bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE CHANGING INDICATIONS FOR CAROTID ENDARTERECTOMY IN THE UK
Authors: Panayiotopoulos YP , Padayachee S , Colchester ACE , Taylor PR 
Published: April 2023

SUMMARYIn early series the majority of carotid endarterectomies were performed in patients with amaurosis fugax (AFx) or transient ischaemic attacks (TIAs) who were thought to have atheromatous ulcers of the carotid bifurcation or the internal carotid artery (ICA). The degree of stenosis was considered to be of secondary importance. We compared our own data with two British series undertaken in the early and late 80s/early 90s. This reflects the broadening of indications and the change of practice for carotid endarterectomy over the years, on the one hand towards including patients who are at greater risk of perioperative stroke (previous CVAs vs TIAs, crescendo TIAs and stroke in evolution), and on the other towards patients who have had no symptoms attributable to the carotid lesion (asymptomatic cases, combined carotid and cardiac procedures).
DIAGNOSIS AND MANAGEMENT OF HYPERLIPIDAEMIA
Authors: Wierzbicki AS 
Published: April 2023

SUMMARYHyperlipidaemia is acknowledged as the major risk factor for coronary heart disease and atheroma progression. This review considers the strategies that should be followed to reduce overall cardiovascular risk in patients with hyperlipidaemia and deals with the identification and management of treating both polygenic and monogenic lipid disorders in the presence or absence of overt cardiovascular disease.
INFORMATION DELIVERY: THE PROVISION OF WRITTEN INFORMATION FOR PATIENTS FOLLOWING CORONARY ANGIOGRAPHY AND POST‐DISCHARGE MANAGEMENT
Authors: Lloyd G , Cooper A , Jackson G 
Published: April 2023

SUMMARYTo improve management of risk factors in patients diagnosed with significant coronary artery disease after day case angiography, we gave patients a discharge information sheet emphasising the importance of prognostic therapy, risk factors and follow‐up. The sheet was evaluated in 40 patients. A nurse talked through the information sheet with the patients after their angiogram and helped to complete relevant sections. One group of patients was given a copy of the sheet to take home, while the second group remained a ‘verbal information only’ group. Providing written information resulted in improvements in follow‐up regarding blood pressure and drug therapy checks, but there was no significant difference between the groups in the follow‐up management of cholesterol or in patient awareness of their cholesterol level. Patients were not likely to remember the sheet, even though a nurse had talked them through it, unless it was backed up with a written copy which could be taken away. It became apparent that the vast majority of patients remembered a pictorial representation of the extent of their disease (routinely provided) in contrast to the relatively disappointing numbers (43%) who remembered the information sheet. To evaluate further the importance of content and style in effective information delivery, we are evaluating the combination of written information with a visual representation of the heart.
SURGERY FOR LUNG CANCER: AGE ALONE IS NOT A CONTRAINDICATION
Authors: Jack CIA , Lye M , Lesley F , Wilson G , Donnelly RJ , Hind CRK 
Published: April 2023

SUMMARYA retrospective analysis of the clinical features, operative procedures, postoperative complications and subsequent survival of 70 (50 male) elderly patients undergoing surgery for lung cancer compared with 74 (53 male) younger patients treated at the same hospital during the same period was performed, to determine if elderly people with lung cancer are less likely to benefit from and/or tolerate surgery. The elderly group had to wait longer for operation (p=0.001) and were more likely to have pre‐existing disease (p=0.019). In contrast, they had fewer recognised postoperative complications (p=0.032) and there was no difference between the two groups in perioperative mortality and subsequent survival. Surgical treatment of localised lung cancer represents the best chance for cure and this study suggests that age should not be a consideration in the decision to operate or not. The patient's general state of health should be assessed and management decisions based on individual status rather than on age.
ANTICOAGULANT CONTROL IN THE FIRST THREE MONTHS AFTER MECHANICAL HEART VALVE REPLACEMENT
Authors: Hsin M , Speight J , Cooper GJ 
Published: April 2023

SUMMARYTo establish the precision of anticoagulant control in the first three months after mechanical heart valve replacement, 53 patients from a consecutive series of 91 were telephoned and asked to read out their anticoagulation record. The levels of international normalised ratio (INR) were analysed by Rosendaal's method. Twenty‐nine per cent of patient days were spent with an INR in the recommended range of 3.0‐4.5. Warfarin dosage was increased at a median INR of 2.1 (interquartile range 1.7‐2.3), unchanged at 2.7 (interquartile range 2.3‐3.1) and decreased at 4.3 (interquartile range 3.6‐5.1). Anticoagulant control is poor in the first three months after mechanical heart valve replacement. Data on the INR at which warfarin dosage is changed suggest either that recommended guidelines are not being followed or a reluctance to increase the dosage in patients receiving inadequate anticoagulation.
A STUDY OF AUTONOMIC CARDIOVASCULAR REFLEXES IN ELDERLY PATIENTS WITH PNEUMONIA
Authors: Vassallo M , Allen SC 
Published: April 2023

