHORAX AS A COMPLICATION OF SUBCLAVIAN VEIN CATHETERISATION
Authors: Spiliotis J , Kordossis T , Kalfarentzos F 
Published: April 2023

SUMMARYDelayed pneumothorax after subclavian vein catheterisation is a poorly recognised complication which can result hours or days after the catheter placement. We present our experience, during a three‐year prospective study of 318 patients with 343 catheter placements in the subclavian vein.Seven patients (2.2%) developed pneumothorax immediately after the subclavian vein catheterisation. Two patients (0.6%) developed delayed asymptomatic pneumothorax that was recognised 48 and 72 hours after the catheter placement.The importance of recognition and treatment of this complication is obvious in patients with a central venous catheter, especially when they are to be operated under general anaesthesia and/or mechanical respiratory support.
THE SELECTIVE USE OF FINE CATHETER PERITONEAL CYTOLOGY AND LAPAROSCOPY REDUCES THE UNNECESSARY APPENDICECTOMY RATE
Authors: Baigrie R J , Scott‐Coombes D , Saidan Z , Vipond M N , Paterson‐Brown S , Thompson J N 
Published: April 2023

SUMMARYThe effect of a management protocol incorporating the selective use of fine catheter peritoneal cytology (FCPC) and laparoscopy on the unnecessary appendicectomy rate was studied in adult patients (≥16 years) treated at one district general hospital over an 11 ‐month period. Appendicectomy was performed on 62 adult patients managed according to this protocol, six (10%) of whom had a histologically normal appendix and no other acute condition requiring surgery. A further 57 patients underwent appendicectomy after standard clinical assessment and investigation without the use of FCPC or laparoscopy. Nineteen (33%) of these patients had a histologically normal appendix removed, with no other acute condition requiring surgical treatment. The selective use of FCPC and laparoscopy significantly reduced the unnecessary appendicectomy rate from 33% to 10% (χ2 = 10.0, P<0.005). The more widespread use of these techniques in patients with suspected appendicitis is therefore recommended.
AUTOLOGOUS BLOOD TRANSFUSION TODAY
Authors: Slater N G P 
Published: April 2023

SUMMARYAutologous blood transfusion — the transfusion to a patient of his or her own blood — is increasingly being recognised as a useful adjunct to traditional transfusion practice. The reasons include fears of disease transmission, the potential adverse effects on the recipient's immune system of transfused donor blood, and logistical factors. The three main techniques of autologous transfusion are: (i) pre‐deposit, in which patients donate blood over a period of time in preparation for elective surgery; (ii) pre‐operative isovolaemic haemodilution, in which blood is removed immediately before surgery and volume replacement is given, the blood being reinfused post‐operatively; and (iii) salvage transfusion – the collection of blood shed at surgery or in similar circumstances, which is reinfused immediately or after concentration and purification. All three techniques can help to improve the safety of transfusion and economise on scarce supplies of donor blood.
TORSION OF A MALIGNANT UNDESCENDED TESTIS MIMICKING APPENDICITIS
Authors: Radford P J , Greatorex R A 
Published: April 2023

SUMMARYTesticular maldescent is known to be associated with later development of malignancy.1 The maldescended testis is prone to other complications — in particular, torsion.1 We report an unusual coincidence of both malignancy and torsion of an intra‐abdominal testis which closely simulated a ruptured appendix abscess. This case demonstrates that an intra‐abdominal testis can develop acute life‐threatening complications which should be considered in any patient with acute abdominal symptoms who has an ‘absent’ testis.
MALIGNANT MELANOMA OF THE PAROTID GLAND
Authors: Roberts C , Jayaramachandran S 
Published: April 2023

SUMMARYWe report a case which demonstrates pitfalls in the management of a parotid gland mass and highlights behaviour of malignant melanoma that is not widely appreciated. The danger of assuming a benign histological diagnosis of such a mass and the subsequent delay of definitive surgery is demonstrated. Metastases within the parotid gland are not uncommon, melanoma being one of the commonest sources. A search should always be made for a primary tumour in the head, neck and chest. This can be made exceptionally difficult by the uncommon phenomenon of spontaneous regression of the primary melanoma.
TOLERANCE AND LONG‐TERM EFFICACY OF A FIXED COMBINATION OF ATENOLOL AND NIFEDIPINE IN THE TREATMENT OF ANGINA PECTORIS
Authors: Saul P A , Oliver I M , Russell W A ,   Stuart Clinical Research Group
Published: April 2023

