bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMBINATION THERAPY IN ANGINA: A REVIEW OF COMBINED HAEMODYNAMIC TREATMENT AND THE ROLE FOR COMBINED HAEMODYNAMIC AND CARDIAC METABOLIC AGENTS
Authors: Jackson G 
Published: April 2023

SUMMARYThe 1997 European Society of Cardiology guidelines emphasised medical therapy as the mainstay of treatment of stable angina. Until recently, the antianginal drugs available to control symptoms (nitrates, beta‐blockers and calcium antagonists) have all been haemodynamic agents that eliminate or reduce angina attacks principally by decreasing myocardial oxygen demand. They may also improve myocardial perfusion. The haemodynamic agents are often used in combination. However, there is conflicting evidence for the efficacy of combination treatment. Two recently published large clinical studies, the Total Ischaemic Burden European Trial (TIBET) study and the International Multicenter Angina Exercise (IMAGE) study, suggest that combined haemodynamic treatment is no more effective than optimal monotherapy. The results from IMAGE suggest that most of the additional effect observed with combined therapy was attributable to recruitment by the second drug of patients who had not responded to monotherapy, and that most patients continued to have a disturbing frequency of anginal attacks after receiving combined therapy. Metabolic agents are a new class of drugs that directly modify the use of energy substrates in the heart, lessening ischaemic injury and improving cardiac performance during ischaemia. Due to their non‐haemodynamic mode of action, metabolic agents such as trimetazidine or L‐carnitine may provide independent benefit in ischaemia when used as monotherapy or additional benefit when used in combination with a conventional agent. Clinical trials have shown that combined haemodynamic and metabolic treatment is more effective than combined haemodynamic therapy and is well tolerated. It is suggested that combination haemodynamic and metabolic therapy is a logical new approach to patients whose angina is inadequately controlled despite optimal haemodynamic therapy.
RISEDRONATE: CLINICAL USAGE
Authors: Chapurlat RD , Delmas PD 
Published: April 2023

SUMMARYRisedronate is a new bisphosphonate – a family of drugs that inhibit bone resorption – and thus can be used in various bone conditions involving increased levels of bone resorption, such as postmenopausal osteoporosis, glucocorticoid‐induced bone loss, and Paget's disease of bone. In placebo‐controlled clinical trials, risedronate has been shown to prevent bone loss in postmenopausal women, to decrease the incidence of vertebral and non vertebral (including hip) fractures in postmenopausal women with osteoporosis, and to prevent bone loss in men and women treated with moderate to high doses of glucocorticoids. Risedronate has also been shown substantially to decrease the severity of bone pain and the level of bone turnover in Paget's disease of bone, and to improve the radiographic lesions of this disease. Risedronate is safe and well tolerated. Thus, risedronate is a new option for the management of postmenopausal osteoporosis, Paget's disease of bone and corticosteroid‐induced bone loss.
IMAGES IN CARDIOLOGY: LEFT VENTRICULAR FREE WALL RUPTURE
Authors: Rinaldi CA , Coutts JF , Jackson G 
Published: April 2023

SUMMARYLeft ventricular free wall rupture is thought to account for approximately 15% of deaths following acute myocardial infarction (MI). We present a case of left ventricular free wall rupture in a 64‐year‐old man following a lateral MI. The diagnosis was made with 2D and colour flow Doppler echocardiography. Unfortunately the patient died before emergency surgery, could be performed.
POLYSEROSITIS AS A RARE COMPONENT OF POLYGLANDULAR AUTOIMMUNE SYNDROME TYPE II
Authors: Algün E , Erkoç R , Kotan Ç , Güler N , Sahin I , Ayakta H , Uygan I , Dilek I , Aksoy H 
Published: April 2023

SUMMARYPolyglandular autoimmune (PGA) syndromes (types I and II) may affect various endocrine and non‐endocrine organs in the body. In the commoner PGA type II, primary adrenal insufficiency, autoimmune thyroid disease and type I diabetes mellitus are the most frequent manifestations. Serositis with pericardial or pleural involvement is not a well known component of the disease. Here, we report a 21‐year‐old man who first presented with a pleuropericardial effusion and Graves' disease, and who then developed type I diabetes mellitus.
SYNCHRONOUS COLONIC TUMOURS OF DUAL PATHOLOGY
Authors: Basu S , Selvachandran SN , Cade D 
Published: April 2023

