bluuebunny/crossref_metadata_2025 huggingface dataset:
One‐year prognosis in patients hospitalized with a history of unstable angina pectoris
Authors: Karlson BjöRn W. , Herlitz Johan , Pettersson Per , Hallgren Per , Strömbom Ulf , Hjalmarson ÅKe
Published: December 2008

The prognosis during 1 year of follow‐up in 715 patients admitted to one single hospital due to suspected acute myocardial infarction (AMI) with a history of unstable angina pectoris immediately preceding hospitalization is described. AMI developed in 192 patients (27%) during the first three days and in 255 patients (38%) during the first year. The mortality during hospitalization was 7% (50 patients) and during 1 year 19% (130 patients). Of the nonsurvivors, 54% died of AMI, 28% of congestive heart failure, and 20% of cardiogenic shock. Based on simple clinical parameters on admission to the emergency room, risk indicators for death during the following year could be identified as follows, in the order of significance: high age (p < 0.001), ST‐segment depression on admission (p < 0.001), and a history of diabetes mellitus (p < 0.05). At admission to the emergency room, risk indicators for development of AMI during the following year were as follows: initial degree of suspicion of AMI (p < 0.001), electrocardiographic signs of acute ischemia on admission (p < 0.001), ST‐segment elevation on admission (p < 0.01), age (p < 0.05), and lack of a previous history of chronic stable angina pectoris (p < 0.05). We conclude that, among patients admitted to hospital due to suspected AMI with a history of unstable angina pectoris immediately preceding hospitalization, 38% developed a confirmed infarction and 19% died during the following year.
Pressure induced tricritical point at the cholesteric-smectic-A phase transition
Authors: Mukherjee Prabir K.
Published: December 2008

A phenomenological theory is presented to describe the pressure effect on the cholesteric to smectic-A phase transition. The problem of first or second order character of the cholesteric to smectic-A phase transition is explored by means of the variation of the pressure. The possibility of the tricritical point at the cholesteric to smectic-A transition line is discussed in a phenomenological way. It is shown that with a particular value of the pressure, the first order cholesteric to smectic-A transition becomes second order at a pressure induced tricritical point. The obtained topologies of the pressure-temperature phase diagram qualitatively agree with experimental results.
Integration of space vector pulse width modulation controlled STATCOM with wind farm connected to multimachine power system
Authors: Muyeen S. M. , Hasanien Hany. M. , Takahashi Rion , Murata Toshiaki , Tamura Junji
Published: December 2008

In this work, dynamic and transient characteristics of a multimachine power system connected with two wind farms composed of fixed speed wind turbine generator systems (WTGS) are analyzed. At each wind farm the terminal one space vector pulse width modulation controlled voltage source converter based static synchronous compensator (STATCOM) is considered to be connected. The capacitor bank capacity of fixed speed wind generator is reduced by certain percentages when a STATCOM is integrated at a wind farm terminal. As wind speed is always fluctuating, the terminal voltage of a fixed speed wind generator also fluctuates randomly, which has an adverse effect on the rest of the power system. It is reported that the STATCOM with a reduced capacitor bank can decrease the voltage fluctuations of the multimachine power system as well as wind generator terminals. Moreover, it is shown that a STATCOM can also enhance the transient stability of induction and synchronous generators when a network disturbance occurs in the power system. Since shaft system modeling of a wind turbine has a significant effect on the transient stability analysis of WTGS, a two-mass shaft model is adopted in this study. Both of the symmetrical and the unsymmetrical faults are analyzed in light of the real wind farm grid code. The transient performance of a STATCOM on the network is evaluated by the transient stability index based on the total kinetic energy of generators. For dynamic performance evaluation, real wind speed data are used in the simulation. Finally, it is concluded that the STATCOM can enhance both dynamic and transient stability of wind farms connected with a multimachine power system.
Nonlinear wave modulation of cylindrical and spherical quantum ion-acoustic solitary waves
Authors: Sabry R. , El-Labany S. K. , Shukla P. K.
Published: December 2008

Cylindrical and spherical amplitude modulation of quantum ion-acoustic (QIA) envelope solitary waves in a dense quantum plasma comprised of electrons and ions is investigated. For this purpose, a one-dimensional quantum hydrodynamic model and the Poisson equation are considered. By using the standard reductive perturbation technique, a modified nonlinear Schrödinger equation with the geometrical and the quantum effects is derived. The effect of quantum corrections and the effect due to the cylindrical and spherical geometries on the propagation of the QIA envelope solitary waves are examined. It is shown that there exists a modulation instability period depending on the quantum parameter, which does not exist for the one-dimensional classical case.
Tunnel magnetoresistance of a single-molecule junction
Authors: Saffarzadeh Alireza
Published: December 2008

Based on the nonequilibrium Green’s function technique and the Landauer–Büttiker theory, the possibility of a molecular spintronic device, which consists of a single C60 molecule attached to two ferromagnetic electrodes with finite cross sections, is investigated. By studying the coherent spin-dependent transport through the energy levels of the molecule, it is shown that the tunnel magnetoresistance (TMR) of the molecular junction depends on the applied voltages and the number of contact points between the device electrodes and the molecule. The TMR values more than 60% are obtained by adjusting the related parameters.
Sickle Cell Anemia, the First Molecular Disease: Overview of Molecular Etiology, Pathophysiology, and Therapeutic Approaches
Authors: Steinberg Martin H.
Published: December 2008

