bluuebunny/crossref_metadata_2025 huggingface dataset:
Nature, incidence and prognosis of neurological involvement in the acquired immunodeficiency syndrome in central London
Authors: Guiloff R J , Fuller G N , Roberts A , Hargreaves M , Gazzard B , Scaravilli F , Harcourt-Webster J N
Published: December 2008

Clinical neurological involvement at various times throughout the illness was recorded in 52% of 122 patients seen in central London who died from acquired immunodeficiency syndrome (AIDS). Various metabolic encephalopathies, dementias, focal encephalopathies, retinopathies and peripheral nerve pathology were the most frequent manifestations. Seven of 9 patients with a neurological presentation had no other major systemic illness. The median time from diagnosis of AIDS to death was 9 months and from onset of neurological symptoms to death 4 months. Human immunodeficiency virus dementia, central nervous system opportunistic infections, presence of Kaposi sarcoma, neurological presentations and minor symptoms were not associated with major change in survival time.
Beta-blockers, lipoproteins and non-insulin dependent diabetes
Authors: Feher M D , Rains S G H , Richmond W , Torrens D , Wilson G , Wadsworth J , Sever P S , Elkeles R S
Published: December 2008

In a study on 138 hypertensive non-insulin dependent diabetic subjects, factors influencing lipoproteins were assessed. Multiple regression analyses were carried out in order to assess the influence of beta-blocker antihypertensive therapy while making allowances for other confounding variables. In males, but not in females, on a beta-blocker for hypertension, total high density lipoprotein- (HDL-) and HDL-subfraction cholesterol were significantly lower while the serum triglyceride was increased, though not significantly. In male non-insulin dependent diabetics, regimens containing a beta-blocker may worsen an already abnormal lipoprotein profile and antihypertensive agents other than beta-blocking agents should be used if possible.
Studies on the mechanism of non-visualization of diseased human gallbladders during oral cholecystography
Authors: Jacyna M R , Ross P E , Hopwood D , Bouchier I A D
Published: December 2008

Oral cholecystography is a well established method for studying the human gallbladder and radiological non-visualization of the gallbladder has been shown to correlate highly with the presence of disease. The exact mechanism by which diseased gallbladders fail to visualize is unclear, but may be due to a failure of the gallbladder to concentrate the luminal contents. Concentration of gallbladder contents is achieved by the reabsorption of water, the driving force for which is active sodium (Na+) absorption. Therefore Na+ transport was studied by measuring the flux of Na22 across isolated human gallbladder mucosa (obtained at cholecystectomy) and compared with the results of oral cholecystography and histological grading. In 27 gallbladders studied, 59% absorbed Na+, whilst the remainder secreted Na+. Comparison with histological grading showed that as gallbladders became more diseased they absorbed less Na+ and were more likely to secrete Na+. In addition, gallbladders that absorbed Na+ were significantly more likely to visualize on cholecystography than those that secreted Na+. These results indicate that some diseased human gallbladders secrete, rather than absorb, Na+ and suggest that the mechanism for radiological non-visualization is failure of fluid absorption and the development of active fluid secretion.
Distended oesophagus as a cause of bilateral recurrent laryngeal nerve palsy
Authors: Wickramasinghe L S P , Chowdhury C R , Pillai S S , Ghosh S
Published: December 2008

We report an unusual case of bilateral recurrent laryngeal nerve palsy caused by gross oesophageal distension due to achalasia.
Spontaneous tension pyopneumopericardium--a case with recovery after surgery
Authors: Bilbao-Garay J , Carreño M C , Roman F , Perez-Maestu R , Masa-Vazquez C , de Letona J M
Published: December 2008

Tension pyopneumopericardium is a rare condition with a very high mortality. The majority of cases are due to perforation of oesophagus or bronchi into the pericardial cavity. We report a patient with spontaneous pyopneumopericardium who survived with antibiotic treatment and surgical drainage.
Scarlet fever can mimic toxic shock syndrome
Authors: Brook M G , Bannister B A
Published: December 2008

We describe a patient who presented with a widespread erythematous rash, diarrhoea, confusion, pre-renal uraemia and hyponatraemia. The diagnosis of staphylococcal toxic shock syndrome seemed likely as she was menstruating and there was no evidence of pharyngitis. A rising ASO titre confirmed a streptococcal aetiology and thus ‘toxic’ scarlet fever. Toxic shock syndrome and toxic scarlet fever are compared.
Myocardial infarction: a complication of amitriptyline overdose
Authors: Chamsi-Pasha H , Barnes P C
Published: December 2008

A 22 year old woman was admitted with amitriptyline overdose. Twenty six hours later she developed acute myocardial infarction. Cardiotoxic effects of tricyclic antidepressants are discussed and the importance of considering myocardial infarction as a complication of tricyclic antidepressant overdose is emphasized.
When to advise surgery for severe obesity
Authors: Garrow J S
Published: December 2008

A typical severely obese patient will have about 50 kg excess weight to lose, which is equivalent to a store of 350,000 kcal. The optimum rate of weight loss in such a patient is about 1 kg/week, which involves an energy deficit of 1000 kcal/day for about a year. It is difficult to maintain this degree of dietary restriction over such a long period, and procedures such as jaw wiring or stomach stapling may help in some cases. Maintenance of weight loss is difficult to achieve and may be helped by fitting a nylon waist cord after weight loss. On theoretical grounds, patients who do not lose weight despite keeping to a properly-designed reducing diet would not benefit from surgery, but in practice this problem does not arise. It is dangerous to resort to surgery for the treatment of severely obese patients who cannot diet by reason of psychiatric disorder.
Renal metastases shown by 99mTc-methylene diphosphonate scintigram which failed to detect vertebral metastases
Authors: Kreel L , Thornton A , Stewart I
Published: December 2008

