bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fractures of the lower vertebral column in ankylosing spondylitis
Authors: Straiton N 
Published: April 2023

SummaryPatients with ankylosing spondylitis are susceptible to spinal fractures. We report two such patients who developed neurological signs following their injury. Practitioners caring for patients with ankylosing spondylitis should be aware that cord damage following a vertebral fracture, is common in such patients.
Premature menopause: three teenage cases
Authors: Dunham A 
Published: April 2023

SummaryThree cases of premature ovarian failure at a very early age (two patients aged 16 and one aged 18) are reported. All presented with secondary amenorrhoea. The diagnosis was made after the finding of greatly raised serum FSH and LH levels and confirmed at laparoscopy and biopsy of the ovary, when a tiny uterus with atrophic ovaries was seen. Ovarian biopsy showed a lack of primordial follicles. All three patients are on hormone replacement therapy.
Mondor's disease and breast cancer
Authors: Hershman M J , Archer M J 
Published: April 2023

SummaryMondor's disease, superficial thrombophlebitis of the breast, is universally regarded as a benign, self‐limiting condition. We report a case in which Mondor's disease is associated with pre‐operative breast cancer.We recognise the generally benign course of Mondor's disease, but emphasise that its presence does not exclude malignancy.
Treatment of peptic ulcer in general practice and in hospital: a comparison of omeprazole and cimetidine
Authors: Davis R Harvard , Stott N C H , Barber J H , Freeling P , Peers E M , Richardson P D I 
Published: April 2023

SummaryThe aim of this study was to compare duodenal ulcer healing and symptom relief after two and four weeks treatment with omeprazole or cimetidine in groups of patients treated in general practice and as hospital out‐patients.It was a randomised, double‐blind, parallel group study with stratification for trial centre (hospital or GP). Endoscopy was performed at entry, after two weeks and, if unhealed at two weeks, after four weeks. All endoscopies were carried out in hospitals.In all. 189 patients were randomised (98 omeprazole, 91 cimetidine), 79 (42 percent) of which by GPs, to either omeprazole 20 mg om (n=41) or cimetidine 800 mg nocte (n=38) for two to four weeks.After two weeks, ulcer healing occurred in 56 percent (omeprazole) and 29 percent (cimetidine) (p<0.05) of patients treated by GPs, and 67 percent (omeprazole) and 36 per cent (cimetidine) (p<0.005) of those treated as hospital out‐patients. Similar differences in healing rates were seen alter four weeks.Omeprazole produces faster duodenal ulcer healing than cimetidine whether patients are treated as hospital out‐patients or by GPs.
Non‐steroidal anti‐inflammatory drugs and gastrointestinal bleeding in the elderly
Authors: Sahi S P , Basu S K , Bansal S K 
Published: April 2023

SummaryCases of gastrointestinal bleeding associated with non‐steroidal anti‐inflammatory drugs (NSAIDs) were analysed. Forty per cent of the 92 cases admitted with gastrointestinal bleeding were found to be on NSAIDs. Sixty per cent of the cases on NSAIDs had a preceding history of dyspepsia or ulcer disease and its complications. Forty per cent presented with spontaneous bleeding. We discuss some of the aspects of the management of these cases in clinical practice.
Routine pre‐operative electrocardiography
Authors: McCleane G J , McCoy E 
Published: April 2023

SummaryIn a study of 877 patients presenting for anaesthesia with an ECG, 45 per cent of the ECGs were found to be abnormal. The incidence of abnormal ECGs was found to be highest in the over‐40 age group, and also in those patients of ASA Grades II, III, IV and V, and this investigation is therefore recommended in these patients.
Intractable epilepsy
Authors: Bwala S A , Gardner‐Thorpe C 
Published: April 2023

SummaryA 26‐year‐old female had her first partial seizure at the age of five years. Further seizures occurred and later became generalised in nature. Control of the seizures became difficult despite the use of nine different anticonvulsants over a period of 20 years. She was not suitable for neurosurgical intervention because of the diffuse nature of her seizures. Cerebellar stimulation had only a marginal effect on seizure frequency. With time she became mentally retarded and was unable to benefit from formal education. Her illness demonstrates many of the long‐term clinical features and management problems of intractable epilepsy.
Efficacy of ceftizoxime in the treatment of uncomplicated gonorrhoea: comparison with amoxycillin
Authors: Veeravahu M , Clay J C , Mohanty K C , Tovey S J , Wanas T M , Roberts K N 
Published: April 2023