SUMMARYSynchronous colonic tumours of dual pathology are extremely rare. A review of the literature revealed that few cases have been reported to date. Because of their rarity and lack of specific symptoms, preoperative diagnosis is not easy and there is no protocol as yet for the ideal management of these cases. We present such a case which was treated by a combination of surgery and chemotherapy.
ENDOMETRIOMA OF THE LIVER
Authors: Bohra AK , Diamond T 
Published: April 2023

SUMMARYHepatic endometriosis is extremely rare. The diagnosis is often missed and treatment is delayed. A 37‐year‐old woman was referred to the gynaecology department with vague abdominal pains. She had a past history of pelvic endometriosis and hysterectomy with bilateral salpingo‐oophorectomy. Further investigations in due course confirmed it to be endometriosis of the liver. She was eventually referred to the hepatobiliary unit, almost three years after her first presentation, where she was operated on with good results.
THE HEALTH ECONOMIC IMPACT OF ANTIDEPRESSANT USAGE FROM A PAYER'S PERSPECTIVE: A MULTINATIONAL STUDY
Authors: Casciano J , Doyle J , Arikian S , Casciano R 
Published: April 2023

SUMMARYA multinational decision analytic model was developed to examine the treatment of major depressive disorder (MDD) in 10 European and American countries. Input to the model was obtained from a meta‐analysis of current clinical trial data obtained from the published literature, and local clinical and health economic experts in each market. The patient‐ and policy‐level impact of MDD treatment was measured in each of the 10 markets. The total expected cost per patient for treating MDD with venlafaxine XR during the six‐month acute phase of MDD was the lowest expected cost in nine of the 10 countries studied, resulting in savings to the primary payer in almost all markets. As well as the cost savings, the higher efficacy and lower rate of dropout found for venlafaxine XR translate to a greater number of symptom‐free‐days (SFDs) per patient. The results of this investigation show that use of venlafaxine XR in most settings across Europe and the Americas will have a favourable impact on healthcare payer budgets and the overall mental health of MDD patients.
PRAVASTATIN IN ACUTE ISCHAEMIC SYNDROMES: RESULTS OF A RANDOMISED PLACEBO‐CONTROLLED TRIAL
Authors: Den Hartog FR , Van Kalmthout PM , Van Loenhout TT , Schaafsma HJ , Rila H , Verheugt FWA 
Published: April 2023

SUMMARYTherapy with individual 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors (statins) has been shown conclusively to diminish coronary event rates and mortality in both primary and secondary prevention. To date, scant attention has been paid to whether initiation of such regimens in the hospital phase of acute coronary syndromes might confer cardioprotective benefits. The purpose of this study was to determine the safety and tolerability of early initiation of statin therapy in patients with acute coronary syndromes. In this randomised, double‐blind, three‐month, pilot study, 100 patients with acute myocardial infarction or unstable angina and low‐density lipoprotein cholesterol >3.5 mmol/l were randomly assigned to pravastatin 40 mg daily or placebo initiated within 48 hours of hospital admission. Pravastatin proved safe and well tolerated in these patients, who were well matched at baseline. No statistically significant differences in death, MI and drug‐related adverse events were observed in the pravastatin group compared with control subjects. This pilot study shows that therapy with pravastatin early after an acute coronary event is safe and well tolerated. Larger, long‐term studies are needed to confirm these findings.
SELF‐MUTILATION: REVIEW AND CASE STUDY
Authors: Parrott HJ , Murray BJ 
Published: April 2023

SUMMARYThis article reviews in a systematic way the literature on severe self‐mutilation, emphasising possible aetiological factors and warning signs of impending self‐mutilation. It provides practical advice on the prevention and management of such events, including legal issues of capacity and consent. An illustrative case history is provided of an artist who cut off his ear.
THE NIACIN SKIN FLUSH TEST IN SCHIZOPHRENIA: A REPLICATION STUDY
Authors: Puri BK , Easton T , Das I , Kidane L , Richardson AJ 
Published: April 2023

SUMMARYThe aim of this study was to confirm a recent report that the non‐invasive niacin skin flush test can be used to demonstrate impaired arachidonic acid‐related signal transduction in schizophrenia. The response to topical aqueous methyl nicotinate solution was recorded at five‐minute intervals over 20 minutes in 21 patients with schizophrenia, and in 20 age‐ and sex‐matched normal individuals with no personal or family psychiatric history. The response was significantly lower in the patients with schizophrenia. At a concentration of 0.001 M, at the 15‐minute timepoint, only two out of the 21 patients with schizophrenia showed a response, compared with 15 out of 20 of the controls (p<0.00002), giving a sensitivity of the niacin skin test of 90% and a specificity of 75%. Our results are therefore consistent with the previous published report and suggest that this test may be useful clinically in the diagnosis of schizophrenia.
MEALTIME GLUCOSE REGULATION IN TYPE 2 DIABETES
Authors: Tuomilehto J , Del Prato S 
Published: April 2023

