bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychosis, central hyperventilation and inappropriate secretion of antidiuretic hormone in systemic lupus erythematosus
Authors: Decaux G , Unger J , Marneffe C
Published: December 2008

A case of systemic lupus erythematosus with reversible psychosis and hyperventilation related to hyponatraemia secondary to a syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is presented. The SIADH was treated successfully by oral urea for more than 8 months.
Is blood pressure different in black people?
Authors: Langford Herbert G
Published: December 2008

Most studies show that blacks have higher blood pressures than whites, and that hypertension-related mortality is significantly greater. Significant pathophysiological differences are present, on the average, between blacks and whites. Blacks tend to have higher blood volume, lower plasma renin activity, and lower kallikrein excretion.

While there may be black-white differences of genetic origin affecting the prevalence of hypertension, at least part of blood pressure difference between black and white is probably of environmental origin.

If socio-economic differences are taken into account, there is no difference between black and white in compliance. Antihypertensive therapy markedly reduces mortality in blacks as well as whites.
The effect of nutrition on Asian and European pregnancies
Authors: Bissenden J G , Scott P H , Wharton B A
Published: December 2008

An assessment of the nutritional status of Asian and European pregnant women was made using anthropometric and biochemical methods. Asian women, having normal pregnancies and appropriate for gestational age infants, had a higher plane of nutrition than did the corresponding European women. Asian women having light-for-gestational-age infants, by comparison with the normal Asian mothers, put on less fat in the second trimester of pregnancy and had some biochemical evidence of poorer nutrition.

It seems that poor nutrition during certain periods in Asian pregnancies can compromise fetal growth.
Spinal cord haemorrhage following herpes zoster: a possible complication of warfarin therapy
Authors: Friedland M L , Wittels E G
Published: December 2008

Haemorrhage is the most serious and common side-effect of warfarin therapy. Bleeding had commonly been observed in the gastrointestinal and genitourinary tracts as well as in the skin and subcutaneous tissue. Central nervous system bleeding has also been reported and has usually been associated with marked prolongation of the prothrombin time. Spinal cord haemorrhage has been infrequently observed. The patient reported here may represent a previously undescribed complication of herpes zoster infection with haemorrhage in the involved dorsal root ganglia. Possible mechanisms are discussed.
Arterial thrombosis and accelerated atheroma in a member of a family with familial antithrombin III deficiency
Authors: Winter J , Bennett B , Donald D , Douglas A S
Published: December 2008

The case is described of a young man with probable familial antithrombin III deficiency, a disorder associated with a marked predisposition to venous thrombo-embolic events. In addition to a history of venous thrombosis and pulmonary embolism, at post-mortem this patient demonstrated widespread arterial thrombosis and atheroma. The probable association of severe arterial thrombosis and atheroma with a clearly definable coagulation disorder predisposing to thrombosis is of interest.
Treatment of small cell lung carcinoma in association with cryptogenic fibrosing alveolitis
Authors: Lipton J R , Carroll K , Mould J J , Winstanley J , Thatcher N
Published: December 2008

Two patients with small cell bronchogenic carcinoma associated with cryptogenic fibrosing alveolitis are described. Both patients received radiotherapy and i.v. chemotherapy with moderate dose methotrexate (100 mg/m2) and escalating high dose cyclophosphamide (1·5 g, 2·5 g, 3·5 g/m2).

Good symptomatic improvement was obtained with concurrent tumour response. No effect upon the alveolitis was observed. The pulmonary toxicity associated with methotrexate, cyclophosphamide chemotherapy and radiotherapy is described. The use of immunosuppressive agents (including cytotoxic drugs) to improve fibrosing alveolitis is also discussed

There is no apparent contraindication for intensive antitumour therapy in patients with small cell lung cancer and fibrosing alveolitis.
Autoimmune endocrinopathy associated with diabetes insipidus
Authors: Bhan G L , O’Brien T D
Published: December 2008

A case is described in which diabetes insipidus was associated with hypopituitarism, insulin-independent diabetes mellitus, pernicious anaemia and circulating antibodies to the thyroid gland, adrenal gland and the pancreatic islet cells.
Coeliac disease presenting as acute bleeding disorders
Authors: Graham David R , Alstead Elspeth , Bellingham Alistair J , Krasner Neville , Martindale John
Published: December 2008

Two young women presented with acute bleeding disorders and were subsequently found to have coeliac disease.
Peritoneal biopsy for diagnosis of abdominal tuberculosis
Authors: Shukla H S , Naitrani Y P , Bhatia S , Das Pritam , Gupta S C
Published: December 2008

Eighty-eight patients with abdominal tuberculosis were studied for the diagnostic value of peritoneal biopsy. Peritoneum for biopsy was obtained during laparotomy in 41 cases and by making a small incision in the right iliac fossa, under local anaesthesia, in 47 cases. In 80% histopathological examination revealed caseation or giant cells and epithelioid cell infiltration. In 20% non-specific inflammatory changes were present. Thus, histopathological examination of the peritoneum was helpful in the diagnosis of abdominal tuberculosis in all the 88 patients.
The many faces of idiopathic oedema of women
Authors: Feely John
Published: December 2008

The variable presentation and paucity of physical signs in idiopathic oedema may commonly delay diagnosis. The resultant unnecessary investigations and hazardous treatment are described for six patients. The management of these patients is discussed in the light of the current controversy concerning the role of diuretics in the pathophysiology of this condition.
Reversible pulmonary hypertension in sarcoidosis
Authors: Davies J , Nellen M , Goodwin J F
Published: December 2008