SummaryFour centres contributed a total of 466 patients to a study comparing the efficacy of oral amoxycillin with that of probenecid and intramuscular ceftizoxime. Both treatments were equally efficacious, except in the small number of penicillinase‐producing Neisseria gonorrhoeae patients, all of whom responded to ceftizoxime and none to amoxycyllin. Both treatments were well tolerated, the only two adverse effects occurring in the ceftizoxime group.
Lymphocyte transformation in elderly non‐insulin‐dependent diabetics before and after improved glycaemic control
Authors: Winocour P H , Lenton J , Puxty J A H , Anderson D C 
Published: April 2023

AbstractMitogen‐induced lymphocyte transformation was examined in 23 elderly patients with poorly controlled Type II diabetes before and after achieving improved glycaemic control with sulphonylureas and compared with 11 healthy controls of similar age. No difference between groups was seen after incubation of lymphocytes with phytohaemagglutinin (PHA). Lymphocyte transformation after 10 μg/ml concavalin A (con A) was significantly greater in diabetic patients after improved control and when compared to healthy controls (p<0.025). The response to 5 μg/ml and 10 μg/ml pokeweed mitogen (PWM) was greatest in diabetic patients after effective metabolic control.
Combined endoscopic cytology and biopsies in the diagnosis of duodenal malignancy
Authors: King A J W , McCabe J , Waldron M , Kerin M J , McGuire M , Given H F 
Published: April 2023

SummaryThe value of combined cytohistochemical examination in the diagnosis of malignant duodenal lesions was assessed in 78 patients with suspicious duodenal lesions seen at endoscopy. Cytological smears were taken using the direct‐vision brushing technique and all were processed by the same experienced cytologist. Duodenal malignancy was confirmed histologically in four patients. Endoscopic biopsy was positive for malignancy in three of the patients and cytology was suspicious of malignant change in two patients and positive for malignant change in one patient. Cytology alone confirmed the diagnosis of malignancy in one patient. The cumulative diagnostic yield using both biopsy and cytology was 100%.
Mitral valve prolapse in a patient with epidermolysis bullosa
Authors: Banerjee A K 
Published: April 2023

SummaryMitral valve prolapse has been assoicated with several connective tissue and developmental disorders, including Ehlers‐Danlos syndrome, Marfan's disease; pseudo‐xanthoma elasticum, myotonic dystrophy. cardiomyopathy, Ebstein's anomaly of the tricuspic valve and atrial septal defect of the ostium secundum variety. Presented here is a case of mitral valve prolapse in a patient with epidermolysis bullosa. The author is unaware of any previously reported cases of this association.
Group G streptococcal septic arthritis
Authors: Rady M , Turner P G , Ross E R S 
Published: April 2023

SummaryThe Lancetleld group G streptococcus is known to be a cause of serious infective illness. However, few cases of septic arthritis are recorded. Only one report of this infection, following total joint replacement, has appeared in the orthopaedic literature.1 Here we describe a further case of infection in a previously normal joint that presented with unusual clinical findings and radiographic changes. We stress the importance of accurate bacteriological investigation and aggressive treatment.
Repair of infected defects of the chest wall by transposition of greater omentum
Authors: Wening J V , Thoma G , Emmermann A , Zornig C 
Published: April 2023

SummaryMyocutaneous flaps have a firm role in the reconstruction of soft tissue defects.1 Furthermore the supply of extremely infected defects of the chest wall with involvement of the ribs is problematic, especially in irradiated regions. The use of the omental transposition flap is an alternative to the latissimus dorsi myocutaneous flap in treatment of such a deficiency associated with necrosis of the ribs and uncovered pleura.2,3 The authors have used this method successfully on eight patients. The scope of this technique is not confined to the chest wall. It can also be extended to defects of the region of the axilla and other parts of the body. For checking the extension and constitution of the greater omentum pre‐operatively a laparoscopy under local anaesthesia is always carried out. All patients seen by the authors experienced primary healing of the omentum and chest wall.
Abolition of electrocardiographic pattern of left ventricular aneurysm by posterior myocardial infarction
Authors: Lim R , Wilson D T R 
Published: April 2023

