bluuebunny/crossref_metadata_2025_split huggingface dataset:
MESENCHYMAL HAMARTOMA OF THE LIVER IN AN ADULT: A REVIEW OF THE LITERATURE
Authors: Papastratis G , Margaris H , Zografos GN , Korkolis D , Mannika Z 
Published: April 2023

SUMMARYMesenchymal hamartoma of the liver is an unusual oncologic entity which occurs almost exclusively in infancy and childhood; fewer than 200 cases have been reported. We present the case of a 21‐year‐old female, who was admitted to our institution with a painful right subcostal mass lasting for 6 months, who had no evidence of generalised disease. Imaging procedures revealed a central solid lesion, 15 cm in diameter, in the right lobe of the liver, with cystic degeneration. The patient underwent a formal right hepatectomy The pathology report ascertained the presence of a benign mesenchymal hamartoma of the liver.
GROWTH FACTORS IN CLINICAL PRACTICE
Authors: Köveker GB 
Published: April 2023

SUMMARYWound repair consists of a complex interaction of cellular and bichemical events. Several growth factors have been identified as regulatory polypeptides co‐ordinating the healing process. Although it is not known precisely why chronic wounds do not follow the normal pattern of healing, diminished growth factor content and accelerated growth factor degradation may contibute to poor healing. Topical application of different factors exert stimulatory effects on wounds in animal models. Human data are limited but the most investigated compound is recombinant human platelet‐derived growth factor‐BB (rhPDGF‐BB). PDGF‐BB enhances granulation tissue formation and facilitates epithelialisation. Clinical trials in patients with ‘hard to heal’ diabetic foot ulcers demonstrated significant improvement in the ‘healing rate’ and the ‘time to healing’ compared with controls. Refinement of therapeutic strategies with growth factors will take place in the future.
STEROIDAL CONTRACEPTION FOR MEN
Authors: Sarkar NN 
Published: April 2023

SUMMARYThis article is a review of the development of male steroidal contraceptives during the past 25 years. Numerous studies have been conducted on male volunteers with oral and/or injectable preparations of single or combined steroids. Progestogen, androgen alone, or progestogen and androgen combinations have been used as weekly or monthly injectable formulations. Most of the studies involved small numbers of subjects. There was reversible suppression of spermatogenesis to oligospermia and/or azoospermia during the treatment period. Alteration of LH, FSH and testosterone levels in the blood was observed in most of these studies, depending on the steroid or combination of steroids used. There were reports about decreased or increased libido and weight gain during treatment with steroids. No other serious side‐effects were found. Attention has recently focused on developing an androgen‐only male contraceptive, because testosterone ester has shown promising results. The development of an effective and reliable steroidal contraceptive for men may be possible but this requires further research.
NEURAMINIDASE INHIBITORS: PROGRESS IN THE MANAGEMENT OF INFLUENZA
Authors: Woodhead M , Lavanchy D , Johnston S , Colman P , Fleming D 
Published: April 2023

SUMMARYInfluenza is a serious respiratory illness and represents a significant clinical burden. As well as being debilitating, influenza can often cause complications leading to hospitalisation and death. Prophylaxis by vaccination is the preferred method of disease management, but because influenza viruses are constantly changing their antigenic properties, influenza outbreaks occur regularly as epidemics. Neuraminidase inhibitors are a new class of anti‐influenza drugs designed to block influenza virus replication. Two neuraminidase inhibitors, zanamivir and oseltamivir, have been licensed for clinical use in the treatment of influenza. Both drugs significantly reduce the severity and duration of the illness when treatment is started within two days of the onset of symptoms. However, while zanamivir and oseltamivir have apparently similar efficacy, they differ in their modes of delivery and tolerability. Zanamivir is delivered direct to the lungs by inhalation and is well tolerated. Oseltamivir is taken in the form of a pill but has the side‐effect of producing nausea and vomiting in some patients. In the absence of a demonstrable difference in efficacy, uptake of the two drugs will depend on evaluation of the relative merits of mode of delivery and tolerability.
PIOGLITAZONE
Authors: Lawrence JM , Reckless JPD 
Published: April 2023

