bluuebunny/crossref_metadata_2025 huggingface dataset:
Birmingham Medical Research Expeditionary Society 1977 Expedition: cardiopulmonary function before, during and after a twenty-one-day Himalayan trek
Authors: Stockley R A , Green I D
Published: December 2008

The heart rate response to exercise was studied in 17 normal subjects before, during and after a 21-day Himalayan trek to 5490 m. The group were fitter before the trek when compared to normal subjects of a similar age (P < 0.001) having a lower heart rate response to exercise for their lean body mass. The trek significantly increased the 'fitness' of the group as a whole (P < 0.025) but this was not seen in the 5 members of the group who had severe acute mountain sickness. Similar changes were noted within the first 8 days of the trek before symptoms of mountain sickness occurred.

The group had normal pulmonary function before the trek but peak expiratory flow rate and vital capacity decreased with altitude. The effect was more marked in the subjects with acute mountain sickness.
Dose response for blood pressure and degree of cardiac beta-blockade with atenolol
Authors: Marshall A J , Barritt D W , Heaton S , Harry J D
Published: December 2008

The hypotensive effect of 25 mg, 50 mg, 75 mg, 100 mg and 0 mg of atenolol daily were compared in a double-blind within-patient study. The fall in blood pressure with 25 mg daily was not significantly different than with 100 mg. The dose response curve lies between 0 and 25 mg daily. Cardiac beta-blockade (measured by suppression of exercise tachycardia) was not maximal with 25 mg of atenolol daily. The dose response curves for beta-blockade and the hypotensive effect are not parallel.
Fatal intestinal amoebiasis
Authors: Thuse M G
Published: December 2008

The clinical presentation of amoebic colitis are diverse. Amoebiasis is comparatively rare in the U.K. and, unless the clinician is aware of the condition, wrong diagnosis often leads to delay in appropriate treatment resulting in high mortality. Diagnosis rests on clinical suspicion, stool examination, sigmoidoscopy with rectal biopsy and serological tests. Amoebiasis is readily treatable and death from it should be very rare.
Quality of specimens and sputum culture results: a retrospective study
Authors: Rahman M
Published: December 2008

A retrospective study of laboratory reports of sputums examined in the first 3 months of 1977 and of 1978 showed some interesting findings, which were similar in these 2 years. Analysis of the findings demonstrated that information from a proportion of sputum cultures were not helpful to the clinicians. Probable causes of such unhelpful results and some ways to overcome these problems were discussed, along with reviews of relevant literature. A conclusion drawn at the end of the discussion was that, under present circumstances, it was not expected that sputum cultures would produce totally reliable aetiological agents, unless attempts were made to obtain a better quality of specimen, e.g. those obtained by transtracheal or bronchoscopic aspirations.
Motor polyneuroapthy and nystagmus associated with chloroquine phosphate
Authors: Marks J S
Published: December 2008

A 49-year-old woman with rheumatoid arthritis developed a motor polyneuropathy and nystagmus after 5 months' treatment with chloroquine phosphate. The peripheral neuropathy resolved after the chloroquine was discontinued.
Ectopic ACTH syndrome from bronchogenic carcinoma in association with chronic lymphocytic leukaemia
Authors: Forfar J C
Published: December 2008

A patient under treatment for chronic lymphocytic leukaemia developed lobar pneumonia after 8 months. When antileukaemic therapy was discontinued, features of an ectopic ACTH syndrome developed, secondary to bronchogenic carcinoma. Exogenous steroid therapy for leukaemia seemed to suppress the clinical manifestations of the ectopic ACTH syndrome while subsequent endogenous steroid production controlled the peripheral lymphocyte count.
Dermatophyte infections
Authors: Clayton Y M
Published: December 2008

The newer antifungal agents, clotrimazole, miconazole and haloprogin are considered for their efficacy and acceptability, and are compared with other topical agents used for the treatment of dermatophyte infections of the skin.
Therapy of fungal infections of the central nervous system
Authors: Speller D C E
Published: December 2008

Fungal infections of the central nervous system present a considerable challenge to available chemotherapy and other forms of treatment. The particular difficulties are discussed here, after an account of the fungi involved and their sensitivity to antifungal agents. Cryptococcal, coccidioidal and candidal infections are considered in more detail.
Rhinocerebral mucormycoses with emphasis on clinical diagnosis, altered host defensive mechanisms and management
Authors: Tanphaichitra D
Published: December 2008

Two cases of malignant form of mucormycosis are presented. In spite of extensive treatment with surgery and antifungal drugs, both cases were fatal. Diminished cellular immunity was demonstrated and considered an important factor in the poor outcome.
The host and the parasitePart of final Panel Discussion.
Authors: Symoens J
Published: December 2008

The role of the host in the management of patients with mycotic infection is considered. In vivo studies with ketoconazole indicate the importance of the host and the possibility of stimulating host immune mechanisms by an immune modulator.
Lithium neurotoxicity
Authors: Newman P K , Saunders M
Published: December 2008

The peripheral and central neurotoxic effects of lithium carbonate are illustrated by 4 case histories. Lithium neurotoxicity is likely to be more common than the literature suggests. Neurological sequelae may be irreversible and may be associated with therapeutic serum levels. Prevention may be facilitated by more stringent case selection, EEG and clinical monitoring and the development of improved methods of drug level assessment.
Cardiovascular effects of amitriptyline, mianserin, zimelidine and nomifensine in depressed patients
Authors: Burgess C D , Montgomery S , Wadsworth J , Turner P
Published: December 2008