SUMMARYPeople recovering from pneumonia are often weak for no apparent reason. Clinical features such as postural hypotension, arrhythmia and syndrome of inappropriate ADH have, in other circumstances, been attributed to impaired autonomic function. The aim of this study was to see whether elderly patients with pneumonia had impaired autonomic cardiovascular reflexes and, if so, how long this persisted. We compared healthy elderly controls, elderly controls with trauma (fractured femoral neck) and elderly patients with pneumonia. Thirty‐eight subjects were studied in a series of cardiovascular autonomic function tests. Results suggest that elderly people have a high prevalence of impaired cardiovascular autonomic reflexes in the immediate post‐pneumonic phase, and that this improves significantly after six weeks, with a further improvement by six months. Elderly patients recovering from pneumonia are predisposed to the adverse effects of drugs and other factors which can further impair autonomic cardiovascular reflexes.
REM SLEEP BEHAVIOUR DISORDER: AN OVERVIEW
Authors: Chiu HFK , Wing YK 
Published: April 2023

SUMMARYREM sleep behaviour disorder (RSBD) is a recently described parasomnia characterised by a history of excessive nocturnal motor activity and absence of muscle atonia during REM sleep. Only limited literature is available on this condition. The exact prevalence is unclear, but recent studies suggest it might not be an uncommon condition. The elderly are more often affected and there is a male preponderance. While transient RSBD can be seen after taking certain drugs or during drug withdrawal, the chronic type is usually idiopathic or associated with an underlying degenerative neurological condition. It can result in considerable distress and/or serious injury to the patients or their bed partners. Differential diagnoses include sleep‐walking, night terrors, nightmares, nocturnal seizures, obstructive sleep apnoea, post‐traumatic stress disorder, dissociative states and nocturnal confusional states. The dramatic response to clonazepam highlights the importance of recognition and appropriate treatment of this sleep disorder.
CHRONOBIOLOGY AND CHRONOPATHOPHYSIOLOGY OF NOCTURNAL ASTHMA
Authors: Syabbalo N 
Published: April 2023

SUMMARYAsthma is increasing in prevalence and severity worldwide despite effective treatment and innovative research developments. Chronobiology is the study of biological rhythms and their mechanisms. Asthma is one of many diseases that exemplifies a circadian pattern in intensity, frequency of attacks and mortality. As many as 90% of asthmatics experience nocturnal symptoms severe enough to awaken them from sleep. Increased airway narrowing at night is thought to occur as a result of circadian variation in neurohormones and intensification of airway inflammation. Furthermore, vagal tone, neurogenic inflammation and airway hyperresponsiveness are increased at night. Many cells contribute to the nocturnal inflammatory process in the asthmatic airways, including mast cells, eosinophils, neutrophils and lymphocytes. These cells are capable of secreting innumerable inflammatory mediators, such as histamine, cytokines, leukotrienes, prostaglandins, neutral endopeptidase and superoxides, which are potent bronchoconstrictors and secretogogues. They also cause increased vascular permeability and airway oedema. All these chronobiological events promote nocturnal worsening of asthma and increased nocturnal deaths. Understanding the mechanisms of nocturnal asthma will help us learn more about asthma, and how to implement appropriate chronotherapeutic interventions.
EMPHYSEMATOUS PYELONEPHRITIS RESPONDING TO MEDICAL THERAPY
Authors: Punnose J , Yahya TM , Premchandran JS , Ahmed HF 
Published: April 2023

SUMMARYWe describe two type 2 diabetic patients with unilateral emphysematous pyelonephritis who responded to medical treatment alone. Escherichia coli was isolated in both patients. The presence of gas was confirmed early by ultrasound and CT scan of abdomen. Following treatment, good functional recovery was demonstrable in the affected kidneys by isotope renogram. We stress the need for early diagnosis of this condition and aggressive treatment with broad spectrum antibiotics.
ACROMEGALY IN A WOMAN PRESENTING WITH DIABETIC KETOACIDOSIS AND INSULIN RESISTANCE
Authors: Szeto C‐C , Li K‐Y , Ko GTC , Chow C‐C , Yeung VTF , Chan JCN , Cockram CS 
Published: April 2023