SUMMARYPioglitazone is a thiazolidinedione. As a PPAR‐γ agonist it alters the expression of a number of genes, resulting in a reduction in insulin resistance. Clinical trial data involving over 4500 patients with type 2 diabetes suggest it is effective both as monotherapy and in combination with sulphonylureas, metformin and insulin, producing both significant falls in HbA1c and favourable improvements in lipid parameters. It is well tolerated, with a low incidence of side‐effects. Unlike troglitazone, its use has not been associated with hepatotoxicity. It has recently been licensed in the US for use as monotherapy and in combination with insulin, metformin and sulphonylureas. Its European licence is more restrictive, allowing use in combination with metformin, and in combination with sulphonylureas in those intolerant of metformin. It provides a useful new option in the treatment of type 2 diabetes mellitus.
A CASE OF RECURRENT IMPETIGO HERPETIFORMIS WITH A POSITIVE FAMILY HISTORY
Authors: Erbagci Z , Erkiliç S 
Published: April 2023

SUMMARYImpetigo herpetiformis is a rare non‐infectious pustular dermatosis of pregnancy. A few non‐gestational cases due to oral contraceptive use have also been reported. Although the disorder is not thought to have a genetic background, there are some familial case reports in the literature. We describe a case of recurrent impetigo herpetiformis in an 18‐year‐old pregnant woman who had normal serum calcium levels and responded well to prednisolone therapy. Interestingly, the patient's mother had also experienced a generalised pustular dermatosis associated with hypocalcaemia during oral contraceptive use, which was diagnosed clinically and histologically as impetigo herpetiformis.
RECURRENT ENCEPHALOPATHY AND GENERALISED SEIZURES ASSOCIATED WITH RELAPSES OF THYROTOXICOSIS
Authors: Chong JSW Li Voon , Leckt BRF , Macfarlane IA 
Published: April 2023

SUMMARYSeizures or encephalopathy associated with thyrotoxicosis are very rare. A 30‐year‐old man with thyrotoxicosis and strongly positive thyroid antibodies presented with generalised seizures preceded by an encephalopathic illness of a few days duration. CSF protein was raised and EEG showed bilateral slowing of activity. Antithyroid drug treatment rendered him biochemically euthyroid, his cognitive state returned to normal and his seizures stopped. Subsequently he had a recurrence of both encephalopathy and seizures on two occasions, coinciding with relapses of the thyrotoxicosis. This supports the view that the hyperthyroid state caused this serious neurological condition. Treatment with 131I caused hypothyroidism and he has remained seizure free and well for six years on thyroxine replacement. Corticosteroids may have been helpful in the management of his encephalopathy.
A CASE OF ISOLATED ACTH DEFICIENCY PRESENTING WITH HYPERCALCAEMIA
Authors: Wong RKM , Gregory R , Lo TCN 
Published: April 2023

SUMMARYA 76‐year‐old man presented with a subacute history of weight loss, malaise and anorexia. Laboratory investigations revealed serially increasing hypercalcaemia, correlating with deterioration in his clinical status. He was subsequently shown to have hypocortisolaemia, which improved with the administration of intravenous steroids. Subsequent biochemical testing revealed the endocrinological defect to be one of isolated ACTH deficiency, which, unlike Addison's disease, does not classically include hypercalcaemia in its presentation.
TRANSOESOPHAGEAL ECHOCARDIOGRAPHY: ITS ROLE IN THE MANAGEMENT OF PATIENTS IN A DISTRICT GENERAL HOSPITAL
Authors: Fragakis N , Patel S , Lloyd G , Lambert G , Robson D , Shakespeare C 
Published: April 2023

SUMMARYThe aim of this study was to assess the value of a transoesophageal echocardiography (TOE) service in a district general hospital (DGH). A series of 151 consecutive cases was analysed retrospectively to determine the relative additional benefit of TOE over transthoracic echocardiography (TTE) in establishing diagnoses and making therapeutic decisions. Of the 151 cases, 140 were suitable for the two procedures to be compared. In 56%, TOE provided useful information for patient management. This consisted of the detection of new major findings (33%) and the exclusion of significant abnormalities (23%), suspected either clinically or by TTE. TOE made a minor clinical contribution in 8% of cases, while in 30% there was concordance between the two studies. Finally, in 6% both examinations were inconclusive. We conclude that TOE has a significant complementary role to TTE in terms of clinical diagnosis and patient management in the DGH setting.
A CROSS‐SECTIONAL SURVEY OF THE CLINICAL AND PSYCHOLOGICAL FEATURES OF LOW BACK PAIN AND CONSEQUENT WORK HANDICAP: USE OF THE QUEBEC TASK FORCE CLASSIFICATION
Authors: Frank AO , De Souza LH , McAuley JH , Sharma V , Main CJ 
Published: April 2023

