Synchronous sclerosing haemangiomas of the lung: an unusual presentation of a rare tumour.

Pulmonary sclerosing haemangioma  is a rare lung tumour with a preponderance for Asian oriental women. Typically a well-circumscribed, solitary lesion with benign characteristics, there are concerns of malignant potential including regional lymph node metastases. Four histological subtypes exist.

Intestinal bowel lengthening in children with short bowel syndrome: systematic review of the Bianchi and STEP procedures.

Background: It has been thirty years since Bianchi introduced the technique that made intestinal lengthening possible. The last three decades have seen lengthening procedures established as vital components of intestinal rehabilitation programs. The goal of the present study was to use a systematic literature review to determine patient outcomes for the two most commonly used lengthening procedures, the Bianchi procedure and the serial transverse enteroplasty procedure (STEP).

Postpartum dilated cardiomyopathy in a patient with systemic lupus erythematosus, nephritis and lupus anticoagulant: a diagnostic dilemma.

A 32-year-old Caucasian woman presented with shortness of breath four weeks postpartum. She was known to suffer from systemic lupus erythematosus with cutaneous, joint and minor renal involvement. During pregnancy, the patient had developed nephrotic syndrome for which she was managed with prophylactic anticoagulation and corticosteroid therapy.

Nutrient intakes and dysglycaemia in populations of West African origin.

Examining the relationship between glucose intolerance and dietary intake in genetically similar populations with different dietary patterns and rates of type 2 diabetes may provide important insights into the role of diet in the pathogenesis of this disease. The objective of the present study was to assess the relationship between dietary variables and dysglycaemia/type 2 diabetes among three populations of African origin. The study design consists of a cross-sectional study of men and women of African descent aged 24-74 years from Cameroon (n 1790), Jamaica (n 857) and Manchester, UK (n 258) who were not known to have diabetes.

Pain relief in outpatient hysteroscopy: a survey of current UK clinical practice.

Background: Outpatient hysteroscopy is increasingly being used as a cost-effective alternative to in-patient hysteroscopy under general anaesthesia. Like other outpatient gynaecological procedures, however, it has the potential to cause pain severe enough for the procedure to be abandoned. There are no national guidelines on pain relief for outpatient hysteroscopy.

Determinants of summiting success and acute mountain sickness on Mt Kilimanjaro (5895 m).

Objective: To determine the incidence of acute mountain sickness (AMS), the frequency of summiting success, and the factors that affect these in trekkers on Kilimanjaro, one of the world's most summitted high-altitude peaks.

Methods: The study group comprised 312 trekkers attempting Mt Kilimanjaro summit by the Marango Route. Trekkers ascended over 4 or 5 days along a fixed ascent profile, stopping at 3 huts on ascent (2700 m, 3700 m, and 4700 m) before attempting the summit.

When only the real thing will do: junior medical students' learning from real patients.

Objectives: This study aimed to explore how medical students experience contacts with real patients and what they learn from them.

Methods: We carried out a post hoc, single-group study in one teaching sector of a 5-year, problem-based, horizontally integrated, outcome-based and community-oriented undergraduate programme, in which students lacked clinical exposure in the pre-clerkship phase. Subjects comprised five cohorts of students on their first clerkships.

'They've all got to learn'. Medical students' learning from patients in ambulatory (outpatient and general practice) consultations.

Background: The dynamics of effective teaching consultations need to be better understood.

Aim: Find from medical students, patients and doctors how to optimize learning in ambulatory consultations.

Methods: Patients and students independently gave semi-structured exit interviews after 25 ambulatory teaching consultations during a clinical attachment set up experimentally to strengthen students' ambulatory learning.

Plasma fatty acid composition as a predictor of arterial stiffness and mortality.

Aortic stiffness predicts cardiovascular mortality and may be influenced by dietary fat composition. The hypothesis that plasma fat composition influences arterial stiffness and subsequent mortality was tested here in a prospective study. A total of 174 randomly sampled nondiabetic participants aged 45 to 74 years were recruited from local populations, stratified by ethnicity and gender, and followed up for mortality.

Development of a method to investigate medical students' perceptions of their personal and professional development.

Personal and Professional Development (PPD) is now key to the undergraduate medical curriculum and requires provision of appropriate learning experiences. In order to achieve this, it is essential that we ascertain students' perceptions of what is important in their PPD. We required a methodological approach suitable for a large medical school, which defines constructs used by the students to describe their PPD, and is not constrained by a researcher's predetermined line of questioning.

Pain relief during hysterosalpingography: a national survey.

Hysterosalpingography is a part of the infertility workup and can be painful. We conducted a postal survey of Obstetric and Gynaecology departments in the UK to evaluate the current clinical practice regarding the methods used to provide pain relief during hysterosalpingography. A total of 166 questionnaires were sent and 104 responses were received.

Recent advances in urocanic acid photochemistry, photobiology and photoimmunology.

Urocanic acid (UCA), produced in the upper layers of mammalian skin, is a major absorber of ultraviolet radiation (UVR). Originally thought to be a 'natural sunscreen', studies conducted a quarter of a century ago proposed that UCA may be a chromophore for the immunosuppression that follows exposure to UVR. With its intriguing photochemistry, its role in immunosuppression and skin cancer development, and skin barrier function, UCA continues to be the subject of intense research effort.

The Oxfordshire Community Stroke Project classification in the early hours of ischemic stroke and relation to infarct site and size on cranial computed tomography.

