bluuebunny/crossref_metadata_2025_split huggingface dataset:
REVERSIBLE LEFT VENTRICULAR DYSFUNCTION: DOES IT AFFECT CLINICAL PRACTICE AND DOES IT MATTER?
Authors: Redwood SR , Ferrari R , Marber  
Published: April 2023

SUMMARYThere is substantial evidence that many patients with impaired left ventricular function secondary to coronary artery disease may have hibernating or stunned myocardium. The identification of these patients is important, as revascularisation is associated with an improvement in function, and there is some evidence that revascularisation of these patients will actually improve prognosis. The most useful investigations for the identification of reversible left ventricular dysfunction are dobutamine echocardiography, thallium scanning and, although not available in many centres, PET scanning.
BIOCHEMICAL MARKERS OF BONE TURNOVER
Authors: Rosalki SB 
Published: April 2023

SUMMARYSince bone markers may reflect different aspects of bone disorders and cell function, and osteolytic and osteoblastic activities may be individually or concomitantly altered, determination of more than one marker type is generally appropriate. Also, the individual markers of a particular type do not necessarily show parallelism. For example, in osteomalacia from vitamin D deficiency, bone‐specific alkaline phosphatase may be grossly elevated because of enhanced osteoblastic activity, whereas the vitamin D dependent osteocalcin may be decreased. With the exception of measurement of the bone enzymes, bone‐specific alkaline phosphatase and tartrate‐resistant acid phosphatase, bone marker measurements require complex and expensive immunoassays. As a general rule, the simple enzyme measurements can precede other investigation in most bone disorders. Bone‐specific alkaline phosphatase measurement alone is generally adequate for the investigation of osteomalacia, Paget's disease and hyperparathyroidism but should be combined with measurement of tartrate‐resistant acid phosphatase in suspected metastatic disease, and in multiple myeloma. Determination of both enzymes together may also be of value in the investigation of osteoporosis but in this disorder added benefit may be obtained by the addition of other bone markers, particularly urine deoxypyridinoline and possibly serum collagen telopeptide.
CONGENITAL DOUBLE UTERUS AND CONGLUTINATIO CERVIX IN LABOUR
Authors: As AK , Antoniou AV 
Published: April 2023

SUMMARYAn interesting case of congenital double uterus and the intrapartum events associated with it are described. In view of the rarity of the condition, its implication to the patient, her general practitioner and the obstetrician/gynaecologist is discussed, with special reference to contraception, cervical smear and operative surgical technique.
CHICKEN FANCIER'S SPLEEN
Authors: Morris‐Stiff G , Foster M 
Published: April 2023

SUMMARYSplenic epidermoid cysts are rare congenital lesions which usually present insidiously with non‐specific symptoms such as dull left upper quadrant pain, or as incidental findings on clinical examination. We present a chicken breeder who presented as an emergency with a tender left upper quadrant mass and septicaemia secondary to zoonotic infection of a primary spienic cyst with Salmonella enteritidis. The cystic nature of the swelling was confirmed by ultrasound and the anatomy assessed with computed tomography. She was aggressively resuscitated and underwent laparotomy and splenectomy, after which she made an uncomplicated recovery. The importance of early diagnosis and surgical treatment is discussed, together with the measures required as prophylaxis against overwhelming post‐splenectomy sepsis.
HORMONE REPLACEMENT THERAPY: WHY ARE GENERAL PRACTITIONERS NOT PRESCRIBING MORE?
Authors: Dunne FP , Sadler GJ , Crampton JA 
Published: April 2023

