bluuebunny/crossref_metadata_2025 huggingface dataset:
Angioimmunoblastic lymphadenopathy, sulphasalazine exposure and villous atrophy
Authors: Smith M A , Steele P R , Youngs G R
Published: December 2008

A woman with inflammatory lesions in the terminal ileum was treated with sulphasalazine. Nine months later she developed angioimmunoblastic lymphadenopathy and was found to have intestinal villous atrophy. Her systemic illness partially responded to oral steroids but a gluten free diet restored clinical and biochemical well being coincident with a return of her villous pattern.
Tuberculosis of the thyroid gland associated with thyrotoxicosis
Authors: Kapoor V K , Subramani K , Das S K , Mukhopadhyay A K , Chattopadhyay T K
Published: December 2008

Tuberculosis of the thyroid gland is rare. A case of tuberculosis of the thyroid gland associated with thyrotoxicosis is reported.
Endomyocardial complications of the Churg-Strauss syndrome
Authors: Lanham J G , Cooke S , Davies J , Hughes G R V
Published: December 2008

Although many similarities exist between the Churg-Strauss syndrome and the hypereosinophilic syndrome, these two disorders have hitherto been characterized by different types of cardiac disease. Two cases of the Churg-Strauss syndrome are described where the typical endomyocardial lesion of the hypereosinophilic syndrome dominated the clinical picture.
Primary hepatocellular carcinoma associated with Wilson's disease in a young woman
Authors: Guan R , Oon C J , Wong P K , Foong W C , Wee A
Published: December 2008

A 27 year old woman with hepato-lenticular degeneration (Wilson's disease) was found to have primary hepatocellular carcinoma (PHC) three and a half years after she was started on treatment with D-penicillamine. The tumour was resected since when she has remained well. Her liver function tests were normal throughout the course of her disease. The available literature is reviewed and possible mechanisms for this association proposed.
Hypereosinophilic syndrome presenting as peripheral neuropathy
Authors: Bell D , Mackay I G , Pentland B
Published: December 2008

An unusual case of hypereosinophilic syndrome is described which presented with peripheral neuropathy with no evidence of cardiac involvement. The response to steroid therapy is documented and the literature on peripheral neuropathy in hypereosinophilic syndrome is reviewed.
Adrenal insufficiency and bilateral adrenal enlargement: demonstration by computed tomography
Authors: Wheatley T , Gallagher S , Dixon A K
Published: December 2008

A patient presented with fever, malaise and a staphylococcal wound infection occurring 3 weeks after severe haemorrhage from a lacerated brachial artery. There were no clinical features to suggest Addison's disease but abdominal computed tomography to exclude abdominal sepsis showed bilateral adrenal gland enlargement with preservation of adrenal shape. This was consistent with resolving adrenal haemorrhage or infarction and endocrinological investigations confirmed primary adrenal failure.
Evaluation of the efficacy of flecainide acetate in the treatment of ventricular premature contractions
Authors: Muhiddin K A , Turner P , Hellestrand K , Camm A J
Published: December 2008

The efficacy of flecainide acetate in suppressing ventricular premature contractions in 14 patients was evaluated in a double-blind, cross-over, placebo controlled, randomized and balanced study. Each treatment period was 2 weeks followed by a 3–4 d placebo washout period and the study lasted 5 weeks. Flecainide was given in a dose of 200 mg twice daily.

A significant reduction in the total number of QRS complexes in a 24 h period was observed during the active compared with placebo treatment (P<0.05). In comparison with placebo, flecainide reduced the number of aberrant and premature aberrant QRS complexes (P<0.01). The mean suppression rate of aberrant QRS complexes during flecainide treatment was 85.4% and that of premature aberrant complexes was 93.2%. Maximum heart rate measured by 24 h ECG decreased significantly during flecainide therapy (P<0.01), although no change occurred with resting heart rate measured clinically or by ECG. Severe dizziness associated with flecainide therapy necessitated withdrawal of 2 patients from the study. A proarrhythmic effect of flecainide, ventricular tachycardia, was observed in one patient.
La toux diabolique: neurogenic tussive crisis
Authors: Jacome D E
Published: December 2008

A 52 year old female non-smoker with multiple sclerosis had a 10 year history of frequent diurnal and nocturnal spontaneous attacks of coughing, relapsing and remitting, with typical symptoms of her illness. Otolaryngeal evaluations failed to show any lesions or vocal cord paresis, and her cardiopulmonary examinations were normal. Her attacks were greatly improved by carbamazepine and valproate sodium. I suggest that tussive crisis constitutes a paroxysmal symptom in multiple sclerosis, amenable to treatment with anticonvulsant agents.
Retinal artery occlusion in migraine
Authors: Gray J A , Carroll J D
Published: December 2008

Retinal artery occlusion is a rare complication of migraine. The following case report highlights the importance of early diagnosis in this condition. The long term management of patients with this and other forms of complicated migraine is discussed.
Haemorrhage through the ampulla of Vater
Authors: Ribbans W J , Pounder R E , Lindsay I
Published: December 2008

A patient with chronic pancreatitis presented with a series of massive upper gastrointestinal haemorrhages due to bleeding into the pancreatic duct. This report emphasizes the value of intensive investigation before surgery, since it may be impossible to identify the site of bleeding at laparotomy.
Reversible coma in Wernicke's encephalopathy
Authors: Gibb W R G , Gorsuch A N , Lees A J , Yudkin J S
Published: December 2008

