bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary insulin levels in health and disease—a concise review
Authors: Aun Frederico , Soeldner J Stuart , Meguid Michael M , Stolf Noedir A G
Published: December 2008

The kidneys are the most important extrahepatic site of insulin breakdown and play a significant role in regulating the systemic insulin level in normal subjects. In man, a renal arteriovenous insulin concentration difference of about 30% has been measured, and since ‘insulin clearance’ values are less than the glomerular filtration rates, insulin is probably removed from blood by a combination of filtration and tubular secretion. In normal subjects a constant fraction of circulating insulin is removed by the kidney. This fraction is independent of the arterial concentration but varies with creatinine clearance. Of the amount filtered, most is completely resorbed and degraded by the cells of the proximal convoluted tubules. These cells have a high insulinase content and recent evidence would point to the possible existence of a renal tubular transport mechanism for insulin. The amount of insulin excreted in the urine is small and does not exceed 2% of the filtered load. In diabetics the insulin requirements often decrease with progressive renal failure. Derangements in carbohydrate metabolism have been noted in patients with renal failure while ‘insulin clearance’ is elevated in uraemia, chronic and acute renal failure. In nephrotic syndrome there is no change in renal insulin excretion. In severe trauma, ‘insulin clearance’ is elevated in patients with normal renal function despite a relative hypoinsulinaemia for the prevailing degree of glycaemia.
The case of the illegitimate gene
Authors: Crane R J
Published: December 2008

Introduction

The purpose of this article is to show how it is possible to overcome, with perseverance, the rather disturbing prospect of tracing the natural family of an illegitimate patient who has been found to have a serious hereditary disease.
Spirillum endocarditis
Authors: McIntosh C S , Vickers P J , Isaacs A J
Published: December 2008

A case of Spirillum endocarditis causing severe aortic regurgitation in a 26-year-old man is reported. The infection responded to treatment with oxytetracycline followed by ampicillin, but the valvular damage led to progressive left ventricular failure. The valve was replaced with a fresh nutrient homograft and the patient made a good recovery. A normal aortic valve appeared to have been infected.
Pancreatitis, multiple infarcts and oral contraception
Authors: Foster M E , Powell D E B
Published: December 2008

The fact that oral contraceptives may predispose to thrombosis is not disputed, although its frequency is still debated. Any reliable assessment of the prevalence of this complication must in the main depend on careful statistical studies of well controlled groups, because the isolated case may well be coincidental when conditions such as coronary thrombosis, cerebral thrombosis, and pulmonary embolism are not extreme rarities in adult women. However, occasionally the clinical and pathological findings are so striking that they afford compelling evidence. The patient to be described presented with clinical features of pancreatitis that did not initially suggest an association with oral contraception. A hitherto undescribed state of multiple infarcts was found at post-mortem. This also illustrates the way in which the official figures for thrombotic complications can be underestimated.
Multiple carcinomas of the large and small bowel in childhood
Authors: Harvey David R , Paradinas Fernando J
Published: December 2008

A case is reported of multiple metachronous carcinomas of the small and large intestine in a child. The latter were associated with multiple adenomatous polyps in the colon. A desmoid tumour and multiple keloids developed in the laparotomy scars. The relationship of this case to Gardner’s syndrome and polyposis coli is discussed and the literature on intestinal carcinoma in childhood is briefly reviewed.
Objectivity and quantification in lung disease
Authors: Reid Lynne
Published: December 2008

Methods of counting and measurement are described which have added much to the understanding of normal lung structure and hence function; these have identified important features of disease previously unsuspected and have permitted experimental analysis of these changes.
Fetal maturity and morbidity as related to placental weight and secondary ossification
Authors: Pryse-Davies J
Published: December 2008

The problem of objectivity in histopathology is illustrated by an attempt to determine the normal range and significance of two observations, placental weight and secondary ossification, made in perinatal pathology. Neither offered a satisfactory estimation of fetal maturity. The placental weight provided little evidence of any primary placental dysfunction: the placenta was very small in association with only 50% of the very small infants and a very small placental fetal weight ratio was an infrequent finding of doubtful significance. A method of classifying relatively retarded and advanced secondary ossification was devised. Significant retardation was found in association with males, growth retardation, some malformations, and multiple births: significantly advanced ossification was found in anencephaly.
Peripheral gangrene in polycythaemia vera
Authors: Gétaz Paul , Jacobs Peter , Louw Jannie H
Published: December 2008