SUMMARYRecent statistics suggest hormone replacement therapy (HRT) is prescribed by only a small number of general practitioners (GPs), despite its use being widely discussed and advocated in the literature. In March 1997, we sent a questionnaire to 200 randomly selected practices in the south Birmingham area to try to find the reason. Eighty‐one (40.5%) completed questionnaires were returned from 57 (70%) male and 24 (30%) female GPs respectively. Seventy (86.4%) claimed they actively prescribed HRT as a prophylaxis for osteoporosis; 76% felt doctors were well informed about the risks and benefits of HRT. However, male and female GP opinions differed as to the most effective duration of HRT use. Comparison of the ethnic backgrounds of male prescribers and non‐prescribers revealed significant differences, and the ethnic group predominating in the catchment areas of prescribers and non‐prescribers was also different.
THE DIFFICULTIES ENCOUNTERED IN COMPLETING AN AUDIT CYCLE IN A DISTRICT GENERAL HOSPITAL
Authors: Ong CC , Chorbachi R 
Published: April 2023

SUMMARYClinical audit has brought about tremendous improvements in the quality of clinical, practice in all aspects of health care. However, completing an audit cycle presents many obstacles. We present our experience in the difficulties encountered in implementing changes to current practice. The factors involved are discussed.
RESPIRATORY MUSCLE FUNCTION IN PATIENTS WITH NEUROMUSCULAR DISORDERS AND CARDIOPULMONARY DISEASES
Authors: Syabbalo N 
Published: April 2023

SUMMARYRespiratory muscle dysfunction frequently occurs in patients with neuromuscular disorders, cardiopulmonary diseases and in patients in intensive care units. Respiratory muscle weakness and/or fatigue is responsible for dyspnoea, reduced exercise tolerance, nocturnal 'desaturation, and prolonged weaning from mechanical ventilation. Chronic respiratory muscle weakness may also be associated with poor quality of life and increased mortality. Patients with severe respiratory muscle weakness are at increased risk of respiratory failure due to respiratory infections, electrolyte imbalance, sedation or uncontrolled inspired oxygen therapy. Although respiratory muscle weakness is often seen in clinical practice, the consequences and the precise point at which respiratory muscle fatigue occurs remain elusive. This article reviews the pathophysiology of respiratory muscle weakness and fatigue, and therapeutic interventions for enhancing respiratory muscle function in patients with neuromuscular and cardiopulmonary diseases.
RECENT DEVELOPMENTS IN THE DIAGNOSIS AND TREATMENT OF LUNG CANCER
Authors: Gilligan D 
Published: April 2023

SUMMARYLung cancer is responsible for 25% of all cancer deaths in the UK and it is estimated that over 80% of lung cancers are related to smoking. Despite numerous health education campaigns, large numbers of young people take up smoking, particularly girls. In the past there has been a somewhat nihilistic attitude to the management of lung cancer, but this is changing due to the emergence of sub‐specialisation in oncology and the development of new techniques and treatment, which are beginning to show promise.
COBB'S COLLAR AND SYRINGOCELE WITH STONE
Authors: Mutlu N , Çulha M , Mutlu B , Acar O , Turkan S , Gokalp A 
Published: April 2023

SUMMARYWe report a case of unusual syringocele with a stone and Cobb's collar. Tubular or cystic dilatation of Cowper's gland duct has been called a syringocele. Congenital urethral narrowing is known as Cobb's collar. This paper presents a rare case of adult syringocele with stone and Cobb's collar. We analysed the clinical, radiological and therapeutic aspects of this entity.
DEEP VEIN THROMBOSIS AS A PRESENTING SYMPTOM OF CONGENITAL INTERRUPTION OF THE INFERIOR VENA CAVA
Authors: Timmers GJ , Falke THM , Rauwerda JA , Huijgens PC 
Published: April 2023

SUMMARYIntrahepatic interruption of the inferior vena cava is a congenital anomaly, resulting in venous drainage of the lower extremities by way of a compensatory enlarged vena azygos system. We report the case of a 37‐year‐old male who presented with symptoms of deep vein thrombosis of the entire right lower extremity. A right‐sided mediastinal mass on the chest X‐ray was mistaken for a haematological malignancy but proved later to represent an enlarged azygos vein. The case illustrates that in a case of deep vein thrombosis, especially in younger patients, interruption of the inferior vena cava should be considered. A right‐sided paratracheal mass on the chest X‐ray may give a clue in making the correct diagnosis.
AN UNUSUAL CASE OF ILEOCAECAL TUBERCULOSIS IN AN 80‐YEAR‐OLD CAUCASIAN MALE
Authors: Kelly J , Warren K , Coutts M , Jenkins A 
Published: April 2023