A patient with breast metastases is presented showing increased nodular renal uptake of tracer on bone scintigraphy that also demonstrated rib metastases and a large metastasis in the pelvis. However, vertebral body metastases were not shown when clearly demonstrated on CT with even partial compression on a thoracic spine film. Most of the renal lesions were hypoechoic on sonography, showed hypoattenuation areas on plain CT and after contrast enhancement but no calcification could be demonstrated. This case once again illustrates the value of scrutinizing the soft tissues on scintigraphy but also the possibility of showing some metastases on CT not visible on scintigraphy.
Unusual presentation of a large pituitary tumour in relation to diving
Authors: Bakheit A M , Kennedy P G E
Published: December 2008

A case of necrosis of a pituitary tumour occurring in the context of diving is described. The presenting features and subsequent course suggested a brain stem vascular event. The tumour was not detected by routine computerized tomographic scanning, but was identified with magnetic resonance imaging. The possible pathophysiological mechanism is discussed.
Diabetes insipidus complicating myelofibrosis
Authors: Dornan T L , Gillett G , Jones P A E , Jeffcoate W J
Published: December 2008

A 68 year old man developed cranial diabetes insipidus 3 years after the diagnosis of myelofibrosis, coincident with a marked increase in nucleated cell count. No mass lesion was demonstrable on computed tomographic or magnetic resonance imaging. It is suggested that hypothalamic damage was caused by local infiltration or infarction, a complication of myelofibrosis which has not previously been reported.
Thrombophlebitis migrans following co-trimoxazole therapy
Authors: Verne-Pignatelli J , Spickett G P , Dalgleish A G , Denman A M
Published: December 2008

We report an unusual and severe vasculitic disorder following co-trimoxazole, given orally for a urinary tract infection. The vasculitis was manifest solely as thrombophlebitis migrans and involving only veins without evidence of polyarteritis nodosa, or underlying malignancy.
Intermittent omental torsion--an unusual cause of recurrent abdominal pain?
Authors: Parr N J , Crosbie R B
Published: December 2008

A case of haemoperitoneum arising from an omental haematoma is described. Histology suggests that this resulted from an omental torsion. The omentum, however, was not torted at the time of laparotomy. Furthermore, there was a history of similar episodes of pain over the previous eighteen months. This suggests that spontaneous derotation of an omental torsion may occur, and may be an unusual cause of recurrent abdominal pain.
Communication in medical practice across ethnic boundaries
Authors: Crisp A H , Edwards W J
Published: December 2008

The communication skills basic to good medical practice are, for many of us, unnatural. The authors attempt to address aspects of the matter with particular reference to communication across ethnic boundaries.
Aortobronchial fistula: an uncommon cause of haemoptysis
Authors: Riancho J A , Gutiérrez J A , Echevarría S , Daroca R , González Macías J
Published: December 2008

A 16 year old patient who presented with haemoptysis as the main manifestation of the infection of an aortic patch graft is reported. The importance of being alert about the possibility of an aortobronchial fistula in patients with haemoptysis who have been previously subjected to cardiovascular surgery is emphasized.
Haemochromatosis and aldosterone deficiency presenting with Yersinia pseudotuberculosis septicaemia
Authors: Conway S P , Dudley N , Sheridan P , Ross H
Published: December 2008

A 50 year old man presented with a pyrexial illness following a holiday abroad. Yersinia pseudotuberculosis was isolated from blood culture. Response to appropriate antibiotic therapy was prompt and complete, but full recovery was complicated by an episode of hyperkalaemia, hyponatraemia and the passing of large volumes of dilute urine. Three years previously he had developed diabetes mellitus and hypogonadotrophic hypogonadism. Investigation on recovery showed underlying haemochromatosis and aldosterone deficiency.
Functional, malignant intrathoracic paraganglioma
Authors: Aggarwal P , Wali J P , Venugopal P , Khosla A , Tickoo S K
Published: December 2008

This paper describes a case of functional, malignant branchiomeric paraganglioma, the third such to be reported. The patient presented with malignant hypertension and symptoms suggestive of excessive catecholamine secretion.
Hypercalcaemia in association with enteric fever
Authors: Connolly M J , Snow M H , Farndon J R
Published: December 2008

We report 2 cases of hypercalcaemia and hypercalciuria, with detectable levels of parathyroid hormone, which appeared to be precipitated by enteric fever. Extensive investigation of one case, including ultrasound, isotope scanning, angiography, computed tomographic scanning and surgical exploration, failed to detect a parathyroid adenoma. In both cases biochemical and hormonal abnormalities resolved several months after recovery of enteric fever. The mechanism of the proposed association is unexplained but it should be considered in any patient with hypercalcaemia and detectable parathyroid hormone levels, who is suffering from or has recently recovered from enteric fever. If such a patient is well, a period of several month’s observation is recommended. We believe these two cases to be the first such reports of hypercalcaemia in association with enteric fever.
Treatment of multiple subcutaneous Nocardia asteroides abscesses with ciprofloxacin and doxycycline
Authors: Bath P M W , Pettingale K W , Wade J
Published: December 2008