A young man presented with severe pulmonary hypertension and was found to have extensive pulmonary sarcoidosis. Following treatment with corticosteroids, his lung infiltration improved radiologically and his pulmonary artery pressure fell. This improvement has been maintained for 6 years, and when last investigated his pulmonary artery pressure was normal.
Microangiopathic haemolytic anaemia associated with recurrent pulmonary emboli and benign pelvic tumours
Authors: Blau A , Kaplinsky N
Published: December 2008

A 42-year-old woman presented with a huge benign pelvic tumour and recurrent pulmonary emboli associated with severe microangiopathic haemolytic anaemia (MAHA). Following removal of the tumour and anticoagulation, all signs of MAHA disappeared. MAHA may occur when red blood cells pass through abnormal blood vessels in tumours. This patient is unusual in that the tumour was benign, rather than malignant. A further site of microangiopathy was the pulmonary vasculature.
Angio-immunoblastic lymphadenopathy: a case with a 17-year follow-up
Authors: Ochshorn Miriam , Tchetchik Mordechai , Michalevicz Rita , Behar Albert , Seligsohn Uri
Published: December 2008

A case of angioimmunoblastic lymphadenopathy with a 17-year follow-up is reported. The patient, who first presented with benign hypergammaglobulinaemic purpura of Waldenstrom and autoimmune haemolytic anaemia appears to be the longest survivor with this condition reported so far.

The marked variations in the clinical course of patients with angio-immunoblastic lymphadenopathy in conjunction with immunological characteristics are discussed.
Electrocardiographic changes in acute ulcerative colitis
Authors: Semple C G , Williamson J M
Published: December 2008

Two young women with acute ulcerative colitis were found to have electrocardiographic abnormalities which returned to normal with clinical improvement and corticosteroid therapy. Clinical and biochemical monitoring failed to reveal any cause for this previously unrecognized association and it is postulated that an aetiological agent or toxin produced by the inflammatory process may have damaged the myocardium or its autonomic supply.
Near-fatal systemic oxygen embolism due to wound irrigation with hydrogen peroxide
Authors: Bassan Mayer M , Dudai Moshe , Shalev Oded
Published: December 2008

Shock and coma developed suddenly in a 54-year-old male undergoing irrigation of an infected and fistulous herniorrhaphy wound with 3% hydrogen peroxide (H2O2). Marked ST elevation was seen in almost all electrocardiogram (ECG) leads. Within one hour the patient recovered completely, and the ECG returned to normal. The mechanism of this occurrence was most likely widespread embolization of oxygen microbubbles released from absorbed H2O2. The danger of hydrogen peroxide irrigation in closed spaces is emphasized.
Recurrent hemiplegia due to hypoglycaemia
Authors: Penman W A , Johnson J K
Published: December 2008

A case of recurrent hemiplegia resulting from hypoglycaemia associated with a large thoracic fibrosarcoma, and the satisfactory response to removal of the tumour, is described. The possible causes of the hypoglycaemia are discussed.
A clinical trial of levamisole in primary biliary cirrhosis
Authors: Hishon S , Tobin G , Ciclitira P J
Published: December 2008

A small pilot study of levamisole in primary biliary cirrhosis failed to demonstrate any improvement in liver function and immunological abnormalities even in ‘early’ cases. This may be due to the fact that the defect in the immune system lies in its afferent arm. At present, levamisole, which is potentially toxic, cannot be recommended in conventional doses for the treatment of this disease.
Opsoclonus and polymyoclonia complicating oat-cell carcinoma of the bronchus
Authors: Sheinman Bryan D , Gawler Jeffrey
Published: December 2008

Opsoclonus, with or without polymyoclonia, is a rare syndrome. We report a case associated with an ‘oatcell’ carcinoma of the bronchus. There is only one previous similar case reported in the world literature.
Spontaneous pneumothorax in pregnancy and labour
Authors: Bending J J
Published: December 2008

A case of spontaneous pneumothorax occurring at the end of labour in a healthy 17-year-old primigravida is described. Its occurrence was accompanied by marked surgical emphysema of the face, neck, arms and thorax. The patient had had previous thyroid surgery and was coincidentally found to have bilateral cervical ribs on chest X-ray. Previously described cases are reviewed, and the management discussed. Hypoxia to the fetus is a definite threat, and spontaneous pneumothorax should be considered in the differential diagnosis of chest pain and dyspnoea during delivery. It is a potential extragenital cause of maternal mortality.
The effect of rectal examination on serum acid phosphatase levels in benign and malignant prostatic disese
Authors: Osegbe D N , Magoha G
Published: December 2008

Serum acid phosphatase was measured in patients with enlarged benign and malignant prostate before and after rectal examination. Amongst the patients with benign glands, rectal examination did not produce any significant false elevation of the enzyme. Rectal examination, however, caused a rise in the enzyme level in a few untreated cancer patients and in cancer patients who had become refractory to hormonal therapy. This rise would help rather than mislead in the diagnosis of malignant prostate and also in identifying treated patients who had become refractory to treatment. Thus, when serum acid phosphatase is properly determined, elevated levels should always arouse suspicion of malignant prostate or other lesions associated with high enzyme level even if such determination was preceded by rectal examination.

