bluuebunny/crossref_metadata_2025_split huggingface dataset:
THERAPEUTIC APPROACHES TO THE MANAGEMENT OF COMMON BALDNESS
Authors: Sommer S , Wilson C 
Published: April 2023

SUMMARYCommon baldness or androgenetic alopecia is a universal problem, having affected both sexes of all races to different extents for as long as mankind has existed. The progressive androgen dependent hair loss follows specific patterns and is a physiological process, which may take on disease quality due to psychosocial compontents. These should be taken into consideration when discussing the several treatment options available, particularly as a cure cannot be offered. Cosmetic measures range from back‐combing over perms to hairpieces and wigs. Medical therapies include systemic antiandrogens and topical minoxidil; surgical options comprise follicular transplantation, scalp reduction and rotation. Before starting treatment, however, careful consideration should be given to the differential diagnosis which includes drug‐induced hair thinning, anagen effluvium, diffuse alopecia areata, metabolic disturbances, nutritional deficiencies and acute as well as chronic telogen effluvium.
UNUSUAL PRESENTATION OF DISSECTING AORTIC ANEURYSM
Authors: Ismil ML , Hussien M 
Published: April 2023

SUMMARYDissecting aneurysms generally cause radiating back pain, chest pain, or symptoms caused by aortic insufficiency. Presentation solely with abdominal pain is rare. We report on a patient with dissecting thoracic aortic aneurysm who presented solely with abdominal pain. The possibility of intrathoracic disease must be considered in every patient with abdominal pain, especially if the pain is in the upper part of the abdomen.
AN ASSESSMENT OF THE EFFICACY OF ATORVASTATIN IN ACHIEVING LDL CHOLESTEROL TARGET LEVELS IN PATIENTS WITH CORONARY HEART DISEASE: A GENERAL PRACTICE STUDY
Authors: Neil HAW , Fowler G , Patel H , Eminton Z , Maton S 
Published: April 2023

SUMMARYAdherence to evidence‐based guidelines for the secondary prevention of coronary heart disease (CHD) has been shown to be poor in a number of surveys. In this open‐label, non‐comparative 17‐week trial, 399 patients with existing CHD and LDL cholesterol concentration >3.4 mmol/l (130 mg/dl) were treated with atorvastatin 10 mg daily. After 5 weeks, the dose of atorvastatin was adjusted according to a patient's LDL cholesterol level. Of the 379 patients remaining in the study after five weeks of treatment, dose titration was not required for 355 patients (94%) who had reached the target LDL cholesterol of ≤3.4 mmol/l. Of the 23 patients titrated to higher doses, 11 achieved the target LDL cholesterol after treatment for 17 weeks. Atorvastatin was well tolerated during the course of the study. Achieving LDL cholesterol targets without the need for dose titration simplifies clinical management and should encourage better adherence to evidence‐based recommendations for secondary prevention of CHD.
NEW VARIANT CREUTZFELDT‐JAKOB DISEASE
Authors: Gordon N 
Published: April 2023

SUMMARYIt is now recognised that new variant Creutzfeldt‐Jakob disease (CJD) can present during adolescence, so it may be within the experience of any paediatrician. Some observations on prion proteins are made, and some of the features of classical CJD are reviewed. Reports of patients with new variant CJD are given. The possible links between this condition and bovine spongiform encephalopathy (BSE) are considered, especially the finding that certain people who are homozygous for methionine at codon 129 of the prion protein may be particularly susceptible to this infection. The diagnosis of new variant CJD can be difficult. Early sensory and psychiatric symptoms can be suggestive, so can the initial signs of ataxia and involuntary movements. The EEG does not help in this variety. Although not specific, some serum and CSF tests may give diagnostic support. It has been claimed that tonsillar biopsy may confirm the diagnosis, but this often necessitates brain biopsy; or the diagnosis may only be made at autopsy. Beliefs about the way infections spread will have to be modified, and more must be learnt about the nature of prions, how they enter the body, and how they spread in the brain.
TUBERCULOUS PERFORATIONS OF THE SMALL INTESTINE
Authors: Talwar S , Talwar R , Prasad P 
Published: April 2023