A case of coma due to Wernicke's encephalopathy complicated by respiratory failure is described. Ventilation and thiamine administration lead to recovery, although Korsakoff's psychosis and ataxia persisted. A review of similar cases of coma emphasizes the absence of diagnostic features, but that if structural disease is excluded the presence of pupillary and ocular signs may support a diagnosis of Wernicke's encephalopathy. The response to thiamine may be diagnostic as in 8 of these patients who received it, but the long-term morbidity remains high.
Acromegaly presenting as subarachnoid haemorrhage in a 76 year old woman
Authors: Beard K , Macdougall I C , Behan W M H
Published: December 2008

Acromegaly usually presents in middle age with the gradual onset of classical signs and symptoms. We report the case of an elderly woman who presented with subarachnoid haemorrhage due to infarction of a pituitary adenoma and rupture into the subarachnoid space.
Primary allergy to monocomponent porcine insulin
Authors: Yap P K
Published: December 2008

An allergic reaction, occurring in a patient who has been put on monocomponent insulin for the first time, is extremely rare. A case of primary allergy to monocomponent porcine insulin, and its subsequent management, is described here.
Congenital hepatic fibrosis and adult-type autosomal dominant polycystic kidney disease in a child
Authors: Lee F I , Paes A R
Published: December 2008

This reports a family with congenital hepatic fibrosis and adult polycystic kidney disease. Adult polycystic kidney disease was present in three generations. In addition, congenital hepatic fibrosis occurred in two members of the third generation. These conditions are generally held to have different modes of inheritance and the significance of their occurrence together is not clear.
Benign gastric ulceration in a health district: incidence and presentation
Authors: Glynn M J , Kane S P
Published: December 2008

In a survey of benign gastric ulceration conducted in the Hounslow Health District from 1981 to 1982, there was an annual incidence for this condition of 43.6 per 100,000 of the population older than 14 y, with a male:female ratio of 0.9:1. This incidence is comparable to that found in other surveys over the last 30 y, but the male:female ratio is lower than in the past. This reduction is accounted for by a rise in the peak age incidence for gastric ulcer, particularly in women, and a greater proportion of the total population in this higher age group being women. In spite of a large local Asian population, no gastric ulcers occurred in this ethnic group. Thirty-eight per cent of the patients presented with acute bleeding, and 44% of these bleeders gave a history of previous ingestion of non-steroidal anti-inflammatory drugs compared with only 14% of the non-bleeding group (P less than 0.015).
Clinical diagnosis: a post-mortem assessment of accuracy in the 1980s
Authors: Mercer J , Talbot I C
Published: December 2008

The clinical diagnoses of a series of 400 patients dying in hospital were compared with the pathological findings at autopsy. The clinical diagnoses were precisely confirmed in only 46.75% of cases (average age 65.3 y). Potentially treatable disease was missed in 13% of patients (average age 72.7 y). The most frequent errors, both of under-diagnosis and over-diagnosis, were for pulmonary embolus, pneumonia and myocardial infarction. Over-diagnosis increased with length of hospital stay. Peritonitis and other deep-seated sepsis were surprisingly frequently missed in life. The findings closely parallel those from other units both in Britain and overseas, and suggest that there is currently a high diagnostic error rate, which varies remarkably little from one institution to another.
Diaphragmatic myasthenia in mother and child
Authors: Mier A K , Havard C W H
Published: December 2008

A 28 year old patient with ocular myasthenia for 2 y gave birth to a baby with diaphragmatic weakness. Following delivery the mother developed severe weakness of the diaphragm and required assisted ventilation. The baby recovered spontaneously and the mother responded to treatment with plasma exchange and immunosuppression. Neither mother nor baby responded to anticholinergic drugs and in neither serum were acetyl choline receptor antibodies detected.
Live abdominal pregnancy presenting as massive rectal bleeding
Authors: Bornman P C , Collins J S , Abrahamson M J , Gilinsky N H
Published: December 2008

A case of massive rectal bleeding resulting from the placental attachment of an abdominal pregnancy to the sigmoid colon is reported. Both mother and infant survived this rare complication which should be considered when abdominal colic and major gastrointestinal haemorrhage occur in a pregnant patient.
Carbamazepine substitution in severe partial epilepsy: implication of autoinduction of metabolism
Authors: Macphee G J A , Brodie M J
Published: December 2008

Established partial seizures are often refractory to treatment and many patients receive polypharmacy. An attempt was made to improve seizure control with the substitution of carbamazepine (CBZ) for existing treatment in 7 consecutive unremitting cases of partial epilepsy referred by their physicians as ‘intractable’. This produced a significant improvement in control of partial (P < 0.02) and secondary generalized (P < 0.01) seizures, with 5 patients experiencing a 50% or greater reduction in seizure frequency. A single patient suffered a generalized seizure during the period of changeover. In 3 cases auto-induction of CBZ metabolism resulted in temporary loss of seizure control which was restored by an increase in dose. A policy of planned substitution of CBZ in partial epilepsy previously regarded as intractable may be successful in selected patients. The possible deleterious effect of CBZ auto-induction should be anticipated.
Prolactinoma during pregnancy causing compression symptoms responding to bromocriptine therapy
Authors: Saunders N J
Published: December 2008