We report on the successful use of oral ciprofloxacin and doxycycline in the treatment of multiple subcutaneous nocardial abscesses in an immunocompromised patient with active non-Hodgkin’s lymphoma. This relatively inexpensive regimen allowed the patient to return home and was not associated with any significant side effects. The patient has shown no sign of relapse of her nocardial infection over an 8-month period on the above regimen.
Congenital absence of the intrahepatic segment of the inferior vena cava with azygos continuation presenting as a mediastinal mass
Authors: Beedie R J , Yeo W , Morcos S K
Published: December 2008

A child with the isolated anomaly of azygos continuation of the inferior vena cava is presented. The interest of this abnormality lies in its detection as a mediastinal mass on the chest radiograph. Computed tomography with intravenous contrast enhancement is the method of choice to diagnose this venous anomaly. Awareness of the caval-azygos abnormality is important to surgeons and cardiologists. Accidental ligation of the azygos vein is fatal and cardiac catheterization using the lower extremity vein is troublesome in patients with this condition.
Confusional state and cerebral infarcts
Authors: García-Albea E
Published: December 2008

Thirteen patients with confusional state and cerebral infarction were studied. Seven patients had optic pathway alterations. On computed tomographic scan, 2 patients had multiple infarctions and 10 had single infarctions, predominantly located in the temporo-occipital associative cortex. One patient had a normal scan. Reduction of ‘selective attention’, ‘release’ hallucinations, amnesic syndrome and secondary individual adjustment could explain the confusional state.
Cirrhosis in partial lipodystrophy
Authors: Robertson D A F , Wright R
Published: December 2008

A patient with partial lipodystrophy, fatty liver and cirrhosis, and autoimmune thyroid disease is described. Treatment with thyroxine led to partial improvement in the hepatic abnormality.
Lymphoplasmacytoid lymphoma elaborating lambda chain paraprotein with amyloid deposition in Sjögren’s syndrome
Authors: Savage A W G , Shareef D S , Maher E J , Bennett M H , Thomas D J B
Published: December 2008

A woman presented with painful enlargement of her parotid and submandibular glands. She was shown to have the previously unreported combination of idiopathic thrombocytopenic purpura, Sjögren’s syndrome, Hashimoto’s disease, and myasthenia gravis. Parotid gland biopsy and bone marrow examination showed the presence of a rare lymphoplasmacytoid lymphoma. There was amyloid deposition in the parotid glands, gums and on muscle biopsy. Immunohistochemical staining of the parotid lymphoma and amyloid was monotypic for lambda light chains, and there was also a lambda chain paraprotein. It is felt that the lymphoplasmacytic lymphoma was responsible for the light chain amyloidosis.
Mediastinal carcinoid tumour with unusual manifestations
Authors: Aggarwal P , Sharma S K , Chattopadhyay T K , Mukhopadhyay A K
Published: December 2008

A rare case of mediastinal carcinoid tumour with superior vena cava obstruction, and osteolytic as well as osteoblastic secondaries in the bones is described. The relevant literature is reviewed.
Use of somatostatin in the management of pancreatic haemobilia
Authors: Tobin M V , Jenkins S A , Gosney J R , Gilmore I T
Published: December 2008

An elderly man, not previously known to have chronic pancreatitis, presented with haematemesis and melaena which was endoscopically diagnosed as haemobilia. Retrograde cholangiopancreatography showed blood clot in both the common bile duct and the pancreatic duct and the computed tomographic scan appearances were those of gross calcific chronic pancreatitis. Despite active bleeding, it was not possible to demonstrate its source at angiography, thus precluding therapeutic embolization. Thirty six hours after commencing an infusion of somatostatin, repeat endoscopy showed no evidence of active or recent bleeding. The infusion was continued for 5 days during which time he had no further bleeding.
Gentamicin-resistant enterococci and endocarditis
Authors: Holliman R , Smyth E
Published: December 2008

We report a case of endocarditis associated with a highly gentamicin-resistant enterococcus that failed to respond to conventional antibiotic combination therapy. Clinical resolution was achieved following cardiac surgery and antimicrobial treatment dictated by in vitro testing of the patient’s organism. Laboratories should test blood culture isolates of enterococci for high level gentamicin resistance. Management of such cases requires individual assessment and extensive laboratory investigation.
Massive prolactinoma with galactorrhoea in a prepubertal boy
Authors: Ross R J M , McEniery J M , Grossman A , Doniach I , Besser G M , Savage M O
Published: December 2008

An 8 year old prepubertal boy presented with raised intracranial pressure, left proptosis and was noted to have galactorrhoea. Cranial computerized tomography revealed a large pituitary tumour infiltrating the cavernous sinus and left orbit. The serum prolactin was 180,600 mU/l (normal value less than 360 mU/l). Prolactinomas are rare in children and galactorrhoea has not previously been reported in a prepubertal child. The management of massive prolactinomas is difficult, but the child presented has made an impressive response to a combination of treatment with surgery, dopamine agonist therapy and radiotherapy.
Systemic Weber-Christian disease with reversible bilateral ureteric obstruction
Authors: Brawn L A , Ramsay L E , Shortland J R , Williams J L
Published: December 2008

