bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLINICAL APPLICATIONS OF PHOTODYNAMIC THERAPY
Authors: Carruth JAS 
Published: April 2023

SUMMARYPhotodynamic therapy is a modality for the treatment of malignant disease in which a photosensitive drug is selectively absorbed or retained by malignant tissues, after intravenous injection and is then photoactivated by light of an appropriate wavelength, often produced by a laser. Over the past two decades, the combination of haematoporphyrin derivative (HPD) and then its active component dihaematoprophyrin ether (DHE), now marketed as Photofrin, plus red light at 630 nm have been used in clinical practice for the treatment of a range of tumours; some very promising results have been obtained. Several countries have approved this drug/light combination for clinical use for a number of tumours. Some second generation photosensitising agents with appropriate light sources, and with perceived advantages over Photofrin, are under investigation, and it is to be hoped that major improvements in drug/light combinations will enable photodynamic therapy to achieve its full potential in the not‐too‐distant future.
CONTROLLED TRIAL OF THE SUBJECTIVE PATIENT BENEFITS OF ACCOMPANIED WALKING TO THE OPERATING THEATRE
Authors: Turnbull LA , Wood N , Rester G 
Published: April 2023

SUMMARYA trial was carried out to determine if walking unpremedicated patients to the operating theatre would prove acceptable to the patients. One hundred surgical patients from a short‐stay ward were randomised into experimental (walked to theatre by ward nurse) and control (taken to theatre on a hospital trolley) groups. Seventy‐eight patients responded to a questionnaire; a large majority indicated they would like to be given the choice of mode of conveyance and perceived this as an improvement in patient care. The results showed that a more favourable impression of walking to the theatre was given by patients who had actually experienced it, and of those given the opportunity to walk, almost all reported that it made them feel more relaxed. The findings are discussed in relation to patient choice, efficiency gains and a reduction in manual handling.
COMPARISON OF EFFICACY AND EASE OF HANDLING OF SALMETEROL AND TERBUTALINE POWDER INHALERS
Authors: Burdon J , Droszcz W , Jones R , Johnston PR , Trowell SJ 
Published: April 2023

SUMMARYA multicentre, randomised, open, parallel‐group study was performed to compare the efficacy, tolerability and ease of handling of salmeterol xinafoate 50 μg twice daily via the DiskusTM inhaler with terbutaline sulphate 500 μg four times daily via the TurbuhalerTM inhaler. Two hundred and sixty‐three patients (aged 18‐79 years, baseline FEV, 50‐90% predicted, mean PEFR 85% of response to salbutamol) were randomised to treatment with salmeterol (n=136) or terbutaline (n=127). A statistically significant difference in favour of salmeterol was seen between treatment groups for the primary efficacy variable, mean morning PEFR (difference in adjusted means 25.4 l/min, p<0.001). Within the groups randomised to each device, ease of handling assessments favoured the Diskus inhaler over the Turbuhaler inhaler. More patients liked the Diskus inhaler than the Turbuhaler inhaler (98% vs 72%, p<0.001). The Diskus inhaler received better scores than the‐Turbuhaler inhaler for all features assessed in the device questionnaire.
THE ECONOMIC IMPLICATIONS OF IMPLEMENTING EVIDENCE‐BASED DIABETIC TREATMENT STRATEGIES
Authors: Phillips CJ 
Published: April 2023

SUMMARYIn Type I diabetes, conclusive evidence exists that intensive insulin strategies can achieve normal or near normal blood glucose levels and, as a result, reduce the risk of major complications and produce major benefits in years of life, years of sight, and years free from end‐stage renal disease and amputation. The evidence in Type II diabetes is less clear but claims are made that insulin‐based strategies should be started earlier, even at initial diagnosis. Intensive strategies have also been shown to improve survival in diabetic patients with acute myocardial infarction. The economic implications of introducing intensive insulin‐based strategies have assumed different rates of obesity and patients currently receiving insulin. Since the costs of an intensive insulin‐based strategy are approximately 50% more than conventional strategies, the average cost per diabetic patient will increase by half the percentage increase in patients receiving intensive therapy. It is argued that the extra costs incurred by the switch in therapy are likely to be offset by savings made as a result of reductions in expensive episodes of care, such as hospitalisation. In addition, evidence exists to show that such a switch is cost effective in generating additional life years and quality adjusted life years for diabetics.
THE EFFECT OF DIETARY INTERVENTION ON CHANGES IN TOTAL CHOLESTEROL, BLOOD PRESSURE AND WEIGHT IN A CAMBRIDGE STUDY
Authors: Yasmin  , Mascie‐Taylor CGN , Brown MJ , Hughes M 
Published: April 2023