A woman with pituitary macroadenoma causing pressure symptoms and a partial right third cranial nerve palsy during pregnancy is described. Complete resolution occurred using oral bromocriptine therapy alone and the remainder of the pregnancy was uneventful.
Primary hepatic pregnancy
Authors: Shukla V K , Pandey S , Pandey L K , Roy S K , Vaidya M P
Published: December 2008

A case of a 28 weeks primary hepatic pregnancy in a 25 year old female is reported. A live male fetus weighing 1300 g was delivered after laparotomy and the placenta was left intact. The uterus was of 8 weeks size with patent tubes. The patient made an uneventful recovery.
Metastatic choriocarcinoma coexisting with full term viable pregnancy
Authors: Kulkarni R , Lister U G
Published: December 2008

A case of choriocarcinomatous lung secondaries coexisting with a full term pregnancy is reported. Both mother and child are alive and well without evidence of the disease 3 years after delivery.
Appendix sepsis tracking along the lateral cutaneous nerve of the thigh
Authors: Gatt D
Published: December 2008

A patient presented with tracking of pus from a chronic appendiceal abscess along the lateral cutaneous nerve of the thigh. In the absence of such a tunnel, which is only present in a small proportion of individuals, the infection would have resulted in a subinguinal psoas abscess. Although pus may conceivably extend in any direction, the reason for this unusual complication remains poorly understood.
Acute viral hepatitis, intravascular haemolysis, severe hyperbilirubinaemia and renal failure in glucose-6-phosphate dehydrogenase deficient patients
Authors: Agarwal R K , Moudgil A , Kishore K , Srivastava R N , Tandon R K
Published: December 2008

Five patients with acute viral hepatitis developed severe intrasvascular haemolysis and unusually high levels of serum bilirubin (427 to 1368 mumol/l). All 5 had high fever, marked anaemia, reticulocytosis and neutrophilic leucocytosis. Three of them developed acute renal failure, which was of non-oliguric type in 2. The clinical course was protracted, but complete recovery occurred in 4 patients between 4 to 10 weeks. One patient with hepatic coma and oliguric renal failure died. Deficiency of the enzyme G-6-PD was confirmed in 4 cases. Massive haemolysis in the patients was probably induced by the administration of chloroquine and other drugs. Intravascular haemolysis should be suspected in patients with acute viral hepatitis, if they show unexplained anaemia and very high serum bilirubin levels, and measures to prevent renal failure should be instituted in such cases.
Abnormalities of thyroid function tests in hospital inpatients
Authors: Sheppard M C , Ramsden D B
Published: December 2008

Results of thyroid function tests were analysed in 199 clinically euthyroid inpatients with normal serum thyroid stimulating hormone values. Serum total triiodothyronine was < 1.25 nmol/l in 61.8% of samples, free triiodothyronine less than 3.9 pmol/l in 57.8%, total thyroxine less than 63 nmol/l in 21.1% and free thyroxine less than 9.5 pmol/l in 17.6%. In contrast, thyroxine binding globulin ratio was below normal (< 5) in only 5 samples. A significant positive correlation (P < 0.001) of serum free thyroxine with total thyroxine, thyroxine/thyroxine binding globulin ratio and free triiodothyronine was present as well as a significant negative correlation (P < 0.001) with serum thyroid stimulating hormone. There was no correlation of free thyroxine measurements with serum albumin or non-esterified fatty acid concentrations. Although serum free thyroxine is low in a number of patients with non-thyroidal illnesses, this does not appear to be due to a rise in non-esterified fatty acids or a fall in albumin as has been proposed. Serum thyroid stimulating hormone measurements are essential to confirm the diagnosis of hypothyroidism in such subjects.
Prognosis in hypertrophic cardiomyopathy with asymmetric septal hypertrophy
Authors: Wadehra Dwarka , Gunnar Rolf M , Scanlon Patrick J
Published: December 2008

Hypertrophic cardiomyopathy with asymmetric septal hypertrophy is not an uncommon disorder in the older adult population, and frequently masquerades as coronary artery disease. Most symptomatic patients with hypertrophic cardiomyopathy diagnosed as adults have a benign course with mild disability lasting for many years. Associated significant obstructive coronary artery disease was present in 22% of our patients and probably represents the cause of symptoms and, therefore, investigation in some of our patients rather than a high incidence of coronary disease in patients with asymmetric septal hypertrophy. Sudden death was not common in our patients (3.6%) and occurred at 11 years after diagnosis in a patient with associated coronary artery disease and 4 years after diagnostic study in a patient with uncomplicated hypertrophic cardiomyopathy.
Levodopa withdrawal syndrome identical to neuroleptic malignant syndrome
Authors: Gibb W R G , Griffith D N W
Published: December 2008

A 60 year old woman with idiopathic Parkinson's disease had been prescribed thioridazine for schizophrenia. Five months after this was stopped, Sinemet also considered of dubious therapeutic value, was withdrawn. One week later she developed features of the neuroleptic malignant syndrome (NMS) accompanied by myoglobinuric renal failure. Post-mortem examination confirmed Lewy body degeneration in the substantia nigra. It is proposed that NMS may be caused by levodopa withdrawal in Parkinson's disease, and that it is withdrawal of dopaminergic drive that causes the syndrome.
The prognostic value of blood glucose and glycosylated haemoglobin estimation in patients with stroke
Authors: Cox N H , Lorains J W
Published: December 2008