SUMMARYThe hospital records of 58 patients operated on for tuberculous perforations of the small intestines at our hospital between 1987 and 1996 were reviewed. Clinical features were non‐specific in the majority of the patients. Pneumoperitoneum on abdominal radiographs was present in only 28 (48.3%) patients. Forty‐five (77.6%) were operated on within 36 hours of perforation. Surgical management consisted of resection and end‐to‐end anastomosis (n=45); oval excision of the perforation and transverse anastomosis reinforced with an omental patch (n=7); ileo‐transverse colostomy (n=5); and peritoneal drainage only (n=1). There were 17 deaths (29.3%). Adverse prognostic factors were operation beyond 36 hours (p<0.01), multiple perforations (p<0.001), and faecal fistula formation (p<0.01). Mortality was least with early resection and end‐to‐end anastomosis of the perforated bowel segment. We conclude that a high index of suspicion is essential for early diagnosis and optimal treatment of patients with tuberculous intestinal perforations.
ATTENTION DEFICIT HYPERACTIVITY DISORDER: POSSIBLE CAUSES AND TREATMENT
Authors: Gordon N 
Published: April 2023

SUMMARYThe possible causes of attention deficit hyperactivity disorder are considered, and the drugs that may be of benefit in treating it. Accurate diagnosis is essential for effective management. This includes the syndrome itself and associated conditions. Theories of causation are discussed. These involve the anatomical substrate but, equally importantly, the role of neurotransmitters; and the use of tests such as positron emission tomography will undoubtedly increase understanding. Genetic factors also play a part. Options for treatment are considered. Evidence supports the effectiveness of stimulant drugs, such as methylphenidate. Among the justifications for such treatment are the excessive strains placed on family relationships by the condition, and the disruption of the child's schooling. It must be carefully planned, and a constant watch kept for adverse effects. These can include difficulty in sleeping, poor appetite, loss of weight and tics. Drugs alone, however, are unlikely to help, and attention must first be given to the situation at home and at school, and how this can be improved. Treatment is often successful, and it can be a rewarding condition to treat.
FEVER, RASH AND WORSENING OF ASTHMA IN RESPONSE TO INTRAVENOUS HYDROCORTISONE
Authors: Vaghjimal A , Rosenstreich D , Hudes G 
Published: April 2023

SUMMARYWe describe a case of a hypersensitivity reaction to intravenous hydrocortisone in a 64‐year‐old female with asthma, and briefly review other cases.
PULSE OXIMETRY: EVOLUTION AND DIRECTIONS
Authors: Middleton PM , Henry JA 
Published: April 2023

SUMMARYPulse oximetry monitoring is a relatively recent technique that has been embraced enthusiastically by medical, nursing and paramedical personnel in many clinical situations. Few people, however, have any idea of how it provides the reading of arterial blood saturation. This review performs several functions: it discusses the haemoglobin molecular structure and explains its relation to spectrophotometry, describes the history and principles of pulse oximetry and the nature of the equipment used, and reviews its common uses. It also explores the principles and proposed uses of its lesser known corollary, photoplethysmography.
CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME PRESENTING AS DILATED CARDIOMYOPATHY WITH BILATERAL BRANCH RETINAL ARTERY THROMBOSIS
Authors: Mandal B , Rathore S , Douglas AF 
Published: April 2023

SUMMARYCardiac manifestation of antiphospholipid syndrome (APS) is mainly in the form of left‐sided valvular insufficiency, intra‐cardiac thrombi or coronary artery occlusion. Dilated cardiomyopathy is a rare but important cardiac manifestation of APS, and responds well to adequate anticoagulation and steroids. We describe a case in which APS presented with dilated cardiomyopathy and bilateral retinal artery thrombosis.
MULTICENTRIC STUDY OF THE EFFECT OF MILK FERMENTED BY LACTOBACILLUS CASEI ON THE INCIDENCE OF DIARRHOEA
Authors: Pedone CA , Arnaud CC , Postaire ER , Bouley CF , Reinert P 
Published: April 2023

