bluuebunny/crossref_metadata_2025_split huggingface dataset:
MALIGNANCY IN CHINESE ADULTS PRESENTING AS FEVER OF UNKNOWN ORIGIN
Authors: Wei W , Hesheng L 
Published: April 2023

SUMMARYIt is difficult to make a diagnosis when malignancy presents as fever of unknown origin (FUO). In order to update information on this disease entity, we performed a retrospective survey on adult cancer patients (n=48) presenting with FUO who were admitted to our university hospital between 1989 and 2002. All 48 patients had a median fever course of 56 days and a diagnostic phase of 13 days. Anaemia was found in 89.6% of the patients and elevated ESR in 77.1%. Of 35 patients (72.9%) with haematological malignancy, most were either lymphoma (n=18) or malignant histiocytosis (n=13). Solid tumours were found in 13 patients (27.1%), of which seven were hepatic carcinoma. Only five patients were correctly diagnosed, and 39 (90.7%) were mistaken for various infections. Inconclusive signs and symptoms, misinterpretation of test results and improper use of broad‐spectrum antibiotics and corticosteroids all contributed to the misdiagnoses.
XELODA® AND TAXOTERE®: A REVIEW OF THE DEVELOPMENT OF THE COMBINATION FOR USE IN METASTATIC BREAST CANCER
Authors: McDonald F , Miles D 
Published: April 2023

SUMMARYDocetaxel (Taxotere®) and capecitabine (Xeloda®) demonstrate synergy in pre‐clinical studies and both show high single‐agent efficacy in metastatic breast cancer patients previously treated with an anthracycline. The two drugs used in combination in a similar group of patients have been evaluated in a randomised phase III trial comparing this combination with single‐agent docetaxel. The results of this study indicate the combination arm to be favourable with significantly superior median time to disease progression (6.1 vs 4.2 months, hazard ratio 0.652, p=0.0001), objective response rate and overall survival without a significant increase in the overall incidence of treatment related adverse effects. This combination of docetaxel and capecitabine provides improved survival prospects for patients with metastatic breast cancer. Ongoing studies will provide further data to optimise the scheduling and use of this combination in the future.
SYMPATHETIC BLOCKADE AND AMITRIPTYLINE IN THE TREATMENT OF REFLEX SYMPATHETIC DYSTROPHY
Authors: Karakurum G , Pirbudak L , Oner U , Gulec A , Karadasli H , Satana T 
Published: April 2023

SUMMARYWe prospectively investigated the outcome of a combination therapy of oral amitriptyline and sympathetic ganglion blockade on 10 patients suffering from reflex sympathetic dystrophy of the upper extremity for at least three months. The efficacy of the treatment was evaluated by clinical examination, pain ratings on the visual analogue scale (VAS) and grip strength measurements using the Jamar dynamometer. The results were statistically analysed with Wilcoxon signed‐ranks test for comparison of the before and after treatment grip strength measurements and with paired t‐test for comparison of the mean of initial and consecutive pain ratings on the VAS. Values of p<0.01 were considered to be statistically significant. Combination therapy proved beneficial in this particular patient population, which, as far as previously documented studies are concerned, would otherwise respond less favourably to a treatment consisting solely of sympathetic blockade.
FEVER OF UNKNOWN ORIGIN: A REPORT FROM CHINA OF 208 CASES
Authors: Zhiyong Z , Bingjun L , Xiaoju L , Xinjian F , Ping F , Wenya W 
Published: April 2023

SUMMARYFever of unknown origin (FUO) is a clinical dilemma in western countries and in China. To investigate the causes and prognosis of FUO, 208 patients with FUO admitted to a large university hospital in China were investigated. The final diagnoses established in 158 cases (75.96%) were: infectious disease in 66 cases (31.73%), collagen vascular disease in 46 patients (22.11%), neoplasm in 35 cases (16.83%), and other disease in 11 patients (5.29%). In 66 cases with infectious disease, tuberculosis, septicaemia and typhoid fever were the principal causes. SLE and adult Still's disease were the most important causes among collagen vascular disease. Lymphoma and malignant histiocytosis were mostly associated with FUO among neoplasms. In 50 cases (24.04%), the cause of fever was not found. On discharge from hospital, fever had subsided in 133 cases (63.94%), and had persisted in 63 cases (30.29%); 12 patients (5.87%) died. In China, infectious disease, collagen vascular disease and neoplasm are the main causes of FUO. While most patients recover, there are some differences in the distribution of causes between the West and China, and there are relatively more deaths than in previous reports.
CLINICAL TRIALS OF SILDENAFIL CITRATE (VIAGRA®) DEMONSTRATE NO INCREASE IN RISK OF MYOCARDIAL INFARCTION AND CARDIOVASCULAR DEATH COMPARED WITH PLACEBO
Authors: Mittleman MA , Glasser DB , Orazem J 
Published: April 2023