In a prospective study of 109 patients admitted to hospital with a provisional diagnosis of acute stroke, 87 were found to have acute hemiplegic stroke lasting more than 24 hours, and did not have any other co-existing life-threatening disorder. In 81 of these patients, blood glucose and glycosylated haemoglobin (HbA1) were measured at the time of admission. Thirteen of these 81 patients (16%) were hyperglycaemic—in 5 cases, normal HbA1 was found in conjunction with hyperglycaemia suggesting that this represented a ‘stress’ response. There was no significant difference in age or in blood glucose level between those who died as a result of stroke and those who survived. However, hyperglycaemia with normal HbA1 was demonstrated in 4 of 26 patients who died compared to only one of 55 survivors (P < 0.02), and all 3 patients with blood glucose greater than 10 mmol/l in conjunction with normal HbA1 died as a result of stroke. Biochemical evidence of ‘stress’ hyperglycaemia in patients with acute stroke suggests a poor prognosis.
Focal myositis and elevated creatine kinase levels in a patient with phaeochromocytoma
Authors: Bhatnagar D , Carey P , Pollard A
Published: December 2008

A case of phaeochromocytoma with marked transient elevation of creatine kinase levels is presented. No obvious cause for the elevation was found in life, but on autopsy a non-specific focal myositis was discovered. Possible reasons for the raised creatine kinase levels and focal myositis are discussed.
Sarcoidosis—a cause of steroid responsive total alopecia
Authors: Smith S R , Kendall M J , Kondratowicz G M
Published: December 2008

We present a case of sarcoidosis complicated by total alopecia and a myopathy occurring in a young West Indian woman. There was a very satisfactory response to oral steroids.
Short PR intervals and tachyarrhythmias in Fabry's disease
Authors: Efthimiou J , McLelland J , Betteridge D J
Published: December 2008

Two brothers with Fabry's disease presenting with palpitations were found to have intermittent supraventricular tachycardias. Their electrocardiograms, when symptom-free, revealed short PR intervals consistent with ventricular pre-excitation. Treatment of one of the brothers with verapamil resulted in improvement of the palpitations and reduction in frequency of the tachycardia. Recurrent supraventricular tachycardia associated with ventricular pre-excitation has not previously been described in Fabry's disease. Evidence suggests that this complication may be due to glycolipid deposition in the conducting system around the atrioventricular node.
Asymptomatic Graves' disease during lithium therapy
Authors: Thompson C J , Baylis P H
Published: December 2008

Lithium salts are widely recognized to cause biochemical hypothyroidism and have been used to treat thyrotoxicosis. We present a case of Graves' disease which developed during lithium therapy. The patient was asymptomatic until the lithium was discontinued; she subsequently developed florid symptoms of thyrotoxicosis.
Acute sulphasalazine hepatotoxicity
Authors: Jennings P E , Blandford R L , Rosenthal F D
Published: December 2008

We describe a case of severe sulphasalazine hepatotoxicity. The features described are those of an acute hypersensitivity reaction which responded to drug withdrawal alone as steroids were withheld. Supportive treatment only is recommended for this potentially fatal condition.
Ulcerative colitis and sarcoidosis
Authors: Barr G D , Shale D J , Jewell D P
Published: December 2008

Ulcerative colitis is not commonly associated with recognizable pulmonary disease and only four sporadic cases of sarcoidosis in association with ulcerative colitis have been previously reported. However, in a series of 680 patients with ulcerative colitis, pulmonary or extra-pulmonary sarcoidosis has at some stage been present in eight. These cases are reported in detail. The onset of either condition bore no relationship to the activity or the presence of recognized peripheral manifestations of the other, suggesting that the two diseases were independent. However, three of the patients had the HLA B8 DR3 phenotype which is a higher prevalence than seen in previous studies of either disease alone. Patients with ulcerative colitis who possess this HLA phenotype may possibly be more susceptible to developing sarcoidosis.
Malignant melanoma involving the small bowel
Authors: Wilson B G , Anderson J R
Published: December 2008

Small bowel is the commonest site of gastrointestinal metastases from cutaneous malignant melanoma. Five patients with malignant melanoma involving the small bowel are reported. One patient was operated on for suspected acute appendicitis, two patients for gastrointestinal bleeding and two patients for small bowel obstruction. Two patients remain well 4 and 5 years after surgery.
Paroxysmal atrial fibrillation associated with an attack of multiple sclerosis
Authors: Chagnac Y , Martinovits G , Tadmor R , Goldhammer Y
Published: December 2008

A young woman presented with an acute right pontine lesion and paroxysmal atrial fibrillation. The lesion was later proven by magnetic resonance imaging to be due to multiple sclerosis. To our knowledge, cardiac arrhythmias have not been previously described in this condition. Published support for this possible association is reviewed.
Hypercalcaemia in chronic lymphatic leukaemia
Authors: Macintyre E A
Published: December 2008

A 75 year old woman with a 13 year history of classical chronic lymphatic leukaemia (CLL) developed hypercalcaemia. Unlike previous reports, this was not associated with blastic transformation, hyperparathyroidism or features of multiple myeloma, but was due to classical CLL per se.
Survival after severe self poisoning with sodium valproate
Authors: Lakhani M , McMurdo M E T
Published: December 2008

A 48 year old patient deliberately poisoned herself with 25 g of sodium valproate and survived with supportive measures only. This case contradicts the experience of those who advocate aggressive management of such severe overdoses.
Chronic hypernatraemia and hypothermia following subarachnoid haemorrhage
Authors: Nussey S S , Ang V T Y , Jenkins J S
Published: December 2008