SUMMARYThe aim of this study was to determine if supplementation of healthy children with milk fermented by yogurt cultures and Lactobacillus casei strain DN‐114 001 could affect the incidence of acute diarrhoea when compared with traditional yogurt. The study was a multicentre, randomised, double‐blind trial, conducted over four months, on 928 children aged, at inclusion, 6–24 months. The study consisted of two periods: supplementation and observation. Subjects were supplemented daily with 100 g of one of the two dairy products being tested: standard yogurt and milk fermented by yogurt cultures and Lactobacillus casei (108 cfu/ml). Frequency or duration of any diarrhoea episode was evaluated. As far as frequency was concerned there was a statistically significant difference between the groups, the incidence of diarrhoea being significantly reduced by supplementation with L. casei fermented milk (15.9%) compared with yogurt (22%) (p=0.03). These results suggest an additional benefit of L. casei in acute diarrhoea in children compared with standard yogurt.
PROSTATE‐SPECIFIC ANTIGEN AND PROSTATE CANCER
Authors: Rosalki SB , Rutherford FJ 
Published: April 2023

SUMMARYSerum prostate‐specific antigen (PSA) measurement is used to investigate patients with lower urinary tract symptoms and to screen for prostatic malignancy in symptom‐free males over 50 years of age. Approximately 60% of patients with early (prostate‐confined) occult malignancy show increased serum PSA levels, as do some 20% of patients with prostatic symptoms from benign prostatic disease. When PSA is only slightly raised, serial PSA measurements, correction for prostatic volume and especially measurement of free (unbound) PSA (which is reduced in prostatic malignancy) may assist the differentiation of prostatic cancer from benign hypertrophy. Serial measurements are also of value for monitoring treatment of prostate cancer and for post‐treatment surveillance.
MANAGEMENT OF ADVANCED BREAST CANCER WITH ENDOCRINE THERAPY: THE ROLE OF THE PRIMARY HEALTHCARE TEAM
Authors: Theobald AJ 
Published: April 2023

SUMMARYOf the 25,000 new cases of breast cancer annually in the UK, at least half will develop metastases at some time. Approximately one‐third of these will be hormone‐sensitive and thus suitable for endocrine manipulation. Such patients may live for several years. Care should be patient‐centred and evidence‐based, with primary care playing an integral part in the multidisciplinary team. Quality of life is paramount, and largely determines decisions to change endocrine therapy. Tamoxifen remains the first choice treatment, but newer agents, in particular the oral aromatase inhibitors, have successfully extended the range of therapy available. Ovarian ablation can be effectively achieved using LHRH analogues, which have the advantage of being reversible if ineffective. In future, further improvements in outcome are likely with new pure antioestrogens and the possibility of sequential or combined use of existing drugs.
SMALL BOWEL CARCINOID TUMOUR PRESENTING WITH INTESTINAL ISCHAEMIA
Authors: Ormandy SJ , Parks RW , Madhavan KK 
Published: April 2023

SUMMARYA rare cause of intermittent intestinal ischaemia is presented to highlight the importance of thorough investigation, including the usefulness of laparoscopy, in the assessment of patients with persistent postprandial abdominal pain and hyperactive bowel sounds. (Int J Clin Pract 2000; 54(1): 42‐43)
INTERPRETATION OF THE DIRECT ANTIGLOBULIN TEST IN NEONATES WITH HAEMOLYTIC DISEASE OF THE NEWBORN
Authors: Tuladhar R , Patole SK , Whitehall JS 
Published: April 2023

SUMMARYNeonatal blood grouping and direct antiglobulin test results need to be interpreted with caution following multiple intrauterine blood transfusions for haemolytic disease of the newborn (HDN). Except for a few reports published about 20 years ago, this fact is not well documented. We report a case emphasising the problem and its consequences. (Int J Clin Pract 2000; 54(1): 64
ACUTE PULMONARY OEDEMA FOLLOWING SMOKE INHALATION
Authors: Saab M , Majid I 
Published: April 2023