SUMMARYAn 80‐year‐old Caucasian male presented with a seven‐week history of diarrhoea and weight loss. Distal duodenal biopsies showed partial villous atrophy but he failed to respond to a gluten‐free diet. Subsequently he developed a right iliac fossa mass associated with radiological evidence of ileocaecal ulceration. Colonoscopic biopsies from the caecum showed non‐caseating granulomata and Ziehl‐Neelsen (ZN) staining and culture for acid‐fast bacilli (AFB) were negative. Crohn's disease was diagnosed and he was started on steroids. Although he showed an initial response, his condition then deteriorated and he died after six weeks. ZN staining of tissue at postmortem showed AFBs. Although a rare diagnosis in the UK, a high index of suspicion should be maintained for ileocaecal TB in patients with appropriate clinical features, even if classical risk factors for TB are absent.
TOPICAL IMMUNOTHERAPY IN DERMATOLOGY
Authors: Buckley DA , Vivier AWP Du 
Published: April 2023

SUMMARYTopical immunotherapy of skin diseases has been used since the 1970s to treat conditions thought to result from an altered immunological state, mainly extensive alopecia areata and resistant viral warts. Despite its effectiveness, only a handful of dermatology departments in the UK currently provide such treatment. Any of three universal contact sensitisers may be used for topical immunotherapy; but diphencyprone (DCP) has advantages over dinitrochlorobenzene (DNCB) and squaric acid dibutyl ester (SADBE). Sensitisation of medical, nursing and pharmacy staff may be avoided by careful handling of the solutions. Local blistering and eczematous eruptions are the most common risks in patients undergoing treatment; vitiligo and erythema multiforme‐like reactions are rare complications. Topical immunotherapy using DCP with close supervision is a useful option for severe alopecia areata and resistant viral warts.
PRIAPISM INDUCED BY CHLORPROMAZINE
Authors: Mutlu N , Ozkurkcugil C , Çulha M , Turran S , Gökalp A 
Published: April 2023

SUMMARYPriapism is a pathologically prolonged and painful penile erection, usually unassociated with sexual desire or intercourse. Causes include certain oral medications, although the mechanism for drug‐induced priapism is unknown. We describe two cases of priapism attributed to chlorpromazine who have presented within the past two years.
MIVACURIUM APNOEA: A TRAP FOR THE UNWARY
Authors: Ogunbiyi OA , Branch KG 
Published: April 2023

SUMMARYWe present a case of unanticipated postoperative apnoea in a patient with associated medical illness to illustrate the diagnostic difficulty that can arise in the detection and subsequent management of mivacurium apnoea. A high index of suspicion is essential in the presence of concomitant medical conditions that may cause prolonged apnoea. To our knowledge, no report exists documenting the unanticipated occurrence of mivacurium apnoea in a patient with previously undiagnosed pseudoCholinesterase deficiency and concomitant medical illness who has previously undergone ‘balanced’ general anaesthesia.
TREATMENT OF COMPLICATED INTRA‐ABDOMINAL INFECTIONS: COMPARISON OF THE TOLERABILITY AND SAFETY OF INTRAVENOUS/ORAL TROVAFLOXACIN VERSUS INTRAVENOUS IMIPENEM/CILASTATIN SWITCHING TO ORAL AMOXYCILLIN/CLAVULANIC ACID
Authors: Luke  , Peterson J 
Published: April 2023

