bluuebunny/crossref_metadata_2025_split huggingface dataset:
CATECHOLAMINE SECRETION AND PLOIDY IN PHAEOCHROMOCYTOMA
Authors: Tormey WP , Fitzgerald RJ , Thomas G , Kay EW , Leader MB 
Published: April 2023

SUMMARYThe aim was to evaluate 24 hr urine catecholamine, HMMA and HVA excretion in relation to ploidy in phaeochromocytoma. Data from five diploid and nine tetraploid tumours showed a significant reduction in urine noradrenaline (p=0.02) and HMMA (p=0.03) in diploid tumours but no difference in adrenaline, dopamine and HVA excretion using the Mann‐Whitney U test. None of the patients showed recurrence after a mean of 5.7 years of follow up. A review of published ploidy studies in phaeochromocytoma shows that malignancy is more than six times more common in non‐diploid tumours but diploidy does not equate with benignity. No biochemical marker is a reliable index of malignancy. All patients should undergo lifetime review for recurrence.
SILDENAFIL CITRATE (VIAGRA®) IS EFFECTIVE AND WELL TOLERATED FOR TREATING ERECTILE DYSFUNCTION OF PSYCHOGENIC OR MIXED AETIOLOGY
Authors: Olsson AM , Speakman MJ , Dinsmore WW , Giuliano F , Gingell C , Maytom M , Smith MD , Osterloh I ,   Sildenafil Multicentre Study Group
Published: April 2023

SUMMARYSildenafil citrate (Viagra®) has been shown to be an effective treatment for erectile dysfunction (ED) of organic aetiology. This study assessed the efficacy and tolerability of sildenafil for treating ED of psychogenic and mixed psychogenic/organic aetiology. Men with ED of psychogenic and mixed aetiology were randomised in a double‐blind, fixed‐dose study to placebo (n=95) or sildenafil 10 mg (n=90), 25 mg (n=85), or 50 mg (n=81) once daily for 28 days. Efficacy was evaluated with two global efficacy questions, a patient log of erectile activity, a sexual function questionnaire and a partner questionnaire. Patients receiving sildenafil had significantly more grade 3 (hard enough for penetration) or grade 4 (fully hard) erections per week than patients receiving placebo, and a greater proportion of patients receiving sildenafil reported that treatment had improved their erections (p<0.001). Results of the sexual function questionnaire demonstrated significant improvement for patients with ED receiving sildenafil compared with patients receiving placebo for frequency, hardness and duration of erections (p<0.01), and for enjoyment of sexual intercourse and satisfaction with sex life (p<0.05). The results of the partner questionnaire were consistent with the results reported by patients and showed that treatment with sildenafil was associated with significant improvement in the partners' own sex lives (p<0.001). Adverse events were mostly mild to moderate in nature. The commonest adverse events were headache, dyspepsia, flushing, myalgia, arthralgia and flu syndrome. Discontinuations due to treatment‐related adverse events were few, ranging from 1.1% to 6.2% for patients receiving different doses of sildenafil and 4.2% for patients receiving placebo. Sildenafil is an effective and well‐tolerated treatment for ED of psychogenic or mixed aetiology with once‐daily dosing.
COMPLICATIONS OF A SIMPLE PROCEDURE: DE QUERVAIN'S DISEASE REVISITED
Authors: Mellor SJ , Ferris BD 
Published: April 2023

SUMMARYWe reviewed the results of 22 operations performed on 21 patients for the relief of de Quervain's disease over the last six years. At a mean follow‐up of 34 months (range 4‐78 months), 18 of 22 wrists had complete relief of their original symptoms. One patient required reoperation because of inadequate decompression, and two others await further surgery. Most operations (14 out of 22) were performed under local anaesthesia, and 17 out of 22 used a longitudinal incision. The use of a longitudinal incision was associated with a significant risk of complications: four patients had a poor cosmetic result, and six showed evidence of superficial radial nerve injury. Two patients had a wound infection, and one developed reflex sympathetic dystrophy. Although surgical decompression for de Quervain's disease is effective in curing the symptoms in most patients, using a longitudinal incision is associated with poor wound healing and damage to the terminal branches of the radial nerve. (Int J Clin Pract 2000; 54(2): 76‐77)
THE EFFECTS OF VALETTE® ON SKIN AND HAIR: A POST‐MARKETING SURVEILLANCE STUDY
Authors: Zimmermann T , Wisser K‐H , Dietrich H 
Published: April 2023