SUMMARYThe study examined the impact of dietary advice on cholesterol reduction, to see whether diet was more effective when preceded by a cholesterol estimation. A total of 635 healthy individuals aged between 40 and 60 years attended a general practice cardiovascular risk screening in 1990. All subjects had their blood pressure, body mass index and smoking history recorded, and 50% were randomised to cholesterol measurement. Two years later, all individuals were invited to participate in a follow‐up screening and 356 individuals took part (158 men, 198 women). All the above estimations were undertaken in 100% of attendees. The mean total cholesterol levels and weight declined in the subjects who were given dietary advice and had their cholesterol measured, while the mean cholesterol level increased slightly in subjects who did not receive dietary advice but had their cholesterol measured. There was a significant increase in diastolic blood pressure in all patients. The figures for reported smokers decreased from 22.4% to 19.4% in men and 19.4% to 8.4% in women. The results suggest that dietary advice can achieve a sustained reduction in cholesterol levels, but may require the stimulus of a prior cholesterol estimation.
ACUTE ON‐CHRONIC MIDDLE EAR DISEASE
Authors: Ghufoor K , Diver J , O'Flynn P 
Published: April 2023

SUMMARYThe discharging ear is a common presenting symptom to GPs and otologists. The commonest causes are otitis externa and otitis media. Less common is cholesteatoma, which presents with a chronic offensive mucopurulent discharge and deafness. Acute mastoiditis as a presenting symptom of cholesteatoma is rare and, with the introduction of antibiotics, the incidence has declined even further. We present three cases of cholesteatoma presenting as mastoiditis.
PROFOUND HYPONATRAEMIA FOLLOWING AN IDIOSYNCRATIC REACTION TO DIURETICS
Authors: WierzbiCki AS , Ball SG , Singh NKP 
Published: April 2023

SUMMARYA case report of a 79‐year‐old woman with a breast adenocarcinoma who presented with clouding of consciousness and anorexia with a hyponatraemia of 97 mmol/l is described. An initial diagnosis of secretion of inappropriate antidiuretic hormone (SIADH) was made on the clinical history and a urine:plasma osmolality ratio of 2.25. Further investigation revealed the correct diagnosis of a sodium‐losing state with dehydration, and that her ADH level was normal. The actual cause of her hyponatraemia was the recent prescription of a thiazide diuretic. This case illustrates the unreliability of urine:plasma osmolality ratios for the diagnosis of SIADH.
THE PREDICTIVE VALUE OF DIAGONAL EAR‐LOBE CREASE SIGN
Authors: Motamed M , Pelekoudas N 
Published: April 2023

SUMMARYStudies on selected cardiac patients have supported the association between diagonal ear‐lobe crease (ELC) sign and coronary artery disease (CAD). The aim of this study was to assess the value of this sign as a predictor of the presence of CAD in the non‐cardiac patient population, to see if any association exists between the two and to compare any association with other established risk factors. A significant association exists between ELC and a history of CAD, which is not solely attributable to the increased prevalence of the sign with increasing age. A higher correlation was found between CAD and ELC than between CAD and other risk factors. The sensitivity of the sign was 48%, the specificity 88%, and the positive predictive value 16%. In this population the finding of an ELC is of little clinical value.
NEW LONG STAY PATIENTS: FROM ACUTE WARDS TO WHERE?
Authors: Rowlands P , Milner E , Wing S , Inch H 
Published: April 2023

SUMMARYInadequate alternatives to the old mental hospitals have placed many inner city acute psychiatric units under great pressure as bed numbers have contracted and disturbed patients have accumulated. This study set out to assess the outcome at two‐year follow‐up of a cohort of 26 patients resident on an acute psychiatric ward for more than six months. Results showed that a substantial minority of ‘new long stay’ patients made a successful return to independent living, but that at two‐year follow‐up half the cohort remained in a highly supported setting. Two deaths had occurred, neither by suicide. Psychiatric services remained involved with 90% of the patients in the cohort.
ANDROGENETIC ALOPECIA IN MEN: THE SCALE OF THE PROBLEM AND PROSPECTS FOR TREATMENT
Authors: Rushton DH 
Published: April 2023