The root cause of sickle cell disease is a single β-globin gene mutation coding for the sickle β-hemoglobin chain. Sickle hemoglobin tetramers polymerize when deoxygenated, damaging the sickle erythrocyte. A multifaceted pathophysiology, triggered by erythrocyte injury induced by the sickle hemoglobin polymer, and encompassing more general cellular and tissue damage caused by hypoxia, oxidant damage, inflammation, abnormal intracellular interactions, and reduced nitric oxide bioavailability, sets off the events recognized clinically as sickle cell disease. This disease is a group of related disorders where sickle hemoglobin is the principal hemoglobin species. All have varying degrees of chronic hemolytic anemia, vasculopathy, vasoocclusive disease, acute and chronic organ damage, and shortened life span. Its complex pathophysiology, of which we have a reasonable understanding, provides multiple loci for potential therapeutic intervention.
Who Is Mobilized to Vote? A Re‐Analysis of 11 Field Experiments
Authors: Arceneaux Kevin , Nickerson David W.
Published: December 2008

Many political observers view get‐out‐the‐vote (GOTV) mobilization drives as a way to increase turnout among chronic nonvoters. However, such a strategy assumes that GOTV efforts are effective at increasing turnout in this population, and the extant research offers contradictory evidence regarding the empirical validity of this assumption. We propose a model where only those citizens whose propensity to vote is near the indifference threshold are mobilized to vote and the threshold is determined by the general interest in the election. Our three‐parameter model reconciles prior inconsistent empirical results and argues that low‐propensity voters can be effectively mobilized only in high‐turnout elections. The model is tested on 11 randomized face‐to‐face voter mobilization field experiments in which we specifically analyze whether subjects' baseline propensity to vote conditions the effectiveness of door‐to‐door GOTV canvassing. The evidence is consistent with the model and suggests that face‐to‐face mobilization is better at stimulating turnout among low‐propensity voters in prominent elections than it is in quiescent ones.
Bureaucratic Job Mobility and The Diffusion of Innovations
Authors: Teodoro Manuel P.
Published: December 2008

In studies of innovation, policy entrepreneurs recognize latent demand for new policies and then expend resources to promote them. But studies of policy entrepreneurs have generally focused on the demand for innovation, while neglecting the supply side of policy entrepreneurship. This article argues that bureaucratic labor markets affect the emergence of policy entrepreneurs, and so affect the diffusion of policy innovations across local governments in the United States. Analysis of a survey of municipal police chiefs and water utility managers relates governments' hiring and promotion policies to their adoption of professionally fashionable innovations. Agency heads who advanced to their current positions diagonally (arriving from another organization) are more likely to initiate these innovations than are agency heads who were promoted from within. Bureaucratic policy entrepreneurs emerge where government demand for innovation meets a supply of mobile administrators, who carry the priorities of their professions into the agencies that they serve.
Regional enteritis associated with amyloidosis
Authors: Ogg C S
Published: December 2008

Two patients with regional enteritis who developed renal failure due to amyloidosis are described. The literature is reviewed briefly and the hope expressed that this association will be recognized more frequently in the future.
Programmed learning in medical education. An experimental comparison of programmed instruction by teaching machine with conventional lecturing in the teaching of electrocardiography to final year medical students
Authors: Owen S G , Hall R , Anderson J , Smart G A
Published: December 2008

Programmed instruction in electrocardiography presented by a teaching machine produced results just as good as very carefully prepared lectures. For academically poorer students and for those whose native tongue was other than English, the programme was probably the more effective teaching method. In this experiment women appeared to learn better from lectures and men from the programme, but further study is required to confirm the generality of this result. The students reacted favourably to programmed instruction and to teaching machines and expressed their preference for these over conventional methods of learning.
Stab-wounds and other penetrating injuries of the abdomen and thorax
Authors: Garland J B
Published: December 2008

A series of 100 penetrating wounds of the abdomen and thorax is reviewed. Eighty-three were due to stab-wounds.

The recent increase in incidence is confirmed and the distribution throughout the day and months of the year is given.

The results and methods of treatment of thirty-six abdominal, ten thoraco-abdominal and thirty-seven thoracic wounds are given and described.

An operative approach to abdominal wounds is supported.

Conservative measures, including more frequent use of intercostal-tube drainage for pneumothorax and haemothorax, are satisfactory for the majority of chest wounds.

Cardiac wounds require urgent assessment and resuscitation with pericardiocentesis and thoracotomy.
A plea for simplicity in the classification of ankle fractures
Authors: Phillips R S , Monk C J E , Balmer G A
Published: December 2008

1. Ashurst and Bromer’s classification of ankle fractures is a useful one, but falls into the complexities of subdivision into sequential progression of severity, i.e. ‘degrees’ of fracture.