SUMMARYThe effects of Valette® ‐ an oral contraceptive containing ethinyloestradiol 0.03 mg and the antiandrogenic progestogen dienogest 2.0 mg ‐ on the skin and hair were surveyed over 63,474 cycles in 10,718 women in routine gynaecological practice. Improvements were greatest in women with severe or moderate androgen‐related symptoms. After six cycles, <1% of women had severely greasy hair and 6% had moderate greasiness, compared with 11 % and 27% at baseline; fewer hair washes were needed per week. The incidence of severe and moderately greasy skin disorders fell from 16% to <1%, and from 39% to 7.5%, respectively. Self‐assessments indicated less greasy hair and improved greasy skin disorders in 70% and 81% of women, respectively. The overall effect of Valette on the skin and hair was rated very good or good by 87.5% of women. These results confirm previous observations of a beneficial effect of Valette on androgen‐related skin and hair conditions. (Int J Clin Pract 2000; 54(2): 85‐91)
IS PAEDIATRIC DAY CASE TONSILLECTOMY DESIRABLE? THE PARENTS' PERSPECTIVE
Authors: Vowles R , Loney E , Williams H , Gormley‐Fleming E , Kulkarni P , Ryan R 
Published: April 2023

SUMMARYTonsillectomy is the most commonly performed otolaryngological procedure in most units. There is considerable financial pressure to perform paediatric tonsillectomy as a day case. Responding to concern that day case tonsillectomy might not be welcomed by parents or felt to be in the best interests of the patients, we carried out an audit of paediatric tonsillectomy, by means of a questionnaire for parents and nursing staff to complete while 32 consecutive patients underwent tonsillectomy as inpatients. Although eight parents (25%) felt that day surgery should be an option, none of those surveyed felt that on this occasion their child was well enough to be discharged home six hours postoperatively. Furthermore, no child in the audit fulfilled all the essential discharge criteria at six hours. In this area, at least, it appears parents do not uniformly welcome paediatric day case tonsillectomy. (Int J Clin Pract 2000; 54(4): 225‐227)
RAMIPRIL
Authors: Smith WHT , Ball SG 
Published: April 2023

SUMMARYRamipril is a long‐acting, lipophylic angiotensin converting enzyme inhibitor. its principle action is to inhibit the conversion of angiotensin I to the active angiotensin II. Ramipril is indicated in the treatment of hypertension, congestive cardiac failure (including that following acute myocardial infarction), nephropathy (with and without diabetes mellitus) and now, following the findings of the HOPE study, in the prevention of cardiovascular events (including myocardial infarction) in high risk individuals. This article concentrates on reviewing the evidence supporting ramipril's use in these indications. (Int J Clin Pract 2000; 54(4): 255‐260)
AN UNUSUAL CAUSE OF CUSHING'S SYNDROME: PRIMARY PIGMENTED NODULAR ADRENAL DYSPLASIA
Authors: Sofat N , Turner J , Khoo B , Sohail M , Krausz T , Evans P , Meeran K 
Published: April 2023

SUMMARYWe report a case of Cushing's syndrome due to primary pigmented nodular adrenal dysplasia (PPNAD) and discuss the diagnostic process and management of this rare case. The diagnosis of PPNAD is discussed in the context of other causes of Cushing's syndrome. Eighty‐five per cent of cases of Cushing's syndrome are due to a pituitary corticotrophic tumour (Cushing's disease). Rarer causes include cortisol secreting adrenal adenoma and ectopic ACTH secretion. In the routine investigation of Cushing's disease it is not unusual to find bilateral adrenal nodules on the CT scan. We present a case of Cushing's syndrome in which this radiographic finding was present and yet the biochemical diagnosis was one of ACTH independent disease. Histology revealed PPNAD. (Int J Clin Pract 2000; 54(4): 269‐271)
A COMPARISON OF PATIENTS ADMITTED TO TWO MEDIUM SECURE UNITS, ONE FOR THOSE OF NORMAL INTELLIGENCE AND ONE FOR THOSE WITH LEARNING DISABILITY
Authors: Puri BK , Lekh SK , Treasaden IH 
Published: April 2023

SUMMARYDifferences between patients being treated in two different medium secure units, one for those of normal intelligence and one for those with learning disability, were investigated.Sociodemographic, psychiatric, medical and medicolegal data were recorded for all inpatients in both secure units. Patients in the medium secure unit for those of normal intelligence were older at the time of the study and at conviction for the index offence, more likely to have been admitted from the penal system, and more likely to suffer from a psychotic disorder, particularly schizophrenia or a mood disorder. Their index offence was more likely to be homicide, attempted murder, manslaughter or grievous bodily harm, while that of the patients with learning disability was more likely to be a sexual offence. A need for separate medium secure unit facilities for those of normal intelligence and those with learning disability is supported by differing psychiatric and behavioural requirements. (Int J Clin Pract 2000; 54(5): 300‐305)
CODEINE ANALGESIA IS DUE TO CODEINE‐6‐GLUCURONIDE, NOT MORPHINE
Authors: Vree TB , Van Dongen RTM , Koopman‐Kimenai PM 
Published: April 2023

