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Kalson NS, Mathews JA, Phillips JRA, Baker PN, Price AJ, Toms AD. Revision knee replacement surgery in the NHS: A BASK surgical practice guideline. Knee 2021; 29:353-364. [PMID: 33690016 DOI: 10.1016/j.knee.2021.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 01/20/2021] [Accepted: 01/30/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Revision knee replacement (KR) is both challenging for the surgical team and expensive for the healthcare provider. Limited high quality evidence is available to guide decision-making. AIM To provide guidelines for surgeons and units delivering revision KR services. METHODS A formal consensus process was followed by BASK's Revision Knee Working Group, which included surgeons from England, Wales, Scotland and Northern Ireland. This was supported by analysis of National Joint Registry data. RESULTS There are a large number of surgeons operating at NHS sites who undertake a small number of revision KR procedures. To optimise patient outcomes and deliver cost-effective care high-volume revision knee surgeons working at high volume centres should undertake revision KR. This document outlines practice guidelines for units providing a revision KR service and sets out: The current landscape of revision KR in England, Wales and Northern Ireland. Service organisation within a network model. The necessary infrastructure required to provide a sustainable revision service. Outcome metrics and auditable standards. Financial mechanisms to support this service model. CONCLUSIONS Revision KR patients being treated in the NHS should be provided with the best care available. This report sets out a framework to both guide and support revision KR surgeons and centres to achieve this aim.
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Affiliation(s)
- N S Kalson
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
| | - J A Mathews
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
| | - J R A Phillips
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
| | - P N Baker
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
| | - A J Price
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
| | - A D Toms
- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom.
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- British Association for Surgery of the Knee Revision Knee Working Group, 35 - 43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom
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Kalson NS, Mathews JA, Alvand A, Morgan-Jones R, Jenkins N, Phillips JRA, Toms AD, Barrett D, Bloch B, Carrington R, Deehan D, Eyres K, Gambhir A, Hopgood P, Howells N, Jackson W, James P, Jeys L, Kerry R, Miles J, Mockford B, Murray J, Pavlou G, Porteous A, Price A, Sarungi M, Spencer-Jones R, Walmsley P, Waterson B, Whittaker J. Investigation and management of prosthetic joint infection in knee replacement: A BASK Surgical Practice Guideline. Knee 2020; 27:1857-1865. [PMID: 33202289 DOI: 10.1016/j.knee.2020.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/23/2020] [Accepted: 09/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The burden of knee replacement prosthetic joint infection (KR PJI) is increasing. KR PJI is difficult to treat, outcomes can be poor and it is financially expensive and limited evidence is available to guide treatment decisions. AIM To provide guidelines for surgeons and units treating KR PJI. METHODS Guideline formation by consensus process undertaken by BASK's Revision Knee Working Group, supported by outputs from UK-PJI meetings. RESULTS Improved outcomes should be achieved through provision of care by revision centres in a network model. Treatment of KR PJI should only be undertaken at specialist units with the required infrastructure and a regular infection MDT. This document outlines practice guidelines for units providing a KR PJI service and sets out: CONCLUSIONS: KR PJI patients treated within the NHS should be provided the best care possible. This report sets out guidance and support for surgeons and units to achieve this.
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Affiliation(s)
- N S Kalson
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - J A Mathews
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - A Alvand
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - R Morgan-Jones
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - N Jenkins
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - J R A Phillips
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
| | - A D Toms
- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland.