The cardiac effects of amitriptyline, mianserin, zimelidine and nomifensine on the systolic time intervals (STI) and on the high speed surface ECG have been studied in depressed patients. Amitriptyline increased pre-ejection period (PEP) index and the PEP/left ventricular ejection time (LVET) ratio of the STI (P <0·05 and P <0·02). It also increased heart rate significantly (<0·02) and tended to prolong Q-T interval. Mianserin shortened QS2I (P <0·05) and LVET (P <0·01) and prolonged PEP/LVET ratio (P <0·01). Zimelidine did not affect the STI but tended to decrease heart rate and prolong the Q-T interval. Nomifensine decreased T wave height. These findings indicate that amitriptyline decreases cardiac contractility and confirm the quinidine-like action of the tricyclic antidepressants. The changes brought about by mianserin are probably due to effects on the peripheral circulation rather than a direct action on the heart.
Potassium in the syndrome of inappropriate antidiuretic hormone secretion
Authors: Padfield P L , Morton J J
Published: December 2008

Serum potassium concentration was normal (≥3·6 mmol/l) in 29 of 32 patients with the syndrome of inappropriate antidiuretic hormone excess (SIADH) associated with a bronchogenic carcinoma. In 11 of the patients there was no significant change in serum potassium concentration after correction of the syndrome, by fluid restriction. Hypokalaemia is thus an uncommon finding in SIADH due to bronchogenic carcinomas.
A fatal case of Legionnaires' disease originating in Scotland
Authors: Lees A W , Tyrrell W F , Boyd J F
Published: December 2008

A 21-year-old female died in May 1976 from a pneumonic illness presenting with a right pleural effusion. Histopathology showed florid hyaline membrane disease of the left lung only, and focal pneumonitis in the lower lobe. Further investigations carried out by the Center for Disease Control, Atlanta, Georgia, showed that this patient had Legionnaires' disease infection, the first indigenous case diagnosed in Scotland. Post-mortem examination showed features differing from those in other published cases.
Gastroduodenal fistula in the Zollinger-Ellison syndrome
Authors: Machell R J , Dick A P , Everett W G
Published: December 2008

A case of Zollinger-Ellison syndrome complicated by a gastroduodenal fistula is described in a 42-year-old man. So far as the authors know, this is the first report of this complication in gastrinoma.
Two cases of the nephrotic syndrome with a reversible coagulation defect
Authors: Baker M R , Davies J A , Tate G M , Lee M R
Published: December 2008

Two cases of the nephrotic syndrome with an apparently identical defect of blood coagulation, discovered during preparation for renal biopsy are described. Plasma from both patients showed prolongation of thrombin and kaolin cephalin times which was probably due to abnormally slow polymerization of fibrin monomer. Corticosteroid therapy reversed the abnormal times in one case. One of the patients showed seasonal relapses which occurred in relation to episodes of hay fever associated with allergy to grass pollen. The other patient showed some similar features, but on renal biopsy was found to have proliferative glomerulonephritis.
Suicide by different methods
Authors: Farmer R D T
Published: December 2008

The annual numbers of suicide deaths for the past 100 years by different methods in England and Wales are presented. It is shown that the numbers of deaths by 2 methods, domestic gas poisoning and poisoning by solid or liquid substances, vary independently of all other methods. It is concluded that inferences as to cause drawn from aggregated data should be viewed with great caution.
A study of hyperbilirubinaemia in clinical practice
Authors: Abbott R J , Carter N W , Clee M D , Bouchier Ian A D
Published: December 2008

The case records of all patients with an elevated serum bilirubin seen in a hospital group over a consecutive 3-month period were analysed. A judgement was made as to whether the hyperbilirubinaemia had been adequately explained and the aetiology was recorded. Appropriate investigations performed and associated liver function tests were noted.

Eleven per cent. of all bilirubins were elevated. Of 415 patients studied no explanation for the hyperbilirubinaemia was given in 106 (26%). In 287 patients the hyperbilirubinaemia was explained, but in 165 (57%) it was not primarily related to liver or biliary disease. The bilirubin was usually higher and associated liver function tests were more likely to be abnormal when primary hepatobiliary pathology was present. An explanation was more likely to be available when the bilirubin was high (>24 μmol/l) (1·4 mg/100 ml). The commonest overall cause of hyperbilirubinaemia was cardiorespiratory failure (30%).
The non-selective use of profundaplasty in lower limb ischaemia
Authors: Heather Brian P , Ware Colin C
Published: December 2008

Previous publications on profundaplasty are reviewed. Results are presented of the use of profundaplasty alone as the sole treatment in 99 limbs with femoropopliteal occlusion. An improvement rate of 77% is recorded in claudicants together with a 28% limb salvage rate in gangrenous limbs. The present place of profundaplasty in treatment of femoro-popliteal occlusion is discussed.
Rickets in a white adolescent
Authors: Fogelman I , Boyce B , Boyle I T
Published: December 2008

A case is presented to illustrate that vitamin D-deficiency rickets, although extremely rare, can still occur in white adolescents, provided the diet is sufficiently abnormal.
Caecal and sigmoid volvulus in the same patient
Authors: Reasbeck P G
Published: December 2008