2. A similar criticism can be made of the Lauge-Hansen classification which has an added semantic disadvantage. Doubts are also cast upon the validity of the direct application of experimental results in cadaveric specimens to a clinical series.

3. A third classification, essentially a modified form of those preceding it but with both an anatomical and a functional basis is presented, in the belief that it can provide evidence of: (a) the mechanism of production and hence the achievement of reduction; and (b) the recognition of significant ligamentous damage, i.e. the recognition of major from minor, stable from unstable injuries—when used in association with radiographs taken while straining the ankle under anaesthesia.

4. An Appendix to the paper (pp. 210-211), giving a more detailed account of our revised classification, is included.
Pyrexia and elevated erythrocyte sedimentation rate in acute gastro-duodenal haemorrhage
Authors: Chapman R S , Mohamed S D
Published: December 2008

Rises in the body temperature and the erythrocyte sedimentation rate (ESR) in the absence of significant associated disease, were each observed in one-third of a large series of patients with acute gastro-duodenal haemorrhage.

While only 15% of the patients showed both a pyrexial reaction and a rise in the ESR, fully 55% of the cases showed one or the other abnormality.

There was no significant difference in the incidence of these abnormalities in haematemesis from chronic duodenal ulcer, chronic gastric ulcer or acute gastric erosion and the rise in the ESR showed no signficant correlation with the severity of bleeding.
Oliguric glomerulonephritis and parathyroid adenoma
Authors: Woolcock Jacqueline A , Shaw Allen B
Published: December 2008

The case is reported of a woman who recovered from acute glomerulonephritis with oliguria of 43 days duration and who subsequently developed hypercalcaemia, treated by parathyroidectomy.

The evidence is presented that the acute nephritis developed in the presence of a primary parathyroid adenoma, providing the natural experiment of hypercalcaemia temporarily depressed by acute renal failure.
Tricuspid incompetence due to right ventricular papillary muscle dysfunction
Authors: Tattersfield Anne E
Published: December 2008

There has recently been much interest in mitral incompetence as a result of papillary muscle damage in myocardial infarction. We report a case of tricuspid incompetence due to papillary muscle dysfunction following myocardial infarction involving the right ventricle.
Intrahepatic granulomatous arteriopathy
Authors: Fox H , Gleeson M H , Logan W F W E
Published: December 2008

The case history is detailed of a 55-year-old woman who was investigated for persistent pyrexia and anaemia. A liver biopsy specimen showed an unusual lesion of the small intrahepatic arteries. Many of these vessels showed circumferential replacement of their adventitial coat by a non-caseating granuloma whilst others showed localized granulomata focally interrupting the adventitial coat. The medial and intimal coats of the affected arteries were normal.

This was an intrahepatic granulomatous arteriopathy of unknown origin. The patient responded promptly and completely to steroid therapy.
The treatment of iron-deficiency anaemia by iron-dextran infusion, with special reference to the effect on blood-grouping, coagulation, sedimentation and haemolysis
Authors: Groden Bernard M , Whitelaw James , Will George
Published: December 2008

Fifty patients with iron-deficiency anaemia were treated by total-dose infusion of iron-dextran. The therapeutic response was satisfactory in all cases. No severe systemic side effects occurred. In ten patients in whom detailed investigations were made there was no change in erythrocyte sedimentation rate or blood coagulation nor was there evidence of haemolysis following the iron-dextran infusion. No difficulty was found in ABO and Rh blood grouping and cross matching after infusion.
The pathogenesis of gallstone pancreatitis
Authors: Trapnell J E
Published: December 2008

The pathogenesis of gallstone pancreatitis has been re-examined. It is concluded that there is no evidence that reflux of bile occurs: even if it does, it is not, of itself, harmful in any way. Opie’s ‘common channel’ theory is of historical interest only and should now be firmly discarded.

Clinical studies have shown the efficacy of comprehensive biliary tract surgery in terminating the recurring pattern of attacks of pancreatitis in these patients. It is suggested that this surgery eradicates a septic focus as well as a mechanical factor and that in the majority of cases it is this infective element which is important in the pathogenesis. This working hypothesis receives strong support from established clinical facts and also from experimental studies.
The differential diagnosis of ‘little strokes’
Authors: Marshall John
Published: December 2008

Transient focal disturbances of cerebral function are often indicative of atherosclerosis. They may occur, however, in association with a number of other conditions which are illustrated by fourteen brief case histories.
The management of oesophageal foreign bodies and their complications
Authors: Donnelly R J , Deverall P B
Published: December 2008

Five patients are described to demonstrate some of the possible clinical courses which may follow the ingestion of a foreign body. The management of such patients is discussed and evidence presented to support the case for detailed investigation, treatment and follow up.
Clinico-pathological aspects of the neurosyphilitic psychoses
Authors: Dewhurst Kenneth
Published: December 2008

(1) The immediate causes of death of eighteen patients with neurosyphilitic psychosis are analysed. There were five females and thirteen males. Their average age was 56 years, and the mean length of stay in a mental hospital was approximately 2½ years.

