bluuebunny/crossref_metadata_2025_split huggingface dataset:
DIPYRIDAMOLE MAY BE USED SAFELY IN PATIENTS WITH ISCHAEMIC HEART DISEASE
Authors: Humphreys DM , Street J , Schumacher H , Bertrand‐Hardy J‐M , Palluk R 
Published: April 2023

SUMMARYIt is thought that up to 50% of patients with cerebrovascular disease will have concurrent ischaemic heart disease. Dipyridamole co‐formulated with aspirin has been shown to increase the relative reduction in risk of second stroke in patients with prior stroke/transient ischaemic attack beyond that obtaining with aspirin alone. We have sought to resolve the question of whether dipyridamole treatment increases the risk of cardiac adverse events in patients with co‐existing ischaemic heart disease. The published literature, periodic safety update reports, the randomised controlled trials of antiplatelet agents in stroke prevention and those including dipyridamole in cardiovascular indications, have been reviewed and analysed. The early reports of serious adverse cardiac effect attributable to dipyridamole occurred in patients with severe coronary artery disease using dipyridamole as a stress test adjunct to cardiac imaging. The randomised controlled trials databases show no evidence of mortality and only isolated cases of significant cardiac morbidity attributable to dipyridamole at recommended oral doses in patients with ischaemic heart disease. We conclude that patients with cerebrovascular and mild to moderate concomitant ischaemic heart disease may be treated safely with dipyridamole for the secondary prevention of stroke.
NEPHROTIC SYNDROME: MORE THAN JUST OEDEMA
Authors: Jayawardene SA , Scoble JE , Goldsmith DJA 
Published: April 2023

SUMMARYOedema is the commonest presenting symptom and sign in nephrotic syndrome. Hypercholesterolaemia, thromboembolic events, and infectious complications may also be features. Three patients are described, each of whose nephrotic syndrome presented with a less common symptom or sign – recurrent pleural effusion, hypercholesterolaemia and oedema, pulmonary embolism – and, as a result, experienced some diagnostic delay. By forgetting to consider nephrotic syndrome, and its underlying causes, there may be inappropriate investigations and treatment for the patient.
THE POTENTIAL OF MIFEPRISTONE (RU486) AS A FEMALE CONTRACEPTIVE DRUG
Authors: Sarkar NN 
Published: April 2023

SUMMARYThis article reviews the development of mifepristone (RU486) as a female contraceptive drug. Mifepristone is an orally active compound with nearly 40% bioavailability after first pass effect. The steady plasma level of mifepristone ranges from 65 nmol/l with 1 mg/day to 1 μmol/l with 10 mg/day and reaches 2.5 μmol/l, 4.5 μmol/l and 5.4 μmol/l with mifepristone 50 mg, 100 mg and 200 mg daily, respectively, over the treatment period. Inhibition of ovulation may be achieved at serum mifepristone concentration of 232.7 nmol/l. Mifepristone appears to antagonise progesterone at the pituitary level to suppress gonadotropin and steroid hormone secretion rather than to act primarily on the hypothalamus to delay or inhibit ovulation. In fact, the endometrium is most sensitive to mifepristone. Low‐dose mifepristone impairs luteal phase endometrial development and receptivity by altering endometrial parakine, cytokine and enzyme activity. Thus, low‐dose mifepristone can significantly reduce the rate of conception without inhibiting ovulation. However, further research is needed to standardise the dose and dose‐schedule to achieve the desired efficacy of low‐dose mifepristone for routine clinical use with minimal or no side‐effects.
SUCCESSFUL PREGNANCY FOLLOWING GONADOTROPIN THERAPY IN A PATIENT WITH HYPOGONADOTROPIC HYPOGONADISM RESULTING FROM CRANIOPHARYNGIOMA
Authors: Hayashi M , Tomobe K , Hoshimoto K , Ohkura T 
Published: April 2023