A patient is described who developed caecal volvulus several years after sigmoid colectomy for recurrent sigmoid volvulus. The pathophysiology of colonic volvulus is briefly reviewed, and it is suggested that an innate tendency to poor muscular tone in the colon may predispose to volvulus, while conversely excessive tone may lead to diverticular disease.
Rupture of a renal angiomyolipoma (hamartoma)
Authors: Stavorovsky M , Irge D , Morag B , Schujman E
Published: December 2008

A 54-year-old woman with spontaneous rupture of angiomyolipoma is presented. The literature on the 2 types of angiomyolipoma, without and with association of tuberose sclerosis, their rarity and the difficulties in their diagnoses, is reviewed.
An unusual inflammatory lesion of the jejunum in a patient with late onset immunoglobulin deficiency
Authors: Williams S E
Published: December 2008

A 40-year-old male patient is reported in whom a grossly inflamed thickened 70-cm segment of jejunum complicated a ‘late onset’ immunoglobulin deficiency state. The pathogenesis is unknown, but extensive occlusion of the vascular supply to the lesion may have contributed to its development.
Diagnosis of haemobilia by duodenoscopy
Authors: Rose J , Hishon S , Machell R
Published: December 2008

A case of haemobilia due to liver abscess presenting as haematemesis and melaena is described. Duodenoscopy in the acute phase can distinguish haemobilia from other causes of upper gastrointestinal bleeding and is the first step towards accurate localization of the lesion by hepatic arteriography.
Pancreatitis in systemic lupus erythematosus--a case report and review of the literature
Authors: Mekori Y A , Yaretzky A , Schneider M , Klajman A
Published: December 2008

A young woman with a past history of haemolytic anaemia was admitted to the hospital for pancreatitis and found to have serological evidence of systemic lupus erythematosus (SLE). The occurrence of pancreatitis as a complication of SLE is reviewed.
The effects of season and stage of pregnancy on plasma 25-hydroxy-vitamin D concentrations in pregnant women
Authors: MacLennan W J , Hamilton J C , Darmady J M
Published: December 2008

Plasma 25-OHD levels were measured in the same 26 Caucasian women before pregnancy and during the first, second and third trimesters of their pregnancy. This was done to assess whether pregnancy alters vitamin D status in healthy women. During most times of the year there was no association between the 25-OHD levels and the stage of pregnancy, but between January and March there was a progressive fall in 25-OHD levels with each trimester. When 25-OHD levels were related to hours of possible sunlight exposure a negative association between 25-OHD levels and stage of pregnancy was noted only in subjects with the lowest possible exposure to sunlight. These observations suggest that pregnancy has an effect on vitamin D metabolism, but that in healthy Caucasian women these effects only become manifest where there is a low level of exposure to sunlight.
Complete atrioventricular block due to giant cell myocarditis
Authors: Singham K T , Azizah N W K , Goh T H
Published: December 2008

A rare instance of complete atrioventricular block due to giant cell myocarditis with histopathological correlation is documented. The haemodynamic changes and echocardiographic findings are described.
Osteosarcoma complicating familial Paget’s disease
Authors: Brenton D P , Isenberg D A , Bertram J
Published: December 2008

A most unusual family with aggressive Paget’s disease is reported. Three brothers out of 10 siblings developed the disease at a relatively early age. Two of these brothers developed an osteosarcoma and died. It is emphasized that very little information is available concerning the predisposition to severe polyostotic disease and even sarcomatous change when Paget’s disease begins at a young age or is familial. Possibly the risk of these serious complications is then greater than when the disease is sporadic and begins later in life.
Axillary temperature differences in hemiplegia
Authors: Mulley G
Published: December 2008

Axillary temperatures were compared in 30 hemiplegic patients. The temperature in the unaffected axilla was greater than or equal to 0.2 degrees C higher in 25 patients, and was greater than or equal to 0.5 degrees C higher in 14 patients. In 4 patients, there was an axillary temperature difference of greater than or equal to 1 degrees C. Axillary temperature readings should always be taken from the normal arm in hemiplegic patients.
Dantrolene and lymphocytic lymphoma
Authors: Wan H H , Tucker J S
Published: December 2008

A patient is reported who was on prolonged treatment with dantrolene for spastic paraplegia; he developed a malignant lymphoma which led to his death.
Sarcoidosis presenting with pleurisy and bilateral pleural effusions
Authors: Johnson N McI , Martin N D T , McNicol M W
Published: December 2008

A patient with acute sarcoidosis is described who presented with pleurisy and bilateral pleural effusions, but no other abnormalities on examination or chest X-ray. This presentation of sarcoidosis is unusual and is discussed.
Amiodarone-induced thyrotoxicosis: four cases and a review of the literature
Authors: Keidar S , Grenadier E , Palant A
Published: December 2008

Hyperthyroidism is a rare side effect of amiodarone treatment.