SUMMARYA 22‐year‐old Chinese woman presented with typical features of diabetic ketoacidosis. There was a family history of diabetes but she was not obese. Plasma glucose and bicarbonate levels were 27.0 mmol/l and 5 mmol/l, respectively. Significant insulin resistance was noticed: she needed up to 15 units of insulin per hour. She required up to 120 units daily for her diabetic control even after her acidosis had subsided. She was then noticed to have the clinical features of acromegaly. The diagnosis was confirmed, and a cranial CT scan confirmed the presence of a pituitary macroadenoma. She underwent uneventful trans‐sphenoidal resection of the tumour and her insulin requirement gradually lessened. Acromegaly should be considered in the differential diagnosis of unexplained insulin resistance.
EMERGENCY TRACHEOSTOMY IN GENERAL PRACTICE
Authors: Frosh A , Joyce R , Hern J , Almeyda J 
Published: April 2023

SUMMARYWe set out to review the need for general practitioners (GPs) to be skilled at forming an emergency alternative airway by assessing mortality figures for acute airways obstruction. We also solicited the views of 100 GPs on the theory and practice of emergency tracheostomy and assessed whether they considered they were equipped to carry out such a procedure in the community. The results suggest a significant number of deaths of otherwise young and healthy individuals could be avoided by training community practitioners in emergency alternative airway formation. The results showed a marked lack of confidence in the practice of emergency airway formation and few GPs felt able to carry out the procedure. They indicated an overwhelming interest in receiving further education on the subject. We recommend that formal training programmes in the techniques of emergency airway formation should be available for community GPs.
COLORECTAL ADENOMA IN PATIENTS WITH A HISTORY OF BREAST CANCER: A PROSPECTIVE STUDY IN TAIWAN
Authors: Wu C‐S , Tung S‐Y , Chen P‐C , Kuo Y‐C , Wang C‐Y 
Published: April 2023

SUMMARYThe increased incidence of colorectal cancer in women with a history of breast cancer is well established. However, the relationship between the prevalence of adenomatous polyps and breast cancer is still controversial. We conducted a prospective study of the incidence of colorectal polyps in patients with a history of breast cancer in Taiwan. Eighty‐nine patients (86 women and 3 men) received colonoscopy to test for precancerous lesions. Mean age was 49.4 ± 10.4 years. Twelve polyps (9 adenomatous, 2 hyperplastic, 1 inflammatory) (13.5%) and one cancer (1.1%) were found. The mean age of patients with and without colorectal neoplasia was 56.3 ± 9.4 and 48.2 ± 10.2 years respectively. (p<0.005); 10 out of 13 patients (77%) with colorectal neoplasia were over 50 (p<0.1). Compared with a study of Chinese people in Hong Kong, our population had a lower incidence of colorectal adenomatous polyps, but breast cancer patients have a greater risk of developing colorectal cancer than the general population in Taiwan.
DOES SMOKING INFLUENCE THE ERADICATION OF HELICOBACTER PYLORI AND DUODENAL ULCER HEALING WITH DIFFERENT REGIMENS?
Authors: Kadayifçi A , Simsek H 
Published: April 2023

SUMMARYTo determine the effect of smoking on Helicobacter pylori eradication and ulcer healing, we investigated 232 patients with H. pylori‐positive duodenal ulcer. Patients were given one of seven different treatment protocols and divided into three groups according to smoking habits. Group 1 (n=128) consisted of non‐smokers, group 2 (n=65) of mild smokers (5‐20 cigarettes/day) and group 3 (n=39) of heavy smokers (>20/day). The eradication of H. pylori and ulcer healing rate was controlled eight weeks later after ceasing the therapy. The overall eradication rate was 66% in all patients and 68%, 66%, 59% in each group, respectively. The eradication rates showed no statistical difference between groups. Complete ulcer healing was achieved in 84% of all patients and ulcer healing rate between groups did not show any significance (85%, 83% and 82% respectively). These results suggest that smoking status does not influence the eradication of H. pylori and duodenal ulcer healing rates at eight weeks in patients on different treatment schedules.
GASTROINTESTINAL AUTONOMIC NERVE TUMOUR PRESENTING AS SMALL BOWEL VOLVULUS: A RARE DISEASE WITH A RARE PRESENTATION
Authors: Chung CC , To KF , Lau WY , Li AKC 
Published: April 2023