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- British Association for Surgery of the Knee (BASK) Revision Knee Working Group, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, United Kingdom of Great Britain and Northern Ireland
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Mathews JA, Blencowe NS, Adcock S, Gane S, Nangalia V, Patel A, Blazeby JM, Birchall M. 'Theatre Comm' - optimising communication in surgical theatres during COVID-19. Br J Surg 2020; 107:e393. [PMID: 32720711 PMCID: PMC7929364 DOI: 10.1002/bjs.11834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/06/2022]
Affiliation(s)
- J A Mathews
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, London.,Population Health Sciences, University of Bristol, London
| | - N S Blencowe
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, London.,Population Health Sciences, University of Bristol, London
| | - S Adcock
- University College London Hospitals NHS Foundation Trust, London
| | - S Gane
- University College London Hospitals NHS Foundation Trust, London
| | - V Nangalia
- Royal Free London Hospitals NHS Foundation Trust, London
| | - A Patel
- University College London Hospitals NHS Foundation Trust, London
| | - J M Blazeby
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, London.,Population Health Sciences, University of Bristol, London
| | - M Birchall
- University College London Hospitals NHS Foundation Trust, London.,Ear Institute, Faculty of Brain Sciences, UCL, London
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Al-Hourani K, Mathews JA, Shiels S, Harries W, Hepple S, Winson I. The symptomatic adult flatfoot: Is there a relationship between severity and degree of pre-existing arthritis in the foot and ankle? Foot (Edinb) 2020; 43:101664. [PMID: 32135346 DOI: 10.1016/j.foot.2020.101664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/15/2019] [Accepted: 01/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The acquired adult flatfoot deformity (AFFD) is a potentially debilitating foot condition with a prevalence thought to be between 3 %-10 %. To the authors' best knowledge, no association has been described between severity of AFFD and degree of pre-existing ankle or foot arthritis. The degree and pattern of preexisting ipsilateral arthritis of the foot and ankle was investigated in those with symptomatic AFFD presenting to hospital. METHODS Retrospective observational study between May 2015 and May 2018, of patients who presented to our tertiary clinic with symptomatic AFFD. Radiographs of one hundred and forty-eight (n=148) patients were reviewed, excluding those with charcot arthropathy, previous trauma or coalition. The primary outcome measure was severity of OA in the ankle, subtalar, talonavicular and calcaneocuboid joints. Secondary outcome was severity of radiographic planovalgus deformity. The independant variables used were age and severity of planovalgus deformity as measured by the Meary angle, calcaneal pitch and medial cuneiform-fifth metatarsal height. A linear regression model was carried out on the outcomes. RESULTS Median age was 60.0 years (IQR 22). There were 56 males to 92 females, with 75 left sided deformities observed and 73 right sided. With increasing severity of planovalgus measurements, there was no significant association observed in severity of arthritis in the ankle joint (p = 0.766), subtalar joint (p = 0.090), talonavicular joint (p = 0.256) and calcaneocuboid joint (p = 0.091). With increasing age, there was significance observed in degree of ankle arthritis, subtalar, talonavicular and calcaneocuboid joints (p = 0.001). There was no significant correlation observed with age for the angular break of Meary's line (p = 0.73), calcaneal pitch (0.262) and medial cuneiform-fifth metatarsal height (p = 0.937). CONCLUSION This observational study shows no significant association between severity of radiographic planovalgus deformity and pre-existing arthritis of the ankle, hindfoot and midtarsal joints.
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Affiliation(s)
- K Al-Hourani
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, United Kingdom.
| | - J A Mathews
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, United Kingdom
| | - S Shiels
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, United Kingdom
| | - W Harries
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, United Kingdom
| | - S Hepple
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, United Kingdom
| | - I Winson
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, United Kingdom
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Smith JRA, Mathews JA, Osborne L, Bakewell Z, Williams JL. Why do patients not kneel after total knee replacement? Is neuropathic pain a contributing factor? Knee 2019; 26:427-434. [PMID: 30770166 DOI: 10.1016/j.knee.2018.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/03/2018] [Accepted: 12/21/2018] [Indexed: 02/02/2023]
Abstract
AIMS Despite kneeling being an important and valued function of the knee, a proportion of patients are unable to kneel following arthroplasty. We explore the reasons for this, and assess whether neuropathic pain is a contributing factor. METHODS In this observational study, data was collected prospectively for 134 knees. At one year follow-up, patients completed a semi-structured questionnaire, the Oxford Knee Score (OKS), and the painDETECT score. Ability to kneel was assessed by question 7 of the OKS. Change in kneeling ability was assessed using Wilcoxon signed-rank test, normal data with independent t-test, and a regression and ANOVA analysis performed to assess predictors of kneeling ability. RESULTS 88% of patients had tried kneeling post-operatively. There was no change in kneeling ability for the whole cohort from pre- to post-operatively (p = 0.313). Patient reasons for not kneeling varied. Male gender, younger age and a reduced pain score were all significantly associated with a greater ability to kneel postoperatively. There was a trend towards an improved ability with increased flexion. Mean pain scores for all kneeling abilities lay within the nociceptive rather than neuropathic range. CONCLUSION Kneeling ability varies greatly post-knee replacement, and is multifactorial. Greater pain is a contributing factor to the inability to kneel postoperatively, but this appears to be nociceptive rather than neuropathic in nature.