SUMMARYThe authors report a rare case of a patient with panhypopituitarism who became pregnant by gonadotropin therapy and gave birth to a healthy baby. A brain tumour and/or the surgical resection of a brain tumour occasionally results in pituitary dysfunction. An 18‐year‐old Japanese patient developed hypogonadotropic secondary amenorrhoea because of a craniopharyngioma, which was surgically removed. The patient came to us, and peripheral blood was collected every 15 minutes for four hours. The levels of luteinising hormone (LH) and follicle‐stimulating hormone (FSH) were measured. Results showed that LH and FSH levels were very low and did not fluctuate. Several years later, the patient complained of infertility, and treatment with human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) was started. The therapy was repeated for several cycles, but she did not conceive, so hMG‐hCG therapy combined with conjugated oestrogen administration was started. The patient became pregnant at the seventh cycle of this combined therapy. She was not treated with supplementary growth hormone.
BLEEDING ANGIODYSPLASIA: SHOULD WE CONCENTRATE MORE ON THE AORTIC VALVE THAN ON THE BOWEL?
Authors: Soran H , Lewis M , Whorwell PJ 
Published: April 2023

SUMMARYA case of bleeding from angiodysplasia in association with aortic stenosis is presented. The particular interest in this patient is that the bleeding ceased immediately after the insertion of a bioprosthetic valve and recurred when the valve restenosed. Furthermore, the bleeding again promptly resolved when the valve was exchanged for a metallic prosthesis despite long‐term anticoagulation. The implications of these observations are discussed.
SHOULD OXYGEN SATURATION BE INCLUDED IN THE VITAL SIGNS SHEET OF ALL MEDICAL ADMISSIONS?
Authors: Al‐Mobeireek AF , Abba AA , Kumo AM 
Published: April 2023

SUMMARYHypoxaemia is not uncommon in hospitalised patients and may be overlooked because cyanosis is a late sign. To estimate the incidence of undetected hypoxaemia we measured oxygen saturation (SpO2) by pulse oximetry randomly in medical patients who were not receiving supplemental oxygen in a teaching hospital and a community hospital. Of 580 patients studied, nine patients (1.55%) had SpO2 <92%. All nine patients had multiple morbidities, but all had cardiopulmonary disease in common. There was no significant difference between the teaching and the community hospitals. We conclude that undetected hypoxaemia is not common in patients on the medical wards, and that routine pulse oximetry is not necessary except for patients with known cardiopulmonary disease.
THE VALUE OF MG7 ANTIGEN IN PREDICTING CANCEROUS CHANGE IN DYSPLASTIC GASTRIC MUCOSA
Authors: Liu J , Hu JL , Zhang XY , Qiao TD , Chen XT , Wu KC , Ding J , Fan DM 
Published: April 2023

SUMMARYThe aim of this study was to ascertain whether MG7Ag is a useful predictor of evolution of gastric dysplasia to carcinoma. A total of 1090 patients with confirmed dysplasia were stained immunohistochemically with MG7 monoclonal antibody by the ABC method. A prospective follow‐up study was undertaken on 19 patients with MG7Ag positive staining and 16 with MG7 negative staining over a period of 10–78 months. The expression of MG7Ag was also compared in another two groups by conducting retrospective studies. One group showed an evolution into gastric cancer over 2–4 years, the other did not. Quantitative analysis of MG7Ag expression was carried out on the last two groups. The receiver operating characteristic curve and Youden index were used to assess the best critical value for MG7Ag. MG7Ag was found positive in 456/1090 cases (41.8%) with dysplasia. Prospective follow‐up of 35 patients showed that 6/19 patients with MG7Ag positive staining developed gastric cancer, but there were no carcinomatous changes in 16 patients with MG7 negative staining. The results of MG7Ag expression in 72 cases with retrospective follow‐up showed there were 24 with positive immunostaining among 34 cancerous cases (70.6%), and only 7 in 38 non‐cancerous cases (18.4%) (p<0.01). Image analysis showed that an average MG7Ag density index ‡0.19 could be regarded as the critical value for high risk of gastric mucosa with dysplasia evolving to cancer. Positive MG7Ag expression in gastric mucosa of patients with dysplasia, especially in cases with a density index ‡0.19, was an indicator of high risk of malignant change.
GASTROGRAFIN ADMINISTRATION IN THE TREATMENT OF POSTOPERATIVE DELAYED GASTRIC EMPTYING
Authors: Karavias DD , Tepetes K , Vagenas K , Panagopoulos K , Agelopoulou H , Androulakis J 
Published: April 2023

