Hypergonadotropic hypogonadism and chromosomal aberrations: clinical heterogeneity and implications on the health of elderly men, case series.

Background: Hypogonadism in older men is often considered as late onset hypogonadism. However, this clinical condition results from primary testicular failure which could be of genetic origin with Klinefelter syndrome being the most common chromosomal abnormality associated with it.

Case Presentation: We report a heterogeneous group of cases who were diagnosed with hypergonadotropic hypogonadism in their adulthood and were found to have rare chromosomal aberrations.

Evaluation of maximum dose intravenous midazolam used in dental intravenous sedation: a West of Scotland regional audit.

Background Intravenous (IV) midazolam sedation is commonly used in the delivery of dentistry for phobic patients. There is currently no guidance on a maximum dose for use specifically in dentistry. Dentists practise with the British National Formulary recommended maximum dose of 7.

Unexpected internal hernia in a patient with small bowel obstruction: an old surgical axiom.

An 85-year-old man with no previous laparotomies and no herniae presented with a small bowel obstruction. CT imaging did not suggest any obvious cause; however, a transition point at the terminal ileum was noted. At laparotomy, the small bowel was unexpectedly found to be obstructed through a tight anterior hiatal defect.

Anatomical pelvic loading of a monoblock polyethylene acetabular component.

Aims: Uncemented metal acetabular components show good osseointegration, but material stiffness causes stress shielding and retroacetabular bone loss. Cemented monoblock polyethylene components load more physiologically; however, the cement bone interface can suffer fibrous encapsulation and loosening. It was hypothesized that an uncemented titanium-sintered monoblock polyethylene component may offer the optimum combination of osseointegration and anatomical loading.

Cutaneous manifestation of leukaemia on the penis-the possible implications.

Skin lesions are common in the patients with chronic lymphoid leukaemia (CLL); however, leukaemia cutis is a cutaneous manifestation secondary to any form of leukaemia and generally an uncommon phenomenon. They typically present on the face and neck as well as exposed areas. Our case looks at a 78-year-old gentleman with known CLL who presented with an asymptomatic raised lesion in his inner prepuce.

The acute management of ankle fractures (Augment) study: A prospective trainee led national collaborative audit of the Boast 12 guidelines.

Background: Ankle fractures are one of the most common fractures in adults aged 20-65 years. The British Orthopaedic Association (BOA) and British Orthopaedic Foot and Ankle Society (BOFAS) jointly produced Standards for Trauma (BOAST) BOAST 12, with the aim of reducing morbidity by standardising care of these injuries. The primary aim of the AUGMENT study was to determine the extent and clinical effect of variation from BOAST 12.

Clinical and Patient-Reported Outcomes after Absorbable Strap Fixation for Ventral Hernia Repair.

Introduction: Various mesh fixation methods are employed by surgeons during ventral hernia repair. These may include tacks, straps, sutures, glue, or a combination of methods. One of these choices is an absorbable fixation device, Securestrap® (Ethicon Inc.

A rare case of primary epithelioid angiosarcoma of the ureter.

Angiosarcoma is an extremely rare vascular malignancy with a 1-year survival rate of 50%, regardless of tumour origin. Distant metastases are common and occur in the lungs, bone, lymph nodes and soft tissues. The majority of patients with angiosarcoma present with localised disease, although 25-45% have distant metastases at presentation.

miR-34a(-/-) mice are susceptible to diet-induced obesity.

Objective: MicroRNA (miR)-34a regulates inflammatory pathways, and increased transcripts have been observed in serum and subcutaneous adipose of subjects who have obesity and type 2 diabetes. Therefore, the role of miR-34a in adipose tissue inflammation and lipid metabolism in murine diet-induced obesity was investigated.

Methods: Wild-type (WT) and miR-34a(-/-) mice were fed chow or high-fat diet (HFD) for 24 weeks.

Gout and diabetes: a common combination.

The aims of this cross-sectional study were to compare metabolic parameters in people with gout and diabetes with gout only and type 2 diabetes mellitus (T2DM) only. Fifty General Practices in NHS Ayrshire and Arran (population 340 377) contributed data. The sample was split into three groups, those with both gout and T2DM, those with gout only and those with T2DM only.

Alcohol dependence and driving: knowledge of DVLA regulations.

Aims and Methods The UK's Driver Vehicle Licensing Authority (DVLA) requires individuals to report if they have a medical condition such as alcohol dependence. General Medical Council guidance indicates that medical practitioners should ensure patients are aware of their impairment and requirement to notify the DVLA. Results In a survey of 246 people with known alcohol dependence, none were aware of advice on driving given by medical practitioners and none had self-reported.