(2) Of the original ninety-one patients, twenty-eight had malaria therapy. There was one death due to malaria therapy, giving a mortality rate of 3·6%. It is concluded that the risk associated with malaria is too great and fever induced by bacterial pyrogens is safer and just as effective.

(3) The duration of mental symptoms before treatment was started is analysed. In one group there was a delay of between 1 and 4 years before treatment was given. In six patients the disease ran a rapidly fatal course in spite of adequate antibiotics. Combined treatment may be beneficial in such cases as fever facilitates the penetration of penicillin into the cerebrospinal fluid.

(4) Of the four cases that came to necropsy, only one had a full pathological and histological examination of the brain and meninges. Although these four patients had profound dementia and considerable deterioration of the personality only minimal neuropathological and histological changes were found. It would seem that the widespread use of antibiotics has modified the pathological and histological picture in neurosyphilis, corresponding to alterations recently reported in the clinical features of the disease.

(5) Such adverse presenting symptoms as epilepsy, and profound dementia associated with pupillary and reflex abnormalities, are discussed.
The design and experience of a Regional Intensive Care Unit
Authors: Hoyle J R , Rowe-Jones D C
Published: December 2008

A 2-year survey has been made of the work of an Intensive Care Unit in a provincial general hospital of 358 beds. We have reviewed from this experience those problems relevant to the establishment of similar units in other parts of the country.
Psychological illness in medical outpatients
Authors: Taylor Thomas R
Published: December 2008

A survey of psychological illness in medical outpatients reveals an incidence of 27·4% which is close to that of previous studies. The bulk of the cases are anxiety states and reactive depressions, and the great majority respond well to drugs and simple psychotherapy. The most important aetiological factors are shown to be disturbances of interpersonal relationships within the family with alcoholism, financial difficulties, illness and bereavement being of special importance. The problem of minor psychological illness is discussed from the viewpoint of community medicine, as well as that of the medical, surgical and gynaecological clinic. A simple scheme for the management of the more difficult cases, in co-operation with a Medical Social Work Department, is presented and is shown to work successfully during busy outpatient clinics.
Factors affecting maximal acid secretion
Authors: Desai H G
Published: December 2008

The mechanisms by which different factors affect the maximal acid secretion of the stomach are discussed with particular reference to nationality, sex, age, body weight or lean body mass, procedural details, mode of calculation, the nature, dose and route of administration of a stimulus, the synergistic action of another stimulus, drugs, hormones, electrolyte levels, anaemia or deficiency of the iron-dependent enzyme system, vagal continuity and parietal cell mass.
Measles vaccination by the intradermal route
Authors: Burland W L
Published: December 2008

Live further-attenuated measles vaccines have been given to two groups of children in the United Kingdom by either the intradermal or subcutaneous routes. The responses have been measured by antibody titration and reaction studies. Intradermal vaccination has been shown to be acceptable on both counts.
Cardiac achalasia in childhood
Authors: Singh Harjit , Sethi R S , Gupta H L , Khetarpal S K
Published: December 2008

Cardiac achalasia is a disorder not unknown in the paediatric age-group and may occur even in the neonatal period. This disorder should, therefore, be considered in all cases presenting with persistent vomiting, as well as in those with chronic respiratory disease in whom more common causes have been excluded.

It is almost universally accepted that the disorder results from a disturbed function of ganglion cells in the distal oesophagus, as the disease has been reproduced in laboratory animals by denervation of the distal oesophagus. The exact pathogenesis of this degenerative change is not well understood. However, in at least some of the cases congenital absence of the ganglion cells may be responsible for this functional disturbance. This is inferred from the fact that the disease may be found in association with Hirschsprung disease, in which there is a congenital absence of ganglion cells in the terminal colon. Moreover, the occurrence of the disease in the neonatal period itself favours a congenital lesion.

Surgery was preferred to other forms of treatment in the paediatric age-group in view of the reported equivocal response to mechanical dilatation and pre-disposition of children to respiratory complications. The results of surgery were satisfactory.
The investigation of an arbovirus encephalitis
Authors: Webb H E
Published: December 2008

A definition of an arbovirus and a broad idea of the groups and the numbers isolated and causing human infection are given. The small incidence of clinical disease compared with overall infection rates is stressed. The conditions for the successful survival of arboviruses is outlined. The investigation of the illness and origin of infection is described. The role of viral antibody in the development of encephalitis and the use of cortisone in treatment is discussed. The over-wintering of arboviruses and their capacity for latency is considered in relationship to the perpetuation of virus and the pathogenic effects on the hosts involved.
Modern trends in leprosy
Authors: Jamison D G
Published: December 2008

Leprosy is being regarded more and more as a general medical condition. The available data about its manifestations and treatment are becoming more widely known.

The problems of infectivity, animal inoculation and cultivation remain to a large extent unsolved. The recent successful inoculation of irradiated mice with fresh organisms is a major advance. It may well prove a means of testing new drugs and of confirming claims of successful cultivation, and more important still, of determining the viability of organisms obtained from both active and treated cases of leprosy.