There appears to be no merit in the teaching that the determination of serum acid phosphatase should be delayed after rectal examination.
Recent advances in respiratory medicine
Authors: Flenley D C
Published: December 2008

In the past tuberculosis so dominated both public and professional views of respiratory medicine that it seemed obvious that the speciality must atrophy, at least in developed countries, when effective therapy for tuberculosis became available. The reality has been rather different. New discoveries in understanding of pathogenesis, in diagnostic methods, and above all in treatment, continue to keep respiratory medicine to the fore amongst the major sub-specialities of medicine, a position that the burden of such disease on society clearly merits. The topics chosen for this review are necessarilv personal, but aim to indicate some areas where these discoveries are being applied in clinical practice today.
Adenoid cystic carcinoma of the breast
Authors: Jaworski R C , Kneale K L , Smith R C
Published: December 2008

Adenoid cystic carcinoma is a rare malignant tumour of the breast. It usually presents as a painful, apparently benign lump near the nipple. The tumour has an interesting histology, natural history and mammographic appearance. Mastectomy is usually curative.
Spontaneous rupture of an epithelial cyst of the spleen
Authors: Spence R A J , Dane T E B
Published: December 2008

A case of spontaneous rupture of an epithelial cyst of the spleen which presented as an abdominal emergency is reported. Following splenectomy the patient made a complete recovery.
Enteric perforation of the gall bladder
Authors: Shukla V K , Kumar M , Khandelwal C , Vaidya M P
Published: December 2008

A case of enteric perforation of the gall bladder in a 20-year-old male is reported. The patient recovered after cholecystostomy with closure of the perforation.
Neurofibrosarcoma of the vagus nerve
Authors: Corris P A
Published: December 2008

A patient whose symptoms of cough and intermittent hoarseness were due to a neurofibrosarcoma of the vagus nerve is described. Attention is drawn to the rarity of the tumour and a short review of the pathology and treatment of neurofibrosarcoma is discussed.
Surgical approaches in endomyocardial disease (abstract)
Authors: Dubost Charles , Prigent Claude , Gerbaux Alain , Maurice Pierre , Passelecq Jacqueline , Rulliere Roger , Carpentier Alain , DeLoche Alain
Published: December 2008

Constrictive fibrous endocarditis first described by Löffler consists of endocardial fibrosis which is potentially constrictive and limited to the ventricular cavities.
Joint contractures and diabetic retinopathy
Authors: Chapple M , Jung R T , Francis J , Webster J , Kohner E M , Bloom S R
Published: December 2008

It has been suggested that joint contractures may be an early marker of microangiopathy, especially retinopathy, in diabetic patients. To investigate this possibility, the prevalence of contractures of the finger joints, as assessed by the painted hand technique, was compared in 106 diabetic patients without, and 105 with retinopathy (proliferative in 66%). There was an increased prevalence of contractures in those with diabetes (25.2%) as compared with an age-matched control of 106 subjects (7.5%, P less than 0.01). The prevalence of contractures was similar in those diabetics with and without retinopathy (29.5% v. 20.8%, P less than 0.1), and did not vary with the type of retinopathy. The contracture prevalence rate was also similar in those with a diabetes duration of 5 or more years (retinopathy 29.3%, no retinopathy, 30%) or of similar diabetic duration (retinopathy 20.8%, no retinopathy, 25%). Diabetic control, as assessed by HbA1, was similar in retinopathic patients with or without contractures. We conclude that although finger joint contractures are more prevalent in adult diabetic patients, they are not necessarily a reliable early indicator of the development of retinopathy of any specific type.
Psoriatic spondylitis in a patient with classical rheumatoid arthritis
Authors: Thurtle O A , Dumbelton I B , Preston J R , Cook P L , Cawley M I D
Published: December 2008

A patient exhibiting typical features of classical rheumatoid arthritis and psoriatic spondylitis is described. The patient, a woman, presented at the age of 29 with an inflammatory arthritis. Twenty years later, she developed psoriasis, and after a further 3 years, she was first noted to have rheumatoid nodules and to be strongly seropositive. Now at the age of 60, she has a rigid spine with radiographic changes of spondylitis. Neither rheumatoid arthritis, nor psoriatic spondylitis can account for all the features of her disease and there is evidence to suggest that both conditions combined to damage her peripheral joints.
Kaposi’s sarcoma in a patient after renal transplantation
Authors: Little P J , Farthing C F , Al Khader A , Bunuan H , Haleem A
Published: December 2008

A patient is described who developed the lesion of Kaposi’s sarcoma 4 months after receiving a cadaveric renal transplant. Immunosuppression had been achieved using cyclosporin A and prednisolone. The lesions spread from the hands to other areas, but later regressed when the dose of cyclosporin A was reduced to 100 mg daily. The patient remains well with no evidence of rejection 15 months later.
Changes in blood pressure and renal function after parathyroidectomy in primary hyperparathyroidism
Authors: Jones D B , Jones J Henry , Lloyd H J , Lucas P A , Wilkins W E , Walker D A
Published: December 2008

Changes in blood pressure and renal function were investigated in 62 patients with primary hyperparathyroidism treated surgically, in an attempt to assess whether or not hypertension and renal impairment should be regarded as important indications for parathyroidectomy.

29% were hypertensive pre-operatively and the blood pressure remained elevated after parathyroidectomy in all of these patients. Hypertension developed for the first time after parathyroidectomy in 45% of those patients who were normotensive before surgery.