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Affiliation(s)
- J D Johnston
- Department of Chemical Pathology, UMDS, St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH
| | - M Lloyd
- Department of Rheumatology, UMDS, St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH
| | - J A Mathews
- Department of Rheumatology, UMDS, St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH
| | - S W Hawthorne
- The Health Centre, Foxley Square, London SW9 7RX, England
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Mathews JA, Vindlacheruvu M, Khanduja V. Is there a weekend effect in hip fracture patients presenting to a United Kingdom teaching hospital? World J Orthop 2016; 7:678-686. [PMID: 27795950 PMCID: PMC5065675 DOI: 10.5312/wjo.v7.i10.678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/29/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare mortality and time-to-surgery of patients admitted with hip fracture to our teaching hospital on weekdays vs weekends.
METHODS Data was prospectively collected and retrospectively analysed for 816 hip fracture patients. Multivariate logistic regression was carried out on 3 binary outcomes (time-to-surgery < 36 h; 30-d mortality; 120-d mortality), using the explanatory variables time-of-admission; age; gender; American Society of Anesthesiologist (ASA) grade; abbreviated mental test score (AMTS); fracture type; accommodation admitted from; walking ability outdoors; accompaniment outdoors and season.
RESULTS Baseline characteristics were not statistically different between those admitted on weekdays vs weekends. Weekend admission was not associated with an increased time-to-surgery (P = 0.975), 30-d mortality (P = 0.842) or 120-d mortality (P = 0.425). Gender (P = 0.028), ASA grade (P < 0.001), AMTS (P = 0.041) and accompaniment outdoors (P = 0.033) were significant co-variates for 30-d mortality. Furthermore, age (P < 0.001), gender (P = 0.011), ASA grade (P < 0.001), AMTS (P < 0.001) and accompaniment outdoors (P = 0.033) all significantly influenced mortality at 120 d. ASA (P < 0.001) and season (P = 0.014) had significant effect on the odds of undergoing surgery in under 36 h.
CONCLUSION Weekend admission was not associated with increased time-to-surgery or mortality in hip fracture patients. Demographic factors affect mortality in accordance with previous published reports.
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Mathews JA. Book review : Autoimmune connective tissue diseases Edited by MA Khamashta, J Font and GRV Hughes Ediciones Doyma: Barcelona. 1993 266 pp. ISBN 84 7592 513 8. Lupus 2016. [DOI: 10.1177/096120339500400516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- JA Mathews
- Consultant Rheumatologist, St Thomas' Hospital
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MESH Headings
- Clinical Competence
- Cross-Sectional Studies
- Education, Medical, Continuing/organization & administration
- Education, Medical, Continuing/standards
- Education, Medical, Continuing/trends
- Education, Medical, Graduate/organization & administration
- Education, Medical, Graduate/standards
- Education, Medical, Graduate/trends
- Health Personnel
- Humans
- Personnel Staffing and Scheduling
- Physicians/statistics & numerical data
- Surveys and Questionnaires
- United Kingdom
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Affiliation(s)
- Matko Marlais
- The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - John Abraham Mathews
- The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - Ian Eardley
- The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK.