SUMMARYWe pooled data regarding myocardial infarction (Ml) and cardiovascular death from more than 120 clinical trials of sildenafil citrate (Viagra®) conducted from 1993 to 2001. During placebo‐controlled trials, the rate of Ml or cardiovascular death was 0.91 (95% CI: 0.52–1.48) per 100 Person‐years (PY) of follow‐up among sildenafil‐treated patients compared with 0.84 (95% CI: 0.39–1.60) per 100 PY of follow‐up among placebo‐treated patients. The relative risk of Ml or cardiovascular death was 1.08 (95% CI: 0.45–2.77) for sildenafil compared with placebo (p=0.88). During open‐label studies, the rate of Ml or cardiovascular death was 0.56 (95% CI: 0.44–0.72) per 100 PY of follow‐up. This analysis showed that the rates of Ml and cardiovascular death were low and comparable between men treated with sildenafil and those treated with placebo. The use of sildenafil was not associated with an increase in the risk of Ml or cardiovascular death.
LEVETIRACETAM: A NEW THERAPEUTIC OPTION FOR REFRACTORY EPILEPSY
Authors: Pinto A , Sander JW 
Published: April 2023

SUMMARYLevetiracetam (LEV) is the most recently licensed antiepileptic drug (AED) for adjunctive therapy of partial seizures. Its mechanism of action is uncertain but it exhibits a unique profile of anticonvulsant activity in models of chronic epilepsy. Three randomised, double‐blind, placebo‐controlled trials enrolling 904 patients with refractory partial epilepsy have demonstrated the efficacy of LEV as adjunctive therapy, with a responder rate (≥50% reduction in seizure frequency) of 28–41%. Long‐term efficacy studies suggest retention rates of 60% after one year, with 13% of patients seizure‐free for six months of the study and 8% seizure‐free for one year. Adverse effects of LEV, including somnolence, lethargy and dizziness, were generally mild and the frequency of incidents was not significantly different between the active treatment and placebo groups in clinical trials. LEV has no clinically significant pharmacokinetic interactions (PKI) with other AEDs, or with commonly prescribed medications. Preliminary data suggest that LEV has efficacy in primary generalised epilepsy and further randomised trials are under way. The combination of potent antiepileptic properties with a relatively mild adverse effect profile makes LEV an attractive adjunctive therapy for partial seizures.
AN UNUSUAL CAUSE OF CARPAL TUNNEL SYNDROME
Authors: Hui ACF , Wong SM , Griffith JF 
Published: April 2023

SUMMARYTuberculosis is an uncommon cause of carpal tunnel syndrome. We report a patient with systemic lupus erythematosus who developed hand numbness. Ultrasonic, operative and microbiological findings supported the diagnosis of median nerve compression secondary to a tuberculous abscess. The symptoms resolved with surgical excision and antituberculous chemotherapy.
BUDESONIDE/FORMOTEROL IN A SINGLE INHALER (SYMBICORT®) REDUCES HEALTHCARE COSTS COMPARED WITH SEPARATE INHALERS IN THE TREATMENT OF ASTHMA OVER 12 MONTHS
Authors: Rosenhall L , Borg S , Andersson F , Ericsson K 
Published: April 2023

SUMMARYThis open, multinational, randomised, parallel‐group, six‐month extension conducted in the Swedish centres of a previous six‐month study compared the costs of a total of 12 months of treatment with budesonide/formoterol in a single inhaler with budesonide plus formoterol separate inhalers in 320 adults with asthma. Patients received budesonide/formoterol (Symbicort® Turbuhaler®) 160/4.5 mg delivered doses, two inhalations b.i.d., or corresponding doses of budesonide (Pulmicort® Turbuhaler) plus formoterol (Oxis® Turbuhaler). Direct costs and indirect costs were estimated. Budesonide/formoterol treatment was associated with reduced healthcare service utilisation and statistically significant reductions in direct (SEK1595, p=0.0004) and total costs (SEK1884, p=0.043) per person per year compared with budesonide plus formoterol. Budesonide/formoterol reduced the average annual emergency room admission cost per person by SEK489.7 (31% of direct cost reduction) and physician costs by SEK235.4 (15%). The direct cost of study, relief and other medication was reduced by SEK893.8 (47% of total reduction). There were no statistically significant differences in efficacy and safety parameters following treatment with budesonide/formoterol from single or separate inhalers, other than a significantly lower proportion of withdrawals with the single inhaler (9.2% vs 19.4%, p=0.008). In summary, budesonide/formoterol treatment from a single inhaler reduced 12‐month treatment costs compared with separate inhalers, while maintaining at least as good control of asthma.
POTENTIAL LONG‐TERM EFFECTS OF RIVASTIGMINE ON DISEASE PROGRESSION MAY BE LINKED TO DRUG EFFECTS ON VASCULAR CHANGES IN ALZHEIMER BRAINS
Authors: Erkinjuntti T , Skoog I , Lane R , Andrews C 
Published: April 2023