A case of peripheral vascular disease which became gangrenous and led to a diagnosis of polycythaemia vera is described. Chemotherapy has been successful and surgical intervention avoided. The authors stress the importance of full haematological examination of any patient presenting with peripheral digital gangrene.
Review of recent advances of lead in clinical research
Authors: Goldberg A
Published: December 2008

‘They were the respectable ones. Well, what did they get by their respectability? I’ll tell you. One of them worked in a white lead factory twelve hours a day for nine shillings a week until she died of lead poisoning. She only expected to get her hands a little paralysed; but she died. … That was worth being respectable for, wasn’t it? …’ (Mrs Warren’s Profession, George Bernard Shaw, 1902).
Lead and the mitochondrion
Authors: Moore Michael R
Published: December 2008

In studies on the distribution of lead in rats given drinking water containing lead acetate at concentrations: 0, 100, 500, 1000 and 5000 μgPb/l for one year, no change was observed in the organ distribution of lead, or in the subcellular distribution of lead in the organelles in the heart.

The mitochondrial enzyme, ferrochelatase, was significantly depressed in both the 500 and 1000 μg/l groups as was the cytoplasmic enzyme δ-aminolaevulinic acid dehydratase. These depressions of enzyme activity were associated with ultrastructural changes in the myocardium after six months, and were most pronounced in the mitochondria.
Current status of childhood lead poisoning
Authors: Barltrop Donald
Published: December 2008

Lead poisoning is now essentially a disease of childhood. It must be seen in both historical perspective and in the context of adult poisoning. Unlike the adult problem, childhood poisoning has been recognized comparatively recently, and apart from the isolated but massive exposures of entire populations in previous centuries, it is only during the last 30 years that it has been diagnosed with any frequency. Thus, at the beginning of this century there were about 1000 cases of adult poisoning from occupational sources alone each year with seventy deaths, whereas at the present time there are about seventy cases per annum reported and the last adult death was 18 years ago. Since lead poisoning is not a notifiable disease in childhood actual figures are difficult to obtain. However, in the United Kingdom it is thought that there are about 100 admissions of children to hospital each year with a diagnosis of lead poisoning and about two deaths per annum. There is every reason to suppose that these figures, which contrast markedly with those in the U.S.A., underestimate the true position. It is difficult to understand why this entirely preventable disease persists in childhood in 1974 when the adult form has virtually been eliminated. I propose therefore to consider the diagnostic problems involved and to examine the measures currently available for prevention, and to suggest improvements in our current approach.
Uptake of inhaled lead from motor exhaust
Authors: Chamberlain A C , Clough W S , Heard M J , Newton D , Stott A N B , Wells A C
Published: December 2008

To assess the contribution of lead in motor exhaust to the total uptake of lead it is necessary to know the amount deposited in the lungs, the uptake thence to blood and other tissues, and the rate of excretion from the body. There are reports of experiments in which volunteers have inhaled aerosols of lead oxide or sesquioxide (Kehoe, 1961; Hursh et al., 1969; Booker et al., 1969; Cole and Lynam, 1972) but the physical and chemical characteristics of the particles differed from those of the exhaust aerosol. Blood lead has also been measured in persons with varying degrees of exposure to exhaust lead (Azar, Snee and Habibi, 1972; Jones, Commins and Cernik, 1972) or industrial lead (Williams, King and Walford, 1969). By attaching a radioactive label (203Pb, radioactive half-life 52 hr) to tetraethyl lead (TEL) which is then mixed with petrol and burnt in an engine, we have made a realistic tagged lead exhaust aerosol, and this has been inhaled by volunteers. The retention in the lung, removal to blood, and excretion of the lead have been followed by measuring 203Pb in the body, in blood and in excreta, using techniques of gamma-ray spectrometry.
Absorption of different lead compounds
Authors: Barltrop D , Meek F
Published: December 2008

A rapid method for the determination of relative absorption of dietary lead by rats is described. The influence of age, weight and dose rate has been determined and using standard conditions the tissue lead content of blood, kidney and femur are significantly correlated with each other and are a function of ingested lead. Eight lead compounds were evaluated using this technique and the findings related to lead acetate as a reference compound. Of the inorganic preparations studied, lead carbonate (basic) and metallic lead showed a twelve-fold difference in absorption, with the remaining compounds giving intermediate values. The absorption of lead from four organic compounds was determined from diets containing 7·5% corn oil added to the standard diet. Lead tallate was absorbed to the same degree as lead acetate, but lesser absorptions resulted from lead octoate, naphthenate and alsynate. The addition of corn oil to a final concentration of 7·5% of the diet enhanced the absorption of lead acetate.
Bites and stings in travellers
Authors: Reid H Alistair
Published: December 2008