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Mathews JA, Ward J, Chapman TW, Khan UM, Kelly MB. Single-stage orthoplastic reconstruction of Gustilo-Anderson Grade III open tibial fractures greatly reduces infection rates. Injury 2015; 46:2263-6. [PMID: 26391592 DOI: 10.1016/j.injury.2015.08.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 08/12/2015] [Accepted: 08/15/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Grade III open fractures of the tibia represent a serious injury. It is recognised that combined management of these cases by experienced orthopaedic and plastic surgeons improves outcomes. Previous studies have not considered the timing of definitive soft tissue cover in relation to the definitive orthopaedic management. This paper reviews the outcomes in patients treated in an orthoplastic unit where the emphasis was on undertaking the definitive orthopaedic and plastic surgical procedures in a single stage, following initial debridement and temporary stabilisation as necessary. METHODS We reviewed medical notes of 73 consecutive patients with 74 Grade III open tibia fractures (minimum 1 year follow up), to compare deep infection rates in patients who had (a) a single-stage definitive fixation and soft tissue coverage vs. those who had separate operations, and (b) those who had definitive treatment completed in <72h vs. >72h. RESULTS (a) Combined Single-stage Orthoplastic Fixation and Coverage: 48 fractures were managed with definitive orthopaedic fixation and plastic surgical coverage performed at the same time, whilst 26 had these performed at separate stages. Of those subjects that had definitive fixation and coverage in one procedure 2 (4.2%) developed deep infections, compared with 9 (34.6%) deep infections (p<0.001) in those who underwent definitive fixation and coverage at separate operations. (b) Timing of surgery: Of the fractures that had definitive fixation and coverage completed within 72h of injury, 5 (20%) developed deep infections, compared with 6 (12.2%) deep infections (p=0.492) in those whose definitive fixation/coverage was completed at later than 72h. CONCLUSION Joint orthoplastic operating lists facilitate simultaneous definitive fixation and cover that greatly reduces infection rates. Based on our experience presented in this paper, we believe that emphasis should be placed on timely transfer to a specialist centre, aiming for a single-stage combined orthoplastic procedure to achieve definitive fixation and soft tissue coverage and optimal outcomes.
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Affiliation(s)
- J A Mathews
- Departments of Trauma & Orthopaedics/Plastic Surgery, North Bristol Trust, Bristol, UK.
| | - J Ward
- Departments of Trauma & Orthopaedics/Plastic Surgery, North Bristol Trust, Bristol, UK
| | - T W Chapman
- Departments of Trauma & Orthopaedics/Plastic Surgery, North Bristol Trust, Bristol, UK
| | - U M Khan
- Departments of Trauma & Orthopaedics/Plastic Surgery, North Bristol Trust, Bristol, UK
| | - M B Kelly
- Departments of Trauma & Orthopaedics/Plastic Surgery, North Bristol Trust, Bristol, UK
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Mathews JA, Ward J, Dickson JK, Chapman T, Kelly M, Khan U. Single-stage combined orthoplastic reconstruction of gustilo III open tibial fractures greatly reduces infection and non-union rates: Experience at a major trauma centre. J Plast Reconstr Aesthet Surg 2014. [DOI: 10.1016/j.bjps.2014.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mathews JA, Ford J, Norton S, Kang D, Dellinger A, Gibb DR, Ford AQ, Massay H, Kepley CL, Scherle P, Keegan AD, Conrad DH. A potential new target for asthma therapy: a disintegrin and metalloprotease 10 (ADAM10) involvement in murine experimental asthma. Allergy 2011; 66:1193-200. [PMID: 21557750 DOI: 10.1111/j.1398-9995.2011.02614.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Elevated levels of CD23, a natural regulator of IgE production, have been shown to decrease the signs of lung inflammation in mice. The aim of this study was to study the involvement of ADAM10, the primary CD23 sheddase, in experimental asthma. METHODS ADAM10 was blocked either by using mice with a B-cell-specific deletion of the protease or pharmacologically by intranasal administration of selective ADAM10 inhibitors. Airway hypersensitivity (AHR) and bronchoaveolar lavage fluid (BALF) eosinophilia and select BALF cytokine/chemokine levels were then determined. RESULTS Using an IgE and mast cell-dependent mouse model, B-cell-specific ADAM10(-/-) mice (C57B/6 background) exhibited decreased eosinophilia and AHR when compared with littermate (LM) controls. Treatment of C57B/6 mice with selective inhibitors of ADAM10 resulted in an even further decrease in BALF eosinophilia, as compared with the ADAM10(-/-) animals. Even in the Th2 selective strain, Balb/c, BALF eosinophilia was reduced from 60% to 23% respectively. In contrast, when an IgE/mast cell-independent model of lung inflammation was used, the B-cell ADAM10(-/-) animals and ADAM10 inhibitor treated animals had lung inflammation levels that were similar to the controls. CONCLUSIONS These results thus show that ADAM10 is important in the progression of IgE-dependent lung inflammation. The use of the inhibitor further suggested that ADAM10 was important for maintaining Th2 levels in the lung. These results thus suggest that decreasing ADAM10 activity could be beneficial in controlling asthma and possibly other IgE-dependent diseases.