Finally, it is in the field of delayed hypersensitivity (CMI) and autoimmune processes initiated by the mycobacterial infections that this slowly progressive, greatly variable and widely disseminated infection may become a most rewarding subject for study by the immunologist of the future.
The neurological manifestations of dissecting aneurysm of the aorta
Authors: Condon John R , Rose F Clifford
Published: December 2008

Six cases of dissecting aneurysm of the aorta, four with cerebral manifestations, one with peripheral neuropathy and one with ischaemic necrosis of the spinal cord are reported. Cerebral manifestations include confusion and stupor, syncope, grand mal epilepsy, ischaemia of the spinal medulla, carotid artery occlusion and cerebral hemisphere infarction.

Ischaemic neuropathy is characterized by severe limb pain not of peripheral nerve distribution, but associated with areflexia and a peripheral pattern of sensory loss.

Ischaemic necrosis of the cord is characterized by flaccid paraplegia and sphincter disturbances with segmental sensory loss exhibiting an upper level on the trunk.

The differential diagnosis of the neurological complications of aortic dissection is discussed and a brief review of advances in management made.
Aspects of the psychological status of patients treated with cardiac pacemakers
Authors: Crisp A H , Stonehill E
Published: December 2008

An initial clinical observation that patients with externally located cardiac pacemakers are more distressed and depressed than those with internally sited pacemakers has been confirmed. The total patient group is also characterized by its tendency to report that it does not worry about getting an incurable illness. At the same time, it is evident to others that it does have such an illness. Those patients who acknowledge that they did worry in this way were found to score significantly higher on several scales of a standardized psychoneurotic index than did the overall ‘pacemaker’ population.

Possible reasons for the greater psychological distress displayed by the group of patients with external pacemakers are discussed.
The use and limitations of isotope studies in clinical shock
Authors: Vickers M D A
Published: December 2008

Blood volume measurements can only be of value in the treatment of clinical shock if the results are obtained quickly. In a changing situation, such as continuing haemorrhage, erroneous conclusions are inevitable.

Assumptions which are commonly made concerning tracer loss rates and mixing rates may be invalid. Semi-automated machines can introduce new sources of error.

The measurement of blood volume should be regarded as an aid to assessing the relative contributions of intravascular volume and vascular tone to the resulting intravascular pressures.
Local and general responses to injury in the newborn rabbit
Authors: Little R A
Published: December 2008

Some physiological responses to experimental bilateral hind limb ischaemia have been studied and compared in neonatal and young rabbits.

The fluid loss into the injured limbs after removal of the tourniquets has been expressed as a percentage of the plasma volume and of the total body water at the different ages.

The reactivity of skin blood vessels to a variety of known mediators of an inflammatory response has been investigated using labelling techniques.
Is there a place for proteinase inhibition? A review of the literature
Authors: Lister G D
Published: December 2008

The evidence demonstrating excessive proteinase activity in states of shock is reviewed. The capacity of extrinsic inhibitors to control such activity is indicated and the literature showing the value of inhibitors in treating shock is summarized. Three principles to be observed in the use of exogenous inhibitors are proposed.
Gastroscopy combined with intragastric photography
Authors: Gibbs D D , Parry D J
Published: December 2008

This paper relates experience in the use of the Olympus GTF fibrescope and intragastric camera. One hundred and eighty-four examinations were made in 157 patients.

The instrument was usually easy to introduce into the stomach and examinations were well tolerated. The youngest patient examined was aged 16 years and the oldest 86. Fibroscopy in the elderly seldom presented difficulties.

This model (GTF) was particularly suited to examination of the mid-stomach and antrum, the view often extending to the pylorus. The range proximal to the angulus on the lesser curve and posterior wall was often limited.

Intragastric photographs of high quality could be taken; they enhanced the value and added to the interest of examinations. Serial pictures, taken at intervals, provided evidence of alterations in the appearances of gastric lesions.

Gastric endoscopy is complementary to radiological examination of the stomach. Its use often increases diagnostic accuracy and understanding of gastric diseases. Within the limits of design of a particular instrument, fibreoptic apparatus renders the procedure simple and efficient.
The relationships between plasma cholesteryl polyunsaturated fatty acids, age and atherosclerosis
Authors: Kingsbury K J , Stovold R , Morgan D M , Brett C G
Published: December 2008

The ages, plasma cholesteryl dienoic acid, 2-hr blood sugar and plasma cholesterol concentrations of 146 patients with aorto-iliac and femoro-popliteal atherosclerosis, were compared with their arterial lesions classified into occlusions, irregularities and stenoses by pulses and arteriograms.

The arterial lesions were also compared with the patient’s prognosis in terms of the development of angina or myocardial infarction.

The results showed that reduced concentrations of cholesteryl dienoic acids were specifically related to an increase in the number of arterial occlusions, independently of the patients’ ages, plasma cholesterol and 2-hr blood sugar levels, arterial irregularities or stenoses.

The arterial occlusions in turn related to the development of myocardial infarction but not angina.