SUMMARYFive cases of delayed gastric emptying (DGE) are reported. Three patients had pancreatic head carcinoma and underwent a Whipple operation during which truncal vagotomy and gastrectomy were performed. The remaining two patients underwent vagotomy and gastrectomy because of benign peptic ulcer. In one of the pancreatectomy cases, the pylorus was at first preserved, but after DGE developed, a gastrectomy was carried out, which did not result in any improvement. The duration of DGE was 16–72 days, during which time the patients were under total parenteral or enteral nutrition. There were no other major complications. The patients received prokinetic agents (metoclopramide, erythromycin) but without any improvement. Finally, all patients were treated with Gastrografin, 40 ml every two hours, via a nasogastric tube. In all cases, gastric motility was restored within 20–36 hours.
INCREASED FREQUENCY OF HCV BUT NOT HBV INFECTION IN TYPE 2 DIABETIC PATIENTS IN TURKEY
Authors: Okan V , Araz M , Aktaran S , Karsligil T , Meram I , Bayraktaroglu Z , Demirci F 
Published: April 2023

SUMMARYThe aim of this study was to investigate the prevalence of hepatitis B and hepatitis C virus infections in type 2 diabetic patients in Gaziantep, Turkey. Six hundred and ninety‐two type 2 diabetic patients and 1014 healthy blood donors were included in the study. No significant difference was found between type 2 diabetic patients and the control group for seropositivity of HBsAg (5.3% vs 5.1%, p>0.05). In contrast, anti‐HCV was significantly more frequent in type 2 diabetic patients (7.5% vs 0.1%, p>0.0001). We found no significant difference for HBsAg seropositivity between type 2 diabetic patients with a disease duration of 12 months or less, but anti‐HCV seropositivity was significantly more frequent in diabetic patients with a longer disease duration (p<0.05). We suggest that HCV infection is not a trigger factor for type 2 diabetes mellitus but is frequently associated with it.
11. BREAST CANCER IN YOUNG WOMEN
Authors: Kothari AS , Fentiman IS 
Published: April 2023

SUMMARYWomen under the age of 35 years comprise only 5% of cases of breast cancer but because of the unexpected nature of the diagnosis this may be associated with delay. In the clinic, the diagnosis may not be immediate because of the low sensitivity of the components of triple diagnosis. The disease tends to be more aggressive with a higher incidence of poorly differentiated (grade III) carcinomas and more hormone insensitive (ER/PR negative) tumours. Additionally, the tumours are often rapidly proliferating and express abnormal p53. Women under 35 have an increased risk of local failure following breast cancer therapy, but this does not affect their cancer‐specific survival. Young women treated with cyclophosphamide, methotrexate and fluorouracil chemotherapy have a greater risk of relapse and death than older premenopausal patients, especially if their tumours express oestrogen receptors, so endocrine treatment should also be offered under these circumstances.
‘WHY DON'T YOU DO AS I TELL YOU?’ COMPLIANCE AND ANTIHYPERTENSIVE REGIMENS
Authors: Hansson L 
Published: April 2023