Renal function was normal initially in 73% and mild renal impairment developed after surgery in 9% of these patients. At the end of the follow-up period, the prevalence of hypertension was higher in patients with renal impairment pre-operatively (88%) than in those with normal renal function (51%).

We conclude that hypertension alone should not be regarded as an indication for parathyroidectomy in asymptomatic hyperparathyroidism. No firm conclusions can be reached about the importance of mild renal failure as an indication for surgery and the question is unlikely to be resolved without conducting a prospective controlled trial.
The clinical pattern of bronchial asthma in General Hospital, Kandy (Sri Lanka)
Authors: Jeyrajah R , Wickramasinghe M D N
Published: December 2008

The clinical features and cutaneous hypersensitivity to skin prick tests were studied in 64 asthmatic patients in General Hospital, Kandy (Sri Lanka). The onset of asthma was mostly in adult life; associated atopic disease and family history of allergy were less frequent when compared with asthmatics in industrialised countries in the temperate zone. In these respects the clinical pattern of asthma in our study resembles that described in other tropical countries. Cutaneous hypersensitivity to one or more of the 10 allergens tested was observed in 75% of asthmatics and 55% of non-asthmatic controls. Although there was a higher incidence of associated allergic disorders, family history of allergy and the onset of asthma before the age of 10 years in the skin test positive group when compared with the skin test negative group of asthmatics, this difference was not statistically significant.
First branchial cleft anomaly
Authors: Al-Fallouji M A R , Butler M F
Published: December 2008

A 15-year-old girl presented with a cystic swelling since birth behind the ramus of the right mandible and diagnosed clinically as a dermoid cyst. Surgical exploration, however, showed that it was closely related to the external auditory canal, with an extension running medially behind the parotid gland and ending in the bony middle ear. The facial nerve was closely related to the deep part of the cyst. Such an anatomical position indicates that this was a first branchial cleft anomaly. Surgical excision of the cyst was performed.
Multifocal fibrosclerosis and renal amyloidosis
Authors: Hamilton D V , Thiru S
Published: December 2008

A 34-year-old female with a 14-year history of multifocal fibrosclerosis developed the nephrotic syndrome due to renal amyloidosis. Although the association between chronic inflammatory processes and amyloidosis is well known, this is the first report of amyloidosis occurring in a patient with multifocal fibrosclerosis. Other interesting features of this case are the involvement of subcutaneous adipose tissue in the inflammatory-fibrotic process and the presence of features of multifocal fibrosclerosis in the patient’s twin sister.
Catecholamine measurements in clinical medicine
Authors: Brown M J
Published: December 2008

There are 3 endogenous catecholamines, noradrenaline, adrenaline and dopamine. Noradrenaline is the neurotransmitter in sympathetic nerve endings, while the adrenal medulla secretes mainly adrenaline. The reason for this difference is that adrenaline synthesis from noradrenaline is catalyzed by an enzyme, phenylethanolamine-N-methyltransferase (PNMT), which is absolutely dependent on induction by glucocorticoids (Wurtman and Axelrod, 1966); only in the normal adrenal medulla is there a high local concentration of Cortisol due to the portocapillary circulation from cortex to medulla. There is little circulating dopamine, whereas in urine, dopamine is the predominant catecholamine. It is formed within the kidney from circulating DOPA (Brown and Dollery, 1981), but earlier reports that it may have a natriuretic action have not been confirmed (Alexander et al., 1974; Oates et al., 1979).
Spontaneous haemothorax in Osler-Weber-Rendu disease
Authors: Karnik A M , Sughayer Ali , Fenech F F
Published: December 2008

A case of hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease) is described who presented with severe, central chest pain mimicking acute myocardial infarction, a presentation which has not been described before. He was found to have developed spontaneous haemothorax which is a very rare complication of this disease.
An unusual cause of arthritis
Authors: Morley K D , Vickers H R , Hughes G R V
Published: December 2008

We present a case of leprosy, an uncommon infection in the United Kingdom, which mimicked features of widely known rheumatic diseases and resulted in subsequent delay of diagnosis.
The anaemia of chronic disorders
Authors: Samson Diana
Published: December 2008

Chronic disease can cause anaemia in a number of ways, such as poor nutrition, chronic blood loss and as a result of drug therapy. Leaving aside these factors, however, there is a specific type of anaemia associated with chronic infection, chronic inflammatory diseases and malignancy. This anaemia is characterised by decreased plasma iron and iron-binding capacity in the presence of normal or increased reticulo-endothelial iron stores, and has been termed the anaemia of chronic disorders (Cartwright and Lee, 1971). Although the anaemia of chronic disorders is one of the most common anaemias encountered in medical practice, its aetiology remains unclear and treatment unsatisfactory.
Recurrent acute pancreatitis due to haemobilia from a hepatic artery aneurysm
Authors: Mee A S , Turner J A McM , Gow N Menzies
Published: December 2008

A case of recurrent acute pancreatitis due to haemobilia secondary to a bleeding hepatic artery aneurysm is presented. Embolization of the hepatic artery resulted in cessation of bleeding and resolution of pancreatitis.
Metronidazole v. cefoxitin in severe appendicitis—a trial to compare a single intraoperative dose of two antibiotics given intravenously
Authors: Corder A P , Bates T , Prior Jean E , Harrison Margaret , Donaldson P J
Published: December 2008

In severe appendicitis, the effect of a single intravenous dose of metronidazole (500 mg) was compared with cefoxitin (1 g). The antibiotics were given by random allocation once the diagnosis had been established at operation.