SUMMARYThree‐ to four‐times‐daily intravenous (IV) imipenem/cilastatin switching to oral amoxycillin/clavulanic acid is often used to manage complicated intra‐abdominal infections. Trovafloxacin, a clinically and bacteriologically proven new‐generation fluoroquinolone antibiotic, given as single‐agent, once‐daily IV/oral therapy, can provide equivalent clinical and bacteriological efficacy. Tolerability and safety of up to 14 days treatment with 300 mg IV alatrofloxacin (the prodrug of trovafloxacin) switching to 200 mg oral trovafloxacin were compared with those of 1 g IV imipenem/cilastatin switching to 625 mg oral amoxycillin/clavulanic acid. Comparable incidences of adverse events, mainly mild or moderate in intensity, were experienced in each treatment group. For both therapies, gastrointestinal events were most common, but diarrhoea was reported by proportionately more comparator group patients. In conclusion, once‐daily IV‐to‐oral trovafloxacin has a comparable safety profile to IV imipenem/cilastatin followed by oral amoxycillin/clavulanic acid. Cost saving may be achieved with trovafloxacin due to the lack of any need to monitor creatinine levels and the once‐daily dosing regimen that allows a switch to the same orally administered drug.
BRONCHODILATORY RESPONSES TO FORMOTEROL, IPRATROPIUM, AND THEIR COMBINATION IN PATIENTS WITH STABLE COPD
Authors: Sichletidis L , Kottakis J , Marcou S , Constantinidis TC , Antoniades A 
Published: April 2023

SUMMARYWe studied 27 patients with stable chronic obstuctive pulmonary disease (COPD) in a randomised, single‐blind, within‐patient, placebo‐controlled clinical study. Each patient was assigned on six separate days to receive one of the following drug regimens in random order: A. 40 μg ipratropium bromide (Atrovent MDI, 20 μg/puff) plus 2 puffs placebo; B. 12 μg formoterol fumarate (Foradil MDI,12 μg/puff) plus 3 puffs placebo; C. 80 μg ipratropium; D. 24 μg formoterol plus 2 puffs placebo; E. 12 μg formoterol plus 40 μg ipratropium plus 1 puff placebo; F. 4 puffs placebo. On each study day, Spirometric indices and vital signs were measured at 5, 10, 15 and 60 minutes, and hourly thereafter up to and including 12 hours after study drug administration. Mean peak FEV1 change (primary endpoint) was maximum with the administration of the combination of ipratropium and formoterol (335.2 ml, SE 24.6), and it differed significantly from the observed peak changes following single administration of the two tested doses of ipratropium (p<0.05 and p<0.05 respectively). Safety and tolerability were satisfactory throughout the study.
SCIATICA IN THE COMMUNITY – NOT ALWAYS DISC HERNIATION
Authors: Hopayian K 
Published: April 2023

SUMMARYThree cases of sciatica seen in general practice are described. The clinical features were consistent with pyriformis syndrome, a condition of compression of the sciatic nerve at the pelvic outlet. The literature on causes and clinical features is briefly reviewed. The prevalence of the condition in the community and the accuracy of clinical diagnosis are unknown. It is suggested that pelvic outlet syndrome, comparable to carpal tunnel syndrome, is a more appropriate name for the condition.
EMERGENCY CONTRACEPTION
Authors: Sarkar NN 
Published: April 2023

SUMMARYEmergency contraception means preventing pregnancy after unprotected sexual intercourse. This is also called postcoital contraception (PCC) or the ‘morning‐after pill’. High doses of oestrogen or progestogen or a combination of both may be used as PCC up to 72 hours after unprotected intercourse. The use of mifepristone as emergency contraception has also proved promising. Some women use emergency contraception, but there are many who do not know much about it. Users, providers and other health professionals need to be educated about this method. Emergency contraception does not fall within the ambit of abortion law, yet its acceptability depends on the legal, cultural and religious consideration of most countries. This method is safe and effective and could be used occasionally to prevent unwanted pregnancy.
‘NOT FOR RESUSCITATION’: GUIDELINES FOR DECISION MAKING AND DOCUMENTATION
Authors: Blackie KA , Davidson AC , Marsh MJ , Kinirons MT 
Published: April 2023