SUMMARYAlzheimer's disease patients with hypertension or other vascular risk factors have been shown to receive greater symptomatic benefits than patients with strictly Alzheimer's disease following short‐term treatment with rivastigmine, an inhibitor of acetylcholinesterase and butyrylcholinesterase. We evaluated the long‐term efficacy of rivastigmine in Alzheimer's disease patients with or without hypertension. Subjects in a 26‐week placebo‐controlled trial of rivastigmine entered an open‐label extension study for 104 weeks. Efficacy measures included the Alzheimer's Disease Assessment Scale–cognitive subscale (ADAS‐cog), Progressive Deterioration Scale (PDS) and Global Deterioration Scale (GDS). Subjects were stratified by the presence or absence of hypertension at baseline. At 104 weeks, there was a trend for hypertensive patients from the original rivastigmine 6–12 mg/day group (early starters), who received rivastigmine for the full 104 weeks) to have better ADAS‐cog scores than the original placebo group (late starters), who received open‐label rivastigmine for the last 78 weeks only). Significant treatment differences were observed in the hypertensive subgroup on the PDS and GDS. In non‐hypertensive patients, changes from baseline at week 104 were similar in ‘early’ and ‘late’ starters of rivastigmine treatment. The additional apparent benefits on disease progression detected in patients with hypertension and Alzheimer's disease may be linked to drug effects on cerebrovascular factors. These findings may have an important influence on the way cholinesterase inhibitors are prescribed.
PATIENT‐REPORTED BENEFITS OF RIZATRIPTAN COMPARED WITH USUAL NON‐TRIPTAN THERAPY FOR MIGRAINE IN A PRIMARY CARE SETTING
Authors: Baos V , Serrano A , Torrecilla M , Bertral C , Caloto MT , Nocea G , Gerth WC 
Published: April 2023

SUMMARYThe purpose of this open‐label study was to compare rizatriptan with usual non‐triptan therapy for migraine in patients who had never received a triptan. Patient‐reported outcomes were examined for a prestudy migraine attack and after three consecutive study attacks, the first and third treated with rizatriptan 10 mg wafer and the second with usual non‐triptan therapy. A total of 97 patients (83% women; mean age 39 years) completed the study Two‐thirds of patients reported severe or total disability during migraine attacks. All comparisons between rizatriptan therapy and usual non‐triptan therapy significantly favoured rizatriptan (p≤0.01). Headache relief by 2 hours was reported by 78–83% of patients after rizatriptan and by 46–48% of patients after usual therapy; 41–47% and 12–18%, respectively, were pain free at 2 hours. Patient satisfaction and migraine‐specific quality‐of‐life scores were also significantly better for attacks treated with rizatriptan. At study end, 62% and 17% of patients were very or completely satisfied with rizatriptan and usual non‐triptan therapy, respectively. Among those patients who worked for pay, therapy with rizatriptan significantly reduced absenteeism and improved the amount and quality of time at work compared with usual non‐triptan therapy. Allowing patients to have experience with rizatriptan may improve the level of medical care for migraine attacks.
A NATIONAL SURVEY OF TRANSRECTAL ULTRASOUND‐GUIDED PROSTATIC BIOPSIES: TIME FOR A NATIONAL GUIDELINE
Authors: Patel HRH , Lee F , Arya M , Masood S , Palmer JH , Sheriff MKM 
Published: April 2023

SUMMARYThe aim of this study was to elicit similarities and differences in transrectal ultrasound guided prostatic biopsy regimens in the UK and the Republic of Ireland. A telephone survey of 60 centres was conducted and information collected on the operator, the anaesthesia used, antibiotic prophylaxis and number of biopsies taken. Most prostatic biopsies were performed by urologists and most procedures involved six cores. There was a marked variation in the use of antibiotic prophylaxis, and anaesthesia was used sparingly. Our survey has shown a diversity in protocols used in transrectal ultrasound guided biopsies in the UK and Ireland. It seems sensible to standardise the technique for optimal patient satisfaction, as well as clinical efficiency. A national co‐ordinated, prospective trial is needed.
ACUTE ACALCULOUS CHOLECYSTITIS IN CHINA
Authors: Li J , Wang W , Luo HS 
Published: April 2023