SUMMARYWhile the precise incidence of androgenetic alopecia is unknown, it is universally acknowledged to be the most common hair problem in men. Balding is generally associated with ageing; consequently, the desire to prolong a youthful appearance inevitably leads to demands for effective treatments. Further, changing attitudes in modern society have resulted in people becoming concerned about their appearance and less tolerant about conditions that might be alleviated by medical intervention. The importance of hair loss upon quality of life has been underestimated by the medical profession. Clinicians failing to accept hair loss as an important medical problem ignore the real distress suffered by a significant proportion of those affected. New options for treatment that selectively target the metabolic pathways involved in the balding process are showing promise. The first generation of such drugs, Propecia, is now available in some countries and other molecules are currently under development.
THE ROLE OF LIPID LOWERING IN TRANSPLANTATION
Authors: Wierzbicki AS 
Published: April 2023

SUMMARYTransplantation is an increasingly common procedure. Yet the contribution of accelerated atherosclerosis to the reduction of graft life is often underestimated. This review examines the evidence for the involvement of hyperlipidaemia and other cardiovascular disease risk factors in the aetiology of chronic graft failure in renal, cardiac, liver and pancreatic transplantation. The evidence for the role of lipid lowering therapy in the prevention of accelerated atheroma in these patients is reviewed.
THE EFFECT OF PREVIOUS ANTIBIOTIC THERAPY ON THE BACTERIOLOGY OF THE TONSILS IN CHILDREN
Authors: Woolford TJ , Hanif J , Washband S , Hari CK , Gangulp LA 
Published: April 2023

SUMMARYThe bacteriology of the tonsillar surface and core in 30 children undergoing tonsillectomy was studied. Antibiotics taken in the six months before surgery were recorded. Haemophilus influenzae and Staphylococcus aureus were the commonest isolates; Streptococcus pyogenes was relatively rare. Eight children had received no antibiotics, the others had been prescribed 65 different courses of 13 different types. No relationship between the various antibiotic regimens prescribed and tonsillar bacteriology could be demonstrated, and it would appear that the tonsillar bacteriology at the time of tonsillectomy is not altered by antibiotics prescribed in the previous six months.
TRANSFUSION IN THE MANAGEMENT OF PATIENTS WITH MEGALOBLASTIC ANAEMIA
Authors: McMullin MF , Cuthbert RIG 
Published: April 2023

SUMMARYTransfusion has been associated with significant morbidity and mortality in megaloblastic anaemia (MA). This retrospective study was undertaken to examine the usefulness of transfusion in the management of MA. Fifty‐two patients with MA were identified. Of the 20 transfused patients 13 were treated with diuretics and six with potassium supplements. The mean haemoglobin (Hb) of the transfused group was 6.5 g/dl (range 4.8‐10.4 g/dl), and of the 32 non‐transfused patients 10.5 g/dl (range 5.6‐17.0 g/dl). The Hb and packed cell volume (PCV) were significantly lower in the transfused group. Only two of 32 non‐transfused group were given potassium supplements. In this small group of patients with MA, transfusion appeared to be safe and no complications of transfusion were identified. However, advice was not being followed. We would suggest that, although transfusion has a minor role in the management of MA, consideration must be given to the general hazards of transfusion.
IS A MAN'S FACIAL APPEARANCE PREDICTIVE OF HOW HE WILL DIE?
Authors: Cummins D , Hoskin P , Young J , Goodman IL , Coupe MO , Halil O , Foy CJ 
Published: April 2023

SUMMARYThe ability of a range of health professionals including an oncologist, a haematologist, a cardiologist, a general practitioner and a counsellor to predict the cause of death from facial appearance has been evaluated. Each participant was asked to predict the cause of death from facial photographs of 200 Caucasian male doctors whose cause of death was known to be due to either arterial disease or neoplasia. Statistically significant concordance was found between the oncologist and both the GP and the counsellor in their predictions of cause of death, although the individual accuracy was no greater than would be expected by chance. This suggests that common judgements based on facial appearances may be shared among certain health professionals.
BECLOMETHASONE DIPROPRIONATE INHALATION AS A TREATMENT FOR POST‐INTUBATION TRACHEAL STENOSIS
Authors: Abo M , Fujimura M , Kibe Y , Kida H , Matsuda T 
Published: April 2023