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Affiliation(s)
- J A Mathews
- Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
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Affiliation(s)
- J A Mathews
- Musicians' Clinic, Department of Rheumatology, St Thomas' Hospital, London.
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Abstract
Four patients are described with destructive rheumatoid arthritis of the cervical spine and neurogenic wasting of forearm and hand muscles. The pathological connection is not immediately obvious, but a relationship between these two observations is described here with clinical, radiological, electrophysiological and necropsy findings. Compression of the anterior spinal artery at upper and mid-cervical levels is demonstrated to be the likely cause of changes lower in the spinal cord. These are shown to be due to the resulting ischaemia of the anterior part of the lower cervical spinal cord, with degeneration of the neurones innervating the forearm and hand muscles. These findings favour external compression of the anterior spinal artery leading to ischaemia in a watershed area as the likeliest explanation for this otherwise inappropriate and bizarre phenomenon.
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Affiliation(s)
- J A Mathews
- Department of Rheumatology, St Thomas' Hospital, London, UK
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Hamilton IN, Mathews JA, Sailors DM, Woody JD, Burns RP. Combination endovascular and open treatment of peripheral arterial occlusive disease performed by surgeons. Am Surg 1998; 64:581-90; discussion 590-2. [PMID: 9619182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The endovascular treatment of peripheral arterial occlusive disease has historically been performed by interventional radiologists and cardiologists. With additional training in endovascular techniques, surgeons become uniquely suited to manage arterial lesions with both endovascular and conventional surgical techniques. Over a 14-month period, 13 patients underwent combination endovascular and open reconstruction on limbs with peripheral arterial occlusive disease. There were 10 males and 3 females. The mean age was 66 years. All procedures were performed in the operating room by surgery residents under the direct supervision of vascular surgeons. After intraoperative angiography, 26 arterial lesions underwent percutaneous transluminal angioplasty (aorta, 1; common iliac, 14; external iliac, 10; superficial femoral, 1). Twenty-five of 26 lesions were further treated with intraluminal stent placement, the lone exception being a case of superficial femoral artery angioplasty. Concomitant open reconstruction was performed on all limbs, 14 as outflow and 1 as inflow. There were two cases of procedural morbidity and one perioperative death secondary to myocardial infarction. There were no wound-related complications. The mean ankle-brachial index of the affected lower extremity improved from 0.41 (+/- 0.15) to 0.74 (+/- 0.14) at 30 days. Mean follow-up was 8 months (range, 2-14). Based on our early experience, simultaneous combination endovascular and open reconstruction of multisegment arterial occlusive disease can be performed safely and efficiently by surgeons.