SUMMARYIn 1991, the government's Chief Medical Officer made it clear that the responsibility for resuscitation policy lay with consultants, and that they should ensure this policy was understood by all staff caring for a patient, in particular junior medical staff. Since then, many hospitals and trusts have provided members of the multidisciplinary team with guidance on how to ensure that adequate and satisfactory communication is in place to record a patient's resuscitation status. However, as is common in the NHS, poor documentation is still evident. Guy's & St Thomas' Hospital Trust has been using a document since April 1998 which is clearly written, user friendly and does not contain ambiguous statements. With ongoing audit of this policy document we hope to reduce the incidence of inappropriate resuscitation attempts which are costly, both emotionally and financially, for all concerned.
HYPERCALCAEMIA: A CLUE TO MYCOBACTERIUM AVIUM INTRACELLULARE INFECTION IN A PATIENT WITH AIDS
Authors: Aly E‐S , Baig M , Khanna D , Baumann MA 
Published: April 2023

SUMMARYHypercalcaemia is uncommon in HIV‐infected patients and should suggest a different priority for differential diagnosis than would be considered in other settings. Although hypercalcaemia has long been associated with granulomatous diseases including tuberculosis, it has only recently been recognised that patients with illness due to Mycobacterium avium intracellulars (MAI) may develop it. We report a patient with AIDS in whom unexplained hypercalcaemia was the harbinger of clinically significant MAI infection. Patients with AIDS who develop hypercalcaemia should be closely evaluated for underlying MAI infection.
INTERNATIONAL MULTICENTRE COMPARISON OF CERIVASTATIN WITH PLACEBO AND SIMVASTATIN FOR THE TREATMENT OF PATIENTS WITH PRIMARY HYPERCHOLESTEROLAEMIA
Authors: Betteridge DJ 
Published: April 2023

SUMMARYAn international multicentre double‐blind randomised trial compared the efficacy and safety of cerivastatin (0.025, 0.05, 0.1 and 0.2 mg once daily) with placebo and simvastatin (20 mg) over a period of 12 weeks, with study extensions to 52 and 100 weeks. The primary efficacy parameter was the percentage change in low density lipoprotein cholesterol (LDL‐C). This was reduced from the baseline by 12.5% (0.025 mg) to 30.6% (0.2 mg) compared with falls of 2.0% on placebo and 40.3% on simvastatin. All four cerivastatin doses and simvastatin (20 mg) produced significantly greater falls than placebo (p<0.0001) and the decrease in LDL‐C was dose‐dependent for cerivastatin. Simvastatin produced significantly greater falls than any cerivastatin dose or placebo (p<0.0001). The effect was maintained at 1 year but somewhat attenuated at 100 weeks. Significant falls were also seen in serum total cholesterol and triglycerides. High density lipoprotein cholesterol (HDL‐C) levels were significantly increased by cerivastatin (0.1 and 0.2 mg) and simvastatin (20 mg) at 12 weeks and increased further by 100 weeks. Mean fasting apolipoprotein A1 and lipoprotein A1 were increased and apolipoprotein B decreased by cerivastatin and simvastatin therapy. All doses of cerivastatin produced significant falls in the total cholesterol/HDL‐C ratio at 12 weeks (0.5‐1.6) compared with a fall of 2.1 for simvastatin (20 mg). Cerivastatin was well tolerated. Elevations in creatine Phosphokinase, aspartate aminotransferase and alanine aminotransferase were mostly minor and transitory. Vital signs, electrocardiogram determinations, urinalysis and ophthalmic assessment showed similar results for both drugs. Cerivastatin, at doses of 0.1 mg and 0.2 mg daily, is considered to be of therapeutic value in the treatment of patients with primary hypercholesterolaemia, with 0.2 mg cerivastatin achieving reductions of LDL‐C and total cholesterol similar to those achieved in the WOSCOP and CARE studies.
ANAESTHETIC ASSESSMENT AND MANAGEMENT OF CARDIAC PATIENTS FOR NON‐CARDIAC SURGERY PART I: ASSESSMENT
Authors: Shaw A , Boscoe MJ 
Published: April 2023