Four patients with this untoward effect are described One patient with mild hyperthyroidism before treatment with amiodarone, developed prolonged severe resistant thyrotoxicosis 6 months after initiation of this drug. A second patient with Wolf-Parkinson-White syndrome and paroxysmal atrial fibrillation was successfully stabilized with amiodarone for 18 months. However, the arrhythmia recurred and the thyroid function tests were found to be elevated. In 2 other patients only slight elevation of the thyroid function tests were found without clinical manifestations 4 months after treatment with amiodarone had been initiated.
A case of apathetic thyrotoxicosis simulating malignant disease
Authors: Dodd M J , Blake D R
Published: December 2008

A patient with apathetic hyperthyroidism and who was initially considered to be suffering from malignant disease and progressed to crisis is described. The role of magnesium in this presentation of thyrotoxicosis is discussed.
A case of blindness associated with myocardial infarction
Authors: Brettle R P
Published: December 2008

A patient presented to hospital with sudden onset of blindness which was subsequently shown both clinically and by radionucleotide scanning to be cortical in nature. Four days before admission he had suffered 2 short episodes of aching jaw, dizziness, and profuse sweating. Myocardial infarction was confirmed by serial ECGs and cardiac enzymes. His cortical blindness was thought to be secondary to an embolus from a myocardial mural thrombus. A review of the literature revealed 5 previous patients with cortical blindness and associated myocardial infarction. In 2 of these, blindness followed within days of the myocardial infarct, but in none was it the presenting feature of a myocardial infarct.
Plasma cell dyscrasia with polyneuritis and dermato-endocrine alterations. Report of a new case outside Japan
Authors: Moya-Mir M S , Martin-Martin F , Barbadillo R , Cuervas-Mons V , Martin-Jimenez T , Sanchez-Miro I , Garcia-Merino J A
Published: December 2008

A new syndrome has been described comprising polyneuropathy, oedema, hyperpigmentation and thickening of the skin, gynaecomastia in males and amenorrhoea in females, monoclonal gammopathy, papilloedema and diabetes. There is frequent osteosclerosis with or without plasmacytoma, hepatosplenomegaly and polycythaemia. There is a good response to corticosteroids, immunosuppressive drugs and occasionally to excision or irradiation of the plasmacytoma. This syndrome was first described in Japan, and is still seen predominantly there, and only occasionally in other areas. An example in a 51-year-old Spanish female is described: she had a spectacular response to prednisone and melphalan. The aetiopathogenic possibilities are discussed.
Pseudohyperkalaemia and infectious mononucleosis
Authors: Ho-Yen D O , Pennington C R
Published: December 2008

Pseudohyperkalaemia is described from a patient with infectious mononucleosis. The in vitro release of potassium was associated with clotting and all the blood cells may have been involved.
Ingestion of formic acid-containing agents--report of three fatal cases
Authors: Naik R B , Stephens W P , Wilson D J , Walker A , Lee H A
Published: December 2008

Three patients were treated after they had deliberately ingested domestic agents containing formic acid. The major complications included the local effects on the oropharynx, oesophagus and stomach, metabolic acidosis, derangement of clotting mechanisms with haemorrhage and shock, widespread intravascular haemolysis, disseminated intravascular coagulation and the acute onset of respiratory and renal failure. All 3 patients died between 2 and 14 days after admission. It is the authors’ belief that intensive therapy from the outset to include exchange transfusion, infusion of clotting factors, high dose steroids, ventilatory support and peritoneal or haemodialysis with parenteral nutrition may perhaps offer a better chance for survival.
Corticosteroid treatment, serum lipids and coronary artery disease
Authors: Jefferys D B , Lessof M H , Mattock M B
Published: December 2008

Serum lipids and the cholesterol concentrations in the high density lipoprotein (HDL) fractions were measured in patients receiving long-term corticosteroid treatment for connective tissue disorders and asthma. Patients who were not receiving corticosteroid treatment had blood lipid levels which did not differ from those of healthy people. However, female (but not male) patients who had received prednisolone for a mean period of 3.1 years had a significant elevation in total cholesterol and a large decrease in HDL cholesterol. It seems possible that high levels of corticosteroids may increase the incidence of premenopausal ischaemic heart disease in females.
The resolution of hypertrophic pulmonary osteoarthropathy following treatment of subacute infective endocarditis
Authors: Shapiro L M , Mackinnon J
Published: December 2008

A patient with a corrected coarctation of the aorta subsequently developed infective endocarditis on a congenital bicuspid aortic valve. Resolution of the radiographic bone changes of hypertrophic pulmonary osteoarthropathy was demonstrated following treatment of the infection.
Thyrotoxic myopathy presenting as dysphagia
Authors: Marks P , Anderson J , Vincent R
Published: December 2008

A case of aspiration pneumonia due to incoordination of swallowing is described. Its aetiology lies in the myopathy of thyrotoxicosis and a tentative hypothesis as to its causation is suggested.
Cardiac arrest following chlormethiazole infusion in chronic alcoholics
Authors: McInnes G T , Young R E , Avery B S
Published: December 2008

Two chronic alcoholics who had cardiac arrests (one fatal) while receiving chlormethiazole by infusion are reported. Although a causal relationship has not been indisputably established, caution is advised when administering this drug to chronic alcoholics during withdrawal.
The effect of prenylamine on the QT interval of the resting electrocardiogram in patients with angina pectoris
Authors: Oakley D , Jennings K , Puritz R , Krikler D , Chamberlain D
Published: December 2008

Resting ECGs were recorded in 29 patients with angina pectoris before, during and after treatment with prenylamine 180 mg daily. The QT interval became significantly prolonged after one week of treatment. The prolongation persisted as long as therapy was continued, which was up to 6 months. After withdrawal of treatment the QT interval returned to normal within 2 weeks. In this study no serious problems were encountered by those patients in whom the QT interval was prolonged.
Ectopic adrenal tissue in adults
Authors: Anderson J R , Ross A H McLean
Published: December 2008

Two examples of ectopic adrenocortical tissue occurring in adults are presented. The embryological basis for this anomaly and is clinical significance are discussed.
Epidermal cysts - a clinicopathological and biochemical study
Authors: Chandrasekaran V , Parkash S , Raghuveer C V
Published: December 2008