In the metronidazole group, 5 out of 48 patients developed a wound infection whilst in hospital compared with 13 out of 48 in the cefoxitin group (P = 0.036). However, 57% of wound infections became apparent after the patient went home and the overall infection rates were similar.

The mean length of postoperative hospital stay was 5.0 days in the metronidazole group and 6.8 days in the cefoxitin group (P = 0.052), but of those who did develop a wound infection, the length of stay was almost double in the cefoxitin group. Anaerobic organisms were cultured from the wound in 7 out of 15 patients who received cefoxitin but in none of 5 patients in the metronidazole group. Whilst metronidazole only delayed the discharge of pus from the wound, it did seem to reduce the severity of infection. Cefoxitin appeared to be less effective, given as a single intravenous injection at a dose of 1 g.
Severe left ventricular dysfunction in critical aortic stenosis—reversal following aortic valve replacement
Authors: Dymond Duncan S , Wolf Francis G , Schmidt Donald H
Published: December 2008

A case of aortic valve stenosis is reported with progressive left ventricular dysfunction demonstrated by radionuclide angiography. A gradient of 120 mmHg was present across the aortic valve. At the time of surgery, the patient was in severe cardiac failure with a left ventricular ejection fraction of 22%. Two months postoperatively, the patient was asymptomatic, and repeat radionuclide angiography demonstrated an ejection fraction of 93%. The reversible nature of this patient’s ventricular dysfunction suggests that the cardiac failure was related to ‘afterload mismatch’ caused by the stenotic valve, rather than due to depressed contractility. The encouraging result in this patient reinforces the view that surgical intervention is warranted in some patients with critical aortic stenosis and extreme impairment of left ventricular function, and that the close relation between ejection fraction and operative survival may not hold true in aortic stenosis.
Progressive muscular atrophy and posterior dislocation of the humerus following electric shock
Authors: Francis D. A. , Heron J. R.
Published: December 2008

A case of progressive muscular atrophy of one limb and posterior dislocation of the humerus following electric shock is described.
Adult listeriosis—a review of 18 cases
Authors: Samra Y. , Hertz M. , Altmann G.
Published: December 2008

Eighteen cases of adult listeriosis (nine with meningitis, one brain abscess and eight bacteraemia) were diagnosed in the Chaim Sheba Medical Center in the years 1964–1982. The infection seemed to be opportunistic in all. Eleven patients had malignant disease, two had cirrhosis of the liver, one had ulcerative colitis, one had bronchial asthma with chronic obstructive pulmonary disease, one had pemphigus, one had diabetes mellitus and one had a renal transplantation. Twelve patients (66%) received radiation therapy and/or cytotoxic and steroid medication.

Diabetes mellitus as an additional underlying disease was strikingly frequent and was found in eight out of 18 patients (44%), in one as the only underlying disease.

In the meningitis group cerebrospinal fluid (CSF) cultures were positive in five patients, and negative in four who had, however, positive blood cultures. The cells in the CSF were predominantly lymphocytes in five and polymorphs in four.

It may be concluded that diabetes mellitus is an important underlying disease in listeriosis. The results also reinforce the fact that lymphocytosis in the CSF does not exclude bacterial meningitis.
Nocturnal activity and the enuresis alarm device
Authors: Crisp A. H. , Sireling L. I. , Faizey J.
Published: December 2008

The effect on nocturnal activity of the wire mesh element within the 'buzzer and pad' enuresis alarm device was studied using healthy adult volunteers in a single or double cross-over design. On the nights when the mesh was in the bed there was less activity, supporting the finding of improved polygraphic sleep on the mesh and suggesting an unexpected therapeutic mechanism.
Appendicitis—a study of incidence, death rates and consumption of hospital resources
Authors: Søreide Odd
Published: December 2008

The incidence of appendicitis in a population of 1.07 million is estimated based on discharge rates compiled by the Central Bureau of Statistics for the years 1977 and 1978. A crude incidence rate of 140 per 100,000 inhabitants is found with a male dominance (153 v. 126). The lowest incidence rate is found in the age group 0–4, whereas the highest rates are found for patients 15–24 years of age. Seventy-four per cent of all appendicitis cases is found in the age group 5–34 years. The mean length of stay was 6.5 days, but with differences between the counties studied of up to 60%. A yearly death rate of 0.30–0.37% with a male dominance is revealed. Appendicitis cases consume only 1.2% of all hospital discharges but 11.8% of all discharges for gastrointestinal diseases. A comparison with previous studies is performed and it is suggested that most of the reported reduction in incidence rates for appendicitis most probably is caused by a more reliable data base in the recent years.
A cutaneous manifestation of acute lymphoblastic leukaemia mimicking urticaria pigmentosa
Authors: Foulds I. S. , Woodcock B. E. , Slater D. N.
Published: December 2008

A 37-year-old female developed what appeared to be the typical cutaneous manifestations of urticaria pigmentosa. These preceded the peripheral blood changes of acute null cell lymphoblastic leukaemia and skin biopsy revealed that the cutaneous changes were due to leukaemic infiltration. Chemotherapy resulted in clearance of the rash. The importance of skin biopsy in patients presenting with suspected urticaria pigmentosa is emphasized.
Beta-adrenoceptor and epoprostenol (prostacyclin) responsiveness of lymphocytes in migraine patients
Authors: Kilfeather S. A. , Massarella A. , Gorgolewska G. , Ansell E. , Turner P.
Published: December 2008