SUMMARYA hospital‐based cross‐sectional study examined 657 consecutive referrals with low back pain over two years to a district rheumatology service serving a population of about 250,000 people. Five hundred and thirty‐eight had mechanical/degenerative low back pain. The mean age was 48.6 (range 18–80 SD 15.3) years; 64% were women. Patients with radiating pain or neurological deficit (Quebec Task Force classification) were significantly more disabled (Roland disability score p<0.001) and depressed (Modified Zung score p<0.05) than those without radiating pain. Women were more impaired (p=0.02) than men but had similar disabilities (mean Roland score 11.7, range 0–24 SD 6.5). Fifty‐three per cent of patients were receiving benefits and were significantly more likely to have musculoskeletal comorbidities than those in work (p<0.025). It is concluded that the Quebec Task Force classification of low back pain impairment is a helpful descriptor and related to both physical and psychological disability and handicap in employment.
A VALIDATION STUDY OF THE SIRIRAJ STROKE SCORE
Authors: Kan CH , Lee SK , Low CS , Velusamy SS , Cheong I 
Published: April 2023

SUMMARYA cross‐sectional study was conducted on 160 Malaysian patients to validate the usefulness of the Siriraj Stroke Score (SSS) for differentiating intracerebral haemorrhage and infarction following acute strokes. Our results indicate that the score lacks sensitivity and specificity. It should thus not be used in epidemiological studies to determine stroke types in a community. More importantly, in the absence of information from neuroimaging of the brain, it cannot be used safely by physicians to assess the need or otherwise of thrombolytic and/or anticoagulant therapy after an acute stroke.
MYOCARDIAL STUNNING AND HIBERNATION IN CLINICAL PRACTICE
Authors: Rinaldi CA , Hall RJC 
Published: April 2023

SUMMARYMyocardial stunning and hibernation are both clinically important causes of myocardial dysfunction and are caused by episodes of myocardial ischaemia. Stunning tends to occur acutely and may produce transient but clinically important reductions in left ventricular function in the setting of myocardial infarction, post coronary artery bypass grafting and even following episodes of effort induced angina. Hibernation refers to a chronic down‐regulation of myocardial function in response to chronic myocardial ischaemia. Hibernating myocardium may be present in up to 50% of patients with significantly impaired left ventricular function and evidence of heart failure. Importantly, both these entities can be either prevented or ameliorated by preventing or lessening ischaemic burden. There is also evidence that there may be an overlap between these two entities and that hibernating myocardium may result from repeated episodes of myocardial ischaemia causing chronic stunning.
PHARMACOLOGY AND EFFICACY OF ELETRIPTAN FOR THE TREATMENT OF MIGRAINE ATTACKS
Authors: Diener H‐C , McHarg A 
Published: April 2023

SUMMARYSumatriptan, a 5‐HT1B/1D agonist, was introduced 10 years ago and was the most effective therapy for migraine attacks at that time. Eletriptan is a new 5‐HT1B/1D agonist with high potency and selectivity at 5‐HT1B/1D receptors. It is effective in animal models in which the vascular and neurogenic mechanisms implicated in migraine were measured. Eletriptan is selective for the intracranial blood vessels over other extracranial vasculature, in particular coronary arteries. Eletriptan has a rapid and complete oral absorption and a good oral bioavailability in migraineurs. In comparative trials 20 mg, 40 mg and 80 mg eletriptan, 100 mg sumatritpan and placebo were compared for the treatment of migraine attacks. All three doses of eletriptan were statistically superior to placebo for headache response and headache‐free patients. The 80 mg dose of eletriptan was also superior to sumatriptan 100 mg. Headache recurrence, defined as return of moderate or severe headache within 24 hours of dosing and following a headache response at two hours after initial dosing, occurred in 33% of the patients following 100 mg sumatriptan and in 28%, 34% and 32% after 20 mg, 40 mg and 80 mg eletriptan. In another large trial, headache response rates were significantly higher for both doses of eletriptan (64% for 40 mg and 67% for 80 mg) than for two doses of sumatriptan (50% for 50 mg and 53% for 100 mg). Eletriptan 40 mg or 80 mg was also superior to ergotamine plus caffeine (Cafergot). In summary, eletriptan is a highly effective and fast‐acting drug for the treatment of acute migraine attacks.
EXTRACRANIAL ARTERIAL ANEURYSMS: A CAUSE OF CRESCENDO TRANSIENT ISCHAEMIC ATTACKS
Authors: Paterson HM , Holdsworth RJ 
Published: April 2023