We describe a 30 year old man who developed chronic adipsic hypernatraemia and hypothermia following a subarachnoid haemorrhage from an anterior communicating artery aneurysm. Anterior pituitary function tests were normal. Hypothermia was demonstrated over 4 years with loss of the ability to control heat conservation despite body temperatures as low as 30°C. He failed to experience thirst despite plasma sodium concentrations of up to 187 nmol/l and plasma osmolalities of up to 397 mOsm/kg. The slope of the plasma vasopressin-plasma osmolality curve indicated loss of the osmoreceptor. There was an absent vasopressin response to insulin-induced hypoglycaemia but a normal response to apomorphine. The apomorphine-stimulated immunoreactive vasopressin was shown to behave identically to the synthetic peptide on HPLC and was bioactive.
Sick sinus syndrome aggravated by carbamazepine therapy for epilepsy
Authors: Hewetson K A , Ritch A E S , Watson R D S
Published: December 2008

A case of sick sinus syndrome aggravated by carbamazepine prescribed for epilepsy is described. A 70 year old woman with previously stable psychomotor epilepsy experienced syncope of increased frequency after her anticonvulsant was changed to carbamazepine. ECG monitoring confirmed a severe sick sinus syndrome which improved on carbamazepine withdrawal. Failure to distinguish carbamazepine-induced cardiac syncope from epileptic attacks may lead to an increase in dosage and aggravation of syncope.
Is inotropic therapy appropriate for patients with chronic congestive heart failure? Or is the digitalis leaf withering?
Authors: Uretsky B F
Published: December 2008

The appropriateness of inotropic therapy in chronic heart failure was examined by critically reviewing five assumptions upon which this form of therapy has been justified. Only the first, that cardiac performance can be acutely improved by inotropic therapy, has been empirically proven. That such acute improvement is sustained appears to be true with non-catecholamine agents whereas the chronic haemodynamic efficacy of oral catecholamines remains in doubt. That any inotropic agent can improve exercise tolerance, make the patient feel better, or effect a change without deleteriously affecting the myocyte is very much in doubt. Thus, although the prospect of using powerful inotropic therapy in the patient with heart failure is theoretically appealing, its utility remains to be proven.
The heart in Portuguese amyloidosis
Authors: de Freitas A F
Published: December 2008

A systematic investigation was performed in patients with familial amyloidotic polyneuropathy, Portuguese type (AFp) to assess the pattern and incidence of cardiac involvement. Of 327 patients investigated, ECG abnormalities were present in 285 (87.2%). Low voltage and QS pattern in V1, V2, V3 were found in 51.3% and 35.7% patients respectively. Conduction disturbances were present in 211 (64.5%). Sinus node disease, 1st degree and Wenckebach interventricular blocks were frequent. Complete atrioventricular block was observed in only 2 patients (0.6%). Left anterior hemi-block was present in 30.8%, left bundle branch block in 3.9%, left posterior hemi-block in 2.4% and right bundle branch block in 2.1%. Holter monitoring showed a much higher incidence of conduction disturbances, most of these occurring at night.

The mean values of septum and posterior wall thickness and mass evaluated by echocardiography in 72 patients were normal. The systolic and diastolic global and regional functions, determined in 12 patients, analysing the echo by a digitization computer technique, were normal. In 7% a trivial pericardial effusion was observed. In 16 patients with ECG changes and normal echocardiograms the technetium 99m pyrophosphate scanning was negative.

We conclude that the ECG is the most precise, sensitive and clinically useful method for detecting cardiac amyloidosis in patients with AFp. In spite of the rarity of congestive and restrictive patterns, the incidence and severity of conduction disturbances does not allow us to consider heart disease in AFp as a benign entity.
Meningism following Salmonella virchow food poisoning
Authors: Norris P G
Published: December 2008

Thirty six patients were admitted to hospital as a result of Salmonella virchow infection during an outbreak of food poisoning in Essex in 1984. Out of 12 patients with evidence of bloodstream invasion, one third presented primarily with meningism and attention is drawn to this unusual clinical picture.
Septicaemia and pleural effusion due to Plesiomonas shigelloides
Authors: Humphreys H , Keogh B , Keane C T
Published: December 2008

Plesiomonas shigelloides is a rare cause of invasive infection, most clinically significant isolates being from the gastrointestinal tract of animals and man. Recently it has been implicated as an increasing cause of opportunistic infections.

We report a case of P. shigelloides septicaemia and pleural effusion in a patient with pre-existing alcoholic liver disease. This case serves to illustrate the possible role of P. shigelloides as an opportunistic pathogen in a compromised host especially where there is co-existing liver disease.
Azathioprine shock
Authors: Rosenthal E
Published: December 2008

Azathioprine has been used as an immunosuppressant for over 20 years in cancer chemotherapy, organ transplantation and diseases with confirmed or suspected immune mechanisms. A hypersensitivity reaction manifesting as fever, rash, myalgia and a neutrophil leucocytosis occurring about 2 weeks after exposure is well documented and has been confirmed by challenge testing. Hypotensive reactions are less common but potentially fatal; a case is reported where repeat exposure resulted in profound circulatory collapse responding only to intervention with inotropic agents.
Hypoglycaemic coma associated with gastric carcinoma
Authors: Macdougall I C , Fleming S , Frier B M
Published: December 2008