SummaryWe report a patient who presented with prominent gastrointestinal symptoms in whom a confident clinical diagnosis of acute posterior myocardial infarction was facilitated because the fresh electrocardiographic changes of true posterior myocardial infarction abolished the old pattern of left ventricular aneurysm. This interesting electrocardiographic phenomenon has not, to our knowledge, been previously reported.
Intestinal obstruction secondary to uterine perforation: an unusual cause of vaginal bleeding
Authors: Davies M F P , At J M T How 
Published: April 2023

SummaryA patient with intestinal obstruction is described in whom small bowel was incarcerated within the uterine lumen. This is thought to have arisen as a result of undiagnosed uterine perforation during a previous dilatation and curettage.
Hypertension in the elderly: a study of a combination of atenolol, hydrochlorothiazide and amiloride hydrochloride
Authors: Duckett G K , Cheadle B 
Published: April 2023

SummaryThe anti‐hypertensive effects of atenolol (Tenormin) 50 mg, a potassium‐sparing diuretic (half‐strength Moduretic) comprising hydrochlorothiazide 25 mg plus 2.5 mg amiloride hydrochloride, and the ‘free’ combination of atenolol and diuretic were compared in elderly hypertensive patients aged 60‐79 years.After a four‐week run‐in period on placebo, patients were randomly assigned, in a double‐blind manner, to atenolol or diuretic treatment, each for four weeks. Thereafter patients were given the ‘free’ combination for a further four weeks and this treatment was continued for six months.Blood pressure and heart rate were measured after the patient had rested for five minutes supine and after two minutes standing. These blood pressure measurements were made at least 24 hours after the preceding dose using a Random Zero sphygmomanometer. Results from 26 of the 27 patients entered into the study showed an advantage for combination therapy combined with either atenolol or diuretic treatment alone.No significant difference was found between treatments in the frequency of supraventricular and ventricular ectopic beats occurring in six patients who underwent 24‐hour ambulatory ECG monitoring. However, ectopic activity was reduced in some patients during beta‐blocker treatment.Few adverse effects occurred with any treatment. Three patients withdrew during the placebo period and three withdrew while taking active treatment.This study has shown that the combination of atenolol, hydrochlorothiazide and amiloride hydrochloride is an effective, safe, well‐tolerated antihypertensive drug regimen when used once daily in elderly hypertensive patients.
A comparative study of terfenadine at two dose levels in the management of hayfever
Authors: Stern M A , Rosenberg R M , Smith R , Fidler C 
Published: April 2023

SummaryOne hundred and twenty patients with hayfever were enrolled in a single‐centre, double‐blind crossover study designed to compare the efficacy and safety of terfenadine at doses of 60 mg bd and 120 mg bd. A two‐week placebo run‐in period was followed by the two treatment periods, each lasting two weeks. Assessments of hayfever symptoms were made daily by patients and at each clinic visit by the investigator. Adverse events were recorded at the end of each treatment period. At the end of the study both investigator and patient rated the overall efficacy and the patient recorded treatment preference. The data were examined by analysis of variance (ANOVA) for treatment, period and crossover effects. Pollen counts were recorded for the duration of the study.Seventy‐four patients completed the study, the majority of withdrawals occurring during the placebo phase. There was no significant difference in symptom relief between the two doses of terfenadine. The number of adverse events, including drowsiness, was similar for the two treatments and for placebo. Mean and peak pollen counts both correlated well with symptom severity. These data show that terfenadine 60 mg bd is an adequate dose for the treatment of hayfever symptoms.
Pseudo‐pyloric tumours
Authors: Courtney Stephen P , Spicer Richard D 
Published: April 2023

SummaryTwo infants presenting with vomiting were thought to have palpable pyloric tumours. At operation hypertrophic pyloric stenosis was not present, but other conditions causing duodenal obstruction were, and these required surgical treatment. The cases illustrate that other abnormalities may masquerade as pyloric stenosis.
Mycotic aneurysm caused by Group B streptococcus: a cautionary tale of management problems and a rare organism
Authors: Burnet N G , Wilkinson R C , Evans D S 
Published: April 2023