The findings of a clinicopathological and biochemical study of epidermal cysts and a review of the relevant literature are presented. A punctum was found in 40% of 34 epidermal cysts that were studied in detail. The findings of the histological study were in favour of the punctum being the orifice of an obstructed hair follicle from which at least a proportion of the epidermal cysts are likely to develop. The biochemical analysis of the contents of the cysts revealed a very low protein and lipid content, thus ruling out any ‘sebaceous’ contribution. Bacteriological study of clinically inflamed cysts showed that inflammation in these lesions was usually aseptic unless there was a communication between the cyst cavity and the exterior.
Finger clubbing and aspartylglucosamine excretion in a laxative-abusing patient
Authors: Malmquist J , Ericsson B , Hultén-Nosslin M B , Jeppsson J O , Ljungberg O
Published: December 2008

A young woman with a previous history of anorexia nervosa presented with severe finger clubbing. Urine samples intermittently contained significant amounts of aspartylglucosamine. Liver biopsy showed abnormal cytoplasmic inclusions in phagocytic cells. The patient was found to be abusing senna laxative.
The place of peripheral neurectomy in the management of trigeminal neuralgia
Authors: Freemont A J , Millac Paul
Published: December 2008

One hundred and forty-six patients with trigeminal neuralgia were studied. Of 49 patients ultimately maintained pain-free by non-medical means, 26 underwent peripheral neurectomy. Twenty of these achieved excellent pain control in the longer term and 5 of the remaining 6 became more responsive to carbamazepine after operation. Seven patients required repeat neurectomies. Peripheral neurectomy is a useful and simple method of pain control in trigeminal neuralgia.
Commercially available sun lamps and vitamin D formation
Authors: Devgun M S , Johnson B E , Cruickshank Alison J M , Paterson C R
Published: December 2008

Four commercially available, medium pressure mercury sun lamps were used to assess their effects on promoting vitamin D synthesis in the skin. It was found that all the lamps studied had vitamin D synthesizing spectral wavelengths and caused an increase in the serum concentrations of 25-hydroxyvitamin D. However, the ultraviolet and visible irradiance measurements showed that a considerable proportion of the ultraviolet radiation was below 290 nm. It was not surprising, therefore, to find that these lamps caused adverse skin reactions. While a useful rise in vitamin D production can be obtained with these sun lamps, the difficulty involved in avoiding skin reaction limits their usefulness. Such lamps are unlikely to provide a safe practical routine method for the prevention of vitamin D deficiency in the home.
Uncontrolled diabetes mellitus due to gastroparesis diabeticorum: treatment with metoclopramide
Authors: Muls Erik E , Lamberigts Gerard F
Published: December 2008

A case is reported of uncontrolled diabetes mellitus due to gastroparesis diabeticorum in which treatment with metoclopramide restored diabetic control. Diagnostic, pathological and therapeutic aspects of diabetic gastroparesis, which is thought to reflect autonomic neuropathy involving the gastrointestinal tract, are discussed.
Serum trypsin levels in acute pancreatic and non-pancreatic abdominal conditions
Authors: Artigas J M Gatell , Garcia M Elena , Faure M R Aused , Gimeno A M Ballesta
Published: December 2008

Serum trypsin levels have been estimated by radioimmunoassay in 26 healthy controls (248 +/- 94.9 micrograms/l; mean +/- s.d.), 12 patients with chronic renal failure (1100 +/- 584 micrograms/l), 34 with acute pancreatitis (1399 +/- 618 micrograms/l) and 23 with acute non-pancreatic abdominal conditions. Mean serum trypsin in acute pancreatitis and in chronic renal failure was significantly higher than in control group (P less than 0.001). Serum trypsin levels were well above the upper limit of normality in all patients with acute pancreatitis and in all but one with chronic renal failure. Serum trypsin was markedly raised in one patient with a traumatic haemoperitoneum and in one of the 11 with peptic ulcer perforation, and moderately raised in 3 of the 6 with acute cholecystitis. Determination of serum trypsin seems to be a specific test for acute pancreatitis, provided renal failure has been excluded. However, the authors suggest it should be prospectively measured in a larger series of acute non-pancreatic abdominal conditions.
Primary polycythaemia presenting with chorea
Authors: Borg-Costanzi J M , Mohr P D , Lewis D
Published: December 2008

A case of primary polycythaemia presenting with severe chorea is reported and compared with previous cases. The aetiological factors of the chorea are discussed and the importance of early diagnosis stressed.
Marfan’s syndrome presenting as bilateral spontaneous pneumothorax
Authors: Gawkrodger David J
Published: December 2008

A case of bilateral spontaneous pneumothorax in a 14-year-old girl with previously undiagnosed Marfan’s syndrome is described. The pulmonary abnormalities of Marfan’s syndrome are not commonly encountered and bilateral pneumothorax is itself a rare event which, in most instances, has been reported following invasive procedures.
Intrahepatic cholestasis and cutaneous bullae associated with glibenclamide therapy
Authors: Wongpaitoon V , Mills P R , Russell R I , Patrick R S
Published: December 2008

Intrahepatic cholestasis and cutaneous bullae associated with glibenclamide therapy are described in a 61-year-old diabetic patient who presented wit hypoglycaemic coma. These features have not previously been reported as side effects of glibenclamide therapy, but intrahepatic cholestasis may occur with chlorpropamide, a similar sulphonylurea agent. The mechanism of this cholestasis is not clear at present.
Cerebral lupus erythematosus responding to plasmaphaeresis
Authors: Evans D T P , Giles M , Horne D J de L , d’Apice A J F , Riglar A , Toh B H
Published: December 2008