Gastric carcinoma may rarely be the cause of tumour-associated hypoglycaemia. We report the case of an elderly woman who presented in hypoglycaemic coma, and who was found subsequently to have an adenocarcinoma of the stomach. Hypoglycaemia persisted despite prednisolone, diazoxide, and a high concentration dextrose infusion. The few published cases are reviewed in which an association was established between gastric carcinoma and hypoglycaemia, and the possible aetiology of the hypoglycaemia is discussed.
Evaluation of Type A personality
Authors: Kittel F , Kornitzer M , Dramaix M
Published: December 2008

When we look for the criteria for causation of Type A behaviour for coronary heart disease, we lack the reproducibility, the predictability to a certain extent, a pathogenic mechanism and an animal model, all four of the eight recognized criteria for causal inference. The debate therefore is still wide open.
Stress and heart disease: evidence of associations between unemployment and heart disease from the OPCS Longitudinal Study
Authors: Moser K A , Fox A J , Goldblatt P O , Jones D R
Published: December 2008

The OPCS Longitudinal Study has been used to study both overall and cause-specific mortality patterns in 1971–1981 among men and women directly or indirectly affected by unemployment in April 1971. Groups studied included men seeking work in 1971, the wives of men seeking work in 1971 and other women in the same households as a man seeking work in 1971. The findings of this project are summarized here and attention is focused on mortality from circulatory diseases, in particular ischaemic heart disease. The study provides evidence which could be seen as supporting hypotheses about relationships between stress and overall mortality, with a marked excess for suicides. The evidence with respect to ischaemic heart disease is positive but less convincing with excess mortality from this cause principally occurring among younger unemployed men and among the wives of men who were seeking work in 1971. Given the sharp contrasts in the pattern and levels of unemployment between 1971 and 1981 it is difficult to extrapolate from these findings to the present day.
The development of diabetes mellitus and chronic liver disease in long term chelated beta thalassaemic patients
Authors: De Sanctis V , D'Ascola G , Wonke B
Published: December 2008

We studied 29 patients with thalassaemia major who had received intensive chelation for between 6.2 and 8.8 years. All patients had normal oral glucose tolerance tests before subcutaneous chelation therapy was introduced and 22 of 29 patients had normal liver function tests. At the end of the period of study 12 patients still had normal oral glucose tolerance (7 with normal liver function tests and 5 with chronic active hepatitis). On the other hand, 11 patients had developed impaired glucose tolerance tests (3 patients had normal liver function tests, 5 with chronic active hepatitis and 3 with cirrhosis), and 6 patients had developed frank diabetes mellitus (one with chronic active hepatitis and 5 with cirrhosis). Patients with chronic active hepatitis showed 91% positivity for one or more hepatitis B markers whilst all patients with cirrhosis were positive. Ferritin levels before subcutaneous chelation in patients with normal oral glucose tolerance tests were lower than in those patients with abnormal oral glucose tolerance or diabetes (P < 0.05) but none had normal serum ferritin levels. In addition, a positive correlation was found between glucose area under the curve after chelation therapy and serum ferritin levels (r = 0.47, P < 0.01).

It is apparent that long term chelation therapy does not prevent the development of abnormal oral glucose tolerance in chronically transfused patients. More intensive chelation therapy is needed to prevent tissue damage. Chronic liver disease may have an important role to play in the deterioration of glucose tolerance.
Gonococcal tysonitis
Authors: Abdul Gaffoor P M
Published: December 2008

A case of gonococcal urethritis with bilateral tysonitis is discussed. The patient was treated successfully with oral tetracycline 500 mg 6 hourly for 10 days, with a complete resolution.
Obstruction of the third part of the duodenum in tuberculosis
Authors: Kriplani A K , Kumar S , Sharma L K
Published: December 2008

Extrinsic compression by tuberculous mesenteric nodes is the rarest form of duodenal obstruction and one such case is presented. Radiology is helpful in differentiating various duodenal lesions. Ideal surgical treatment is duodeno-jejunostomy but in some cases only gastroenterostomy is possible.
Group B streptococcal meningitis in a diabetic adult
Authors: Lakhani M , Smith E A H
Published: December 2008

A rare case of adult group B streptococcal meningitis is presented. The association with diabetes mellitus is emphasized and attention is drawn to microscopic and serological confusion that may arise in differentiating it from pneumococcal meningitis.
Dental infection as the cause of pyrexia of unknown origin—two case reports
Authors: Samra Y , Barak S , Shaked Y
Published: December 2008

Two cases of pyrexia of unknown origin are described in which no cause was found despite exhaustive inpatient investigation until occult dental infection was detected: extraction of the teeth involved was followed by resolution of the pyrexia. Dental infection should be considered as an unusual but eminently treatable cause of pyrexia of unknown origin.
Crohn's colitis and sarcoidosis
Authors: McCormick P A , O'Donoghue D P , FitzGerald M X
Published: December 2008

We report a patient with both sarcoidosis and Crohn's colitis, an association not previously documented. We review the literature and discuss the areas of overlap in these two conditions.
Granular cell tumour of the common bile duct
Authors: Cheslyn-Curtis S , Russell R C G , Rode J , Dhillon A P
Published: December 2008

Granular cell tumors are a rare cause of benign biliary stricture. A case is reported which is unusual in that the diagnosis was made before the onset of jaundice. We emphasize the importance of accurate histology of biliary strictures, to eliminate confusion between those of benign and malignant nature and to ensure that the appropriate management is undertaken. Immunohistochemical evidence for the neural origin of this rare tumour is presented.
Ileal stricturing after long-term indomethacin treatment
Authors: Saverymuttu S H , Thomas A , Grundy A , Maxwell J D
Published: December 2008