It is concluded that a relationship existed between the reduced concentrations of cholesteryl dienoic acids and the occlusive element of human atherosclerosis which is a major factor in the patient’s prognosis.
Severe acute myocardial infarction treated with hyperbaric oxygen. Report on forty patients
Authors: Ashfield R , Gavey C J
Published: December 2008

Forty patients, aged 35-72, who had had an acute myocardial infarct in the preceding 24 hr, and who were seriously ill, were treated in a hyperbaric oxygen bed at 2 atm (atmospheres) absolute for sessions of 2 hr in and 1 hr out for an average period of 4 days.

There were thirty-seven survivors after the treatment, giving an immediate mortality of 7·5%, but three of those died later before leaving hospital, giving a total mortality of 15% in seriously ill patients.

Pain and dyspnoea were usually improved in the first hyperbaric session, relapsed in air and progressively improved in successive sessions.

Arrhythmias, including heart block, showed similar benefit. No case of cardiac arrest occurred while the patients were actually receiving hyperbaric oxygen.

There was, in the opinion of the authors, during a period of over 2 years’ experience, a consistent pattern of improvement over and above that expected as spontaneous improvement.

The hyperbaric oxygen bed is a promising method of treatment for the acute phase of myocardial infarction, and it is simple to use. There will of course always be an irreducible minimum of patients who will die from obstruction of both coronary arteries or other structural lesions such as rupture or emboli.
Familial sarcoidosis terminating as neurosarcoidosis
Authors: Salm R
Published: December 2008

A case of sarcoidosis is recorded in a 27-year-old male, whose elder sister has also been suffering from sarcoidosis.

The disease was characterized by involvement of the mucosa of the upper respiratory tract, gross transient peripheral lymphadenopathy and terminal neurosarcoidosis, death being due to an acute obstructive hydrocephalus.
The association of syphilis with hepatic cirrhosis: a report of six cases and a review of the literature
Authors: Karmi G , Thirkettle J L , Read A E A
Published: December 2008

Among forty-nine patients with cirrhosis admitted to the Bristol Royal Infirmary in the years between 1962 and 1967 inclusive, six cases were found who also had syphilis.

The possible significance of this association is discussed and a short review of the literature presented.

The importance of routine serological testing for syphilis on all cirrhotic patients, particularly male, is stressed.
Psychiatric referrals since the Abortion Act 1967
Authors: Kenyon F E
Published: December 2008

During the 1st year of the Abortion Act, 1967, sixty-five patients were seen for a psychiatric opinion. Of these 50% were single, 36% married and 14% separated or divorced.

Referral was by the general practitioner in 60%, gynaecologist 36% and ‘other’ 4%.

Mean length of psychiatric history was 18·9 months. Half had had unhappy childhoods and family relationships were frequently disturbed. Four (6%) were University students.

Mean length of pregnancy was 11·0 weeks and for 87% of the single patients it was their first; for 36% of the married group it was their third. In fourteen (21%) the pregnancy resulted from a contraceptive failure.

There was a previous psychiatric history in 69%. The commonest diagnosis was depression, mainly of neurotic type (52%) but 29% had no gross psychiatric disorder.

Termination of pregnancy was recommended in thirty-two (49%), this included six where sterilization was also advised.
Thrombocytosis following thrombocytopenia in man
Authors: Ogston D , Dawson Audrey A
Published: December 2008

Observations are presented on the changes in the platelet count of patients during the treatment of Addisonian pernicious anaemia with vitamin B12, of thrombocytopenic purpura with prednisone, and of malignant disease with methotrexate.

In each of these clinical situations, thrombocytopenia was succeeded, after a delay of a number of days, by a phase of thrombocytosis.
Vascular changes in the lungs on the plain radiograph of the chest
Authors: Kerr I H
Published: December 2008

The normal anatomy of the pulmonary vessels is considered and correlated with the angiographic appearances.

Some pathological conditions causing an alteration in the vascular pattern as seen on the plain films are considered and the changes are described.

It is concluded that an appreciation of these changes in vascular pattern may indicate to the clinician the presence of local or distant disease.
The influence of the platelet count on the incidence of thrombotic and haemorrhagic complications in polycythaemia vera
Authors: Dawson Audrey A , Ogston D
Published: December 2008

In polycythaemia vera, those patients who have an elevated platelet count develop more thrombotic and more haemorrhagic complications than those with a normal count, even when the haematocrit is maintained by therapy within the normal range.
Dislocated hip in East African infants and children
Authors: Griffiths J C
Published: December 2008

A true congenital hip dislocation (CDH) occurring in a native African child is described.

Other forms of hip dislocation in Africa are presented.

Differential diagnosis is stressed especially between true CDH and the teratological form.

The rarity of true CDH in Africa is discussed.
The evolution of diabetes from prediabetes
Authors: Danowski T S
Published: December 2008

Temporary stress-induced undue hyperglycaemia following an oral carbohydrate load taken during hospitalization is being tested as a possible indicator of prediabetes.

Observations in patients 15 months after hospitalization have permitted us to compare the blood sugar, insulin and growth hormone patterns evoked by an oral glucose load before and after glucose intolerance has appeared, viz. to speculate upon the evolution of diabetes from prediabetes. Though the numbers of such instances are as yet limited, they already suggest several possible sequences. Thus, our data support the concept that glucose intolerance, in addition to stemming from a decrease in insulin levels, can develop with true increases or with no evident decrease in the insulin responses to oral glucose.

