SUMMARY The incidence of reduplicative paramnesia was sampled with a structured interview in 50 consecutive alcoholic inpatients. Four had reduplicative paramnesia (RP group) and 46 did not (non-RP group). Three of four patients in RP group had acute right hemispheric lesions and none had a left hemispheric lesion; 19 non-RP patients had left hemispheric lesions, 2 had right, and 25 had none. These data are in keeping with the previous suggestions that the neuroanatomical basis for reduplicative paramnesia is an acute right hemispheric lesion superimposed on chronic diffuse or bifrontal deficit.Reduplicative paramnesia' is a specific disturbance in memory characterised by subjective certainty that a familiar place, person, object or body part has been duplicated. It is most commonly seen in postraumatic encephalopathy,2 although it has been described in other conditions as well, such as tumours of the third ventricle and upper brainstem, rupture of aneurysms of the circle of Willis and arteriovenous malformations, prefrontal lobotomy, after electroconvulsive therapy and other metabolic and toxic encephalopathies.2 3 It has been suggested that it is a result of a combination of right hemispheric and frontal-lobe pathology.4-1 l These suggestions, however, emanate from analyses of single case studies or selected cases. To provide a better estimate of neuropathological correlates of reduplicative paramnesia, we administered a structured interview designed to elicit paramnesic phenomena to 50 consecutive patients who met the study's criteria. Based on past experience in this centre, the following criteria for patients' selection were adopted to increase the probability of discovering patients with reduplicative paramnesia. The patients were (1) at risk for diffuse cortical or bifrontal dysfunction secondary to alcoholism and (2) had an acute neurological event necessitating the admission. Accepted 10 February 1988 were studied. All were males (age 30-76 years). None had an acute confusional state when studied. The structured questionnaire given to elicit reduplicative paramnesia is given in table 1. This questionnaire covered the possibilities of reduplicative paramnesia for place, person and body parts. It was initially administered by a neurology resident (HH) and the presence of reduplicative paramnesia was later verified independently by a board-certified neurologist (NPV) and a licensed neuropsychologist (MFG). The reduplicative paramnesia was rated as present only if the belief persisted for a week or more despite counter-argument. The clinical characteristics of the two groups were compiled in detail using both direct patient interviews and their clinical records. Three of the patients with reduplicative paramnesia were followed up to a period of one year jointly by the neurology resident and the staff neurologist. Subjects and methodsThe relative frequency of presence or absence of right hemispheric lesions in the two groups was tested with chisquare test for independence with Yate's correction.

BackgroundEvery year, Around 5000thousands of patients with peripheral vascular disease undergo major lower limb amputation each year in the UK. Despite this, evidence for optimal management is weak. Core outcome sets capture consensus on the most important outcomes for a patient group to improve the consistency and quality of research. We aimed to define short-and medium-term core outcomes sets for studies involving patients undergoing major lower limb amputation MethodsA systematic review of the literature; and focus groups involving patients, carers and healthcare professionals; were used to derive a 'long-list' of potential outcomes. Findings informed a threeround online Delphi consensus process, where outcomes were rated for both short-term and medium-term studies. Results of the Delphi were discussed at a face-to-face consensus meeting, and recommendations made for each core outcome set. ResultsA systematic review revealed 45 themes to carry forward to the consensus survey. These were supplemented by a further five from focus groups. The consensus survey received responses from 123 participants in round 1, and 91 individuals completed all three rounds. In the final round, nine outcomes were rated as 'core' for short-term studies and a further nine for medium-term studies.Wound infection and healing were rated as 'core' for both short-term and medium-term studies.Outcomes related to mortality, quality of life, communication and additional healthcare needs were 4 also rated as 'core' for short-term studies. In medium-term studies, outcomes related to quality of life, mobility and social integration/independence were rated as 'core'. The face-to-face stakeholder meeting ratified inclusion of all outcomes from the Delphi and suggested that deterioration of the other leg and psychological morbidity should also be reported for both shortand medium-term studies. ConclusionsWe established consensus on 11 core outcomes for short-and medium-term studies. We recommend that all future studies involving patients undergoing major lower limb amputation should report these outcomes.What does this study add to the existing literature and how will it influence future clinical practice?Major lower limb amputation is a common procedure, but evidence for optimal management is weak and the literature is heterogeneous. Through a rigorous four-step process we have established consensus on core outcome sets for this patient group, identifying 11 core outcomes each for short-and medium-term studies involving patients undergoing major lower limb amputation. Adoption of these core sets will improve the consistency and quality of research and audit for this patient group.

Objective: To present a case of lingual thyroid Hürthle cell carcinoma (HCC). Clinical Presentation and Intervention: A 37-year-old female presented with dysphagia and recurrent haemorrhage. Histopathology was suggestive of HCC; the tumour was excised by the trans-glossal approach which provided adequate exposure and helped avert external scarring or mandibular osteotomy. Histopathology showed a tumour-positive right lateral resection margin. This prompted referral to nuclear medicine for radio-iodine ablation. Conclusion: Lingual thyroid cases should be followed up closely and fine-needle aspiration biopsy should be considered when in doubt.

source population for this study comprised almost 1 million individuals. Results: Between 2010-2014, we identified 3.677newly diagnosed PAD patients. Most patients (91%) were diagnosed in primary care, and in primary care at the end of the study (83%). Almost half of all patients (49%) had no APT dispensing record. Within this group, 33% received other anticoagulant therapy (vit.-k antagonist or DOAC). Mono-APT was dispensed as aspirin (40% of patients) or P2Y12inhibitors (2.5% of patients). Dual-APT (DAPT) combining aspirin with a P2Y12-inhibitor was dispensed to 8,5% of the study population. Conclusion: Half of all patients with newly diagnosed PAD are not treated conform (international) guideline recommendations on thromboembolism prevention through APT. At least 33% of all patients with newly diagnosed PAD do not receive any antithrombotic therapy.Evaluation and improvement of APT prescription and thereby improved prevention of (secondary) cardiovascular events is warranted. We advise all physicians to inquire if PAD patients receive APT and if not, to investigate if there is a valid reason to omit prescribing these medicines.

Hypoglossal nerve palsy is not an uncommon neurological finding but primary nasopharyngeal tuberculosis (TB) presenting as hypoglossal nerve palsy is very rare. A 31-year-old woman presented with headache and progressive tongue deviation towards the right side. Diagnostic nasal endoscopy revealed soft tissue mass lesion on the posterior wall of nasopharynx while MRI revealed isointense tumour in nasopharynx with normal hypoglossal nerve and brain. Histopathological examination found TB. We discuss the clinical challenges and possible pathogenesis of this rare clinical entity.