It has been proposed that idiopathic retroperitoneal fibrosis may be a consequence of ‘healed’ retroperitoneal lesions of systemic Weber-Christian disease. However ureteric obstruction which is the hallmark of idiopathic retroperitoneal fibrosis, has not been described in systemic Weber-Christian disease. We report a patient with systemic Weber-Christian disease who, during a relapse, developed bilateral ureteric obstruction which resolved when the Weber-Christian disease remitted. The radiological appearances were consistent with a diagnosis of idiopathic retroperitoneal fibrosis, but the clinical course was slightly atypical in that the ureteric obstruction resolved completely and rapidly. Ureteric obstruction can complicate systemic Weber-Christian disease and this observation gives support to the hypothesis that idiopathic retroperitoneal fibrosis is related to systemic Weber-Christian disease.
Acute presentation of cystic fibrosis in an adult
Authors: Gardiner K R , Cranley B
Published: December 2008

The case history of a female patient presenting at the age of 25 with cystic fibrosis is described. Despite longstanding significant respiratory symptoms, she did not attend hospital until she was 23 and then failed to appear for further investigations and treatment.

At the age of 25, she was admitted with a severe lower respiratory tract infection and respiratory failure. Within 5 days, acute intestinal obstruction developed which was unresponsive to conservative therapy. At laparotomy the small bowel was obstructed just proximally to the ileocaecal valve by solid faecal material. Post-operatively, the diagnosis of cystic fibrosis was confirmed by quantitative pilocarpine iontophoresis tests.

The literature is reviewed regarding the adult presentations of cystic fibrosis and the recommended treatment for distal intestinal obstruction syndrome. The presence of adult cystic patients within the community is emphasized.
Mesenteric desmoid tumours in Gardner’s syndrome--review of medical treatments
Authors: Eagel B A , Zentler-Munro P , Smith I E
Published: December 2008

Gardner’s syndrome comprises a triad of polyposis coli, osteomata and soft tissue tumours including desmoid tumours which can often present difficult problems in management. We report a patient with Gardner’s syndrome treated with tamoxifen and medroxyprogesterone acetate. The literature on this rare syndrome and its management is reviewed.
Xanthogranulomatous cholecystitis associated with carcinoma of the gallbladder
Authors: Benbow E W
Published: December 2008

When the histological material from 35 examples of carcinoma of the gallbladder was reviewed, three specimens were found to show xanthogranulomatous cholecystitis as well as the tumour, suggesting that these two lesions are associated with each other. This is important because xanthogranulomatous cholecystitis can mimic carcinoma, and there is potential for diagnostic confusion.
Use of adrenal arterial embolization in severe ACTH-dependent Cushing’s syndrome
Authors: Blunt S B , Pirmohamed M , Chatterjee V K K , Burrin J M , Allison D J , Joplin G F
Published: December 2008

The management of a patient with severe Cushing’s syndrome due to ectopic ACTH produced by a medullary carcinoma of the thyroid is described. Initial treatment with maximal adrenolytic medical therapy and two attempts at bilateral adrenal venous infarction had failed to control the disease, and she was at that time unfit for surgery. Subsequent use of bilateral adrenal arterial embolization enabled medical therapy to produce sufficient control of the Cushing’s syndrome to allow bilateral adrenalectomy to be performed successfully, with resultant cure of the excessive cortisol production.
Myocardial abscess and sternal osteomyelitis following myocardial infarction and resuscitation
Authors: Smith R E A , Martin J E , Mills P G
Published: December 2008

A 58 year old man presented with an anterior myocardial infarction requiring repeated resuscitation. He had impaired glucose tolerance. He died five weeks later and post-mortem examination revealed a myocardial abscess and sternal osteomyelitis due to Staphylococcus aureus. These had not been apparent clinically. The possible aetiology and difficulties in diagnosis are discussed.
Carcinoid syndrome without liver metastasis
Authors: Hossain J , al-Mofleh I , Tandon R , Dhahada N M
Published: December 2008

The carcinoid syndrome generally occurs due to metastasis of a carcinoid tumour in the liver. A patient is presented who had carcinoid syndrome due to abdominal disease without hepatic metastasis.
Ilioinguinal nerve entrapment: a little-known cause of iliac fossa pain
Authors: Knockaert D C , D’Heygere F G , Bobbaers H J
Published: December 2008

The ilioinguinal nerve entrapment syndrome is an abdominal muscular pain syndrome, characterized by the clinical triad of muscular type iliac fossa pain with a characteristic radiation pattern, an altered sensory perception in the ilioinguinal nerve cutaneous innervation area, and a well-circumscribed trigger point medial and below the anterosuperior iliac spine. Relief of pain by infiltration of a local anaesthetic confirms the diagnosis.

This report describes retrospectively the clinical picture of ilioinguinal nerve entrapment in 32 mainly non-surgical patients. In 14 cases a definite diagnosis was established and in 18 patients the diagnosis was considered probable. The mean delay in diagnosis was 12.8 months. Better knowledge of this syndrome may avoid invasive investigations and be cost saving.
Alveolar proteinosis and nocardiosis: a patient treated by bronchopulmonary lavage
Authors: Pascual J , Gómez Aguinaga M A , Vidal R , Maudes A , Sureda A , Gómez Mampaso E , Fogué L
Published: December 2008

Alveolar proteinosis is a relatively rare disease of unclear pathogenesis associated with opportunistic-infections. Although nocardiosis is the most frequent one, only 22 cases have been reported previously and are reviewed here.