Beta-adrenoceptor blocking drugs are of prophylactic value in some patients with migraine. Beta-adrenoceptor responsiveness as measured by lymphocyte cAMP responsiveness to isoprenaline has, therefore, been compared in ten untreated classical migraine patients and ten matched non-migraine control subjects. Lymphocyte responsiveness to epoprostenol (prostacyclin, PGI2) was also compared. No difference in response to either agent was found between the two groups. A generalized abnormality of beta-adrenoceptor function does not appear to be present in classical migraine, but a defect localized to specific vascular regions cannot be excluded.
Hypoglycaemia and septicaemia
Authors: Walsh Thomas D.
Published: December 2008

A patient with severe hypoglycaemia complicating staphylococcal septicaemia is reported. No recognized cause of hypoglycaemia was detected during life or at autopsy. This case adds to the existing evidence that through several possible mechanisms septicaemia can give life-threatening hypoglycaemia.
Malignant ureteric obstruction relieved by dexamethasone
Authors: Walsh Thomas D. , West Thomas S.
Published: December 2008

A case is described where dexamethasone relieved tumour-induced ureteric obstruction with improvement in the biochemical abnormalities and clinical features of post-renal failure. Such intervention is not always appropriate but may be of great value in symptom control. Because of this and similar applications, corticosteroids are finding increasing favour in the palliative care of patients with advanced cancer.
Duodenal diverticula occurring in a family—chance or inheritance?
Authors: Sternberg Ahud , Deutsch Alexander A. , Kott Itamar , Reiss R.
Published: December 2008

The incidence, aetiology and possible inheritance of duodenal diverticula remain controversial. These aspects are discussed through the presentation of a family, in which duodenal diverticula occurred in a man and his two sons. To the best of our knowledge, this is the first such family documented in the medical literature. This familial occurrence may be attributed solely to the high incidence of duodenal diverticula in the general population (set by various authors at up to 14.2%), and, therefore, of no hereditary significance at all. We believe a screening study of the families of individuals with proven duodenal diverticula is most desirable, for it could shed light upon the controversial questions of incidence, aetiology, and inheritance patterns of duodenal diverticula.
Cutaneous leucocytoclastic vasculitis associated with acute sarcoidosis
Authors: Johnston C. , Kennedy C.
Published: December 2008

A case of acute sarcoidosis associated with the simultaneous appearance of cutaneous leucocytoclastic vasculitis and erythema nodosum is reported. Circulating immune complexes were demonstrated and may have been important in the pathogenesis of both types of skin lesion.
Cholecystoduodenocolic fistula and gallstone ileus
Authors: Gibbons C. P. , Ross B.
Published: December 2008

A patient with cholecystoduodenocolic fistula and gallstone ileus is described. Barium enema and barium meal and follow through demonstrated the passage of the gallstone from the gallbladder region to the small bowel. The clinical features and operative management are discussed in the light of four previously recorded cases.
Ketanserin in essential hypertension: a double-blind, placebo-controlled study
Authors: Cameron H A , Ramsay L E
Published: December 2008

The antihypertensive effect of the selective serotonin antagonist ketanserin was examined in a double-blind, placebo-controlled, parallel group study in 20 patients with essential hypertension. After 7 weeks treatment with ketanserin (mean dose 71 mg/d) there was a significant fall of both systolic and diastolic blood pressure, as compared to placebo, with a peak effect of 19.1/9.1 mmHg lying (P < 0.01/P < 0.01), and 16.5/11.3 mmHg standing (P < 0.01/P < 0.01); twice daily dosage appeared satisfactory. Subjective side effects were similar in the ketanserin and placebo groups. Ketanserin is an effective antihypertensive drug of moderate potency when given twice daily, with no orthostatic effect.
Addison's disease due to metastases to the adrenal glands
Authors: Mor F , Lahav M , Kipper E , Wysenbeek A J
Published: December 2008

A 43 year old patient with Addison's disease secondary to extensive metastases to both adrenal glands is presented. Thirty two previously reported cases are reviewed; in only 13 cases was the diagnosis of Addison's disease confirmed biochemically. Reasons for the apparent rarity of Addison's disease in spite of the frequency of adrenal metastases are discussed. The need to consider the possibility of Addison's disease complicating known malignant disease arising in other tissues is stressed.
Fetal heart rate variation with umbilical haematoma
Authors: Ballas S , Gitstein S , Kharasch J
Published: December 2008

Umbilical cord haematoma is an infrequent condition associated with high perinatal and fetal mortality and morbidity. This report describes a rare case of umbilical cord haematoma associated with loss of fetal beat to beat variation during labour. The infant exhibited mild asphyxia only.