SUMMARYGlucose control remains the cornerstone of therapeutic strategies designed to reduce the risk of long‐term complications in patients with type 2 diabetes. This article reviews a growing body of evidence suggesting that post‐mealtime glucose spikes may exert an independent effect on diabetic complications, and discusses how a more effective strategy requires better focus on the regulation of mealtime glucose. New treatment options, specifically designed to restore a more physiological post‐mealtime insulin profile, may provide better tools to ensure more comprehensive glycaemic control, which will allow for better prevention of micro‐ and macrovascular complications in type 2 diabetic patients.
SMOKING CESSATION: A CONSENSUS STATEMENT WITH SPECIAL REFERENCE TO PRIMARY CARE
Authors: Jackson G , Bobak A , Chorlton I , Fowler G , Hall R , Khimji H , Matthews H , Stapleton J , Steele C , Stillman P , Sutherland G , Swanton RH 
Published: April 2023

EXECUTIVE SUMMARY
Nicotine addiction is a serious medical condition that needs to be treated like any other chronic disease.1
Primary care must play a key role in smoking cessation2 and offering help should be a routine part of primary care practice.
As the most frequent opportunity for intervention lies within primary care, GPs should ensure that they raise the issue of stopping smoking at least annually with their smoking patients. When the smoker is ready to stop, the initial personal involvement of the GP is likely to increase the chance of a successful quit attempt. Follow‐up may be with another healthcare professional.
The support of healthcare professionals for the smoker who is motivated to quit, combined with appropriate pharmacotherapy, can substantially increase the chances of a successful quit attempt.3
Secondary care staff should also make every effort to help people to stop smoking and should communicate effectively with primary care – opportunities during hospitalisation are frequently missed.
Specialist smoking cessation clinics have an essential role in providing more intensive specialist treatment and the expertise to partner and support the primary care effort.
Smoking cessation is one of the most cost‐effective healthcare interventions that can be made.4
CLINICAL RATIONALE FOR ROSUVASTATIN, A POTENT NEW HMG‐COA REDUCTASE INHIBITOR
Authors: Hanefeld M 
Published: April 2023

SUMMARYCoronary heart disease (CHD) is the leading cause of death worldwide, and effective treatment of hyperlipidaemia can prevent development of CHD and significantly reduce the risk for cardiovascular events and mortality in this disease. The advent of 3‐hydroxy‐3‐methylglutaryl coenzyme A (HMG‐CoA) reductase inhibitors (statins) has revolutionised the treatment of hyperlipidaemia, but many patients receiving these drugs still do not achieve their therapeutic goals. Rosuvastatin (Crestor™; formerly ZD4522) is a new, potent and long‐lasting inhibitor of HMG‐CoA reductase that is highly selective for hepatocytes. Its pharmacokinetics permit once‐daily dosing, and a lack of oxidative hepatic metabolism results in a reduced potential for drug‐drug interactions. Preliminary clinical results indicate that it produces rapid dose‐related reductions in total cholesterol, low‐density lipoprotein cholesterol, triglycerides, and apolipoprotein B that may exceed those achieved with other currently available statins. Increases in high‐density lipoprotein cholesterol have also been observed. Rosuvastatin is also well tolerated, with no evidence of either hepato‐ or myotoxicity. It is hoped that new agents such as rosuvastatin may help to reduce the high global morbidity, mortality and associated costs of CHD and related vascular disorders.
MAJOR ARTERIAL OCCLUSION BY EMBOLISATION OF AN OCCULT THROMBUS FOLLOWING THROMBOLYTIC THERAPY FOR MYOCARDIAL INFARCTION
Authors: Kathula SK , Bhargava A 
Published: April 2023

SUMMARYWe describe a case in which thrombolytic therapy for acute myocardial infarction resulted in a major arterial embolism from an existing aortic mural thrombus. Clinicians should be alert to this rare complication of thrombolytics, because timely diagnosis and treatment may prevent serious morbidity and mortality.
DOES BALANCE CONTROL DEFICIT ACCOUNT FOR WALKING DIFFICULTY IN PARKINSON'S DISEASE?
Authors: Chong RKY , Barbas J , Garrison K , Herolz A , Teheng R , Sethi K 
Published: April 2023