SUMMARYCrescendo transient ischaemic attacks (TIAs) should be regarded as a medical emergency. Patients require hospitalisation with urgent assessment and symptom control with anticoagulant therapy. We report on three patients, all of whom had atherosclerotic aneurysmal disease of the extracranial arterial circulation who presented with crescendo TIAs. The possibility of extracranial aneurysmal disease should always be considered and excluded.
INTERFERON TREATMENT FOR THROMBOCYTOPENIA ASSOCIATED WITH CHRONIC HCV INFECTION
Authors: Uygun A , Kadayifci A , Ercin N , Bagci S , Dagalp K 
Published: April 2023

SUMMARYThrombocytopenia is commonly seen in patients with chronic liver disease, due mainly to hypersplenism secondary to portal hypertension. We report a case of chronic hepatitis C admitted with thrombocytopenia of unknown cause. The patient's symptoms and platelet count improved markedly with interferon treatment. We conclude that interferon treatment in chronic C hepatitis may improve HCV‐induced thrombocytopenia.
METASTATIC TUMOUR OF THE TUNICA VAGINALIS TESTIS FROM CARCINOMA OF THE STOMACH
Authors: Wai HPS , Yau T‐K , Sze W‐M , Yeung M‐W , Moe F , Lee AWM 
Published: April 2023

SUMMARYA 50‐year‐old man with advanced inoperable gastric adenocarcinoma and diffuse peritoneal metastasis received six cycles of palliative chemotherapy and responded clinically with weight gain. Two months after the completion of chemotherapy, however, he developed a left hydrocele. Aspiration yielded 70 ml of yellowish hydrocele fluid, which contained metastatic adenocarcinoma cells, consistent with a gastric primary tumour. A diagnosis of malignant hydrocele was made. Two weeks later, he developed a painful recurrent left hydrocele with increasing pain and swelling. Left orchidectomy was performed. Tiny white mural nodules measuring 1 mm in size were noted on the tunica vaginalis. No focal lesion was noted in the testis. On microscopic examination, the tunica vaginalis showed reactive mesothelial hyperplasia and extensive lymphatic permeation by poorly differentiated adenocarcinoma, consistent with a gastric primary tumour.
TRAUMATIC RUPTURE OF THE DIAPHRAGM
Authors: ÇubukÇu A , Paksoy M , Gönüllü NN , Sirin F , Dülger M 
Published: April 2023

SUMMARYDiaphragmatic rupture following trauma is often an associated and missed injury. The diagnosis is difficult, so is usually made intraoperatively. Twenty‐one patients with traumatic rupture of the diaphragm (TRD) who presented between 1995 and 1998 were retrospectively analysed: 12 had penetrating injuries and nine had blunt injuries. Right‐sided defects exceeded left (12 vs 9). Only seven patients had signs and symptoms directly referrable to rupture of the diaphragm. All patients were operated on through a midline laparotomy. Diaphragmatic hernia was seen in six patients (28.5%); 20 (95%) patients had concomitant injuries. The liver was the most commonly injured organ (10 patients). The aim of this study was to report our experiences with TRD and review the literature. We conclude that correct preoperative diagnosis of TRD needs a high index of suspicion. It can be diagnosed intraoperatively by explorative laparotomy. Most ruptures can be repaired by the abdominal approach. (Int J Clin Pract 2000; 54(1): 19‐21)
IMAGING ASSESSMENT OF UNCOMPLICATED BLADDER OUTFLOW OBSTRUCTION
Authors: Probert JL , Mills R , Persad RA , Sethia KK 
Published: April 2023

SUMMARYTo assess the impact of the use of plain X‐ray films and ultrasound examinations on clinical decision‐making in patients referred with symptoms of bladder outflow obstruction. Patients with symptoms of bladder outflow obstruction were recruited prospectively. After clinical assessment they underwent standard investigations of plain X‐ray of the kidneys, ureters and bladder, and upper and lower urinary tract ultrasound. A management decision was made on the basis of all results. These decisions were then reviewed with specific reference to radiological findings to assess the role of imaging in the decision‐making process. A total of 320 men were recruited for the study. X‐ray of the kidneys, ureters and bladder detected 10 upper tract calculi, none of which has required active intervention to date. Four bladder calculi were detected. Two of these were also seen on ultrasound scan: one was small and insignificant, the other had caused microscopic haematuria, necessitating cystoscopy regardless of the X‐ray findings. Upper tract ultrasound revealed abnormalities and anatomical variants which did not affect management. Four patients had upper tract dilatation but these had already had surgery planned on the basis of other investigations, including residual urine volume determination by lower tract ultrasound. Lower urinary tract ultrasound should be the only routine imaging used in the initial assessment of patients with bladder outflow obstruction, with consequent implications of reduced patient stress and reduced investigation cost. (Int J Clin Pract 2000; 54(1): 22‐24)
SOCIAL DRIFT IN FORENSIC PSYCHIATRIC INPATIENTS WITH SCHIZOPHRENIA
Authors: Treasaden IH , Lekh SK , Puri BK 
Published: April 2023