SUMMARYA case of acute pulmonary oedema after smoke inhalation from a chip pan fire is presented. The role of bronchial and pulmonary circulation in the development of pulmonary oedema after smoke inhalation is discussed. We stress the importance not only of observation after smoke inhalation, as the manifestation of pulmonary oedema may be delayed, but also of a baseline chest X‐ray before admission for comparison. (Int J Clin Pract 2000; 54(2): 115‐116)
PERFORATION OF UTERUS BY THE GYNEFIX INTRAUTERINE CONTRACEPTIVE DEVICE
Authors: Al‐Kamil RK 
Published: April 2023

SUMMARYA case of intrauterine perforation by a GyneFix contraceptive device in a 29‐year‐old parous woman is described. It is the first report of uterine perforation by the frameless, anchored GyneFix in the UK since its introduction here in 1997. Perforation was diagnosed 12 days after insertion and was complicated by visceral perforation and infection. (Int J Clin Pract 2000; 54(2): 128‐129)
DUODENAL OBSTRUCTION DUE TO A SWALLOWED NASOGASTRIC TUBE
Authors: Naraynsingh V , Maharaj D , Rampaul R 
Published: April 2023

SUMMARYNasogastric tubes are commonly used, not only in surgical practice but in all disciplines. Their use, however, is not without complications. We present the first reported case of duodenal obstruction due to a swallowed nasogastric tube, and recommend that nasogastric tubes be used in their entirety (uncut) with the splayed distal end intact. This simple procedure will prevent a rare but distressing complication that might be amenable only to laparotomy. (Int J Clin Pract 2000; 54(2): 130)
CURRENT MANAGEMENT OF MULTIPLE SCLEROSIS
Authors: Leary SM , Thompson AJ 
Published: April 2023

SUMMARYMultiple sclerosis is a complex disease which presents a unique challenge in clinical management. This decade has seen the advent of new therapies which are partially effective in modifying the disease course. However, current therapies have no impact on existing neurological deficits and so supportive measures, symptomatic treatment and comprehensive rehabilitation remain at the core of management. Historically clinical practice has often been empirical but management should now be evidence‐based and guided by consensus opinion if improvements in care are to be made. (Int J Clin Pract 2000; 54(3): 161‐169)
DAPSONE‐INDUCED METHHAEMOGLOBINAEMIA: A SOURCE OF DIAGNOSTIC CONFUSION
Authors: Craig D , Cadden ISH , Gormley WP , Rilet  , Jones FGC , Mcmullin MF 
Published: April 2023

SUMMARYArterial desaturation as measured using pulse oximetry may not reflect cardiorespiratory disease; other possible causes, including certain drugs, should be sought. Within the literature, examples exist of dapsone‐induced methaemoglobinaemia causing diagnostic confusion, particularly where respiratory disease is a feature. Few cases have been reported that demonstrate the potential of relatively low levels of methaemoglobinaemia to upset pulse oximetry readings. We describe three examples of dapsone‐induced methaemoglobinaemia emphasising the potential for low‐grade methaemoglobinaemia to cause diagnostic confusion. Widespread use of the pulse oximeter indicates this problem may occur more regularly, hence there is a need for increased awareness. (Int J Clin Pract 2000; 54(3): 194‐196)
CHYLOUS ASCITES: A RARE COMPLICATION OF RADICAL GASTRECTOMY
Authors: Rajasekar A , Ravi NR , Diggory RT 
Published: April 2023