SUMMARYA 78‐year‐old Chinese woman presented with recurrent postprandial abdominal pain. Computerised tomography revealed a small bowel tumour causing volvulus of a segment of the small bowel. Laparotomy confirmed an extraluminal ileal tumour with partial volvulus of the involved small bowel segment. Small bowel resection was done. Histological and ultrastructural studies confirmed a gastrointestinal autonomic nerve tumour. We review the medical literature on this rare tumour.
SUBACUTE CEREBELLITIS IN LYME DISEASE
Authors: Neophytides A , Khan S , Louie E 
Published: April 2023

SUMMARYCerebellitis is not a recognised manifestation of Lyme disease. We describe a patient with clinical features of subacute cerebellitis, cerebrospinal fluid (CSF) monocytic pleocytosis, positive CSF Borrelia burgdorferi antibodies, negative brain magnetic resonance imaging and a benign course after treatment with ceftriaxone. Possible earlier cases are discussed. Lyme disease should be considered in all cases of subacute cerebellitis.
BLUNT LARYNGEAL TRAUMA: AN UNUSUAL CASE
Authors: Saab M , Birkinshaw R 
Published: April 2023

SUMMARYLocal external evidence of neck trauma – bruising, subcutaneous emphysema, cuts, abrasions and so on – signs of upper airway obstruction, dysphonia and dysphagia are the hallmarks of laryngotracheal lesions. Such lesions tend to occur after motor vehicle accidents and usually require surgery. We describe a case of blunt laryngeal trauma, resulting from an unusual mechanism, which healed spontaneously.
GASTROSTOMY‐RELATED PANCREATITIS IN A CHILD: A FATAL CASE
Authors: Rashid A‐MH 
Published: April 2023

SUMMARYA case of acute pancreatitis following gastrostomy feeding tube insertion is presented. This is a rare and fatal complication, which has not been described before. The role of the gastrostomy catheter and total enteral nutrition in the causation of acute pancreatitis is discussed. Pathologists and clinicians should be aware of this disastrous and potentially avoidable condition.
DRUG ALLERGY: FACT OR FICTION?
Authors: Bowrey DJ , Morris‐Stiff GJ 
Published: April 2023

SUMMARYFrom our clinical practice, it was apparent that patients often reported drug allergies without a substantiating history. A prospective study over six months was undertaken to examine the reporting of drug allergies by hospital patients. Based on the history, allergic reactions were triaged into one of three categories: high probability of an allergic reaction, low probability of an allergic reaction, and uncertain, where the history was incomplete or unclear. Of 1519 patients interviewed, 133 (9%) reported prior drug allergies. The most commonly implicated agents were penicillin (74%), septrin (6%), aspirin (6%), cefuroxime (2%) and trimethoprim (2%); 61% of reactions were deemed to be high probability, with the. remainder either low (29%) or uncertain (10%) probability. It was apparent that patients often considered drug allergy to be synonymous with adverse reaction. Preventing patients from being labelled as drug allergic, thus being denied therapy with first‐line agents, requires patient education and vigilance by doctors in their history‐taking.
PROMOTING EFFECTIVE COMMUNICATION IN NEONATAL INTENSIVE CARE UNITS BY AUDIOTAPING DOCTOR‐PARENT CONVERSATIONS
Authors: Koh THHG , Jarvis C 
Published: April 2023

SUMMARYParents of newborn babies receiving intensive care may find it difficult to understand, remember and accept information. We evaluated how practical and useful it is to give parents a tape‐recording of their initial conversation with the neonatologist. They seem to benefit from being able to listen repeatedly to such recordings. Parents and nurses have similar scores of usefulness of the method but their score is significantly higher than that of the neonatologists. This method could be useful in other clinical situations.
SUMATRIPTAN SUPPOSITORIES FOR THE ACUTE TREATMENT OF MIGRAINE
Authors: Tepper SJ , Cochran A , Hobbs S , Woessner M ,   S2B351 Study Group
Published: April 2023

SUMMARYA randomised, double‐blind, parallel‐group, placebo‐controlled trial was undertaken to assess the efficacy and tolerability of the sumatriptan suppository in 184 patients with acute migraine. Patients used a sumatriptan suppository (12.5 mg or 25 mg) or placebo at home for the treatment of a moderate or severe migraine attack and those who experienced headache recurrence within 24 hours of dosing had the option to repeat the dose. By 2 hours post‐dose, 68% of patients in the sumatriptan 25 mg group and 47% of patients in the sumatriptan 12.5 mg group compared with 25% of placebo patients achieved headache relief. Relief rates 2 hours post‐dose for nausea, vomiting, photophobia and phonophobia were similar to those reported 2 hours post‐dose for headache. Post hoc review of the recurrence data showed that administration of a second suppository was effective in alleviating recurrent headache in over 80% of the sumatriptan‐treated patients experiencing recurrence. No serious or unusual adverse events were reported, and the pattern and incidence of adverse events did not vary as a function of dose. These data demonstrate that the sumatriptan suppository is a well‐tolerated, effective treatment for the acute treatment of migraine pain and its associated symptoms.
MANAGEMENT OF THYROTOXICOSIS IN PREGNANCY
Authors: Ghaneim A , Atkins P 
Published: April 2023