We present a patient with alveolar proteinosis with nocardiosis treated as an emergency with bilateral bronchopulmonary lavage and antibiotics. No previous cases of this association have been successfully managed in this way.
Pancreatic pseudocyst haemorrhage presenting as a bleeding duodenal ulcer
Authors: Muckart D J J , Bade P
Published: December 2008

We present a case of upper gastrointestinal haemorrhage where the preoperative endoscopic findings suggested a duodenal ulcer as the cause. Although at operation this proved to be the site of bleeding, the source was found to be the splenic artery in the base of a pancreatic pseudocyst.
Localized fibrous mesothelioma of the mediastinum devoid of pleural connections
Authors: Balassiano M , Reichert N , Rosenman Y , Hertcheg E , Lieberman Y , Yellin A
Published: December 2008

Localized fibrous mesothelioma of the pleura is an uncommon neoplasm. Very rarely (there have been three previous cases) it may occur as an isolated mediastinal tumour. Such a tumour was present for at least 3 years in a 47 year old man, causing shortness of breath and superior vena cava syndrome. A mass weighing over 600 g was completely resected through a median sternotomy. The pertinent literature is reviewed.
Duodenal pseudotumour: a silent impacted common bile duct calculus
Authors: Finch P J , Haddock J , Grundy A
Published: December 2008

We report the case of a man with mild dyspeptic symptoms referred for barium meal, who was initially thought to have a duodenal tumour. Subsequent investigation showed this to be a pseudotumour caused by impaction of a gallstone in the distal common bile duct, and endoscopic sphincterotomy effected a cure. This readily treatable condition should be remembered when filling defects are demonstrated in the duodenal loop.
Renal tubular function in hyperparathyroidism
Authors: van’t Hoff W , Bicknell E J
Published: December 2008

Renal tubular function was assessed in a group of patients with mild hyperparathyroidism before and after a mean period of 2.7 years conservative management. It was also assessed, before and after a mean of 3.3 years following surgery in a group of patients with initially higher plasma calcium concentration.

Mean maximum urine osmolality was within the accepted range as was the maximum urine plasma hydrogen ion gradient in both groups at the time of diagnosis.

No significant change in renal tubular function was observed in either group over the periods of this study. Although deterioration after a long period cannot be excluded, we do not consider that regular assessment of renal tubular function is necessary in the conservative management of primary hyperparathyroidism.
Pulmonary embolism--incidence and prognosis in hospitalized elderly
Authors: Mangion D M
Published: December 2008

In a retrospective study of 210 patients with pulmonary embolism diagnosed by ventilation perfusion lung scan or at post-mortem, the incidence of pulmonary embolism was greater in patients over 50 years old (1.4%; P less than 0.05). This was largely due to an increased prevalence of serious associated disease (53%; P less than 0.05).

Mortality in elderly patients (70 years and older) diagnosed by ventilation perfusion lung scan was similar to that in younger age groups (P greater than 0.05). However, the number of cases first diagnosed at post-mortem (44.50%; P less than 0.05) and total mortality (55%; P less than 0.05) were highest in this age group. Of elderly patients first diagnosed at post-mortem 14 (32%; P less than 0.05) had no other associated disease and had a recorded duration of symptoms sufficient to have allowed premortem diagnosis.
Comparison of chlortenoxicam and indomethacin on frusemide-induced diuresis
Authors: Hitoglou-Makedou A , Lawson M , Turner P , Ferber H P
Published: December 2008

A single oral dose of chlortenoxicam 4 mg, a new non-steroidal anti-inflammatory drug, significantly antagonized the diuretic and natriuretic actions of frusemide when compared with placebo in normal human volunteers. Indomethacin 50 mg significantly reduced the natriuretic, but not diuretic action of frusemide.
A thrilling case of hiatus hernia
Authors: Gleadle J , Dennis M
Published: December 2008

A 65 year old woman was found to have a left parasternal heave and a systolic murmur associated with a thrill. A chest radiograph, echocardiogram and gastrograffin swallow demonstrated a massive obstructed hiatus hernia which displaced the heart anteriorly. Aspiration of the contents of the hernia led to complete resolution of the physical signs. Possible mechanisms for their production are discussed.
The anti-phospholipid antibody syndrome in a 77 year old man with digital gangrene
Authors: Roche S W , Niriella D C , O’Mahoney A , Cayley A C D
Published: December 2008

A 77 year old man with digital gangrene of his left hand had anti-phospholipid antibodies, the lupus anticoagulant and antcardiolipin antibodies. This patient, as far as we are aware, is the first elderly person to present in such fashion with this uncommon syndrome.
Syndrome of downward gaze paralysis, amnesia and hypersomnolence
Authors: Nagaratnam N , Ghougassian D F , Mugridge V
Published: December 2008

A 60 year old woman with computed tomographic-verified bilateral thalamic infarction is described. She demonstrated downward gaze paralysis, amnesia and hypersomnolence. On the functional level such tasks as walking and eating were disconcerting. Although there have been only a few reports of the complete triad it may be more common than realized and represents a distinct syndrome that can be identified by the bedside.
Percutaneous transcolonic puncture of retained Foley balloon catheter
Authors: Lloyd S N , Godwin R J
Published: December 2008

A case of large bowel obstruction complicated by a retained intracolonic Foley balloon catheter is reported, and the minimally invasive technique for removal is described.
Danazol-induced hypercalcaemia in alphacalcidol-treated hypoparathyroidism
Authors: Hepburn N C , Abdul-Aziz L A S , Whiteoak R
Published: December 2008