SUMMARYAlthough hypertension is recognised as one of the major health hazards in the developed world, compliance with antihypertensive regimens is still undesirably low This brings important costs, both to patients in increased morbidity and mortality, and to society in hospitalisations and lost productivity. This review surveys possible reasons for non‐compliance with treatments generally and antihypertensive medications specifically It also looks at how insights into reasons for non‐compliance can help us design more effective treatments, and discusses current and emerging medications in the context of compliance. As one of the reasons for low compliance is thought to be the impact of a drug on the patient's lifestyle, recently developed agents such as angiotensin II‐receptor blockers may be expected to have less effect on patients' daily lives than earlier treatments, which brings hope for increased compliance with these regimens.
MALIGNANT BY NAME OR MALIGNANT BY NATURE: A CASE OF WEGENER'S GRANULOMATOSIS DIAGNOSED AS ADENOCARCINOMA OF UNKNOWN PRIMARY
Authors: Virik K , Karapetis C , Harper P 
Published: April 2023

SUMMARYMost malignancies are characterised by malignant behaviour at some point in the disease trajectory. However, non‐malignant diseases may exhibit malignant behaviour. A diagnosis of malignancy based on fine needle aspiration cytology (FNAC) can be misleading. We report a case of Wegener's granulomatosis initially diagnosed by FNAC as adenocarcinoma of unknown primary. The limitations of FNAC, the disparate prognoses of the two diagnoses despite a compatible clinical picture and the need for clinical vigilance in monitoring a disease course are highlighted.
DISCLOSURE OF CANCER DIAGNOSIS AND PROGNOSIS BY PHYSICIANS IN KUWAIT
Authors: Qasem AA , Ashour TH , Al‐Abdulrazzaq HK , Ismail ZA 
Published: April 2023

SUMMARYTo analyse preferences for disclosure of cancer diagnosis and prognosis among physicians practising in Kuwait, a cross‐sectional survey was conducted in public hospitals in both urban and suburban parts of the country, which included physicians likely to encounter adult cancer patients in their practice. A total of 217 physicians participated, 67% indicating they preferred full and complete disclosure of cancer diagnosis to patients. However, 79% of those would withhold the truth if the patient s family requested them to do so. Preference for concealment was more common among physicians who had experienced cancer directly with a friend or a family member, or who were in medical as opposed to surgical specialties. The belief that patients in Kuwait did not want to hear the truth about cancer diagnosis or prognosis was also significantly associated with concealment preference. Changes in public norms and expectations should be monitored, because they seem to play a major role in physicians preference for disclosure of cancer diagnosis and prognosis.
DELIBERATE SELF‐POISONING WITH RODENTICIDE: A DIAGNOSTIC DILEMMA
Authors: Walker J , Beach FXM 
Published: April 2023

SUMMARYA 71‐year‐old man presented with a recurrent bleeding diathesis requiring frequent blood transfusions, vitamin K and fresh frozen plasma. Extensive investigations revealed vitamin K deficiency. After repeated interviews the patient admitted to deliberately ingesting rat poison. Superwarfarins are an uncommon cause of deranged clotting and specialised tests are available to identify them. They can cause prolonged coagulation abnormalities and may require treatment with oral vitamin K for several months after just a single dose.
TWO CASES OF SUBMUCOSAL HAEMATOMA OF THE OESOPHAGUS AND MALLORY‐WEISS TEAR
Authors: Ganeshram KN , Harrisson P 
Published: April 2023

SUMMARYSubmucosal haematoma of the oesophagus is an uncommon condition which may be under‐recognised. Presentation may be with chest pain, dysphagia or haematemesis. Endoscopy, CT scan, barium meal or a combination of these modalities makes the diagnosis. Most patients make a full recovery.
SURVEILLANCE STUDY OF BACTERAEMIC EPISODES IN FEBRILE NEUTROPENIC CHILDREN
Authors: Ariffin H , Navaratnam P , Lin HP 
Published: April 2023