Previous publications are reviewed and fetal heart rate changes associated with umbilical cord haematoma are discussed.
Occult pancreatic cancer with recurrent acute pancreatitis
Authors: Wilson C , Imrie C W
Published: December 2008

A patient with occult pancreatic carcinoma associated with recurrent acute pancreatitis is reported. Endoscopic retrograde cholangiopancreatography after the first attack was normal, the diagnosis being made at repeat examination 10 months later.
Amyloid (AL) in an octogenarian diagnosed by abdominal wall fat biopsy
Authors: Mallinson W J W , Corrado O J , Milkins S R
Published: December 2008

Systemic amyloid (AL) was diagnosed by abdominal wall fat biopsy in an 81 year old woman presenting with severe postural hypotension. The advantages of this little-used diagnostic method are discussed.
Malignant transformation of neurofibromas at multiple sites in a case of neurofibromatosis
Authors: Leslie M D , Cheung K Y P
Published: December 2008

A patient with classical neurofibromatosis is reported in whom malignant transformation of neurofibromas at multiple sites occurred, leading to a fatal outcome. One of these malignant tumours developed within the thyroid gland.
Intestinal absorption at high altitude
Authors: Chesner I M , Small N A , Dykes P W
Published: December 2008

Three tests of small intestinal function were performed at 3100 m and 4846 m to seek evidence of malabsorption of high altitude. Xylose tolerance did not change in 11 subjects but, in three who ascended to 5600 m, one-hour xylose levels were significantly lower. The results of an oxalate loading test did not suggest significant fat malabsorption. A direct fat absorption test using chylomicron levels after ingestion of 100 g fat showed significantly increased levels at high altitude. We conclude that there is no evidence of malabsorption up to 4846 m.
Bronchobiliary fistula due to acute cholecystitis in a suprahepatic gall bladder
Authors: Allison M C , Milkins S , Burroughs A K , Rogers H S , Thomas H C
Published: December 2008

We describe a patient presenting with painless jaundice, anorexia and pruritus. The gall bladder was found to be lying above and behind a hypoplastic right lobe of liver. There was no evidence of cholangitis or biliary obstruction. The patient subsequently developed a bronchobiliary fistula with severe wheeze, cough and bile-stained sputum. Emergency percutaneous drainage of the gall bladder led to immediate cessation of bronchospasm and biloptysis, rendering the patient fit for definitive surgery.
Missed Addisonian crisis in surgical wards
Authors: Small M , MacCuish A C , Thomson J A
Published: December 2008

Three women were admitted to the surgical wards with acute gastro-intestinal symptoms and despite good clinical (pigmentation, hypotension) and biochemical (hyponatraemia, acidosis) evidence of Addisonian crisis had unnecessary investigations with delay in the diagnosis and appropriate management of this medical emergency. Clinicians should take careful note of the typical electrolyte upset seen in Addisonian crisis.
Isolated hepatic tuberculosis with scrofuloderma
Authors: Gautam A , Singh J P
Published: December 2008

A case of isolated hepatic tuberculosis with tubercular involvement of the overlying skin is described. The combination does not appear to have been previously described.
Location of extra-adrenal catecholamine secreting tumours by selective venous sampling and nuclear magnetic resonance scanning
Authors: Cockcroft J R , Ritter J M , Allison D J , Causon R , Brown M J
Published: December 2008

Iodinated meta-iodobenzylguanidine (MIBG) scanning is a safe non-invasive method for locating extra-adrenal paragangliomas. However, a positive result is dependent on the presence of an uptake mechanism in the tumour. We report two cases of MIBG negative intracranial catecholamine secreting tumours successfully located by selective venous sampling and nuclear magnetic resonance scanning.
A cumulative dose comparison between salbutamol and fenoterol metered dose aerosols in asthmatic patients
Authors: Bellamy D , Penketh A
Published: December 2008

The potency and side effects of salbutamol and fenoterol inhalers have been compared in 8 asthmatic patients using a dose response curve. There was no significant difference in the absolute or percentage increase in FEV1 with the two treatments, but fenoterol caused a significantly greater (P less than 0.01) increase in heart rate than did salbutamol. A greater degree of bronchodilatation was observed with increased doses and we suggest that regular higher doses may provide better bronchodilatation and control of asthma in selected patients.
Neoplastic transformation in longstanding fistula-in-ano
Authors: Welch G H , Finlay I G
Published: December 2008

A case in which an infiltrating mucinous carcinoma developed within a suprasphincteric fistula-in-ano is presented. The diagnosis was suspected on biopsy and confirmed by repeat biopsy. The clinical and histological features of this case establish with certainty that the carcinoma arose within the fistula and was not a secondary manifestation of the tumour. It is suggested that this rare complication of chronic fistula-in-ano may be prevented by prompt expert management of complex primary fistula.
Gastritis and gastric campylobacter-like organisms in patients without peptic ulcer
Authors: Sethi P , Banerjee A K , Jones D M , Eldridge J , Hollanders D
Published: December 2008

Gastric biopsy specimens were obtained from 83 patients without peptic ulcer disease and analysed histologically. Culture and serological studies were done on the last 64 patients. The patients were divided into two age groups (young and old groups.) In 34 patients with chronic superficial gastritis, gastric campylobacter-like organisms (GLCO) were identified histologically in 91% and grown on culture in 88%: antibody to GCLO was detected in 81%. No age-related difference in the prevalence of the organism was demonstrated. In the 23 patients with atrophic gastritis (all elderly), presence of the organisms appeared to be related to the presence of an inflammatory cell infiltrate into the gastric mucosa.