SUMMARYChylous ascites is the accumulation of lymphatic fluid within the peritoneal cavity, due to trauma or obstruction to the lymphatic system. Postoperative chylous ascites is a rare complication of abdominal surgery. This is frequently reported after retroperitoneal dissections, and results in high morbidity and mortality. The treatment options are varied and include total parenteral nutrition (TPN), elemental diet with medium chain triglycerides (MCT), repeated paracentesis and surgical ligation. We report a case of post‐operative chylous ascites after D2 distal gastrectomy. Treatment by fasting, TPN followed by fat‐free diet resulted in complete resolution of ascites within 3 weeks. To our knowledge this is the first report of such a complication following radical gastrectomy. We review the literature and briefly discuss the management options. (Int J Clin Pract 2000; 54(3): 201‐203)
ALTERNATIVES TO HYSTERECTOMY FOR THE TREATMENT OF EXCESSIVE UTERINE BLEEDING
Authors: Robins JC , Liu J 
Published: April 2023

SUMMARYAbnormal uterine bleeding is a common gynaecological problem that traditionally has been treated with hysterectomy. However, there are many other conservative treatment modalities that should be considered before hysterectomy. Medical therapies are effective in most cases. Endometrial ablation may be an effective surgical alternative to hysterectomy. This article reviews and updates the diagnostic concepts and management options for the treatment of abnormal uterine bleeding. The authors present a review of the pertinent literature and describe their experience with the latest balloon device for endometrial ablation therapy. (Int J Clin Pract 2000; 54(4): 233‐237)
POTT'S PUFFY TUMOUR: A RARE CAUSE OF FOREHEAD SWELLING IN A CHILD
Authors: Hore I , Mitchell RB , Radcliffe G , De Casso Moxo C 
Published: April 2023

SUMMARYWe report a case of Pott's puffy tumour in a 12‐year‐old. Owing to the late development of the frontal sinuses, frontal sinus infection in children is rare. When present it can lead to osteomyelitis associated with forehead swelling. Early diagnosis and active treatment prevent progression to life‐threatening intracranial spread. (Int J Clin Pract 2000; 54(4): 267‐268)
THYROTOXICOSIS IN DOWN'S AND TURNER'S SYNDROMES: THE LIKELIHOOD OF HASHIMOTO'S THYROIDITIS AS THE UNDERLYING AETIOLOGY
Authors: Idris I , O'Malley BP 
Published: April 2023

SUMMARYBiochemical thyrotoxicosis in young women is almost invariably due to Graves' disease. Its occurrence in females with Turner's and Down's syndromes, both of which are seldom associated with Graves' hyperthyroidism but are frequently allied to Hashimoto's thyroiditis, should alert physicians to the possibility of the latter. The discharge thyroiditis of Hashimoto's disease can be recurrent and protracted. A brisk response to antithyroid therapy would favour a thyroiditis and, in this circumstance, radio‐iodine uptake should be reduced. The absence of TSH receptor antibodies in such cases, while not wholly refuting the notion of active Graves' disease, lends support to the existence of Hashimoto's thyroiditis. (Int J Clin Pract 2000; 54(4): 272‐273)
MOXIFLOXACIN (AVELOX): AN 8‐METHOXYQUINOLONE ANTIBACTERIAL WITH ENHANCED POTENCY
Authors: Ball P 
Published: April 2023

SUMMARYMoxifloxacin is a novel 8‐methoxyquinolone with enhanced potency against important Gram‐positive pathogens, notably Streptococcus pneumoniae. It retains class activity against Gram‐negative bacteria. Currently available for oral use, it has a prolonged half‐life, enabling once‐daily administration and reflecting balanced renal and hepatic elimination. Clinical trials have demonstrated an excellent safety record with minor class effects in the skin and gastrointestinal systems. Potential for phototoxicity is minimal and moxifloxacin is free of clinically significant neurological, hepatic or cardiac effects. Investigated primarily in respiratory infections, moxifloxacin has shown excellent performance in community‐acquired pneumonia (both pneumococcal and atypical), acute exacerbations of chronic bronchitis and acute maxillary sinusitis. It is available in many European countries and in the US where it is rapidly establishing clinical acceptance and formulary inclusion. (Int J Clin Pract 2000; 54(5): 329‐332)
BISOPROLOL ALONE AND IN COMBINATION WITH AMLODIPINE OR NIFEDIPINE IN THE TREATMENT OF CHRONIC STABLE ANGINA
Authors: Ferguson JD , Ormerod O , Lenox‐Smith AJ 
Published: April 2023