SUMMARYBetween April 1985 and June 1995, 20 patients being treated for thyrotoxicosis became pregnant. These patients are reviewed. Control of thyrotoxicosis early in pregnancy using minimal doses of propylthiouracil or carbimazole, followed by subtotal thyroidectomy in the middle trimester, is safe for both mother and fetus.
TUBERCULOUS TENOSYNOVITIS: A RARE MANIFESTATION OF A COMMON DISEASE
Authors: Soub H Al 
Published: April 2023

SUMMARYTwo cases of tuberculous tenosynovitis of the hand are presented. The clinical features were those of a gradually enlarging swelling and mild pain over several months. Diagnosis was not initially suspected in either patient, reflecting decreased awareness of this uncommon condition. Both patients had concomitant active pulmonary tuberculosis which was quiescent in the second patient! Combined surgical debridement and antituberculous drugs led to a successful outcome. The condition is discussed and pertinent literature is reviewed.
RETROPERITONEAL PERFORATION OF DUODENAL ULCER PRESENTING AS SCROTAL SEPSIS
Authors: Rajasekar A , Macintyre IMC 
Published: April 2023

SUMMARYRetroperitoneal extravasation is an extremely uncommon complication of duodenal ulcer perforation. The preoperative diagnosis is difficult and may even be missed at operation. There were, 25 cases reported in the literature. Only one patient was correctly diagnosed preoperatively and only seven patients survived. We describe the first case of retroperitoneal extravasation from perforated duodenal ulcer presenting as scrotal sepsis.
A MULTICENTRE, DOUBLE‐BLIND, RANDOMISED STUDY COMPARING THE EFFICACY AND SAFETY OF ORAL LEVOFLOXACIN VERSUS CIPROFLOXACIN IN THE TREATMENT OF UNCOMPLICATED SKIN AND SKIN STRUCTURE INFECTIONS
Authors: Nicodemo AC , Robledo JA , Jasovich A , Neto W 
Published: April 2023

SUMMARYA multicentre, randomised, double‐blind trial in Latin America compared oral levofloxacin 500 mg once daily for 7 days with oral ciprofloxacin 500 mg twice daily for 10 days in 272 patients with uncomplicated skin and skin structure infections. Among 253 subjects evaluable for clinical efficacy (129 levofloxacin, 124 ciprofloxacin), clinical success (cure and improvement) was observed in 96.1% of levofloxacin‐treated patients and in 93.5% of ciprofloxacin‐treated patients. Overall, bacteriological eradication rates by pathogen were 93.2% and 91.7%, respectively. Levofloxacin eradicated 94% (66/70) of Staphylococcus aureus and 94% (17/18) of Streptococcus pyogenes isolates, compared with 93% (70/75) and 92% (12/13) for ciprofloxacin. Microbiological eradication rates by subject were approximately 93% and 90% for the levofloxacin and ciprofloxacin groups, respectively. Drug‐related adverse events were reported by 8.9% of those receiving levofloxacin and 8.2% of those administered ciprofloxacin. Findings support the efficacy of oral levofloxacin for uncomplicated skin and skin structure infections due to S. aureus and S. pyogenes.
MORNING VERSUS EVENING DOSING WITH DOXAZOSIN IN BENIGN PROSTATIC HYPERPLASIA: PHARMACOKINETICS, EFFICACY AND SAFETY
Authors: Kirby RS 
Published: April 2023

SUMMARYPharmacokinetic and clinical data from two studies provided evidence that the pharmacokinetics of doxazosin indicate its clinical behaviour: the long half‐life of doxazosin allows once‐daily dosing, with no differences, in terms of clinical efficacy or tolerability, between morning and evening dosing.
HORMONE REPLACEMENT THERAPY AND BREAST CANCER
Authors: Faiz O , Fentiman IS 
Published: April 2023

SUMMARYHormone replacement therapy (HRT) leads to a similar annual increase in risk of breast cancer as does each extra year of remaining premenopausal. Taken for more than 10 years HRT leads to a 35% increase in risk of developing breast cancer. It does not increase a woman's risk of dying of breast cancer, and may improve the prognosis. Some breast cancer patients can safely take HRT and some formulations might reduce the subsequent risk of relapse.