SUMMARYIn order to study the clinical characteristics of patients with acute acalculous cholecystitis (AAC) in China, we retrospectively analysed the epidemiology, clinical manifestations and treatment of hospitalised cases with AAC in our hospital between January 1991 and October 1998, and compared the results with western reports. Most AAC cases in our series were younger than 60 years, and there was no significant difference between males and females. Their clinical manifestations were usually not serious. Only one patient suffered complications. The rate of complications and mortality was lower than those in western countries. All patients were treated and recovered; none needed an emergency operation and there were no deaths.
SLEEP DISORDERS IN PARKINSON'S DISEASE
Authors: Abdelgabar A , Sharma J 
Published: April 2023

SUMMARYSleep quality is one of the major sources of dissatisfaction among patients with Parkinson's disease (PD). Insomnia, parasomnia and daytime sleep disorders are all common. The motor problems accompanying PD are well studied and documented, yet little is known about sleep and the other non‐motor problems. Dopaminergic medications, the neurochemical and neurodegenerative changes may all contribute to the pathogenesis of sleep disorders in PD. Subjective or objective sleepiness assessment should routinely be performed by physicians looking after PD patients. Patients should be informed of the risks associated with excessive daytime sleepiness. Management is difficult and should be targeted to the specific sleep disorder and its likely cause. Simple sleep measures such as sleep hygiene should be tried first before pharmacological treatment is initiated.
THE COST‐EFFECTIVENESS OF A NEW STATIN (ROSUVASTATIN) IN THE UK NHS
Authors: Palmer SJ , Brady AJ , Ratcliffe AE 
Published: April 2023

SUMMARYStatins are central to the government's National Service Framework (NSF) for coronary heart disease (CHD). NHS spending on statins is currently about £500 million per annum and rising at an annual rate of 30%. Although generally considered to be a cost‐effective treatment for hyperlipidaemia and cardiovascular disease, given the high and rising expenditure on statins in the UK, there is a pressing need to ensure that the choice between available statins reflects cost‐effectiveness considerations. A decision model was developed to establish the cost‐effectiveness of treating new hypercholesterolaemic patients to UK and European target levels of blood total cholesterol (TC) and low density lipoprotein‐cholesterol (LDL‐C), using rosuvastatin, atorvastatin, simvastatin, pravastatin or fluvastatin. The model was used to estimate the proportion of patients reaching target and the associated costs over a one‐year period from the perspective of the NHS. The effectiveness of the alternative statins were modelled using data from the Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin (STELLAR) trial. Monte Carlo simulation was used to reflect uncertainty in the parameter estimates applied in the model. Rosuvastatin is demonstrated to dominate (i.e. lower costs and a higher number of patients treated to target) atorvastatin, simvastatin and pravastatin. Compared with fluvastatin, the incremental cost per additional patient to target (PTT) for rosuvastatin was £24 using LDL‐C and £83 using TC. The probability that rosuvastatin is cost‐effective exceeds 95%, provided the NHS is prepared to pay at least £35 per PTT to achieve target LDL‐C cholesterol levels (£160 for TC). The analysis demonstrates rosuvastatin is more cost‐effective than the other statins in achieving UK and European cholesterol targets.
PATIENT SATISFACTION WITH CONVENTIONAL AND NURSE‐LED TELEPHONE FOLLOW‐UP AFTER NASAL SEPTAL SURGERY
Authors: Uppal S , Nadig S , Mielcarek MW , Smith L , Jose J , Coatesworth AP 
Published: April 2023

SUMMARYThe need to bring down costs while maintaining a high standard of care has led to the expansion in the role of nurses in recent years. We present results of an audit of patient satisfaction with conventional and nurse‐led telephone follow‐up after nasal septal surgery. Our results indicate that patient satisfaction with nurse‐led telephone follow‐up is significantly higher than conventional follow‐up (p=0.001, two‐tailed). More patients in the conventional follow‐up group felt that a follow‐up appointment with an ENT doctor was essential compared with the patients in the nurse‐led telephone follow‐up group (p<0.001, two‐tailed). We conclude that nurse‐led telephone follow‐up avoids unnecessary outpatient appointments, while identifying patients who require further care. It makes more appointment slots available for patients with pressing clinical problems and has the potential to reduce outpatient access times in the NHS.
EFFICACY AND TOLERABILITY OF FORMOTEROL TURBUHALER® IN CHILDREN
Authors: Von Berg A , Papageorgiou Saxoni F , Wille S , Carrillo T , Kattamis C , Helms P‐J 
Published: April 2023