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Affiliation(s)
- I N Hamilton
- Department of Surgery, University of Tennessee College of Medicine-Chattanooga Unit, USA
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Roe SM, Mathews JA, Burns RP, Sumida MP, Craft P, Greer MS. Stereotactic and ultrasound core needle breast biopsy performed by surgeons. Am J Surg 1997; 174:699-703; discussion 703-4. [PMID: 9409600 DOI: 10.1016/s0002-9610(97)00199-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The authors evaluated outcomes and treatment costs of stereotactic core needle biopsy (SCNB) and ultrasound core needle biopsy (UCNB), and needle localization biopsy (NLB) in managing patients with mammographic abnormalities presenting to the surgeon. METHODS Data for all patients with mammographic lesions who underwent SCNB or UCNB since their introduction at this institution were prospectively collected over 17 months. Mean inclusive costs of the three procedures were accumulated and compared. RESULTS Stereotactic core needle biopsy was performed for 342 lesions in 319 women, for a malignancy rate of 19%; UCNB was performed for 157 lesions in 144 patients, yielding a malignancy rate of 17%. With a mean follow-up of 13.5 months, 1 patient with in situ carcinoma was diagnosed late. Absolute cost savings for the period studied was $721,963. CONCLUSIONS Minimally invasive breast biopsy procedures can safely and reliably be performed by surgeons in clinical practice with increased patient convenience and decreased costs.
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Affiliation(s)
- S M Roe
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga Unit, 37403, USA
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Mathews JA. Key developments in rheumatology. Practitioner 1997; 241:446-8. [PMID: 9425704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Stevens RJ, Mathews JA. A new protocol for back pain. Practitioner 1997; 241:351-4. [PMID: 9230519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R J Stevens
- Department of Rheumatology, St. Thomas' Hospital, London
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Johnston JD, Lloyd M, Mathews JA, Hawthorne SW. Racial variation in serum creatine kinase levels. J R Soc Med 1996; 89:462-4. [PMID: 8795501 PMCID: PMC1295889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- J D Johnston
- Department of Chemical Pathology, UMDS, St Thomas Hospital, England
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Mathews JA, Somberg LB, Barker DE. Diaphragmatic rupture. J Tenn Med Assoc 1996; 89:117-9. [PMID: 8867229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J A Mathews
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, USA
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24
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Abstract
A 52 year old man developed a painful swollen left knee. Clinically there was an effusion and radiographs showed local osteoporosis. Sepsis was suspected but tests proved negative and the symptoms gradually settled. During the course of the following year he developed similar pain migrating from the left foot to the right knee then to the right foot. Investigations showed a right knee effusion and 'punctate' radiographic lucencies in the patellae thought to be erosions. A bone scan demonstrated increased uptake at all four sites and sepsis was once again suspected. Biopsies and culture proved negative and a computed tomographic scan confirmed that the lucencies were due to focal osteoporosis rather than erosions. This case of transient regional osteoporosis illustrates two unusual features of this condition which resulted in diagnostic difficulty with respect to sepsis.
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Affiliation(s)
- T E McAlindon
- Department of Rheumatology, St Thomas' Hospital, London, UK
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25
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Abstract
The Society for Academic Emergency Medicine suggests a systematic approach to evaluating proposals for reform of the medical care system. Described are the three components of the problem--access, cost, and quality. Then, goals are proposed for health care reform. With this background, we describe the major questions that reform proposals must address and the potential impact of reform on emergency medicine. Emergency physicians must actively support health reform legislation that is in the over-all best interest or our patients and our specialty, and work with the new federal administration to evaluate proposed changes.
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Affiliation(s)
- R A Lowe
- Prevention Sciences Group, University of California, San Francisco
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26
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Mathews JA. The cervical spine in rheumatoid arthritis. BMJ 1993; 306:655. [PMID: 8461843 PMCID: PMC1676937 DOI: 10.1136/bmj.306.6878.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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27
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28
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Mathews JA, Griffiths RD, Moses RG. Prevalence of diabetes mellitus in patients aged 20-39 years in the Illawarra area of New South Wales. Med J Aust 1991; 154:855. [PMID: 2041523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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29
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Asherson RA, Angus H, Mathews JA, Meyers O, Hughes GR. The progressive systemic sclerosis/systemic lupus overlap: an unusual clinical progression. Ann Rheum Dis 1991; 50:323-7. [PMID: 2042989 PMCID: PMC1004420 DOI: 10.1136/ard.50.5.323] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Three patients with the unusual combinations of discoid lupus, systemic lupus erythematosus (SLE), and progressive systemic sclerosis (PSS) are reported. The first patient developed PSS eight years after a diagnosis of discoid lupus had been made and this was complicated by myositis six years later. The second patient developed PSS more than 20 years after being diagnosed as having SLE. The third patient developed SLE with predominant features of urticarial vasculitis six years after PSS. Mild myositis also ensued. There were no antibodies to U1RNP demonstrable in any of these patients. The clinical progression of SLE to PSS or vice versa in the absence of features of mixed connective tissue disease is distinctly uncommon.