The simplified in-hospital carbohydrate tolerance test employed in assembling groups of possibly prediabetic individuals is also an efficient means of detecting permanent glucose intolerance of the diabetes mellitus type.
One-session treatment of gonorrhoea in males with procaine penicillin plus probenecid
Authors: Cobbold R J C , Morrison G D , Spitzer R J , Willcox R R
Published: December 2008

Six hundred and thirteen male patients with acute uncomplicated gonorrhoea have been treated alternately with single injections of 1·2 mega-units of aqueous procaine penicillin alone or with the same dose and preparation of penicillin with an additional 1·0 g of probenecid given orally immediately prior to injection.

Whether the failure rates were assessed on the basis of an absence of further sexual exposure or by classifying all recurrences within 1 or 2 weeks regardless of history as treatment failures the results were significantly better when probenecid was also given.

The use of a single dose of probenecid is thus capable of maintaining the success of single injection procedures for the treatment of gonorrhoea based on procaine penicillin and thus represents a bulwark for the future should the powers of penicillin against the gonococcus in London deteriorate further.
Peripheral nerve and root lesions developing as a result of haematoma formation during anticoagulant treatment
Authors: Parkes J D , Kidner P H
Published: December 2008

Three further cases of peripheral nerve and root lesions occurring during anticoagulant therapy are described. The literature is briefly reviewed.
Developing viable medical equipment, in general and for patient monitoring
Authors: Taylor D J W
Published: December 2008

The importance of the relationship between demonstrable clinical advantage and total costs in the use of equipment, the role of the professional medical administrator in its development and the differences between the industrial and the ethical medical approaches to marketing are stressed.

In the final analysis routine service equipment should be assessed by actual profitability, recognizing the effects of philanthropic or research funding when it occurs.
The patient-sensor interface
Authors: Crockett G S
Published: December 2008

During the assessment of monitoring equipment on acute medical cases in a general ward, a quantitative investigation of technical faults revealed that 44% of these occurred at the patient-sensor interface.

While the attachment of the equipment was accepted by the patient and was suitable for application by nursing staff, this degree of technical breakdown indicates that more progress is necessary in the design of this aspect of monitoring equipment before it is possible to have a reliable system.
Axillary skin excision as a treatment for axillary hyperhidrosis
Authors: Weaver P C
Published: December 2008

This report describes three severe cases of axillary hyperhidrosis successfully treated with the Hurley-Shelley operation. It appears to be a simple and effective method of dealing with a condition which is certainly not rare and in its most severe form can be a great social embarrassment to the patient.
P wave abnormalities with myocardial infarction: an aid to the diagnosis of left ventricular failure
Authors: Hassell T A , Hoffbrand B I
Published: December 2008

An investigation during a prospective study of myocardial infarction has confirmed previous observations of P wave changes in association with left ventricular failure. Although an indicator of pre-existing left ventricular disease as well as acute left atrial distension, a negative deflection of 1 mm or more in the P wave of lead V1 should raise strong suspicions about the presence of this serious complication.
Calcium metabolism in sarcoidosis
Authors: Dent C E
Published: December 2008

Fifteen patients with hypercalcaemia and sarcoidosis have been studied. Twelve were males of average age 34; the three females averaged 53.

Cases included widely varying sarcoid manifestations, but five gave a clear history of rather excessive ingestion of low-dosage vitamin D preparations. The data confirm that in most cases there is an undue sensitivity to all the actions of vitamin D, the situation therefore mimicking vitamin D intoxication. Two patients volunteered to receive ultra-violet irradiation and became hypercalcaemic with corresponding clinical and biochemical changes.

Steroids make normal the calcium abnormalities just as they do in straight vitamin D intoxication. However, in three further patients the hypercalcaemia did not respond to steroids and was shown to be due to the presence of an over-acting parathyroid gland, removal of which corrected the abnormality. There are a sufficient number of other similar cases in the literature to suggest that the development of parathyroid adenomas is another even rarer complication of sarcoidosis which must be carefully distinguished from vitamin D sensitivity.
Sarcoidosis in bone
Authors: Pygott F
Published: December 2008

Radiologically demonstrable bone change is found in about one in every six patients with sarcoidosis. The hands and feet are affected and rarely the trunk, an unusual distribution for a disseminate disease.

Osteoporosis, cortical thinning and mottled rarefaction are the earliest signs, followed by cystic changes due to the coalescence of adjacent lesions and perhaps pathological fractures.

The nasal bones may be directly involved in patients with lupus pernio. Changes in the rest of the skull, in the spine and pelvis are rare and may be bizarre.
The treatment of sarcoidosis
Authors: Israel Harold L
Published: December 2008

A discouraging conclusion to many years of study of the natural history of sarcoidosis is the realization that the proper word for the course of sarcoidosis is ‘unpredictable’. An impressive lesson of a controlled study was the frequency with which unexpected and dramatic improvement occurred in the placebo group. Although patients with pulmonary infiltration, uveitis and cutaneous sarcoid have a worse prognosis than the asymptomatic patient with hilar adenopathy, many patients in the former category will recover and some in the latter will go on to death.