Haemosuccus pancreaticus, an uncommon cause of upper gastro intestinal bleeding: Case report and review of the literature.

Haemosuccus Pancreaticus is defined as upper gastro intestinal (GI) bleeding from the ampula of vater via the pancreatic duct. It is most commonly associated with pancreatic inflammation, erosion of the pancrease by aneurysm or pseudo-aneurysm of the splenic artery. We report a 69 year old man with previous history of acute pancreatitis who was admitted with recurrent haematemesis.

Intracranial metastasis of adenocarcinoma of the prostate presenting with symptoms of spinal cord compression.

Spinal cord compression is a not uncommon complication of metastatic prostate cancer. Intracranial metastasis of prostatic adenocarcinoma is however unusual. We report a case of a 67-year-old man with metastatic prostate carcinoma, who presented with a 3-day history of lower limb weakness and collapse.

Impact of socioeconomic status and gender on glycaemic control, cardiovascular risk factors and diabetes complications in type 1 and 2 diabetes: a population based analysis from a Scottish region.

Aims: In this cross-sectional study, the aims were to investigate the association of the socioeconomic status and gender on the prevalence of type 1 and 2 diabetes, glycaemic control, cardiovascular risk factors plus the complications of diabetes in a population-based analysis in the county of Ayrshire and Arran, Scotland.

Methods: Quality Outcome Framework data was obtained from General Practices in Ayrshire and Arran, Scotland (n=15,351 patients).

Results: In type 1 diabetes, there was an increasing linear trend in HbA1c across deprivation levels (P<0.

The accuracy and reliability of pre-operative templating in revision total knee arthroplasty. A comparison of analogue and digital methods.

Aims: To determine whether the size of the prostheses used in revision knee arthroplasty may be accurately and reproducibly predicted using analogue or digital pre-operative templating techniques.

Methods: Pre-operative radiographs were templated using analogue radiographs and acetate templates, digital radiographs and acetate templates and digital radiographs and digital templating software.

Results: Overall accuracy of predicting the size of implant used at surgery was 44%.

Gender differences and patterns of cardiovascular risk factors in Type 1 and Type 2 diabetes: a population-based analysis from a Scottish region.

Aim: To explore the gender differences, along with the relationships between BMI, glycaemic control, cardiovascular risk factors and the prevalence of diabetes complications, in a representative population-based group of people with Type 1 and Type 2 diabetes.

Methods: Data were obtained from general practices in Ayrshire and Arran, Scotland for 15 351 patients.

Results: In the cohort with Type 1 diabetes, after adjustment for age, men had a significantly lower BMI (P = 0.

A study of patient experience using a blood glucose meter with an in-built insulin dose calculator.

Accurate calculation and adjustment of insulin doses is integral to maintaining glycemic control in insulin treated patients. Difficulties with insulin dose calculations may lead to poor adherence to blood glucose monitoring and insulin treatment regimes, resulting in poor metabolic control. The main objective of this study was to evaluate ease of use and user preference of a high specification touch screen blood glucose meter, which has an in-built insulin calculator, compared to patients' usual method of testing blood glucose and deciding insulin doses.

Is Clostridium difficile associated with the '4C' antibiotics? A retrospective observational study in diabetic foot ulcer patients.

Aims: Clostridium difficile is an anaerobic cytotoxin-producing bacterium that can cause infectious diarrhoea, pseudomembranous colitis and toxic megacolon. The major risk factors for developing C. difficile infection include recent or current antimicrobial use, diabetes, age over 65, proton pump inhibitor use, immunosuppression and previous infection with C.

The properties of an improvised piston pump for the rapid delivery of intravenous fluids.

To maximise the effect of a small fluid load, it is occasionally desirable to bolus manually with multiple depressions of a large-capacity syringe. This is usually achieved by placing the syringe on the side port of a three-way tap. We modified this technique by placing two-one-way valves in line with the three-way tap, effectively creating a piston pump, the infusion rates via which we compared with those achieved by an inflatable pressure-infuser in a simulated resuscitation.

A new class of drug for the management of type 2 diabetes: sodium glucose co-transporter inhibitors: 'glucuretics'.

Background: Type 2 diabetes is a common, chronic disease with a prevalence that is increasing at epidemic proportions. Management involves advice on lifestyle changes, oral anti-hyperglycaemic agents and/or insulin. The kidneys play a major role in the regulation of glucose, re-absorbing 99% of the plasma glucose filtered through the renal glomeruli tubules.

BET 2: no evidence for prophylactic antibiotics in pinna laceration.

A short cut review was carried out to establish whether prophylactic antibiotics should be given to patients with a laceration to the pinna. No studies directly answered the question. The clinical bottom line is that there is a lack of evidence on this subject and that local expert advice should be sought.