SUMMARYA 67‐year‐old man was intubated for one week and suffered from wheeze and dyspnoea three months after the extubation. Bronchoscopy revealed tracheal stenosis by a web, which subsequent biopsy showed to be granulation tissue. The stenosis was removed by laser therapy but the stenosis soon returned. As cardiac function was poor, beclomethasone diproprionate (BDP) inhalation therapy (1200 μg daily) was started and proved successful. Discontinuation of inhalation therapy resulted in restenosis. Steroid inhalation therapy may be able to control post‐intubation tracheal stenosis caused by granulation tissue.
SUPRACONDYLAR NAIL FAILURE: TWO CASE REPORTS
Authors: Thompson NS , Cooke EA , Craig BF 
Published: April 2023

SUMMARYWe describe two case reports of supracondylar nail failure in young patients who had sustained high energy, closed, comminuted supracondylar femoral fractures. These injuries had been successfully treated using retrograde intramedullary nails which failed several months later because of excessive activity on the part of the patient without the presence of full flexion at the knee. The failed implants were removed and dynamic condylar screws were inserted with bone graft to the fracture site. This revision procedure produced solid bony union. We recommend that these patients should not fully weight bear, or engage in strenuous physiotherapy after nailing, until the fracture has consolidated and a functional range of knee motion has been obtained. Failed implants should be managed by nail removal, bone grafting and insertion of a dynamic condylar screw.
AN UNUSUAL CAUSE OF UNILATERAL FACIAL PAIN
Authors: Chukwuemeka AO , John LCH 
Published: April 2023

SUMMARYCardiac pain that is referred to the face is a common symptom in patients with angina pectoris, but unilateral facial pain referred from a non‐ischaemic cardiac source is rare. We report a case of unilateral facial pain that occurred in relation to a large pericardial effusion and which resolved on drainage of the effusion.
ANAESTHETIC ASSESSMENT AND MANAGEMENT OF CARDIAC PATIENTS FOR NON‐CARDIAC SURGERY PART 2: MANAGEMENT
Authors: Shaw A , Boscoe MJ 
Published: April 2023

SUMMARYIn an earlier article in this journal (June 1999) we discussed the risk that the presence of cardiac disease poses to patients undergoing non‐cardiac surgery. We outlined factors in the patient's medical history, examination findings and the value of various tests in arriving at an overall assessment of risk for any given patient. In this article we concentrate on the management of these patients as they undergo surgery itself. We shall consider what measures may usefully be employed in order to minimise the risk of an adverse cardiac event occurring in the perioperative period.
POLYCYSTIC OVARIAN SYNDROME: IS COMMUNITY CARE APPROPRIATE?
Authors: Gupta S 
Published: April 2023

SUMMARYIn recent years the complexities and heterogeneity of polycystic ovarian syndrome (PCOS) have been recognised. Most PCOS sufferers with amenorrhoea, menstrual dysfunction, hirsutism, acne and infertility can be evaluated and safely managed in primary care. It is prudent to remember that all women with PCOS are at risk of insulin resistance and the associated abnormalities of the insulin resistance syndrome – dyslipidaemia, hypertension, coronary artery disease and diabetes mellitus.
DELAYED DIAGNOSIS OF AN ENTERIC DUPLICATION CYST
Authors: Parks RW , Casey J , Paterson‐Brown S 
Published: April 2023

SUMMARYEnteric duplication cysts are rare and often prove extremely difficult to diagnose. We report a case in which the definitive diagnosis was made 40 years after first presentation and following five exploratory laparotomies. A review of the literature is presented, with discussion regarding the presenting features, potential complications, radiological investigations and surgical treatment of this uncommon clinical entity.
A SYSTEMATIC APPROACH TO ERECTILE DYSFUNCTION IN THE CARDIOVASCULAR PATIENT: A CONSENSUS STATEMENT
Authors: Jackson G , Betteridge J , Dean J , Hall R , Holdright D , Holmes S , Kirby M , Riley A , Sever P 
Published: April 2023