SUMMARYEighty per cent of codeine is conjugated with glucuronic acid to codeine‐6‐glucuronide. Only 5% of the dose is O‐demethylated to morphine, which in turn is immediately glucuronidated at the 3‐ and 6‐ position and excreted renally. Based on the structural requirement of the opiate molecule for interaction with the μ‐receptor to result in analgesia, codeine‐6‐glucuronide in analogy to morphine‐6‐glucuronide must be the active constituent of codeine. Poor metabolisers of codeine, those who lack the CYP450 2D6 isoenzyme for the O‐demethylation to morphine, experience analgesia from codeine‐6‐glucuronide. Analgesia of codeine does not depend on the formation of morphine and the metaboliser phenotype. (Int J Clin Pract 2000; 54(6): 395‐398)
RUPTURED ECTOPIC PREGNANCY PRESENTING WITH HYPERGLYCAEMIA
Authors: Bhattacharyya A , Tymms DJ 
Published: April 2023

SUMMARYA ruptured ectopic pregnancy is always an emergency. The key to successful treatment is early diagnosis, which is not always easy, mainly because typical presenting features may be absent. We report a case of a ruptured ectopic pregnancy that presented with a gastroenteritic illness together with hyperglycaemia, leading to an initial diagnosis of diabetes mellitus. The patient was treated successfully, however, once the correct diagnosis had been made. We conclude that a urine pregnancy test should be a routine procedure in all abdominal emergencies involving female patients of childbearing age, to avoid misdiagnosis or a delay in diagnosis. (Int J Clin Pract 2000; 54(6): 409‐410)
THE FOLEY CATHETER IN THE MANAGEMENT OF EPISTAXIS
Authors: Holland NJ , Sandhu GS , Ghufoor K , Frosh A 
Published: April 2023

SUMMARYThe Foley urinary catheter has been used in the management of epistaxis for many years, yet it has never been designed or licensed for this purpose. We performed a telephone questionnaire of senior house officers in 90 ENT departments in England and Wales. The aim was to determine how many departments used the Foley catheter for epistaxis management, whether licensed nasal balloon devices were available and if there had been any complications associated with their use. Eighty‐three (92%) ENT departments in the study used the Foley catheter for epistaxis management and 44 (49%) departments had licensed balloon devices available. Only 22% of ENT senior house officers questioned were aware that the Foley catheter was not licensed for use in the nose. Most complications associated with the use of nasal balloon devices appear to be due to Foley catheters.
CONSERVATIVE MANAGEMENT OF LOW BACK PAIN
Authors: Frank AO , De Souza LH 
Published: April 2023

SUMMARYBack pain is prevalent worldwide, but back pain disability has reached epidemic proportions in many industrialised societies. Few patients have serious medical pathology or direct neurological involvement requiring surgery. Although the causes remain unclear, physical stress and its consequences on discs, facet joints and supporting soft tissues at work or leisure are important, sometimes aggravated by adverse psychosocial factors. Modern management emphasises the role of self‐care, beginning in primary care with the first episode. Without root compression, bed rest should not exceed 48 hours. Emphasis is on encouraging a rapid return to physical fitness and other activities, including employment, acknowledging that returning to a normal life may require working through pain. Medication facilitates this. No one should remain in pain beyond six weeks without being referred to a specialist service for a physical and psychosocial assessment by appropriately trained professionals and with consultant support for investigation, pain management and rehabilitation when needed.
RIFAMPICIN TEST IN THE DIAGNOSIS OF GILBERT'S SYNDROME
Authors: Erdil A , Kadayifci A , Ates Y , Bagci S , Uygun A , Dagalp K 
Published: April 2023