SUMMARYWe prospectively studied the type, frequency and outcome of infections in 513 patients with 762 consecutive episodes of febrile neutropenia (FN) over a five‐year period between 1995 and 1999 in a single paediatric oncology unit. The findings were then compared with a similar study carried out in our unit between 1990 and 1994. The types of bacterial isolates and sensitivity patterns were also studied to identify trends and to gauge the suitability of antibiotics chosen for empirical therapy. Bacteraemia was documented in 35.4% of FN episodes, although 70% of patients did not have an obvious site of sepsis. The majority of isolates (61.9%) were Gram‐negative bacteria, a consistent finding throughout the study period. Resistance to ceftazidime, amikacin and imipenem among Gram‐negative bacteria was 26.3%, 21.2% and 0.7%, respectively. Methicillin resistance among Gram‐positive bacteria was 26.3%, while no vancomycin‐resistant bacteria were encountered. There were 36 sepsis‐related deaths. Factors associated with a fatal outome were prolonged capillary refill time, hypotension, fever above 39°C and pneumonia. Rapid neutrophil recovery was associated with a good prognosis. A change to our current choice of empirical antibiotics for FN, comprising ceftazidime/ceftriaxone and amikacin appears necessary because of the relatively high resistance rates found.
14. BREAST CANCER PREVENTION
Authors: Salih AK , Fentiman IS 
Published: April 2023

SUMMARYIncreased risk of breast cancer may result from potentially modifiable causes such as endogenous hormone levels, obesity, HRT, and non‐lactation, or non‐modifiable factors including genetic susceptibility and increasing age. The Gail model, based on known factors, may be useful for estimating lifetime risk in some individuals, but those risk factors that are easier to modify may have a limited impact on the totality of breast cancer. Tamoxifen prevention still remains contentious, with a significant reduction in risk of breast cancer in women given tamoxifen in the NSABP P1 study but no effect in the Italian and Royal Marsden trials. Raloxifene, tested in the MORE trial, reduced the incidence of breast cancer by 65% but this was restricted to oestrogen receptor positive tumours. Lifestyle factors such as diet, obesity, exercise and age at first full term pregnancy and number of pregnancies have a mild to moderate impact on risk, so may have little effect on the incidence of breast cancer. Reduction of alcohol intake could lead to a modest reduction in the risk of breast cancer but possibly adversely affect other diseases. Fat reduction and GnRH analogue reduce mammographic density but have not yet been shown to affect risk. For women with BRCA1/2 mutation, options include unproven surveillance and prophylactic mastectomy with an unquantified risk reduction. Interesting new candidates for chemoprevention include aromatase inhibitors, new generation SERMs, demethylating agents, non‐selective COX inhibitors, tyrosine kinase inhibitors and polyamine synthetic inhibitors.
CLINICAL MANAGEMENT OF CHILDHOOD OSTEOPOROSIS
Authors: Chan YY , Bishop NJ 
Published: April 2023

SUMMARYA current working definition of osteoporosis in children is ‘fragility fractures in association with low bone mass’. This review illustrates the determinants of bone mass and fracture risk. We elucidate the pathophysiology and causes of osteoporosis in various childhood disorders, with a particular focus on the commonest iatrogenic problem, glucocorticoid‐induced osteoporosis. We discuss clinical evaluation, investigation and multidisciplinary management including lifestyle advice, diet, physiotherapy and occupational therapy, drug treatments and monitoring for children with osteoporosis. We also emphasise the important concepts of bone mass assessment and interpretation in children.
CURRENT CONCEPTS IN VENOUS THROMBOEMBOLISM AND MAJOR LOWER LIMB ORTHOPAEDIC SURGERY
Authors: McCahill JP , Carrington RWJ , Skinner JA 
Published: April 2023