EXECUTIVE SUMMARY• Sexual activity is no more stressful to the heart when compared with a number of other natural daily activities, e.g. walking one mile on the level in 20 minutes.• The cardiac risk of sexual activity in patients diagnosed with cardiovascular disease is minimal in properly assessed and advised patients.• Erectile dysfunction (ED) is common, affecting 10% of men aged 40‐70 years and increases in frequency with age.• ED and cardiovascular disease share many of the same risk factors and often coexist.• ED in the diagnosed cardiovascular patient should be identified by routine questioning in general practice. Modern therapies can restore a sexual relationship in the majority of patients with ED and can lead to a substantial improvement in quality of life.• The majority of patients assessed to be at low or intermediate cardiac risk, as defined later in this paper (Table 4), can be effectively managed in primary care. Primary care treatment for ED in patients defined as high risk can be initiated following a specialist opinion and/or confirmation that the patient's cardiovascular condition is stabilised.• There is no evidence that currently licensed treatments for ED add to the overall cardiovascular risk in patients with or without diagnosed cardiovascular disease.
NEW THERAPEUTIC APPROACHES FOR RHEUMATOID ARTHRITIS
Authors: Abdelaty EM , Schumacher HR 
Published: April 2023

SUMMARYBetter understanding of the immunopathogenesis of rheumatoid arthritis over the past few decades has promoted the innovation of new therapeutic approaches targeting the disease more specifically. In addition, refinements in the non‐steroidal anti‐inflammatory drugs (NSAID) may offer advantages for patients with RA. This brief review reports and analyses some of the important aspects of these new therapies available for treatment of RA and in which situations you might consider each. Before using any of these agents, physicians should become thoroughly familiar with the package inserts.
III. ALCOHOL, DRUGS AND STIGMA
Authors: Ritson EB 
Published: April 2023

SUMMARYAlcohol and drug‐related problems are common in clinical populations but are often stigmatised by the public and the professions. These attitudes may interfere with patients obtaining effective help. The reasons for these barriers are explored, including the views that these problems are self‐inflicted – and therefore less worthy of help – and the stereotypes and resistances that abound in working with those who have become addicted. Training and public education may go some way to improve this situation.
CYSTIC LYMPHOCYTIC HYPOPHYSITIS, VISUAL FIELD DEFECTS AND HYPOPITUITARISM
Authors: Farah JO , Rossi M , Foy PM , MacFarlane IA 
Published: April 2023

SUMMARYA 45‐year‐old man presented with anterior pituitary failure, requiring thyroxine, hydrocortisone and androgen replacement. An MRI scan revealed a large cystic pituitary mass and thickening of the pituitary stalk. Over three years, diabetes insipidus and bitemporal hemianopia developed and the cystic mass had enlarged on MR scanning. Transphenoidal resection was performed with normalisation of the visual fields. Histology revealed lymphocytic hypophysitis, which is rare in men. The presentation with cystic enlargement is unique.
THE ROLE OF STATINS IN ACUTE CORONARY SYNDROMES: MANAGING THE UNMET NEED
Authors: Jackson G 
Published: April 2023

SUMMARYCoronary heart disease is the major cause of death in the industrialised world. As the prevalence increases with advancing age, coronary heart disease will be a growing problem as the average age of the population increases. The cost of treatment following an acute coronary syndrome is considerable and there is a substantial risk of further episodes. However, there is much evidence that the disease is a dynamic and reversible process and further episodes are preventable. Numerous trials have shown the efficacy of statins in coronary heart disease. The most recent studies have shown efficacy in secondary prevention when statin therapy was started early (hours/days) after an acute episode. Although guidelines recommend that statin therapy should be initiated following an acute coronary syndrome, prescription rates seem to be static at around 40%. A number of measures need to be taken to improve the situation. Firstly, each hospital and coronary care unit should implement a clearly defined protocol delineating patient management following hospital admission. Provision of comprehensive discharge information should be a key feature of this communication. Secondly, regular audit of prescribing habits is essential to assess the situation. Finally, patient adherence to their regimen should be improved by collaborative involvement of doctor and patient in planning and implementing the treatment regimen.
DIAGNOSES IN DISCHARGE COMMUNICATIONS: HOW FAR ARE THEY RELIABLE?
Authors: Adhiyaman V , Oke A , White AD , Shah IU 
Published: April 2023

SUMMARYTo discover whether general practitioners are correctly notified of a patient's final diagnosis following hospital discharge, an observational study was undertaken in a district general hospital. The final diagnosis was compared with the diagnosis documented in the discharge summary and the take‐home prescription. Two hundred discharges were studied. Only 163 (81%) discharge summaries and 138 (69%) take‐home prescriptions had the correct diagnosis; 24 (12%) take‐home prescriptions did not have any diagnosis at all. In some cases the diagnosis differed between the discharge summaries and the take‐home prescriptions. Only in 122 (61%) cases was the final diagnosis correctly documented in both instances. Communication regarding diagnosis in discharge letters is less than adequate. Every effort should be made to improve this.