SUMMARYGilbert's syndrome (GS) is characterised by the existence of chronic mild unconjugated hyperbilirubinaemia. The value of rifampicin as a provocative test for the diagnosis of GS was evaluated and compared with a fasting test. Twenty‐two patients with GS, 15 patients with chronic liver disease and 20 healthy controls were included. Both rifampicin and fasting tests were applied to all subjects. In the fasting test, the subjects were given a 400 calorie/day diet for 24 hours; in the rifampicin test, unconjugated bilirubin levels was measured before and four hours after taking 600 mg of rifampicin. Both tests achieved a significant increase in mean unconjugated bilirubin levels in patients with GS but not in the controls. The sensitivity and specificity of a rifampicin test in the diagnosis of GS were comparable with the fasting test. However, both tests caused a significant increase in unconjugated bilirubin levels in nearly half the patients with chronic liver disease. A rifampicin test may be used in the diagnosis of suspected GS instead of a fasting test, as it is simpler and more practical. However, its specificity for GS is not sufficient, because it also causes an increase in unconjugated bilirubin levels in some patients with chronic liver disease.
THE COST‐EFFECTIVENESS OF DOXAZOSIN FOR THE TREATMENT OF HYPERTENSION IN TYPE II DIABETIC PATIENTS IN THE UK AND ITALY
Authors: Casciano J , Doyle J , Casciano R , Kopp Z , Marchant N , Bustacchini S , Arikian S , Kim R 
Published: April 2023

SUMMARYThe objective of this analysis was to assess the cost‐effectiveness of achieving ‘tight control’ versus ‘less tight control’ of blood pressure, as defined in the UK Prospective Diabetics Study 38, in type II diabetic patients in the UK and Italy. The effect of including doxazosin in a ‘tight control’ combination therapy was analysed. Given doxazosin's positive impact on lipid levels in addition to its antihypertensive effect, it is hypothesised that treatment including doxazosin will reduce the incidence of macrovascular complications. For each country, a Markov model was constructed to simulate macrovascular outcomes of patients on various drug combinations. Transitional probabilities were based on the risk rates presented in UKPDS 38. Risk rates were adjusted for the ageing of the cohort and the lipid‐lowering properties of doxazosin using Framingham risk equations. Incremental cost‐effectiveness ratios ranged from £2224 to £4867 (US$3225–7057) per life‐year saved for the UK and from L1.8–9.3 million (US$818–4159) per life‐year saved for Italy. Doxazosin is a cost‐effective agent when included in a combination therapy in the treatment of hypertension in the diabetic populations of the UK and Italy.
NECROSIS OF THE NASAL ALA AFTER IMPROPER TAPING OF A NASOGASTRIC TUBE
Authors: Lai PBS , Pang PCW , Chan SKC , Lau WY 
Published: April 2023

SUMMARYInserting a nasogastric tube during various abdominal procedures is a common manoeuvre to decompress the upper gastrointestinal tract. Improper placement and taping of the nasogastric tube results in excessive pulling on the nasal ala and subsequent pressure necrosis. This complication not only carries serious cosmetic morbidity, it is also preventable if a proper taping technique is employed.
CARDIAC SAFETY IN THE EUROPEAN STROKE PREVENTION STUDY 2 (ESPS2)
Authors: Diener H‐C , Darius H , Bertrand‐Hardy JM , Humphreys M 
Published: April 2023

SUMMARYThe second European Stroke Prevention Study investigated the prevention of stroke and/or death in 6602 patients with transient ischaemic attack or stroke with aspirin (25 mg b.d.), dipyridamole (400 mg b.d.), the combination of aspirin and dipyridamole or placebo. This post hoc analysis investigated cardiac events in patients with coronary heart disease or myocardial infarction (MI) at entry. Dipyridamole did not result in a higher number of cardiac events, e.g. angina pectoris, MI, or death from all causes. The combination of aspirin plus dipyridamole was superior to either drug alone in the prevention of stroke.
AN UNUSUAL CAUSE OF RENAL IMPAIRMENT: A LATEX GLOVE
Authors: Shah J , Jayawardene S , Das G 
Published: April 2023

SUMMARYMale genital self‐mutilation is thought to be increasing in incidence and is underreported in the literature. We therefore have no clear and uniform treatment programmes. We present a case of genital self‐mutilation involving a 16‐year‐old male. The case highlights an important complication and the multidisciplinary approach to its management.
LYMPHOCYTIC HYPOPHYSITIS: SPONTANEOUS RESOLUTION ON MRI WITH PROGRESSION OF ENDOCRINE DEFECT
Authors: Krimholtz MJ , Thomas S , Bingham J , Powrie JK 
Published: April 2023

SUMMARYLymphocytic hypophysitis is an uncommon condition that typically occurs during the last trimester of pregnancy or in the postpartum period. Presentation is of an anterior pituitary mass with varying degrees of pituitary dysfunction. We present a case in which there was dramatic resolution of the pituitary lesion on sequential MRI scanning. Despite this apparent resolution, however, the patient continues to have significant pituitary dysfunction.
HAIR AS A BIOLOGICAL SPECIMEN FOR THERAPEUTIC DRUG MONITORING
Authors: Beumer JH , Bosman IJ , Maes RAA 
Published: April 2023