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Affiliation(s)
- R A Asherson
- Lupus Arthritis Research Unit, St. Thomas's Hospital, London
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30
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Mathews JA. Common Vertebral Joint Problems. Ann Rheum Dis 1990. [DOI: 10.1136/ard.49.5.282-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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31
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Mathews JA. Rheumatology in Rasiguères, 1989. BMJ 1989; 299:1594-5. [PMID: 2558752 PMCID: PMC1838766 DOI: 10.1136/bmj.299.6715.1594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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32
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Ridley MG, Wolfe CS, Mathews JA. Life threatening acute pneumonitis during low dose methotrexate treatment for rheumatoid arthritis: a case report and review of the literature. Ann Rheum Dis 1988; 47:784-8. [PMID: 3052323 PMCID: PMC1003598 DOI: 10.1136/ard.47.9.784] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A patient is described with definite rheumatoid arthritis (RA) who developed life threatening acute pneumonitis after receiving a total dose of only 12.5 mg methotrexate (MTX). This complication has been previously described, but this is probably the lowest reported dose before development of pneumonitis in a patient with RA. The possible significance of this case is discussed in the light of recent reports suggesting an increased susceptibility of patients with RA to the pulmonary toxicity of MTX.
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Affiliation(s)
- M G Ridley
- Department of Rheumatology, St Thomas's Hospital, London
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Mathews JA. Back Pain: The Facts. Ann Rheum Dis 1988. [DOI: 10.1136/ard.47.6.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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35
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Mathews JA, Mills SB, Jenkins VM, Grimes SM, Morkel MJ, Mathews W, Scott CM, Sittampalam Y. Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. Br J Rheumatol 1987; 26:416-23. [PMID: 2961394 DOI: 10.1093/rheumatology/26.6.416] [Citation(s) in RCA: 184] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Four treatment regimens for patients with specified combinations of low back pain and sciatica were evaluated. The largest group studied had low back pain with limited straight-leg raising (SLR) and in them the beneficial effect of manipulation in hastening pain relief was highly significant. In similar patients without limitation of SLR, the effect was of borderline significance. In all the other groups, treated patients also recovered more quickly than their controls. Traction, for patients with low back pain and sciatica, and epidural injections when a root palsy was present also produced some significant pain relief. The effect of sclerosants for back pain was less clear.
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Affiliation(s)
- J A Mathews
- Department of Rheumatology, St. Thomas' Hospital, London, UK
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37
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Sheehan NJ, Slavin BM, Donovan MP, Mount JN, Mathews JA. Lack of correlation between clinical disease activity and erythrocyte sedimentation rate, acute phase proteins or protease inhibitors in ankylosing spondylitis. Br J Rheumatol 1986; 25:171-4. [PMID: 2423177 DOI: 10.1093/rheumatology/25.2.171] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Disease activity was assessed clinically and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), orosomucoid, alpha 1-antitrypsin (alpha 1AT) and alpha 2-macroglobulin (alpha 2M) were measured in 65 patients with ankylosing spondylitis (AS). Positive correlations were found between ESR and the acute phase proteins (APP), CRP, orosomucoid and alpha 1AT, but none of these variables correlated with the clinical assessment of activity. No relationship was demonstrated between the protease inhibitor, alpha 2M and clinical activity, ESR or any of the APP. While the treatment of AS remains predominantly symptomatic, routine management of patients should continue to be founded on the clinical assessment of disease activity rather than on laboratory indices of inflammation.