SUMMARYPatients with Parkinson's disease (PD) walk slowly, in part to compensate for their balance control deficit. We tested the effect of balance support to determine if walking performance in PD patients would improve. The sample consisted of unmedicated older adults with idiopathic Parkinson's disease who had poor balance control but no stooped posture, arthritis or muscle weakness. There was no difference in walking speed between unsupported and supported walking. The speeds were between those reported for disease‐free older adults and older adults with muscle weakness and a history of falling. PD patients' walking difficulties, even while using a balance aid, may be partly explained by their set‐changing problems. They frequently hold the cane off the ground when walking, suggesting their set‐changing difficulty may be severe enough that using it aggravates their walking difficulty. Treatment of walking difficulty in PD patients should consider interventions other than those dealing only with balance control.
FACIAL PARALYSIS WITH AN INFLAMMATORY PAROTID MASS
Authors: Halfpenny W , Bhandari R , Dunkley S 
Published: April 2023

SUMMARYFacial paralysis in association with a parotid mass is usually associated with a diagnosis of malignancy. Benign parotid neoplasms and inflammatory processes resulting in facial paralysis are extremely rare. This report describes such a case and highlights some of the difficulties surrounding the diagnosis and management of these cases.
COLLECTING DUCT CARCINOMA OF THE KIDNEY ASSOCIATED WITH THE SICKLE CELL TRAIT
Authors: Yip D , Steer C , Al‐Nawab M , Van Der Walt J , Harper P 
Published: April 2023

SUMMARYCollecting duct carcinoma of the kidney is a rare neoplasm that arises from the medullary collecting ducts. It has an aggressive clinical course and patients usually present with metastatic disease. Treatment approaches apart from surgery have been unrewarding. Renal medullary carcinoma is also an aggressive tumour which occurs predominantly in young, black, male patients with sickle cell trait. We describe a case of collecting duct carcinoma in a 61‐year‐old black female who exhibited the sickle cell trait. Histopathology revealed a high‐grade tubular carcinoma with marked desmoplasia, adjacent dysplastic collecting ducts and positive immunohistochemical staining for high and low molecular weight cytokeratins and epithelial membrane antigen. The association of collecting duct carcinoma with sickle cell trait has not been previously reported. This case supports the postulate that collecting duct carcinoma and renal medullary carcinoma may be part of the same spectrum of renal malignancies.
CONGENITAL ANOSMIA
Authors: Ho TP , Carrie S 
Published: April 2023

SUMMARYWe present two cases demonstrating congenital anosmia. In both cases, magnetic resonance imaging (MRI) has served to highlight an interesting clinical oddity. To date, there has only been one study of the use of MRI in the assessment of patients with congenital anosmia who do not have Kallmann's syndrome.
WORD DEAFNESS PRESENTING AS A SUDDEN HEARING LOSS
Authors: Murray A , Fields MJ 
Published: April 2023

SUMMARYSudden hearing loss is a condition frequently seen in ENT departments and is usually due to otological pathology. We present a patient who described symptoms of a sudden inability to hear but who, on further questioning and investigations, had 'word deafness' due to bilateral temporoparietal infarcts. We discuss the clinical syndromes associated with these infarcts and the specific management of word deafness.
FOLLOW‐UP OF BREAST CANCER: TIME FOR A NEW APPROACH?
Authors: Donnelly J , Mack P , Donaldson LA 
Published: April 2023

SUMMARYAfter treatment for breast cancer women are monitored for recurrent disease by means of routine hospital‐based follow‐up appointments. The aim of this study is to determine the efficiency of this system, by establishing how recurrence presents to our hospital. The study comes at a time of increasing pressure on breast clinics from new patient referrals and the need, since April 1999, to see all cases classified as urgent within two weeks of referral. A consecutive series of 643 patients who presented with operable breast cancer between 1992 and 1998 were reviewed. Details about the 108 patients who had locoregional or metatstatic relapse were obtained from our breast cancer database and their clinical records. Full data were available on 104 patients: 77 (74%) were seen at expedited (interval) appointments and a further 18 (17.3%) drew attention to symptoms at a routine visit. Two cases of locoregional recurrence were revealed by surveillance imaging. Unsuspected disease, locoregional in all cases, was detected on examination in 7 (6.7%) patients. The median time to presentation of recurrence was 19 months for metastatic and 18 months for locoregional disease. Breast cancer recurrence usually presents to an interval clinic. Most cases that are confirmed following a routine review are already symptomatic. Long‐term routine hospital follow‐up after treatment for breast cancer appears inefficient and unnecessary. Following liaison with local general practitioners we propose to discharge patients from routine review after two years. Thereafter they will have scheduled appointments with their GPs with immediate access to specialist review in the breast care unit if required.
SIMILAR FREQUENCY OF TT VIRUS INFECTION IN PATIENTS WITH LIVER ENZYME ELEVATIONS AND HEALTHY SUBJECTS
Authors: Kadayifci A , Guney C , Uygun A , Kubar A , Bagci S , Dagalp K 
Published: April 2023