SUMMARYTo study the potential of hair as a biological specimen in therapeutic drug monitoring (TDM), a review of the correlation between hair concentration, blood levels, dose and therapeutic effects of various drugs is presented. The results indicate there is a fair correlation between plasma and hair for several medicines. Moreover, hair samples have the advantage of providing information of more prolonged drug intake, thus allowing a better evaluation of patient compliance. Using segmental hair analysis, only a single sample is necessary. We conclude that hair has potential as a biological specimen in TDM – at least as far as compliance is concerned and possibly as a longer term record of drug concentrations – and that correlation between hair concentration, blood levels and clinical efficacy should be investigated for all drugs where TDM is indicated.
GLATIRAMER ACETATE (COPAXONE)
Authors: Francis DA 
Published: April 2023

SUMMARYGlatiramer acetate (Copaxone) is a novel preparation of synthetic peptides composed of four amino acids. Laboratory studies have shown that it prevents, or modifies, experimental allergic encephalomyelitis, the animal model for multiple sclerosis (MS), in several mammalian species. Its mode of action has not been fully elucidated but it is known to induce suppresser T‐cells, known to be deficient in MS, and competitively inhibits the effect of CNS myelin antigens, thought to be important in the pathogenesis of MS, through MHC blockade. Controlled clinical trials have shown it to improve the natural history of MS by reducing both the relapse rate and the resultant disability. GA shows similar efficacy to interferon‐beta (IFN‐β) but with fewer systemic side‐effects and appears to be better tolerated by patients. It has thus justified its place in the new era of disease‐modifying treatments for MS. While the evidence suggests GA should be considered as first‐line therapy in selected patients, its differing mechanism of action also gives patients and doctors the option of an alternative agent when the efficacy of IFN‐β is waning or side‐effects predominate.
DOES LOW TRI‐IODOTHYRONINE INDEPENDENTLY PREDICT MORTALITY IN ELDERLY HOSPITALISED PATIENTS?
Authors: Gupta A , Haboubi N , Thomas P 
Published: April 2023

SUMMARYA fall in serum tri‐iodothyronine (T3) is the earliest abnormality in thyroid hormonal function tests in non‐thyroidal illnesses. Our study shows an association of low serum T3 with patient mortality in elderly hospitalised patients.
4. BREAST CANCER SCREENING
Authors: Michell MJ 
Published: April 2023

SUMMARYMammographic screening reduces breast cancer mortality by 24% in women aged ≥50 years. Women aged 50–53 are invited for their first screen in the National Health Service Breast Screening Programme (NHSBSP), thereafter at three‐year intervals until the age of 64. Two‐view mammography is offered at the first (prevalent) screening examination and one‐view for subsequent (incident) screens. The screening films are sorted into either ‘normal’ or ‘abnormal requiring further assessment’. Assessment is carried out by a specialist multidisciplinary team using the triple approach: clinical examination, imaging and, where appropriate, needle biopsy. Imaging is planned according to the mammographic abnormality – paddle compression view to assess parenchymal distortion, magnification view to assess microcalcification. After confirmation of a suspicious abnormality, needle biopsy is performed. Results of triple assessment are considered together by the multidisciplinary team and further management is planned. There are four likely outcomes: benign/normal, confirmed breast cancer, suspicious but needing diagnostic surgical excision, and diagnostic uncertainty needing early recall for screening.
SENSORINEURAL HEARING LOSS IN LINEAR IgA DISEASE
Authors: Hari CK , Hanif J , Frosh A 
Published: April 2023

SUMMARYA 23‐year‐old female with progressive sensorineural hearing loss developed widespread blistering eruptions while under evaluation for the hearing loss. The lesions showed findings characteristic of linear IgA disease (LAD) on histochemical studies. Linear IgA disease is a dapsone responsive autoimmune subepidermal blistering disease characterised by linear IgA deposits in the basement membrane zone. The complete spectrum of this systemic disease is still not clear and this is the first report of association between LAD and sensorineural deafness.
THE NATURAL HISTORY AND ASSOCIATIONS OF SLEEP DISORDERED BREATHING IN FIRST EVER STROKE
Authors: Lawrence E , Dundas R , Higgens S , Howard R , Rudd A , Wolfe C , Williams A 
Published: April 2023

SUMMARYAlthough the prevalence of sleep‐disordered breathing (SDB) in patients following stroke has been found to be high, there are few data about whether these changes persist in the months that follow stroke. The present study aims to confirm the prevalence of SDB following first ever stroke, to investigate an association between SDB and subtype of stroke and to determine the change in SDB three months following a first ever stroke.