SUMMARYA randomised, double‐blind trial was undertaken to investigate the efficacy and tolerability of formoterol Turbuhaler® in children with mild to moderate asthma. After a two‐week run‐in, 248 children aged 6–17 years were randomised to receive formoterol 4.5 and 9 ug b.i.d. or placebo for 12 weeks. Morning PEF (primary variable), was significantly improved versus placebo only in the formoterol 9 ug b.i.d. group (13 l/min, 95% CI: 1.9, 24.2%; p=0.02). Both formoterol 4.5 and 9 ug significantly increased the pre‐bronchodilator FEV1 by 5.2–6.7% (p<0.05) and reduced use of daytime relief medication versus placebo (p<0.05). Formoterol 9 ug significantly reduced night‐time reliever use and awakenings due to asthma versus placebo (p<0.05). Both doses of formoterol were as well tolerated as placebo. In conclusion, formoterol 4.5 and 9 μg b.i.d. is effective and well tolerated as maintenance therapy in children with mild to moderate asthma.
THE ADJUNCTIVE EFFECT OF TELMISARTAN IN PATIENTS WITH HYPERTENSION UNCONTROLLED ON CURRENT ANTIHYPERTENSIVE THERAPY
Authors: Gil‐Extremera B , Ma PTS , Yulde J , Kalnins U , Harkin N , Williams L 
Published: April 2023

SUMMARYThis prospective, double‐blind, randomised, parallel‐group, multicentre study assessed the adjunctive effect of telmisartan monotherapy versus placebo in controlling blood pressure during the last six hours of the 24‐hour dosing period. After a two‐week run‐in phase, 375 patients with essential hypertension uncontrolled on existing therapy were randomised to either placebo or telmisartan (40 mg uptitrated to 80 mg after four weeks, if needed) for eight weeks. Ambulatory blood pressure monitoring (ABPM) was conducted at randomisation (baseline) and treatment end. The change from baseline in diastolic blood pressure (DBP) over the last six hours (primary endpoint) was significantly greater with telmisartan than placebo (adjusted mean treatment difference in favour of telmisartan: −3.7 mmHg, 95% confidence interval (CI) −5.5, −1.9 mmHg, p≤0.001, n=350), as was the reduction in 24‐hour DBP (adjusted mean treatment difference: −5.0 mmHg, 95% CI −6.5, −3.5 mmHg, p≤0.001). Telmisartan also reduced mean systolic blood pressure significantly more than placebo over the last six hours and the entire 24‐hour dosing interval. Responder rates (ABPM DBR seated DBR and overall [seated SBP/DBP]) at 8 weeks were significantly higher with telmisartan than with placebo (p≤0.01). All treatments were well tolerated. When added to existing antihypertensive regimens, telmisartan offers additional effectiveness while maintaining placebo‐like tolerability
TRIMETAZIDINE IN GERIATRIC PATIENTS WITH STABLE ANGINA PECTORIS: THE TIGER STUDY
Authors: Kölbel F , Bada V 
Published: April 2023

SUMMARYThis study aims to assess the efficacy and tolerance of the metabolic antianginal agent trimetazidine, a 3‐KAT inhibitor, in 141 stable angina patients aged 65–86 years. Efficacy was assessed with exercise tests and clinical evaluation after 12 weeks of treatment. The main outcome was an increase in exercise duration by 52±92 sec (p<0.001). Other exercise test parameters also improved, with no change in rate‐pressure product. Angina attacks and short‐acting nitrate consumption significantly decreased, indicating an improvement in quality of life. Two adverse events were reported (gastric pain and dyspepsia) but they were mild and transient. In conclusion, in elderly stable angina patients, trimetazidine improves exercise stress tests and angina symptoms. Because of its metabolic effect, free from any haemodynamic action, trimetazidine proved to be beneficial in elderly patients and with an excellent tolerance profile.
BRONCHIAL ENTRAPMENT OF A CHICKEN BONE FOR 14 YEARS
Authors: Lee SW , Fang TJ , Hsu CW , Li HY 
Published: April 2023

SUMMARYProlonged airway entrapment of a foreign body is a rare occurrence. We report a case of a chicken bone retained in the right main bronchus for 14 years and highlight the importance of a foreign body in the airway in the differential diagnosis of chronic and intractable cough.