A 44-year-old nurse with a 12-year history of systemic lupus erythematosus developed a schizophrenia-like psychosis due to cerebral lupus. Prednisolone in doses up to 200 mg daily was ineffective. Levels of immune complexes by the Raji cell assay were greatly increased in serum and cerebrospinal fluid. Plasma exchange was performed on 4 occasions over 4 days. Three days later, there was a marked and sustained improvement in the mental state, the psychosis resolved and tests of psychological function and electroencephalographic abnormalities improved. There was a corresponding decrease in levels of immune complexes and in titres of anti-neuronal antibody. Five months later, several serological indices had risen to pre-plasmaphaeresis levels except for the level of immune complexes. The patient remained in clinical remission. This case provides further evidence that high levels of circulating immune complexes may be a determinant of cerebral lupus and that plasmaphaeresis may be of lasting benefit in this disease.
Subarachnoid haemorrhage and the electrocardiogram - a review
Authors: Harries Anthony D
Published: December 2008

Electrocardiographic abnormalities occur in approximately 50% of patients with subarachnoid haemorrhage. The changes can resemble those of myocardial damage, although in most cases post-mortem studies show no macroscopic evidence of injury. Failure to appreciate this can lead to misdiagnosis of organic cardiac disease, cause delay in surgical treatment or even lead to inappropriate therapy. This review deals with the changes that may occur in the electrocardiogram, discusses the explanations put forward, and examines how this may influence future trends in management.
Endometriosis of the colon
Authors: Michowitz M , Lazarovici I , Hammar B , Solowiejczyk M
Published: December 2008

A case of endometriosis of the colon is presented. The incidence, symptomatology and treatment are discussed.
A case of prenylamine toxicity showing the torsade de pointes phenomenon in sinus rhythm?
Authors: Meanock Colin I , Noble Mark I M
Published: December 2008

A case of torsade de pointes attributed to prenylamine is described. In addition, the authors show QRS axis variation of a similar nature in sinus rhythm. It is postulated that these changes of QRS axis direction, seen in ventricular tachycardia and sinus rhythm, are both manifestations of partial refractoriness, within the ventricle, producing gross changes in the mean QRS vector.
The quality of genetic counselling in osteogenesis imperfecta
Authors: Paterson C R , Mowat Elizabeth
Published: December 2008

A survey is reported of the genetic advice given to 272 families with osteogenesis imperfecta. An appreciable number of families were not given advice by anyone even though they had asked for it, and only one quarter of the families had been referred to a clinical genetic specialist. Overall approximately one third of the information recollected as having been received was incorrect but genetic specialists were clearly more successful than other doctors.
Malignant islet-cell tumour of the pancreas presenting with non-bacterial thrombotic endocarditis and eosinophilia
Authors: O’Boyle C P , Dempsey J , Otridge B , Barniville H
Published: December 2008

A case of severe persistent eosinophilia and non-bacterial thrombotic endocarditis complicating a malignant islet-cell tumour of the pancreas is documented. Although these are well recognized complications of malignant tumours, they do not appear to have been previously documented from the same patient. These complications probably reflect ectopic synthesis and are unlikely to be causally interrelated.
Bilateral obturator herniae and associated femoral hernia
Authors: Watkins R M , Leach R D , Ellis H
Published: December 2008

A case of a strangulated obturator hernia associated with a strangulated femoral hernia is reported. The development of obturator herniae and their association with other herniae are discussed.
Response of ectopic prostatic ACTH production to metyrapone
Authors: Statham B N , Pardoe T H , Mir M A
Published: December 2008

A case of ectopic prostatic ACTH production exhibiting a good response to metyrapone is reported.
Blood pressure variability: the effects of repeated measurement
Authors: Burstyn Peter , O’Donovan Barbara , Charlton Ian
Published: December 2008

A series off 3 BP measurements were carried out on 2 groups of people. People not accustomed to BP measurements showed a decrease in pressure between the 1st and 3rd cuff inflation, while people trained to having their BP measured showed no such change.

Measurement of the BP of 111 people on 2 successive occasions 8 days apart showed that the mean BP of the whole group decreased between visits. Approximately one third of the people showed a drop in pressure bringing them from borderline hypertension to normotension between the 2 visits.

People whose BP dropped substantially between the 1st and 2nd visits achieved higher anxiety scores on a questionnaire than did the remainder of the sample. This may partially explain their labile BP.

Single measurements tend to overestimate the BP and the frequency of hypertension. Training experimental subjects by repeated measurement of their BP may be useful in preventing spurious BP changes unrelated to experimental manoeuvres.
Partial end organ resistance to thyroid hormone in congenital hypothyroidism
Authors: Connell John M C , McLaren E H
Published: December 2008

End organ resistance to thyroid hormone has been described for a number of years: the defect may be partial or generalized. A case of partial end organ resistance to thyroid hormone in congenital hypothyroidism is described, with evidence of an alteration in TSH threshold to feedback inhibition by thyroid hormone. The implications of this factor in the management of hypothyroidism are discussed.
Renal vein thrombosis in nephrotic syndrome—a prospective study and review
Authors: Chugh K S , Malik N , Uberoi H S , Gupta V K , Aggarwal M L , Singhal P C , Suri S , Jain S K
Published: December 2008

The incidence of renal vein thrombosis (RVT) and other thrombo-embolic phenomena was evaluated in 44 unselected patients with nephrotic syndrome. Renal vein thrombosis was demonstrated by selective renal venography in 10 patients and at post-mortem in one. Extension of the thrombus from the renal veins into the inferior vena cava was seen in 3 patients. Evidence of thrombo-embolism elsewhere in the body was seen in the form of thrombophlebitis in the lower extremities in 4 patients (9.1%), pulmonary embolism in 3 (6.8%) and myocardial infarction in one (2.3%).