SUMMARYTT virus (TTV) is a novel DNA virus that has been identified in patients with post‐transfusional hepatitis of unknown aetiology. However, its pathogenic role in liver injury remains unclear. To determine its frequency and clinical impact in cryptogenic liver diseases, we investigated the TTV prevalence in patients with liver enzyme elevations of unknown aetiology and in healthy subjects. Fifty‐four patients (33 male, 21 female) who have been followed up for elevated ALT/AST levels of unknown aetiology and 118 healthy subjects (99 male and 19 female) were included in the study. TTV DNA was investigated by the polymerase chain reaction. Other possible causes of transaminase elevation were excluded in detailed biochemical and serological tests. A liver biopsy was performed in 45 patients. TTV DNA was detected in 46 patients with liver enzyme elevations (85.1%) and in 94 healthy subjects (79.6%). There was no statistical difference between the groups (p=0.51). Histological examination of the liver revealed no specific change in TTV DNA positive patients that could be attributed to this virus infection. These results showed that TTV is a common virus in patients with liver enzyme elevation of unknown aetiology and even among healthy subjects in our geographical area. TTV infection is therefore widespread in the general population and does not seem to be associated with liver damage.
2. BENIGN BREAST DISEASE
Authors: Hamed H , Eentiman IS 
Published: April 2023

SUMMARYBenign breast disorders (BBD), classified by the ANDI system (aberrations of normal development and involution), constitute the major workload in breast clinics. Breast pain (mastalgia) is classified as cyclical, and non‐cyclical extramammary causes such as ribcage pain have to be identified. Most patients need reassurance alone but those with moderate/severe pain present for >6 months may need treatment: randomised trials have shown danazol, bromocriptine and tamoxifen to be effective. Fibroadenoma is the commonest benign solid lump in women aged 15–30 years. The diagnosis must be confirmed by triple assessment. Cysts occur usually in women of middle to late reproductive life. After ultrasound has confirmed the lump as cystic, it can be aspriated. Nipple discharge should be tested for the presence of haemoglobin (Hb). Those with HB+ discharge may require microdochectomy for treatment and diagnosis, common causes being duct papilloma and duct ectasia. Breast abscesses may occur during lactation or in women with duct ectasia and are treated by incision or aspiration together with antibiotics.
CLINICAL EFFICACY WITH FORMOTEROL IN THE ABSENCE OF A RESPONSE TO SALMETEROL: A REVIEW
Authors: Kottakis J , Wood R , Gros V Le , Cioppa G Bella 
Published: April 2023

SUMMARYSalmeterol and formoterol are both β2‐agonist bronchodilators with a long duration of action and are often classified together, yet they are distinctly different in their pharmacology. Recent evidence suggests there is a subpopulation of asthmatic patients who do not respond to salmeterol, yet can attain clinical benefit with formoterol. Following a literature search, three published case reports are reviewed as well as results from two published clinical trials designed specifically to document response to formoterol in ‘non‐responders to salmeterol’ asthmatics. Possible mechanisms underlying this observation are discussed, including pharmacological differences of the two drugs relating to agonism at the β2‐receptor and to effect on nuclear transcription factors.
OMALIZUMAB, A MONOCLONAL ANTIBODY AGAINST IgE FOR THE TREATMENT OF ALLERGIC DISEASES
Authors: Solèr M 
Published: April 2023

SUMMARYOmalizumab, a recombinant, humanised monoclonal antibody against human IgE, will be introduced soon for the treatment of allergic asthma. This antibody binds circulating IgE molecules and inhibits the type I immune response in the lung and other target organs. In the phase II and III studies performed, it demonstrated a significant and important effect in controlling and stabilising asthma by reducing exacerbations and the need for inhaled corticosteroids. The safety and tolerability up to one year of treatment were very good. This new treatment may have a role in patients with difficult‐to‐control asthma, with recurrent exacerbations, and those with concurrent asthma, nose and eye symptoms.