We report a case of idiopathic hypoparathyroidism, maintained on alphacalcidol who developed hypercalcaemia during treatment with danazol for endometriosis.
Pulmonary infiltrates--diagnostic problems in lymphoma
Authors: Campbell J H , Raina V , Banham S W , Cunningham D , Soukop M
Published: December 2008

The use of invasive investigations in immunocompromised patients with pulmonary infiltrates is controversial. We report a series of 22 pulmonary lesions occurring in 19 patients with underlying Hodgkin’s (7) and non-Hodgkin’s (12) lymphoma in whom invasive investigations were performed. The principle techniques used were fibreoptic bronchoscopy, bronchoalveolar lavage and transbronchial lung biopsy. A specific diagnosis was made on 12 occasions (55%). Involvement of the lung with lymphoma (6) and cytotoxic drug induced pneumonitis (4) were the commonest diagnoses, infection being found on only one occasion. In 15 of these 22 procedures (68%) the information obtained made a positive contribution to patient management.
Acute polymyositis in an adult associated with Mycoplasma pneumoniae infection
Authors: Bennett M R , O'Connor H J , Neuberger J M , Elias E
Published: December 2008

A previously healthy adult developed a hitherto unreported major complication of Mycoplasma pneumoniae infection, namely acute polymyositis.
Metastatic non-seminomatous germ cell tumour and dermatomyositis
Authors: Barker R A , Currie D C , Horwich A , Spiro S G
Published: December 2008

Twenty to thirty percent of cases of dermatomyositis in adults are associated with malignancy. We report a case in which dermatomyositis heralded the development of a testicular germ cell tumour. Germ cell testicular tumours are treatable and our case emphasizes the importance of measuring blood levels of beta-human chorionic gonadotrophin and alpha-fetoprotein and examination of the testes in young males with indications of possible malignancy.
Spontaneous benign pneumoperitoneum complicating scleroderma in the absence of pneumatosis cystoides intestinalis
Authors: London N J M , Bailey R G , Hall A W
Published: December 2008

We describe a 64 year old woman with a 3-year history of scleroderma who presented as an emergency with increasing painless abdominal distention. Radiological investigations revealed a pneumoperitoneum in the absence of either visceral perforation or pneumatosis cystoides intestinalis. This is only the fourth report of spontaneous benign pneumoperitoneum complicating scleroderma without pneumatosis cystoides intestinalis. The possible aetiology of this condition is discussed.
Survival after ultrasonographic demonstration of portal venous gas due to mesenteric artery occlusion
Authors: Bloom R A , Lebensart P D , Levy P , Craciun E , Anner H , Manny J
Published: December 2008

Portal vein gas as a result of bowel necrosis following occlusion of the superior mesenteric artery has an extremely grave prognosis. Only two previous cases have been recorded as having survived. In both those cases the diagnosis of portal vein gas was made on an abdominal radiograph. The present report is of the first such case surviving after ultrasonic demonstration of portal gas. In this case, no evidence of portal gas was seen on the abdominal radiograph. The increased sensitivity of ultrasound over plain radiography mandates urgent liver and portal ultrasound in all cases of suspected mesenteric event.
Neurosarcoidosis: therapeutic success with methotrexate
Authors: Soriano F G , Caramelli P , Nitrini R , Rocha A S
Published: December 2008

Sarcoidosis affects the nervous system in 5% of cases. Treatment with corticosteroids is usually effective. We describe the case of a patient with neurosarcoidosis in which therapy with prednisone failed whereas the result of methotrexate administration was satisfactory.
A study of serum zinc, albumin, alpha-2-macroglobulin and transferrin levels in acute and long stay elderly hospital patients
Authors: Craig G M , Evans S J , Brayshaw B J , Raina S K
Published: December 2008

Serum zinc levels measured by atomic absorption spectrophotometry were found to be low (less than 10.5 mumols/l) in 38% of acute geriatric admissions, 69% of long stay geriatric patients and 19% of a control group of elderly hospital patients with a normal serum albumin.

There was a significant positive correlation between serum zinc and serum albumin in all groups. In acutely ill geriatric patients only, there was a weak but statistically significant positive correlation between serum zinc and alpha-2-macroglobulin (A2M) (r = 0.20), P < 0.05).

Serum transferrin was low in 46% of acute geriatric patients and 22% of long stay geriatric patients but there was no correlation between serum zinc and serum transferrin levels in any patient group. There were significant differences in serum zinc, A2M and transferrin levels between the acute and long stay geriatric patients. The differences in serum zinc levels between these patients groups could not be explained by changes in serum A2M, transferrin or albumin. Changes mediated by an acute phase response may have influenced results in the acute geriatric group of patients.
Accidental self administration of xylazine in a veterinary nurse
Authors: Samanta A , Roffe C , Woods K L
Published: December 2008

A 19 year old male veterinary nurse accidentally injected himself with 200 mg of xylazine (a muscle relaxant and sedative used in veterinary practice). He subsequently became comatose, hypotensive, bradycardic and acidotic. He required intensive supportive therapy, and made a full recovery over the next few hours.