SUMMARYTo monitor the tolerance and long‐term efficacy of a low‐dose fixed combination of 50 mg atenolol and 20 mg nifedipine (slow release formulation) in patients with stable angina pectoris, 157 patients received treatment twice daily in a multi‐centre, open‐label fashion for periods up to 12 months following a four week run‐in period on atenolol 50 mg twice daily. A total of 122 patients completed the study and had data from all treatment visits. In these patients the median number of weekly anginal attacks was halved, compared to the run‐in period on atenolol alone following one month's fixed combination treatment, and this benefit was maintained throughout the 12‐month study period. In addition, GTN consumption similarly declined on the fixed combination in comparison with the run‐in period.Treatment with the fixed combination was not associated with any long‐term increase in the frequency of reported side‐effects or adverse biochemical changes compared to run‐in. The fixed combination of atenolol 50 mg and nifedipine 20 mg reduced anginal frequency and GTN consumption compared to atenolol alone without causing any increase in adverse effects.
A CRITICAL APPRAISAL OF IN‐PATIENT NEUROLOGICAL SERVICES IN A SUBREGIONAL CENTRE
Authors: Clarke C E , Shepherd D I , Yuill G M 
Published: April 2023

SUMMARYA computer database was established for the medical audit of admissions to the North Manchester General Hospital neurology unit. Over a six‐month period, 277 patients completed 300 hospital stays. A higher proportion of patients were admitted from the North Manchester District compared with the peripheral districts served by the unit, suggesting that more neurology in these areas was performed by general physicians. This supports claims for an increase in the number of neurologists to improve the quality of service at district level. The introduction of a programmed investigation unit, closed at weekends, would allow financial savings since 60% of cases did not require a bed at the weekend. It would also allow more efficient pre‐booking of investigations.The diagnostic yields from routine B12 and folate levels, syphilis serology, thyroid function tests, chest radiography and electrocardiography were low and should be replaced by more selective investigations. Savings might also be made by performing the 38% of myelograms restricted to the lumbar region in the out‐patient department. The introduction of out‐patient magnetic resonance imaging will make significant savings by obviating the need for many of the inpatient myelograms which were required in 55 patients.The simple and relatively inexpensive technology used in this study provided medical staff with valuable information on which to base changes in practice and evaluate their consequences.
SEVERE ORTHOSTATIC HYPOTENSION IN CARCINOMA OF THE PANCREAS
Authors: Ashraf W , Farrow L J 
Published: April 2023

SUMMARYAutonomic dysfunction has been described in patients with advanced forms of cancer.1–10 We report a case of severe orthostatic hypotension in a patient with carcinoma of the pancreas in whom there was no clinical evidence of autonomic failure to account for the severity of the hypotension. Despite normal circulating levels of nor‐adrenalin and an appropriate rise in the erect position, the vascular system appeared unresponsive.We suggest that in this patient the orthostatic hypotension was due to a paraneoplastic complication of the pancreatic tumour.
A NOVEL SUSTAINED‐RELEASE FORMULATION OF IBUPROFEN PROVIDES EFFECTIVE ONCE‐DAILY THERAPY IN THE TREATMENT OF RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS
Authors: O'Connor T P , Anderson A M R , Lennox B , Muldoon C 
Published: April 2023

SUMMARYThe efficacy and safety of a novel sustained‐release formulation of ibuprofen given once‐daily was compared with conventional‐release ibuprofen tablets 400 mg given four times daily, in a single‐blind, parallel‐group study. This study was conducted at 84 general practice centres throughout the UK among patients with osteoarthritis or rheumatoid arthritis. An unequal randomisation in the ratio of 4:1 was carried out, with 463 patients who received sustained‐release and 115 who received conventional‐release ibuprofen providing evaluable data.In this study sustained‐release ibuprofen was shown to be a more effective alternative to conventional ibuprofen therapy for the treatment of arthritic diseases in general practice, offering the convenience of once‐daily dosing and the associated potential benefit of improved patient compliance.
SYDENHAM'S CHOREA: A NEW LOOK AT AN OLD DISEASE
Authors: Al‐Eissa A 
Published: April 2023