Of the 11 patients with RVT, renal histology showed membranous glomerulonephritis in 3, minimal change nephritis in 5, membrano-proliferative in one and focal and diffuse proliferative glomerulonephritis in one patient each. The characteristics clinical findings such as gross haematuria and flank pain were noted in only 3 patients with RVT. No significant difference could be detected between the plasma fibrinogen, serum cholesterol, β-lipoprotein, triglycerides and phospholipid concentration of those who showed RVT and the remainder in whom RVT was not demonstrated. The possible mechanisms involved in the pathogenesis of RVT in nephrotic syndrome are discussed.
Anorexia nervosa, liquorice and hypokalaemic myopathy
Authors: Nightingale S , Smith P E , Turnbull D M
Published: December 2008

A patient with a past history of anorexia nervosa developed a hypokalaemic myopathy following a ‘flu-like illness. Although she was apparently in remission from anorexia nervosa, the diet was found to be markedly abnormal with an excessive ingestion of liquorice and a low potassium salt intake. The clinical features and investigations, including muscle biopsy, are described. The patient is compared, with 2 reported cases of liquorice-induced myopathy, and the relationship between anorexia nervosa, liquorice and hypokalaemic myopathy is discussed.
Adrenocortical failure in diabetic pregnancy
Authors: Soler Norman G
Published: December 2008

A Caucasian class F diabetic developed features suggestive of adrenocortical insufficiency during the second half of pregnancy. Serial biochemical and hormonal studies confirmed a diagnosis of progressive primary adrenal failure. Replacement therapy was introduced at 31 weeks’ gestation and the pregnancy ended successfully 6 weeks later. Addison’s disease is another autoimmune disorder that may occur in association with diabetic pregnancy.
Serum calcium in pulmonary tuberculosis
Authors: Sharma Subhash C
Published: December 2008

Serum calcium was studied serially in 94 patients with active pulmonary tuberculosis. An equal number of age- and sex-matched patients with chronic obstructive pulmonary disease were controls. Seventy patients in the study group were normocalcaemic and 10 were hypercalcaemic. These 10 were on a higher supplement of vitamin D than the 70 normocalcaemic patients. There was a positive correlation between the daily vitamin intake and the degree and duration of hypercalcaemia. None of the controls showed hypercalcaemia.
A microbiological study of non-gonococcal proctitis in passive male homosexuals
Authors: Munday P E , Johnson A P , Thomas B J , Jeffries D J , Dawson S G , Osborn M J , Philip S , Harris J R W , Taylor-Robinson D
Published: December 2008

In a study of 180 male homosexual patients attending a venereal disease clinic, a correlation was sought between symptoms and signs of proctitis and the isolation of Neisseria gonorrhoeae, group B streptococci, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis and herpes simplex virus. Faecal specimens were examined for enteric pathogens and serological tests for hepatitis B virus, syphilitic and chlamydial infections were performed.

There was no association between proctitis, as diagnosed by examination of a Gram-stained rectal smear, and the isolation of any micro-organism or detection of a positive serological test. There was, in addition, no association between any symptom or abnormal physical sign and any positive microbiological findings. Since 23% of patients from whom N. gonorrhoeae was isolated had no abnormal physical signs, it is difficult to assign a pathogenic role to other micro-organisms isolated from patients with and without clinical signs of proctitis. Approaches to further investigation of the problem are discussed.
Paradoxical embolism associated with patent foramen ovale
Authors: Leonard R C F , Neville E , Hall R J C
Published: December 2008

Two patients are described in whom paradoxical embolism was diagnosed during life. One patient with cerebral embolism died and the other, with peripheral embolization, survived after treatment with streptokinase. Thrombolytic therapy has not previously been described in the treatment of patients with paradoxical embolism.
Studies of red cell cation transport in white and black essential hypertensives
Authors: Woods K L , Weissberg P L , West M J , Beevers D G
Published: December 2008

It has been reported previously in white patients with essential hypertension that red cell sodium pump activity as measured by ouabain-sensitive uptake of the potassium analogue 86Rb from a potassium-free medium, is very significantly greater than in white controls. In a further study of black (West Indian) subjects reported here no similar abnormality was present in black hypertensives when compared with black normotensive individuals. Red cell rubidium uptake was significantly lower in normotensive blacks than in normotensive whites although sodium pump activity was the same. These results may be relevant to observed racial differences in sodium handling and in the pathophysiology of essential hypertension.
Haemorrhagic breast infarction complicating anticoagulant therapy
Authors: Banik S , Brun C
Published: December 2008

Haemorrhagic infarction of the breast induced by anticoagulant therapy is rare and has been infrequently reported in the literature. The following report illustrates such a case in which there was development of massive haemorrhagic infarction of the breast during treatment with nicoumalone for deep venous thrombosis after an operation for carcinoma of the colon.
Pulmonary paraprotein production in Waldenström’s macroglobulinaemia
Authors: Hull R G , Barton E J
Published: December 2008