SUMMARYCardiac disease is known to increase the risk of non‐cardiac surgery to patients who suffer from it. Clinical and investigation data may be used to identify those at increased risk. Attempts have been made to integrate these risk factors into systems that can quantify risk in terms of increased morbidity and mortality. In this article we discuss the various aspects of cardiac illness that are known to increase risk for patients and then look at the different scoring systems that have been produced. We consider the type and urgency of surgery and finish by providing an approach to risk assessment for non‐cardiac surgery.
THERAPEUTIC ADVANCES IN ACUTE ISCHAEMIC STROKE
Authors: Bhalla A , Rudd AG 
Published: April 2023

SUMMARYNo drug has yet been shown to be unequivocally effective for acute stroke. Over the past decade, however, there has been an explosion in stroke research resulting in the development of novel therapeutic approaches. Therapies to improve arterial recanalisation and agents used to protect the brain from neurotoxic cellular damage are currently being evaluated. Tight control of physiological parameters may also limit neuronal damage. It is likely that within the next few years effective therapy will become available that will need a major change in the way that services are provided for stroke patients in the acute phase of their illness.
OBSTRUCTIVE SLEEP APNOEA CAUSES TRANSIENT AND SUSTAINED SYSTEMIC HYPERTENSION
Authors: Zwillich CW 
Published: April 2023

SUMMARYApnoea with associated fall in arterial oxygen tension results in increased blood pressure and a striking surge in sympathetic activity, which can be measured as high catecholamine levels or increase in muscle sympathetic nerve activity. Following the termination of apnoea with resumption of breathing, sympathetic nerve activity decreases and blood pressure returns to lower values. Sympathetic mediated alternations in peripheral vascular resistance best explain these findings. Hypertension during wakefulness in untreated patients with apnoea is also associated with high sympathetic nervous system activity. Nasal continuous positive airway pressure (CPAP) has been shown to lower blood pressure in some hypertensive obstructive sleep apnoea (OSA) patients. Recently, previously untreated OSA patients exhibiting awake sympathetic hyperexcitation demonstrated striking attentuation of the response following initiation of effective CRAP therapy. Accordingly, the common problem of systemic hypertension found in untreated OSA appears to be mediated by sympathetic excitation and responds to effective CRAP therapy.
STAPHYLOCOCCUS AUREUS ENDOCARDITIS PRESENTING AS MENINGITIS AND MIMICKING MENINGOCOCCAL SEPSIS
Authors: Kelly J , Barnass S 
Published: April 2023

SUMMARYA case of Staphylococcus aureus meningitis (SAM) secondary to endocarditis is presented. The presence of a petechial rash affecting the lower limbs led to an initial presumptive diagnosis of meningococcal meningitis. There were no stigmata of endocarditis at presentation, though these subsequently developed. Underlying endocarditis should be diligently sought in any patient presenting with spontaneous SAM, even if typical stigmata are initially absent. In view of the association with skin lesions and neurological complications, S. aureus endocarditis may mimic the classical presentation of meningococcal sepsis.
PAPILLARY THYROID ADENOCARCINOMA ARISING IN A THYROGLOSSAL TRACT REMNANT FOLLOWING EXCISION OF A THYROGLOSSAL CYST: THE IMPORTANCE OF THE SISTRUNK PROCEDURE
Authors: Rampaul R , Maharaj D , Naraynsingh V , Ramcharan KS , Josa D 
Published: April 2023

SUMMARYCarcinoma of the thyroglossal tract is a rarity – over the past 85 years only 160 cases have been reported. We report the first case of carcinoma arising in a thyroglossal tract remnant 10 years after simple excision of a thyroglossal cyst. This case highlights the importance of the Sistrunk procedure, (the removal of the entire thyroglossal tract) for preventing not only cyst recurrence, sinus and fistula formation, but also the occurrence of carcinoma.