Xylazine toxicity in humans is very rare, and the effects are discussed.
Clinical presentation and investigation of patients proceeding to isotope lung scanning for suspected pulmonary embolism
Authors: Fennerty A G , Shetty H G M , Paton D , Roberts G , Routledge P A , Campbell I A
Published: December 2008

The presenting features of 250 consecutive patients who underwent a ventilation/perfusion lung scan for suspected pulmonary embolus (PE) were analysed. Ninety-six patients had lung scans highly suggestive of PE, with one or more unmatched segmental perfusion defects (scan positive), 86 had low probability scans (scan negative) and 68 an indeterminate scan.

Scan positive patients were more likely to have a PaO2 of less than 10.7 kPa, an elevated P(A-a)O2 and an abnormal chest X-ray compared with scan negative patients but these measurements were of poor specificity. Furthermore, scan-positive patients had a higher incidence of lung disease. Localized chest wall tenderness was more common in scan-positive patients, occurring in 9% of patients, but there were no other significant differences in individual symptoms, signs or electrocardiographic findings between scan-positive and scan-negative patients.

The diagnosis of PE should not be made on clinical grounds alone and all patients suspected of having a PE should at least undergo isotope lung scanning.
Leaking thoraco-abdominal aortic aneurysm presenting with a massive left haemothorax: a clinical trap
Authors: Huddy S P J , Joyce W P , Pepper J R
Published: December 2008

A case is described in which a patient, who had had an aortic aneurysm repair 10 years previously, presented with a thoraco-abdominal aortic aneurysm which ruptured immediately above the previous graft. The implications for the management of patients with an abdominal aortic aneurysm repair are discussed.
Irradiation-induced penile angiosarcoma
Authors: Prescott R J , Mainwaring A R
Published: December 2008

We report a case of angiosarcoma of the glans penis in a 77 year old male Caucasian. The tumour developed 18 years after a course of radiotherapy for a penile ulcer which was an intra-epidermal squamous carcinoma. The differential diagnosis and the concept of radiotherapy-induced angiosarcomas are discussed.
A controlled trial of a low sodium, low fat, high fibre diet in treated hypertensive patients: the efficacy of multiple dietary intervention
Authors: Little P , Girling G , Hasler A , Trafford A , Craven A
Published: December 2008

An 8-week combination low sodium, low fat, high fibre diet was compared to the individual components of this diet in a controlled trial using 193 patients already on treatment for essential hypertension. No significant changes were observed in the high fibre group. The low sodium group showed a decrease in systolic blood pressure which was close to significance. The low fat group showed a small but significant decrease in seated diastolic blood pressure and weight. The combination group showed larger and highly significant decreases in seated and standing systolic blood pressures, seated diastolic blood pressure and weight, as well as a significant reduction in standing diastolic blood pressure.

We conclude that multiple dietary intervention in this case in the form of a low sodium, low fat, high fibre diet, is more effective than any single dietary intervention and is useful in patients already on medication.
Failure of thiazide diuretics to increase plasma calcium in mild primary hyperparathyroidism
Authors: Farquhar C W , Spathis G S , Barron J L , Levin G E
Published: December 2008

Thirteen patients with mild primary hyperparathyroidism who were taking thiazide diuretics intermittently for periods of up to 18 months were followed up for a mean of 5.3 years. No significant difference was found in either plasma total calcium corrected for albumin or whole blood ionized calcium in these patients between the periods on or off thiazides.

We conclude that thiazide diuretics are not contraindicated in such patients.
Relationship of urinary pH to symptoms of ‘cystitis’
Authors: Brumfitt W , Hamilton-Miller J M T , Cooper J , Raeburn A
Published: December 2008

The pH of urine samples from patients suffering symptoms suggesting urinary infection (e.g. dysuria, frequency, urgency) was measured while the patients were symptomatic and again when they had become asymptomatic. There was no correlation between the urine pH and the incidence or number of symptoms. No differences were observed between either the distribution or means of urine pH values in symptomatic and asymptomatic patients. There were also no significant differences in either symptomatology or urine pH between patients with significant bacteriuria and those without significant bacteriuria. These results cast doubt upon the traditional (but unproved) belief that alkalinizing the urine helps to reduce symptoms of dysuria and/or frequency, whether or not associated with urinary infection.
Clinical hyperthyroidism due to non-neoplastic inappropriate thyrotrophin secretion
Authors: Chan A W , MacFarlane I A , van Heyningen C , Foy P M
Published: December 2008

We report a case of hyperthyroidism due to inappropriate thyrotrophin (TSH) secretion in a patient with selective pituitary resistance to thyroid hormone action. Symptoms of hyperthyroidism in patients with this disorder are usually mild, implying some peripheral tissue resistance to the metabolic effects of thyroid hormone. Our patient had unusually severe symptoms, including marked weight loss and cardiac arrythmias which required carbimazole and beta-blocker therapy for control. Somatostatin was ineffective in suppressing TSH secretion. The introduction of sensitive thyrotrophin assays should facilitate the accurate diagnosis of TSH-induced hyperthyroidism and avoid inappropriate treatment.
Psoas abscess as a complication of subclavian venous catheterization
Authors: Kwok T , Coles J
Published: December 2008

A 76 year old woman developed a psoas abscess from vascular seeding of an infected subclavian venous catheter. The presentation was insidious and diagnosis delayed. Despite adequate surgical drainage, the case proved to be fatal. Venous catheters should be regarded as a potential source of septicaemia and occult abscess formation.
Torsion of an accessory spleen in an elderly patient
Authors: Hems T E J , Bellringer J F
Published: December 2008

Torsion of an accessory spleen is recognized as a rare cause of acute abdominal pain in childhood. A case is reported which, however, is unusual in that it occurred in a patient of 75, who had had no previous symptoms which might have suggested the presence of an accessory spleen.
Spontaneous pyelo-jejunal fistula
Authors: Evans P F
Published: December 2008

This case report describes a patient with a spontaneous jejunal fistula. This is a rare type of nephro-intestinal fistula with only two previously recorded similar cases.