SUMMARYEight children with Sydenham's chorea were studied to illustrate the clinical characteristics and the outcome of the disease. Their ages ranged from 8 to 13 years and the male to female ratio was 1.7:1. Most of them had hemichorea, which frequently affected the right side of the body. The common presenting manifestations were involuntary movements, facial grimacing, clumsiness, and emotional instability. The duration of chorea ranged from one week to three years, with a median of 11 weeks. One half of the patients had associated mild carditis. Recurrences of chorea occurred only among patients who were not maintained on continuous penicillin prophylaxis. Haloperidol seemed to be an effective and tolerable agent in controlling the motor manifestations of the disease.
THE NEED FOR THREE STOOL SPECIMENS IN ROUTINE LABORATORY EXAMINATIONS FOR INTESTINAL PARASITES
Authors: Nazer H , Greer W , Donnelly K , Mohamed A E , Yaish H , Kagalwalla A , Pavillard R 
Published: April 2023

SUMMARYThis study was designed to test whether three sequential stool specimens are necessary for reliable detection of intestinal parasites in routine laboratory examinations. There were 175 patients in whom a single species of intestinal parasite or ova was identified on at least one occasion when three stool specimens were examined over a period of 14 days from the first recorded specimen. Examination of a first stool specimen detected parasites and/or ova in 102/175 patients (58.3%); examination of a second specimen identified an additional 36 positive patients (20.6%) and examination of a third specimen yielded a final 37 previously undetected patients (21.1%).These findings indicate that at least three stool specimens should be examined to confirm the presence of intestinal parasites. Even with such practice, it is not possible to guarantee that there is no infestation, but examination of fewer specimens would run a definite risk of false negative results.
INTRALESIONAL VINBLASTINE IN THE TREATMENT OF ORAL KAPOSI'S SARCOMA
Authors: Moyle G , Youle M , Barton S 
Published: April 2023

SUMMARYKaposi's sarcoma is a common tumour in HIV‐infected patients, frequently involving the oropharynx. Conventional treatment with radiotherapy is efficacious, but causes considerable discomfort. This paper illustrates a new technique of local injection of vinblastine into oral lesions, which combines satisfactory palliation with high patient acceptability.
ATHEROSCLEROSIS
Authors: Joiner C 
Published: April 2023

George Payling Wright was Professor of Pathology at Guy's Hospital when I went there as a student in 1941 and I came to know him in 1943. He was a great man, a great scholar and an inspired teacher. Of unimpressive appearance, it was only when he began to lecture or to explain or to demonstrate that his great abilities became apparent. He influenced his students profoundly, and wholly for the good. None suffered and all who could benefited from his teaching. Much of what he said was prophetic and I have seen it emerge as truth over the last 40 years.He spoke of the blood supply to the tissues, of the structure and function of the vessels which convey the blood to the body cells — the arteries, the arterioles, the capillaries. He said that future generations of doctors would do well to consider in more detail the decisive influence of adequate supply of blood to the tissues on the functions (and indeed the structure) of organs. He mentioned the work of Poisseuille (1843) who had studied the factors that influenced the flow of liquids through tubes. He detailed the formula relating the pressure forcing it onwards, its viscosity, the length of the tube and its radius on the volume that passed in a given time. And of these factors he showed the supreme importance of the bore of the tube, for the flow was found to vary with the fourth power of the radius. What does this mean? A glance at Figure 1 shows the dramatic effect of reduction of the diameter of the vessel on the flow.With increasing age in the population, reduced blood supply has become a problem second only to neoplasia in importance as a cause of morbidity and death. And of the pathological processes causing the reduction it is atheroma that is paramount.
A COMPARISON OF BECLOMETHASONE DIPROPIONATE AND BUDESONIDE IN THE TREATMENT OF ASTHMA
Authors: Davies B 
Published: April 2023

SUMMARYSeveral reports have claimed that beclomethasone dipropionate (BDP) and budesonide (BUD) differ with regard to therapeutic efficacy and associated adverse effects, based either upon clinical data, or upon theoretical considerations.Although long‐term comparisons are lacking, the consensus of numerous studies is that these drugs are of equivalent therapeutic efficacy. Assessment of pharmacological data suggests that beclomethasone 17‐monopropionate (17‐BMP), the active bronchial metabolite of BDP, has a greater glucocorticoid receptor affinity than BUD and thus theoretical claims for greater efficacy of BUD based on comparison with the receptor affinity of unchanged BDP are inaccurate. Similarly, clinical experience has not revealed any significant differences between the adverse effect profiles of BDP and BUD, in terms of adrenal suppression, changes in bone metabolism and growth, or cataract formation. Critical examination reveals that those reports describing differences in efficacy or safety profile between the two drugs have study design flaws which may undermine the validity of their conclusions. Current evidence indicates that, in terms of therapeutic efficacy and safety profile, BDP and BUD are effectively indistinguishable.