AbstractWe report a case of mycotic aneurysm of the femoral artery which highlights the diagnostic features and management problems of the condition. Our patient required emergency ligation of the artery for life‐threatening haemorrhage and subsequently his leg was not viable. The alternative treatment options of simple ligation and excision versus ligation, excision and immediate bypass grafting of the artery are discussed.The causative organism, beta‐haemolytic group B streptococcus (S. Agalactiae), is an extremely rare cause of embolic mycotic aneurysm. This rarity is unexplained and is surprising since this organism is a well‐known cause of infective endocarditis, which can be complicated by mycotic aneurysms.Mycotic aneurysms may become more common because of the rise of intravascular drug abuse, which combines the risk factors of vessel trauma, endocarditis and immunosuppression, notably from HIV infection.
Thyrotoxicosis in a patient with Addison's disease
Authors: Casson I F , Walker B A , Hipkin L J 
Published: April 2023

SummaryWe report the case of a patient who suffered recurrent episodes of hypoadrenal crisis, despite conventional replacement therapy for Addison's disease. She was found to have hyperthyroidism and after this was treated, she had no further relapse. Thyrotoxicosis should be considered when patients taking replacement therapy for Addison's disease present in hypoadrenal crisis.
Aspiration pneumonia as a cause of death
Authors: Haleem M A 
Published: April 2023

AbstractThis study of aspiration pneumonia is based on postmortem examinations carried out over a decade from 1979 to 1988 at York, on subjects of all ages and both sexes. The purpose of this study was not only to analyse the autopsy findings, but also to find out the real prevalence, the major causes leading to aspiration pneumonia, and its associated clinical features.
THE ASSOCIATION BETWEEN BLOOD COAGULATION MARKERS, ATHEROTHROMBOSIS AND DEMENTIA
Authors: Gupta A , Pansari K 
Published: April 2023

SUMMARYAbnormalities of coagulation and the fibrinolytic system leading to a hypercoagulable state could lead to accelerated atherogenesis. The abnormalities of haemostasis and resulting ischaemic cerebrovascular disease may contribute to cognitive decline in the elderly. There is increasing evidence in the literature of haemostatic abnormalities not only in vascular dementia but also in patients with Alzheimer's dementia. Among the serum markers of hypercoagulability leading to thrombosis and dementia, serum fibrinogen has been one of the factors most commonly studied. Modification and control of these serum markers of hypercoagulability offer an exciting approach to the control of dementia in the community. This article explores the association between serum markers of hypercoagulability, associated atherothrombosis and the risk of dementia.
CHRONIC LOBAR CONSOLIDATION
Authors: Jayakrishnan B , Abul AT , Behbehani NA 
Published: April 2023

SUMMARYLobar consolidation in a chest X‐ray is often thought to be due to infection. We present the problem of a 66‐year‐old female with low grade non‐Hodgkin's lymphoma of the mucosa associated lymphoid tissue (MALT) type who had features of lobar consolidation that persisted for years. The different causes, both infectious and non‐infectious, of this kind of presentation are discussed.
OPEN ACCESS ECHOCARDIOGRAPHY: A PROSPECTIVE AUDIT OF REFERRAL PATTERNS FROM PRIMARY CARE
Authors: Williams SG , Currie P , Silas JH 
Published: April 2023

SUMMARYFollowing recently published recommendations and guidelines, a prospective audit of 222 consecutive patients referred for open access echocardiography was conducted over a period of three months in a large district general hospital in the UK. Our study demonstrated the waiting time for an open access echocardiogram to be shorter than the waiting time for the outpatient clinic, which allowed identification of clinically significant cardiac disease sooner, leading to early advice on patient management. Specialist referral was avoided by the inclusion of management comments by a cardiologist in the technical echocardiogram report. We showed that open access echocardiography for detection of left ventricular systolic function, should be performed only if the ECG is abnormal, confirming previous reports. ECG interpretation in primary care is unreliable. In view of limited resources, hospitals should vigorously screen referrals for open access echocardiography.
A SIMPLE QUESTIONNAIRE TO DETECT HYPERMOBILITY: AN ADJUNCT TO THE ASSESSMENT OF PATIENTS WITH DIFFUSE MUSCULOSKELETAL PAIN
Authors: Hakim AJ , Grahame R 
Published: April 2023