A trial of prednisone therapy in a small number of patients with disease restricted to the mediastinal and hilar nodes (Stage I) suggests that prednisone treatment in this form of sarcoidosis may minimize dissemination and progression. An extended trial in Stage I sarcoidosis appears warranted. In more disseminated forms of the disease, the effects of corticosteroids seem to be merely palliative: there is no persuasive evidence that their use in pulmonary sarcoidosis averts fibrosis.

Occasionally corticosteroid therapy is contraindicated, poorly tolerated, or ineffective. In such circumstances chlorambucil or methotrexate may be given a trial. It is clear that both drugs exert an antiinflammatory action similar to that of the corticosteroids; in a few instances these agents appear to surpass corticosteroids in effectiveness.
Obesity: some current views regarding its aetiology
Authors: Sheldon Joanna
Published: December 2008

Obesity results from an imbalance between calorie intake and calorie output. Although an excessive calorie intake is the most obvious and usual explanation for the development of obesity, a variety of factors influencing calorie expenditure may also be involved. Some of these factors may even be inborn.

Recent work on controls of energy utilization, and on the relation between obesity and changes in the size and number of adipocytes in the body, is reviewed.
Acanthocytosis, normolipoproteinaemia and multiple tics
Authors: Critchley E M R , Nicholson J T , Betts J J , Weatherall D J
Published: December 2008

A chronic degenerative neurological disorder is described which is characterized by tics, grimacing, involuntary movements, a severe disturbance of swallowing and a concurrent malformation of the erythrocytes. This condition is clearly different from familial hypo-betalipoproteinaemia and abetalipoproteinaemia, the two previously described neurological disorders associated with abnormal red cells.
Acanthocytosis with normolipoproteinaemia: biophysical aspects
Authors: Betts J J , Nicholson J T , Critchley E M R
Published: December 2008

The electrokinetic properties of normal and pathological red cells and platelets are compared.

The electrophoretic mobilities and isoelectric points of normal and pathological erythrocytes do not differ significantly, adsorption of calcium and uranyl ions occur to the same extent and treatment with neuraminidase induces almost identical mobility decreases.

The pathological platelet-plasma system is more sensitive to adenosine diphosphate (ADP) than normal systems; platelet aggregation and electrophoretic mobility increases are induced by much lower concentrations of ADP than those normally required. The pathological platelet system shows a greater tendency to aggregate spontaneously. The abnormal sensitivity to ADP of the pathological platelet-plasma system is considered in terms of plasma components.
The double glucagon test, a new liver function test
Authors: Verhaegen H , Verhaegen-Declercq M L , de Beukelaer A , Krug F
Published: December 2008

A double glucagon test was performed in 100 patients and seventeen control subjects. Two intravenous doses of glucagon (1 mg) were administered at a 1-hr interval. Glucose was determined before the first injection and 20, 25 and 30 min after both doses, and the increases after each successive dose were added up.

In normal persons, the total increase in glycaemia was higher in the second than in the first hour and reached at least 110 mg. Normal values were found in cases of obstructive jaundice, cholelithiasis and adult diabetes, and abnormal values in patients with infective hepatitis, liver congestion and cirrhosis.

The double glucagon test was found to be very useful for the differential diagnosis of liver cell impairment and hepatic obstruction.
The diagnosis of pulmonary embolism: a review with particular reference to the use of radionuclides
Authors: Cook David J , Lander Harry
Published: December 2008

Pulmonary embolism was first recognized as an important entity early in the nineteenth century. The evolution of our knowledge of this disorder has been reviewed with particular emphasis on the various diagnostic techniques which have been used to assist in its recognition. These have included physical examination to demonstrate the presence of classical physical signs, electrocardiography, biochemical tests, radiological examinations, pulmonary function tests, ultra-sound and methods employing radionuclides. The wide variety of techniques applied to this problem clearly indicates that no currently available test is entirely satisfactory alone. Probably the most significant advance in recent years has been the development of lung perfusion scanning which has provided at the very least a valuable screening test and a ready method of studying serially the natural history of the perfusion defects produced by thromboembolic disease.
Metacarpal bone dimensions in young and aged South African Bantu consuming a diet low in calcium
Authors: Walker Alexander R P , Walker B F , Richardson B D
Published: December 2008

Groups of South African Bantu boys and girls of 14 years, compared with local Caucasian children, have lower cortical thickness, cortical score, and crosssection and volume scores for second metacarpal. Yet, when these parameters on groups of aged Bantu men and women, 70-79 years, are compared with published values on corresponding Caucasians, there are no significant differences. Further, aged Bantu have lower prevalences of hip fracture and severe collapse of vertebral bodies. Since a low calcium intake, and in aged Bantu women numerous pregnancies and long lactations, are compatible with satisfactory bone data, it is questioned whether the present insistence on a high calcium intake is justified.