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Abstract
Two cases are reported of a reactive arthritis due to infection with Yersinia enterocolitica. These are the fifth and sixth cases reported in the United Kingdom. This interesting cause of arthritis may be more common than previously thought and should be considered even in the United Kingdom, although the practical implications are limited.
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Abstract
Raised serum alkaline phosphatase (AP) levels were found in 13 of 76 patients (17%) with ankylosing spondylitis (AS), and 11 of these 13 underwent further investigation to determine the origin of the increased enzyme activity. Three had levels within the normal reference range on re-estimation, and, of the remaining 8, AP isoenzyme studies indicated an increased liver fraction in 6. Serum gamma-glutamyl transpeptidase (GGT) was raised in only 3 patients. Increased AP activity did not appear to be directly related to disease activity or to drug therapy. These findings confirm the occurrence of increased serum AP activity in AS but challenge a previously reported suggestion that bone is the source of the increased enzyme.
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Mathews JA. A critique of the internal logic of ICRP risk factor derivation. Ann Occup Hyg 1983; 27:291-300. [PMID: 6638763 DOI: 10.1093/annhyg/27.3.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
In rheumatoid disease only 4 cases have been reported in which lung nodules preceded arthritis. Two further cases are presented in which intrapulmonary nodules were noted at the onset of the disease, thus provoking a diagnostic dilemma. In the first patient rheumatoid factor tests were initially negative, and diagnostic thoracotomy was performed. In the second patient serological tests were positive, and biopsy was avoided. It therefore seems that detection of circulating rheumatoid factor in patients with lung shadows can be a useful aid to diagnosis and management.
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Abstract
The concentration of lactic acid in synovial fluid was estimated in 43 specimens from patients with an acute monoarthritis by a simple enzyme method. In 9 patients with 10 episodes of septic arthritis concentrations of synovial fluid lactic acid were significantly higher (mean 10.8 mmol/l) than in 33 patients with nonseptic effusions (mean 3.1 mmol/l). With this method concentrations of synovial fluid lactic acid provide a rapid diagnostic guide in the separation of septic from nonseptic arthritis.
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44
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Mathews JA, Pemberton J. Radiological anatomy of the neck. Physiotherapy 1979; 65:77-80. [PMID: 451045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ansell BM, Major G, Liyanage SP, Gumpel JM, Seifert MH, Mathews JA, Engler C. A comparative study of Butacote and Naprosyn in ankylosing spondylitis. Ann Rheum Dis 1978; 37:436-9. [PMID: 363071 PMCID: PMC1000272 DOI: 10.1136/ard.37.5.436] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A double-blind, cross-over comparison of Naprosyn (naproxen) 750 mg daily and Butacote (enteric-coated phenylbutazone) 300 mg daily was carried out in a multi-centre trial. Twenty-five patients, mostly male and under 40 years of age, were entered. After a 2-week period in which any existing anti-inflammatory drugs were tailed off, patients were entered into the trial and treated for 1 month with each drug. Patients were assessed at 4-weekly intervals. Both drugs significantly reduced morning stiffness. Morning pain and discomfort and wall-tragus distance were also significantly reduced by both drugs during the trial. Results of the Schober test showed improvement during both treatment periods. There were no overall statistically significant differences between the effects of the 2 drugs on objective parameters. However, overall subjective assessment of symptoms showed a greater improvement on Butacote. Treatment preferences by physician and subjective assessment by the patient both favoured Butacote but the difference between the 2 drugs was not statistically significant. Side effects were mostly of a minor nature. One patient had to discontinue the trial, due to indigestion while taking Butacote.
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Mathews JA. Neurological manifestations of the rheumatic diseases. Practitioner 1978; 220:93-100. [PMID: 203924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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50
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Mathews JA, Yates DA. Hazard of glutethimide. Br Med J 1976; 2:1014. [PMID: 974706 PMCID: PMC1689237 DOI: 10.1136/bmj.2.6042.1014-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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