Background And Purpose: The Oxfordshire Community Stroke Project (OCSP) classification clinically subdivides cerebral infarction into total anterior circulation (TACS), partial anterior circulation (PACS), posterior circulation (POCS) and lacunar (LACS) syndromes. We compared the OCSP classification in patients presenting within 12 hours of onset of stroke with infarct site and size on computed tomography (CT) brain scan at 5 to 7 days.

Methods: OCSP classification was prospectively assigned by 1 of 3 observers in 43 patients presenting within 12 hours of stroke.

New formulae for predicting tracheal tube length.

Background: The aim of this study was to determine the accuracy of standard techniques for estimating oral and nasal tracheal tube length in children and to devise more accurate predictive formulae that can be used at the bedside.

Methods: Data were collected from 255 children who required tracheal intubation whilst on the Pediatric Intensive Care Unit over a period of 1 year. Age, weight, the final length of the tracheal tube and the internal diameter were documented.

Is there an association between anti-TNF monoclonal antibody therapy in rheumatoid arthritis and risk of malignancy and serious infection? Commentary on the meta-analysis by Bongartz et al.

A recent meta-analysis of randomized clinical trials reported by Bongartz and coworkers raised concerns about an increased rate of malignancy and serious infection in rheumatoid arthritis patients treated with anti-tumour necrosis factor monoclonal antibodies. This commentary discusses some of the methodological issues in their analysis and urges caution in interpreting the results.

Adiponectin in umbilical cord blood is inversely related to low-density lipoprotein cholesterol but not ethnicity.

Context: Adiponectin is a recognized protective risk marker for cardiovascular disease in adults and is associated with an optimal lipid profile. The role of adiponectin at birth is not well understood, and its relationship with the neonatal lipid profile is unknown. Because ethnic disparities in cardiovascular risk have been attributed to low adiponectin and its associated low high-density lipoprotein cholesterol (HDL-C), investigation at birth may help determine the etiology of these risk patterns.

An evaluation of the decision tree format of the American College of Rheumatology 1987 classification criteria for rheumatoid arthritis: performance over five years in a primary care-based prospective study.

Objective: The American College of Rheumatology (ACR) 1987 criteria for rheumatoid arthritis (RA) can be applied in 2 formats, a standard "x/y" list and a decision tree. This study evaluated the performance of the decision tree compared with the list approach in the ascertainment of RA in subjects with new-onset inflammatory polyarthritis (IP) over the first 5 years of observation. Moreover, the use of clinical surrogates to substitute for missing rheumatoid factor (RF) and radiologic erosion data was assessed for validity and for its influence on the resulting RA prevalence estimates.

Outcome following onset of juvenile idiopathic inflammatory arthritis: I. frequency of different outcomes.

Objective: To determine the outcome, following the onset of juvenile idiopathic inflammatory arthritis, in terms of remission of disease activity, loss of function and structural damage based on a review of the available published data.

Methods: Electronic databases were searched for major studies publishing outcome data in the past 10 yr in juvenile idiopathic arthritis, juvenile rheumatoid arthritis and juvenile chronic arthritis, and 21 studies were selected. The proportions of children in the different categories of the outcomes of interest are described.

Outcome following onset of juvenile idiopathic inflammatory arthritis: II. predictors of outcome in juvenile arthritis.

Objective: To assess the relative contributions of demographic, clinical and laboratory variables in predicting outcome in juvenile idiopathic inflammatory arthritis (JIA), based on a review of the existing literature.

Methods: Electronic reference database searches for the previous 10 yr were conducted and studies examining the role of major potential predictors of main outcomes were identified. Where possible, subjects were grouped by JIA disease subtype.

Does early rheumatoid arthritis exist?

The 'life cycle' of established rheumatoid arthritis can be divided into four phases. The first is the period leading up to the onset of arthritis. The second is the period during which persistence or remission is determined.

Opportunities for prevention of 'clinically significant' knee pain: results from a population-based cross sectional survey.

Background: There is little UK-based evidence on the prevalence and predictors of knee pain associated with disability across all adult ages. We aimed to estimate the prevalence of 'clinically significant' knee pain, identify and assess the population impact of independent risk factors, and estimate levels of healthcare need.

Methods: A cross-sectional survey of three general practice populations was conducted.

To clot or not to clot? That is the question in central venous catheters.

Aim: To establish the relationship between the tip position of tunnelled central venous catheters (CVC) and the incidence of venous thrombosis.

Materials And Methods: A randomly sampled, retrospective review of 428 CVC inserted into 334 patients was performed. The chest radiograph obtained post-catheter insertion, as well as follow-up radiographs, linograms, venograms and Doppler ultrasounds (US), were reviewed.

Childhood linear IgA disease in association with autoimmune lymphoproliferative syndrome.

A child is described who had the signs of autoimmune lymphoproliferative syndrome from an early age and later developed a blistering dermatosis that was shown to be childhood linear IgA disease.

Traditional cardiovascular risk factors measured prior to the onset of inflammatory polyarthritis.

Background: Cardiovascular mortality is increased in patients with seropositive inflammatory polyarthritis (IP). We tested the hypothesis that the increased risk of cardiovascular disease (CVD) can be explained by elevated traditional CVD risk factor levels in persons prior to development of IP.

Methods: In a population-based, prospective nested case-control study, 25 600 people aged 45-75 yr participated in a health survey, including standard CVD risk factor assessment, between the years 1993 and 1997.