A patient on long-term indomethacin therapy developed intestinal obstruction due to ileal strictures. No other cause apart from indomethacin could be implicated in the pathogenesis of the stricture.
The sensation of facial swelling in temporal arteritis: a predictor for the development of visual disturbance
Authors: Friedman G , Friedman B
Published: December 2008

The sensation of facial swelling in temporal arteritis may be an important predictor of the development of visual disturbance. A clinical report of two patients who developed a sensation of puffiness of the face without altered facial appearance, as a presenting symptom of temporal arteritis with visual disturbance is presented. This symptom, though documented previously by us, has not been identified before as a predictor of visual disturbance.
Destructive bone lesions in primary amyloidosis
Authors: Kramer M R , van Dijk J M , Hadas I , Hershko C
Published: December 2008

We describe a patient with primary amyloidosis in whom multiple osteolytic lesions caused by amyloid bone tumours developed, and review the clinical features of the 18 cases with primary amyloidosis in whom destructive bone lesions have been reported. In contrast to amyloidosis associated with multiple myeloma, destructive lesions in the primary disease are mainly located to long bones; joint involvement is common, and radionuclide bone scan shows pronounced uptake of 99mTc-PP by the destructive bone lesions. Despite the superficial similarity between the destructive bone lesions associated with primary amyloidosis and multiple myeloma, distinction between these entities on clinical grounds is possible and may be easily confirmed by direct aspiration of the osteolytic infiltrates.
Multiple myelomatosis: an unusual cause of small bowel intussusception
Authors: Hill S A , Yudelman P L
Published: December 2008

A 55 year old woman with multiple myeloma presented with a pathological fracture of the right neck of femur. Following internal fixation, and during subsequent radiotherapy, she developed small bowel obstruction. Laparotomy revealed an intussusception about a small bowel myeloma deposit. This is a previously unreported cause of small bowel intussusception.
Heart failure in sinus rhythm as the sole manifestation of Graves' disease
Authors: O'Malley B P , Northover B J , Woods K L
Published: December 2008

A middle-aged man with Graves' disease presented with heart failure in sinus rhythm which preceded the more typical manifestations of the disease by some months. Once suspected, the diagnosis was supported by measurement of systolic time intervals, enabling the instigation of treatment in advance of biochemical confirmation.
Aluminium phosphide poisoning: a prospective study of 16 cases in one year
Authors: Chopra J S , Kalra O P , Malik V S , Sharma R , Chandna A
Published: December 2008

Sixteen patients suffering from aluminium phosphide poisoning were treated during the year from January 1985 to December 1985. These accounted for approximately half the total number of cases of acute poisoning. Profuse vomiting, pain in the upper abdomen and shock were the most common presenting features. Six patients succumbed to their illness. Analysis of various prognostic factors revealed that ingestion of ‘unexposed’ tablets of aluminium phosphide taken from a freshly opened bottle was associated with a greater risk of fatal outcome. Aluminium phosphide poisoning has become an important matter of public health in parts of India.
Urography prior to prostatectomy
Authors: Lucas M G , Bodley R N , Lindsell D R M , Fletcher E W L , Scott N P
Published: December 2008

As part of the pre-operative assessment for prostatectomy, the routine intravenous urogram continues to be requested by many practitioners.

One hundred and ten patients being considered for prostatectomy underwent, prospectively, intravenous urography and trans-abdominal ultrasound. This paper specifically examines the respective contribution to management of these investigations. In 34% of patients, management was influenced in some way. This could have been achieved by ultrasound and plain abdominal radiograph alone. Additional intravenous urography would not have affected the clinical management of any patient.
Transient atrial fibrillation in hypertensive patients with thiazide induced hypokalaemia
Authors: Emara M K , Saadet A M
Published: December 2008

During the previous 34 months, 3 hypertensive patients on long-term thiazide therapy were admitted to the medical department, Mubarak Hospital, Kuwait, with atrial fibrillation (AF) and hypokalaemia. They received potassium chloride by intravenous infusion, followed by oral therapy with reversion to sinus rhythm. There were no clinical, electrocardiographic, radiological, or echocardiographic signs of cardiac or pericardial disease, and the other usual cases of AF were also excluded. The contribution of thiazide-induced hypokalaemia to the occurrence of AF in our patients is discussed.
Intussusception in intestinal lymphoma: the role of colonoscopy
Authors: Goldin E , Libson E
Published: December 2008

Intussusception is a well known complication and sometimes the presenting symptom of intestinal lymphoma. The final diagnosis in most patients is made by surgery.