SUMMARYVenous thromboembolism remains a major cause of morbidity and mortality among patients undergoing major orthopaedic surgery. With improved surgical techniques, the use of heparin‐based thromboprophylactic agents has allowed significant advances in the prevention of thrombosis during the past 30 years. With an aging population and the growing burden of degenerative joint disease, the management of this preventable disease remains at the forefront of surgical care. Despite the use of the supposedly most effective antithrombotic agents (low‐molecular‐weight heparins), recent studies have highlighted considerable prevalence of thrombosis, especially among hip fracture patients. New prevention strategies include a greater use of existing therapies, combining chemical and mechanical methods, extending the duration of prophylaxis and, most importantly, developing more effective agents with improved benefit to risk ratios.
FULVESTRANT: A REVIEW OF ITS DEVELOPMENT, PRE‐CLINICAL AND CLINICAL DATA
Authors: Wardley AM 
Published: April 2023

SUMMARYHormone therapy is the most important systemic treatment of hormone receptor‐positive breast cancer at all stages. Selective oestrogen receptor modulators (SERMs), such as tamoxifen, the mainstay of hormone receptor positive breast cancer manipulation for many years, are limited by their agonist actions. Oestrogen‐like activity of these drugs may stimulate cancer growth such as in the endometrium and is a mechanism of resistance in breast cancer. Fulvestrant, the first of a new class of drugs, an oestrogen receptor down regulator, may have advantages over tamoxifen in the treatment of oestrogen‐dependent disease. The pre‐clinical development and early clinical data of fulvestrant are reviewed. Fulvestrant was as effective as the aromatase inhibitor anastrazole in second‐line advanced breast cancer. The phase III trial of fulvestrant versus tamoxifen, as first‐line treatment for metastatic breast cancer, has completed accrual and is maturing. Fulvestrant has useful activity against breast cancer as well as a favourable side‐effect profile and is likely to represent a useful addition to the fight against hormone dependent breast cancer. Its place will be better defined by ongoing clinical trials.
INCREASED SERUM FERRITIN LEVELS IN ACTIVE BEHÇET'S DISEASE
Authors: Odabas AR , Karakuzu A , Cetinkaya R , Selcuk Y , Keles S , Bilen H 
Published: April 2023

SUMMARYThere is no routine test to evaluate the activity of Behçet's disease (BD). Ferritin as a serum predictor of iron storage is an important acute phase reactant. In this study, we assessed serum ferritin levels in patients with active BD and compared them with those of patients with inactive BD. We aimed to show the relationship between ferritin and BD. The patients with BD were subdivided into two groups according to disease activity: active (24 patients; 18 men and 6 women, average age 36.5 ± 4.9 [28–45] years), and inactive (20 patients; 16 men and 4 women, average age 37.2 ± 5.2 [30–49] years). Twenty healthy volunteers (15 men and 5 women; average age 38.2 ± 4.6 [30–47] years) served as controls. Patients with active BD had significantly higher serum ferritin levels (p=0.0001) than the inactive and control groups. Ferritin levels in patients with inactive BD did not differ significantly from healthy control subjects (p=0.687). We concluded that in patients with active BD, serum ferritin levels are increased and do not reflect serum iron levels.
MYELOFIBROSIS: RESPONSE TO BUSULFAN AFTER HYDROXYUREA FAILURE
Authors: Naqvi T , Baumann MA 
Published: April 2023

SUMMARYWe report a case of myelofibrosis with myeloid metaplasia (MMM) that responded dramatically to oral busulfan treatment after failure of hydroxyurea. Although busulfan treatment of this disease has fallen out of favour due to the favourable toxicity profile of hydroxyurea and reports of efficacy of interferon‐α, our observation suggests there may still be a role for busulfan treatment of MMM in the setting of hydroxyurea or interferon failure or intolerance.
SUBMANDIBULAR CASTLEMAN'S DISEASE
Authors: Chan SC , Ng SH , Lee KF , Hao SP , Cheung YC , Wan YL 
Published: April 2023

SUMMARYCastleman's disease is a rare benign lymphoid tumour of unknown aetiology, which usually appears as a solitary mediastinal mass. We report an unusual case of Castleman's disease, an asymptomatic submandibular mass in the lower jaw, and we discuss the computed tomography appearance.