A case of Waldenström’s macroglobulinaemia is presented where marrow examination was normal and production of the abnormal protein was centered on the lungs. Symptomatic and biochemical improvement was achieved with chlorambucil and prednisone. Lung manifestations in the disease are briefly reviewed.
Ergotamine absorption and toxicity
Authors: Orton D A , Richardson R J
Published: December 2008

Adverse reactions to ergotamine were noted in 16 out of 41 studies in which therapeutic doses of the drug were given to normal, healthy volunteers. In 17 of the studies 0.25 mg ergotamine was given by injection, 6 i.v. and 11 i.m., in 20 studies 2 mg ergotamine was given by mouth, and 4 subjects received 2 mg ergotamine by suppository. Plasma and urinary ergotamine was measured by radio-immunoassay. Adverse reactions were significantly more frequent in subjects in whom plasma ergotamine exceeded 1.8 ng/ml. Pharmacokinetic data derived from the study are presented and their relevance to the therapeutic use of ergotamine are discussed.
Bilateral femoral neck fractures as a result of coeliac disease
Authors: Rubinstein A , Liron M , Bodner G , Gefel A
Published: December 2008

An elderly patient presenting with severe tetany secondary to hypocalcaemia causing bilateral fractures of the femoral necks, was proved to have coeliac disease. Severe muscle pains, an organic mental syndrome and personality changes are rare complications of coeliac disease and are reversible with treatment.
Association of von Recklinghausen’s neurofibromatosis with adult polycystic disease of kidneys and liver
Authors: Varma Subhash C , Kaushik S P , Talwar K K , Sharma B K
Published: December 2008

A case of von Recklinghausen’s neurofibromatosis with adult polycystic disease of the kidneys and liver (APDK) is reported. Although neurofibromatosis and APDK have been reported in association with many hereditary disorders, their association together has rarely been described.
Chronic small bowel ischaemia presenting as chronic pancreatitis
Authors: Morgan R J , Imrie C W , Russell R I , Pollock J G
Published: December 2008

A patient presenting with abdominal pain was initially thought to have chronic pancreatitis. Investigation revealed normal pancreatic structure but an indirect test of exocrine function showed low enzyme activity. The true diagnosis of chronic small intestinal ischaemia was demonstrated angiographically and confirmed at laparotomy. The early distinction between chronic pancreatitis and chronic small intestinal ischaemia is important because ischaemia may be the harbinger of acute and possibly fatal bowel infarction. Direct stimulation tests of pancreatic function showing normal results should turn attention to the possibility of small bowel ischaemia.
Iatrogenic nerve injuries
Authors: Winer J B , Harrison M J G
Published: December 2008

Thirty-one examples of iatrogenic peripheral nerve injuries have been collected from a review of the case records of one neurological referral centre over a 7-year period. The clinical details are described to call attention to the special care needed with the management of patients subjected to certain invasive procedures.
Blood platelet behaviour during infusion of an Intralipid based intravenous feeding mixture
Authors: Burnham W R , Cockbill S R , Heptinstall S , Harrison S
Published: December 2008

Blood platelet behaviour was studied in six patients during infusion of an Intralipid-based intravenous feeding mixture. Lower concentrations of sodium arachidonate were required to induce platelets to aggregate and to undergo a release reaction during intravenous feeding than were required before or after intravenous feeding. This change was not due to a change in serum albumin level. The platelet behaviour that was induced by adenosine diphosphate or by adrenaline remained unchanged during intravenous feeding.
Natural history of severe thrombocytopenia in infectious mononucleosis
Authors: Wong Su Yong , Bennett Bruce
Published: December 2008

The natural history of severe thrombocytopenia in two patients with infectious mononucleosis (minimum platelet counts under 10 × 109 and 17 × 109/l respectively) is described. In both, the platelet count rose rapidly and spontaneously, reaching approximately 100 × 109/l on the seventh day. Bleeding symptoms were also transient and never life-threatening. The possibility of very rapid spontaneous recovery from severe thrombocytopenia must be borne in mind in assessing the effect of any drug in the management of this complication of infectious mononucleosis.
Galactorrhoea, hyperprolactinaemia, and pituitary adenoma presenting during metoclopramide therapy
Authors: Cooper B T , Mountford R A , McKee C
Published: December 2008

A 49-year-old woman presented with a one month history of headaches, loss of libido and galactorrhoea. She had been taking metoclopramide for the previous 3 months for reflux oesophagitis. She was found to have substantially elevated serum prolactin levels and a pituitary adenoma, which have not been previously described in a patient taking metoclopramide. The drug was stopped and the serum prolactin level fell progressively to normal with resolution of symptoms over 4 months. This suggested that contrary to our original impression that she had a prolactin-secreting pituitary adenoma which had been stimulated by metoclopramide, she had metoclopramide-induced hyperprolactinaemia and an incidental pituitary tumour.
Angioneurotic oedema and urticaria induced by hyoscine butylbromide
Authors: Robinson Anne C R , Teeling Mary
Published: December 2008

A case of angioneurotic oedema and urticaria developing during therapy with hyoscine butylbromide is described. It is believed to be the first reported.
Pleuropericardial effusion associated with minoxidil administration
Authors: Webb D B , Whale R J
Published: December 2008

A patient on minoxidil developed pericardial and pleural effusions with a high protein content. This finding is not compatible with the view that such effusions in patients taking minoxidil are transudates.