SUMMARYBeta‐blockers and calcium antagonists are both effective monotherapy for stable angina. When symptoms persist, these two agents are commonly co‐prescribed in the hope that this combination has added benefit compared with monotherapy alone. We investigated the additional efficacy of the calcium antagonists amlodipine and nifedipine when added to bisoprolol in patients with stable angina. Patients were randomised in a multicentre, single‐blind study, with crossover of three treatments consisting of bisoprolol 10 mg once daily, bisoprolol plus nifedipine 20 mg twice daily, and bisoprolol plus amlodipine 5 mg once daily. Exercise tests were performed at the end of each four‐week study period and the exercise time to onset of angina was assessed. A total of 198 patients from 17 centres were recruited of whom 147 were evaluable for efficacy. There were no statistically significant differences in exercise duration to onset of angina between any of the groups. The combination of bisoprolol plus nifedipine was least well tolerated. In summary, this study suggests there is little benefit in adding a calcium antagonist to bisoprolol in treating patients with stable angina. (Int J Clin Pract 2000; 54(6): 360‐363)
ACUTE SPONTANEOUS HAEMATOMA OF THE RECTUM
Authors: Babu ED , Axisa B , Taghizadeh AK , Delicata RJ 
Published: April 2023

SUMMARYGastrointestinal haematomata occur usually in the small intestine and may be secondary to anticoagulation. Spontaneous intramural haematoma of the rectum is rare. We report such a case which presented as acute abdominal pain and which was treated by simple drainage.
EXTRAFINE BECLOMETHASONE DIPROPIONATE BREATH‐ACTUATED INHALER (400 μG/DAY) VERSUS BUDESONIDE DRY POWDER INHALER (800 μG/DAY) IN ASTHMA
Authors: Reichel W , Dahl R , Ringdal N , Zetterstrom O , Van Den Elshout EJJ , Laitinen LA 
Published: April 2023

SUMMARYHydrofluoroalkane‐134a beclomethasone dipropionate extrafine aerosol breath‐actuated inhaler (Qvar™ Autohaler™; BDP‐AH) provides an alternative to chlorofluorocarbon metered dose inhalers or dry powder inhalers (DPIs). The aim of this six‐week, open‐label study was to determine whether BDP‐AH demonstrates equivalent asthma control to twice the dose of budesonide (BUD)‐DPI (Pulmicort Turbuhaler®). Adults with symptomatic asthma inadequately controlled on BUD‐DPI 400 μg/day and β‐agonist were enrolled. Patients (n=193) were randomised to receive 400 μg/day BDP‐AH (n=98) (two puffs of 100 μg/actuation inhaler twice daily) or 800 μg/day BUD‐DPI (n=95) (two puffs of 200 μg/actuation inhaler twice daily). Both groups showed a statistically significant change from baseline in morning (a.m.) peak expiratory flow (PEF) at weeks 5–6 (p<0.01), indicating study treatment improved a.m. PEF over prestudy 400 μg/day BUD. Changes from baseline in a.m. PEF at weeks 5–6 were 15.9 l/min for BDP‐AH and 14.2 l/min for BUD‐DPI; the groups were statistically equivalent (90% Cl ‐7.02–10.44; p<‐0.001 [equivalence=within ± 25 l/min]). Other efficacy assessments (evening PEF, FEV1, asthma symptoms, β‐agonist use) confirmed the treatments were clinically equivalent. Thirty‐nine (40%) patients on BDP‐AH and 35 (37%) on BUD‐DPI experienced at least one adverse event (p=0.767). Four (4%) patients on BDP‐AH and 3 (3%) on BUD‐DPI reported increased asthma symptoms. BDP‐AH at half the daily dose provided equivalent asthma control to BUD‐DPI; both treatments were well tolerated.