Our patient presented with such a fistula diagnosed by antegrade pyelography, associated with a staghorn calculus and proven at surgery. The value of antegrade pyelography is discussed along with the treatment options and the outcome to be expected in such patients.
Aperistaltic oesophageal disorders unmasked by severe post-fundoplication dysphagia
Authors: O'Brien C J , Collins J S A , Collins B J , McGuigan J
Published: December 2008

Two patients were referred because of persistent dysphagia which developed for the first time after Nissen fundoplication. Investigations, including oesophageal manometry, demonstrated the presence of achalasia in one case, confirmed histologically, and aperistaltic oesophagus associated with an underlying connective tissue disorder in the other case. Our observations highlight the importance of assessing oesophageal motility before referring patients for anti-reflux surgery and illustrate the effect of such surgery on patients in whom oesophageal dysmotility was not suspected.
Infective arthritis secondary to bladder outflow obstruction
Authors: Ubhi S S , Cooke T J C
Published: December 2008

We describe two cases of septic arthritis occurring in association with lower urinary tract infection in elderly men. In both cases the organism isolated from both the joint and the urine was Staphylococcus aureus. Further investigation of the urinary tract in both individuals identified bladder outflow obstruction secondary to benign prostatic hyperplasia predisposing them to infection.

The urinary tract should be suspected as a focus of infection in septic arthritis in elderly men and further investigation of the urinary system may disclose a surgically correctable lesion.
The accuracy of creatinine clearance with and without urine collection as a measure of glomerular filtration rate
Authors: Waller D G , Fleming J S , Ramsey B , Gray J
Published: December 2008

Conventional creatinine clearances involving urine collections over 2, 4 and 24 hours and creatinine clearance predicted from plasma creatinine concentrations without urine collection were compared to glomerular filtration rate (GFR) estimated by 99mTc DTPA clearance in 171 patients with a wide range of GFR.

All creatinine clearance methods involving urine collection had standard errors of the estimate of GFR greater than predictions from formulae.

Predictions of creatinine clearance by formulae had coefficients of variation of the estimate of approximately 23% when compared to isotopically determined GFR.

Creatinine clearances determined by these equations in patients with stable renal function are an easier and at least as accurate a guide to GFR as methods involving urine collection.
A study of admissions to paediatric beds
Authors: Rajaratnam G
Published: December 2008

The reasons for admission of children to paediatric beds and the appropriateness of those admissions were investigated by a retrospective study of admission notes by two paediatricians. Approximately 3% and 9% of the admissions according to assessor, were for purely social reasons and the remainder for predominantly medical reasons. There were a number of admissions for whom the assessors were unable to justify admission. Assessor 1 considered that 20% and assessor 2 15%, of those studied could have been managed without admission. Agreement over individual cases between assessors was poor but significant. The assessors agreed that admission was appropriate in 74% and inappropriate in 8% of cases. In the remaining 18 cases, the assessors did not agree on the need for admission. It is suggested that there is a need for local specialty specific admission policies to ensure cost-effective use of facilities.
Acute myocardial infarction with normal coronary arteries in a case of polyarteritis nodosa: possible role of coronary artery spasm
Authors: Rajani R M , Dalvi B V , D'Silva S A , Lokhandwala Y Y , Kale P A
Published: December 2008

A 20 year old man with no previous history of heart disease presented with acute left ventricular failure following extensive anterior wall myocardial infarction. Selective angiography revealed multiple aneurysms in the renal, mesenteric and hepatic arteries with an infarct in the lower pole of the right kidney. These findings, along with the presence of circulating hepatitis B surface antigen favoured the diagnosis of polyarteritis nodosa. In view of normal coronary angiogram and absence of myocardial vasculitis, coronary vasospasm was implicated as the cause of myocardial infarction. Such an occurrence, which could have different therapeutic and diagnostic implications, has not, to our knowledge, been previously described in polyarteritis nodosa.
Unstable anginal syndrome and pulmonary oedema due to thyrotoxicosis
Authors: Glikson M , Freimark D , Leor R , Shechter M , Kaplinsky E , Rabinowitz B
Published: December 2008

We report on a 40 year old woman who presented with typical unstable angina pectoris associated with pulmonary oedema, due to poorly controlled hyperthyroidism. No cardiac abnormality was detected by echo-Doppler and nuclear ventriculography. Coronary angiography demonstrated normal coronary arteries. This case represents a new manifestation of the known association of cardiac ischaemia with hyperthyroidism in the presence of normal coronary arteries.
Squamous cell carcinoma arising in a subcutaneous dermoid cyst
Authors: Stephenson G C , Ironside J W
Published: December 2008

A case of malignant transformation to a squamous cell carcinoma in a long-standing subcutaneous dermoid cyst in a 44 year old man is presented. Malignant transformation in dermoid cysts is extremely uncommon and has never previously been recorded at this site. The need for adequate investigation and treatment of superficial midline lesions presenting in childhood is emphasized.