SUMMARYThe highest social class before admission of 27 forensic psychiatric inpatients in a regional secure unit who suffered from schizophrenia was found to be significantly lower than that of their fathers. This is the first report of social drift in this group of patients. (Int J Clin Pract 2000; 54(1): 28‐29)
V. THE STIGMA OF ANXIETY DISORDERS
Authors: Davies B 
Published: April 2023

SUMMARYPeople with genuine anxiety disorders can be misdiagnosed and mismanaged, because of negative public and professional attitudes to anxiety and the ‘worried well’. Misdiagnosis includes not taking symptoms seriously and giving patients pejorative labels such as ‘personality disorder’ or ‘inadequate’. This can lead to mismanagement such as reluctance to investigate symptoms fully, with regard to both physical and psychological aetiologies. Also, poor understanding of appropriate treatments can lead to mismanagement of these disorders. This paper reviews sources of stigma in dealing with anxiety disorders and ways in which this stigma might be avoided. (Int J Clin Pract 2000; 54(1): 44‐47)
SAFE AND EFFECTIVE MANAGEMENT OF HYPERTENSION WITH FIXED‐DOSE COMBINATION THERAPY: FOCUS ON LOSARTAN PLUS HYDROCHLOROTHIAZIDE
Authors: Benedict CR 
Published: April 2023

SUMMARYTreatment of hypertensive patients with fixed‐dose combination therapy consisting of losartan and hydrochlorothiazide (HCTZ) has several potential benefits over monotherapy with each of the individual components: more effective blood pressure control, a reduction in the likelihood of adverse effects, and facilitation of patients staying on therapy due to a simple once‐daily regimen. Losartan plus HCTZ fixed‐dose combination therapy lowers blood pressure in mild to moderate or severe hypertensive patients to a level comparable with other classes of antihypertensive drugs in combination with HCTZ. Fixed‐dose combination therapy with losartan plus HCTZ is therefore an excellent choice for hypertensive patients in whom combination therapy is necessary to achieve additional blood pressure reductions. (Int J Clin Pract 2000; 54(1): 48‐54)
A RANDOMISED COMPARISON OF SIMVASTATIN VERSUS SIMVASTATIN AND LOW CHOLESTEROL DIET IN THE TREATMENT OF HYPERCHOLESTEROLAEMIA
Authors: Thuraisingham S , Tan KH , Chong KS , Yap SF , Pasamanikam K 
Published: April 2023

SUMMARYThere is little evidence to show that strict dietary modification alone confers any significant impact on cardiac events in primary and secondary prevention of coronary heart disease. Given the efficacy of the statins, the need for strict dietary modification in patients on statin therapy has been questioned. This study was performed to assess 1) the added benefit on serum lipid levels of a strict low‐fat dietary regimen in patients with hypercholesterolaemia already treated with simvastatin; 2) the efficacy of simvastatin on the lipid profile of our sample Asian population; and 3) the tolerability and side‐effect profile of simvastatin. This study was a prospective evaluation of 60 patients with hypercholesterolaemia treated with simvastatin who were subjected to either a normal diet or a dietitian guided low‐fat diet. Assessment of the effects on serum lipid levels, side‐effects, biochemical and haematological markers were performed. After 24 weeks of treatment, a strict dietitian guided low‐fat diet conferred no additional benefit over and above what was achieved by simvastatin alone. Furthermore, a higher dose of simvastatin was needed in the dietitian guided diet group to achieve the target LDL‐cholesterol level. Simvastatin resulted in a significant positive alteration of lipid profiles in all patients. The drug was well tolerated, with no significant change in either haematological or biochemical indices. Simvastatin is a highly effective cholesterol‐lowering drug with a beneficial effect on the entire lipid spectrum in a cross‐section of Asian patients, and is well tolerated. A dietitian guided dietary approach confers no additional advantage once statin therapy has been initiated. (Int J Clin Pract 2000; 54(2): 78‐84)