SUMMARYThe aim of the study was to develop a simple and reproducible self‐reporting questionnaire that identifies individuals with hypermobility. Two hundred and twelve consecutive hypermobile female new attendees to the hypermobility clinic at two London teaching hospitals and a random selection of 57 healthy volunteers completed a 10‐part questionnaire. Questions were selected from clinical experience (RG), and assessed musculoskeletal symptoms and past and present physical agility. Of the 212 cases, 30 were hypermobile with no other underlying disorder and 182 fulfilled the 1998 Brighton criteria for benign joint hypermobility syndrome (BJHS). Odds ratios for the presence of hypermobility were calculated for each question. Six questions were found to be significant and the model of ‘best fit’ for sensitivity and specificity contained five of these. To demonstrate the reproducibility of the five‐part questionnaire a second cohort of 170 hypermobile cases with BJHS and 50 controls was surveyed. Analysis demonstrated that a positive answer to any two questions in the five‐part questionnaire gave the highest combined sensitivity and specificity for detecting hypermobility. The sensitivity and specificity was 84% and 89% respectively in the first cohort and reproduced with values of 84% and 80% in the second cohort. Overall the questionnaire correctly identified 84% of all cases and controls. This simple and reproducible questionnaire for detecting hypermobility could be of particular use as an adjunct in the clinical assessment of chronic, diffuse pain syndromes where hypermobility is often missed yet is potentially treatable.
AN OPEN‐LABEL, MULTICENTRE STUDY TO ASSESS THE SAFETY AND EFFICACY OF A NOVEL REFLUX SUPPRESSANT (GAVISCON ADVANCE®) IN THE TREATMENT OF HEARTBURN DURING PREGNANCY
Authors: Lindow SW , Regnéll P , Sykes J , Little S 
Published: April 2023

SUMMARYThis study investigated the efficacy and safety of a novel reflux suppressant, Gaviscon Advance®, in the treatment of heartburn during pregnancy. The study was an open‐label, multicentre, phase IV study in general practice and antenatal clinics in the UK and Republic of South Africa. Pregnant women (≤38 weeks gestation; n=150) aged 18–40 years suffering from heartburn were instructed to take Gaviscon Advance 5–10 ml, as required, to relieve symptoms. The main outcome measures were the efficacy rating of the study medication by the investigator and women after four weeks using a five‐point efficacy scale. After four weeks the investigators' and women's rating of efficacy was ‘very good’ or ‘good’ in 88% and 90% of women, respectively. Most women (57%, n=83) reported symptom relief within 10 minutes. Thus Gaviscon Advance effectively and rapidly treats heartburn during pregnancy. Its use during pregnancy presents no known significant safety concerns for mother or child.
ACUTE RHABDOMYOLYSIS DUE TO PROLONGED EXPOSURE TO THE COLD
Authors: Korantzopoulos P , Papaioannides D , Sinapidis D , Kolios P 
Published: April 2023

SUMMARYRhabdomyolysis represents an acute skeletal muscle injury and may be accompanied by acute renal failure due to myoglobinuria. This disorder has many potential causes. We describe the case of a 75‐year‐old man who developed rhabdomyolysis after prolonged exposure to cold but without associated hypothermia. This unusual case highlights that an appropriate investigation for rhabdomyolysis such as serum CK measurement should be performed in patients presenting with a history of prolonged exposure to cold, even in the absence of an obvious precipitating factor.
COMBINATION FIB RATE‐STATIN THERAPY FOR THE TREATMENT OF SEVERE HYPERTRIGLYCERIDAEMIA IN RENAL DISEASE
Authors: Badawy O , Wierzbicki AS , Hilton R 
Published: April 2023

SUMMARYThis case report describes the treatment of a patient with end‐stage renal disease on peritoneal dialysis who presented with triglycerides of 35 mmol/l, cholesterol of 14 mmol/l and visible chylomicronaemia. She was only partially responsive to statin and fibrate monotherapy, so was treated with fibrate‐statin combination therapy. Daily fibrate therapy resulted in a myositis, but once‐weekly fibrate therapy with nocturnal daily statin therapy resulted in a reduction in total cholesterol of 49%, triglycerides of 82% and raised HDL by 52%, enabling her to achieve a target LDL of 3 mmol/l and HDL of 1 mmol/l. Combination therapy with low frequency (weekly) fibrate administration and daily statin treatment may provide a means to control the severe hypertriglyceridaemia of patients with renal disease.