We report a 12 year old boy with intussusception in whom the diagnosis was established by colonoscopy and surgery was avoided.
Gastric cancer following highly selective vagotomy
Authors: Houghton P W J , Leaper D J
Published: December 2008

A case of gastric cancer occurring seven years after a highly selective vagotomy is described. This operation may not be the appropriate choice for the surgical treatment of gastric ulcers and H2 blockers should be used with caution in these patients.
Temporary sequential atrioventricular pacing in myocardial infarction
Authors: Sheron N , Clarke M
Published: December 2008

The loss of atrial contraction can seriously impair cardiac output when complete heart block follows myocardial infarction. We describe two cases in which temporary sequential atrioventricular pacing was lifesaving. The pacemaker used was a previously explanted internal pacemaker. By avoiding the need for an expensive dedicated temporary pacemaker this technique may be more widely applied.
Acute pancreatitis and non-Hodgkin’s lymphoma
Authors: Anderson J H , Morran C G , Anderson J R , Carter D C
Published: December 2008

We report two patients presenting with acute pancreatitis, the aetiology of which was subsequently proven to be non-Hodgkin’s lymphoma. Histological confirmation of tumour-associated pancreatitis is essential so that appropriate therapy can be planned.
Herpes zoster and its neurological complications
Authors: Chang C M , Woo E , Yu Y L , Huang C Y , Chin D
Published: December 2008

Ninety-three Chinese patients with cutaneous herpes zoster were seen during a 4-year period. Thoracic zoster occurred most commonly, followed by ophthalmic, cervical and lumbosacral zoster. Neurological complications were present in eleven patients (11.8%), the commonest being Ramsay-Hunt syndrome and segmental limb paresis. The clinical picture, pathogenesis, treatment and outcome of segmental limb paresis, myelitis and delayed contralateral hemiparesis following zoster ophthalmicus are discussed. Nine immunocompromised patients received intravenous adenine arabinoside (vidarabine) or acycloguanosine (acyclovir), and no cutaneous or visceral spread occurred in these patients.
Reduced plasma high-density lipoprotein and increased platelet activity in arterial versus venous blood
Authors: Aviram M , Viener A , Brook J G
Published: December 2008

Plasma lipid and lipoprotein pattern and platelet activity were studied in blood samples derived from veins and arteries of 10 healthy male subjects. A significant reduction in plasma high-density lipoprotein (HDL) cholesterol, triglyceride and protein levels, as well as in plasma apolipoprotein A-I, was found when lipoproteins were derived from arterial blood in comparison to venous blood. All other lipoproteins were not significantly changed. Platelet activity measured as plasma beta-thromboglobulin levels and as collagen-induced platelet aggregation and 14C-serotonin release in platelet-rich plasma was markedly elevated when platelets were derived from arterial blood. Since reduced plasma HDL concentration and platelet activation are known risk factors for atherosclerosis, our study may suggest a further explanation for the presence of atherosclerotic lesions in arteries but not in veins.
Testicular dysfunction in men with sickle cell disease
Authors: Osegbe D N , Akinyanju O O
Published: December 2008

In order to assess the role of the gonads and anterior pituitary gland in the production of poor quality semen of males with homozygous sickle cell disease (SCD) serum gonadotrophins, namely follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin and serum testosterone, were assayed radioimmunologically in 33 men with sickle cell disease and in 29 age-matched normal control subjects.

Our results show a significantly lower mean serum testosterone, a higher mean FSH and prolactin in SCD subjects than in normal controls. No single SCD subject had significantly low serum testosterone associated with low FSH, LH or prolactin.

The tendency for higher gonadotrophins associated with lower testosterone in subjects with SCD suggests that the hypothalamic/pituitary function in these patients is intact and that the primary fault leading to poor sperm production lies in the testes.
The origin of proteinuria at high altitude
Authors: Winterborn M H , Bradwell A R , Chesner I M , Jones G T
Published: December 2008

Urinary protein excretion was measured before and after the intravenous infusion of lysine in 14 normal subjects after 4-6 days’ acclimatization at 4846 m. Urinary albumin excretion before lysine was elevated in 11 subjects but alpha 1-microglobulin was detected in only four. After lysine a large increase in albumin excretion occurred in all subjects. Together with the absence of alpha 1-microglobulin before lysine this implies that increased glomerular capillary permeability is the major cause of proteinuria after acclimatization to high altitude. The estimated minimum glomerular fluid albumin concentration was increased two to three fold above the published values in normal controls.
Carcinoma of the colon presenting with dyspepsia
Authors: O’Reilly D , Long R G
Published: December 2008

Three patients with upper abdominal symptoms responding to anti-ulcer medication are reported who had negative upper gastrointestinal endoscopies. Subsequent barium enemas showed that each of the patients had either a carcinoma of the transverse colon or caecum. Investigation of the colon should be considered in all such cases.
Guillain-Barré neuropathy during treatment with captopril
Authors: Chakraborty T K , Ruddell W S
Published: December 2008

A patient is described who developed acute peripheral neuropathy of Guillain-Barré type occurring shortly after commencement of captopril for moderately severe hypertension and resolving after discontinuation of the drug.
Effect of prostaglandin E1 on deposition of autologous labelled platelets onto human atherosclerotic lesions in vivo
Authors: Sinzinger H , O’Grady J , Fitscha P
Published: December 2008

The effects of infusions of prostaglandin E1 (PGE1) on platelet deposition at atherosclerotic sites in vivo in man have been examined. Thirteen patients with atherosclerotic vascular disease received intravenous PGE1 25 mg/kg/min for 6 hours daily for 5 days. Prostaglandin E1 had no effect on platelet uptake at atherosclerotic sites but prolonged platelet half-life significantly (P less than 0.001).
Pure red cell hypoplasia secondary to isoniazid
Authors: Lewis C R , Manoharan A
Published: December 2008

We describe a 77 year old man who developed pure red cell aplasia while receiving antituberculous therapy including isoniazid. Prompt recovery occurred following cessation of isoniazid. In this paper we also review previously described case reports of isoniazid-induced pure red cell aplasia.