These figures for the prevalence of the organism in this selected group of patients are similar to those reported in previous studies of unselected patients which included those with peptic ulcer. This suggests that GCLO is unlikely to be causally related to peptic ulcer.
Severe hypokalaemia from kaolin and morphine abuse
Authors: Kirkham B , Cowell R , Rees J
Published: December 2008

A 34 year old man, registered disabled as a result of muscle weakness, was admitted to hospital because of increasing weakness. He had profound hypokalaemia and admitted to taking up to 1400 ml of kaolin and morphine mixture daily. After considerable potassium replacement muscle power recovered completely. The hypokalaemia is likely to have been caused by the combination of liquorice extract and sodium bicarbonate in kaolin and morphine.
Ruptured abdominal aortic aneurysm in Marfan’s syndrome
Authors: Lafferty K , McLean L , Salisbury J , Cotton L T
Published: December 2008

A rare case of ruptured abdominal aortic aneurysm in Marfan’s syndrome is described. The patient was treated successfully with a straight aortic tube graft. Histology of the aneurysm wall showed changes typical of cystic medial necrosis.
Alternate day corticosteroid causes alternate day hyperglycaemia
Authors: Greenstone M A , Shaw A B
Published: December 2008

Patients taking alternate day corticosteroid treatment have greater impairment of glucose tolerance on the corticosteroid day than on the alternate day. Allowance for this must be made in the detection and management of diabetes mellitus in these patients.
Acquired immune deficiency syndrome without the recognized risk factors
Authors: Rademaker M , Thomas R H M , Provost T G , McEvoy M , Grint P C , Heath R , Kirby J D T
Published: December 2008

We report two cases of acquired immune deficiency syndrome (AIDS), apparently without the usual exposure factors, in whom a temporal association was detected after detailed epidemiological investigation.

The index case, a 45 year old housewife, had provided terminal home-nursing care for a 33 year old African man, who died from an undiagnosed encephalitis. At that time she had fissures of the skin of both her hands. Review of post-mortem pathology specimens of the African man allowed a retrospective diagnosis of AIDS with cerebral toxoplasmosis to be made.

The type of home-nursing care given by the index case was quite different from that normally provided by health care workers with the training and facilities to prevent the spread of infection.
Malignant cysts of the male breast
Authors: Stebbings W S L , George B D , Boyle S , Plowman P N , Gilmore O J A
Published: December 2008

Two cases of male breast carcinoma presenting as cystic swellings are reported. Cysts of the male breast are rare, but unlike cysts in female breasts are more likely to represent significant pathology. We recommend consideration of excision biopsy of isolated cysts in male breasts.
Histiocytic necrotizing lymphadenitis
Authors: Shirakusa Takayuki , Eimoto Tadaaki , Kikuchi Masahiro
Published: December 2008

Eleven cases of histiocytic necrotizing lymphadenitis were studied. Originally four were misdiagnosed as cervical tuberculous lymphadenitis. The characteristic symptoms and signs were local tenderness, fever, leucocytopenia and good prognosis. Antibody to Epstein-Barr virus was elevated in 2 of 3 cases. Biopsy of the affected lymph node was necessary when the differential diagnosis from lymph node tuberculosis or malignant lymphoma could not be made. The characteristic histological feature was focal necrosis without neutrophil infiltration in cortical or subcortical areas. Ultrastructurally, we found characteristic inclusions (‘tubulo-reticular structures’) in histiocytes and lymphocytes.
Left vocal cord paralysis caused by coalworkers’ pneumoconiosis and progressive massive fibrosis
Authors: Haffar M , Banks J
Published: December 2008

We report a case of recurrent laryngeal nerve palsy caused by coalworkers’ pneumoconiosis with progressive massive fibrosis (PMF). This illustrates that PMF alone may be added to the list of lesions which can cause recurrent laryngeal nerve palsy. However, efforts should always be made to exclude more common causes, in particular bronchogenic carcinoma, before attributing the palsy to PMF.
Progressive multiple cranial neuropathies presenting as a delayed complication of radiotherapy in infancy
Authors: Pall H S , Nightingale S , Clough C G , Spooner D
Published: December 2008

A 38 year old woman who had undergone irradiation during infancy for a left facial cutaneous arteriovenous malformation sequentially developed complete palsies of the ipsilateral VII, V, XI, IX, X, XII and VI cranial nerves.

Apart from optic and olfactory nerve damage there are few reports of radiotherapy causing cranial nerve injury. We link the unusually extensive and progressive neural damage and the prolonged latency to the patient’s age at time of irradiation.
Acute phlegmonous gastritis
Authors: O’Toole P A , Morris J A
Published: December 2008

A fatal case of acute phlegmonous gastritis in a 30 year old man is reported. It was caused by Group A Streptococcus (M type 1, T type 1). Although extremely rare, clinicians need to be aware of this condition as, without intervention, it is rapidly fatal. The recommended treatment is antibiotics combined with surgical resection.
Acquired hernias of the diaphragm
Authors: Johnson C D , Ellis H
Published: December 2008

We present our experience over five and a half years of acquired hernias of the diaphragm. Each case represents a different presentation of this condition, which may follow blunt or penetrating trauma or iatrogenic injury. Diaphragmatic hernia may present in the acute phase after injury but late presentation may occur after many years, with chronic abdominal or respiratory symptoms, or with acute intestinal obstruction. The problems in diagnosis and management are discussed.
Paraplegia caused by spinal epidural abscess
Authors: Stephanides G C , Gibson R M
Published: December 2008

Two patients with spinal epidural abscess, but with different neurological outcomes, are presented. The pathogenesis, clinical features and current treatment are reviewed. The need for early diagnosis is once again stressed.
Sequential growth hormone deficiency and acromegaly
Authors: Heffernan A
Published: December 2008

This is the case of a patient with a pituitary tumour presenting initially with growth hormone deficiency and requiring treatment with human growth hormone. Eight years later he represented with acromegaly. This sequence of events has not to my knowledge been reported previously.