As a rule, bites and stings in travellers are merely a nuisance. But it is sensible to be informed about the more serious possibilities which can result. Systemic diseases can be transmitted, the skin lesions from insects can be troublesome and finally, some bites and stings can cause envenoming. Thus, the bather may be harmed by venomous fish stings, sea urchins, jellyfish and in Asian-Pacific waters by sea-snakes. Land hazards include bites or stings by scorpions, spiders, ticks, centipedes, bees, wasps, caterpillars and snakes. The main clinical features of such bites and stings, including treatment and prevention, are outlined.
Sexually transmitted diseases and the mobility explosion
Authors: Catterall R D
Published: December 2008

The very great increase in the tourist industry during the past 20 years is described. This has occurred at a time when there has been an unprecedented rise in the incidence of sexually transmitted diseases. Evidence is presented that there is a relationship between the number of tourists and other travellers and the prevalence of sexually transmitted diseases. Case histories from three different categories of tourist are described and the impact of tourism on the spread of disease is stressed. It is suggested that health authorities throughout the world should give further consideration to plans to meet the challenge of the mobility explosion.
Respiratory virus infections in travellers
Authors: Tyrrell D A J
Published: December 2008

Respiratory viruses affect travellers, but the main significance of this is probably that it is in this way that the viruses reach new hosts and thus survive as infectious agents.
Problems of pilgrimages
Authors: Henderson R J
Published: December 2008

‘Then longen man to go on pilgrimage, to Canterbury, the holy blissful martyr for to seek’. Chaucer, Prologue to the Canterbury Tales.
Some problems of high speed travel
Authors: Reader D C
Published: December 2008

Some aspects of high speed flight are examined to investigate whether increase in speed implies any lowering of safety standards. The problem of circadian dysrhythmia is discussed and methods of attenuating its effects are explained and some new hypnotic drugs are mentioned. The risk of decompression has been quantified and predictions have been made for risks in commercial service. Cosmic radiation in supersonic aircraft is unlikely to limit commercial operation or significantly increase risks to passengers and crew. The supersonic boom is likely to limit the terrain over which supersonic aircraft can operate and regulations covering engine noise on the ground could restrict some flights.
A psychoanalytic view of sleep
Authors: Pines Malcolm
Published: December 2008

The basic psychoanalytic contributions to theories of sleep, awakening, falling asleep and the sleep wakefulness continuum are briefly discussed. Some clinical material illustrates the psychopathology underlying sleep occurring during the psychoanalytic session.
Study of EEG sleep characteristics in patients with anorexia nervosa before and after restoration of matched population mean weight consequent on ingestion of a ‘normal’ diet
Authors: Lacey J H , Kalucy R S , Crisp A H , Hartmann Margot , Chen C
Published: December 2008

This experimental study confirms that insomnia and especially early morning waking is associated with low body weight in anorexia nervosa. It extends the view that there is a relationship between reduced nutritional intake and consequent change in weight and sleep disturbance. This relationship was studied by comparison of certain sleep EEG parameters in a group of hospitalized anorexia nervosa patients before and after a regime of re-feeding to matched population mean weight on a ‘normal’ diet. At low body weights, the patients had less sleep and more restlessness, especially in the last 4 hr of the night. After weight gain, there was a significant increase in length of sleep and REM sleep. The implications of these results are discussed with particular reference to an association between various anabolic profiles and differing need for REM sleep.
‘Depression by any other name...’
Authors: Bridges P K
Published: December 2008

There is a popular conviction that psychological disturbance is invariably a reaction to environmental events. This approach is associated with total rejection of the so-called ‘medical model’. However, allowance must be made for the fact that contemporary knowledge of psychiatric illness is well behind what is now known about general medicine, and current ideas about psychiatric aetiology may be emotionally determined to give satisfying concepts which are often almost impossible to refute.

By tracing the progress of some hypotheses in general medicine, as they developed in the past, there are similarities with some current observations about the methods of action of physical treatments in psychiatry, treatments which have been discovered empirically.

There is a widespread assumption that psychological responses relate precisely to the degree of evoking stress or the patient's personal attitudes to the stress. However, emotional responsiveness may show an intrinsic individual variation so that many patients who over-respond to stress may do so because of enhanced responsiveness rather than necessarily because psychological events have brought about a state of vulnerability.

The exclusively dynamic approach to psychiatry has been perhaps unnecessarily encouraged by naming an illness ‘endogenous depression’ which could well be a primarily physical metabolic disturbance in the central nervous system but which happens to present with prominent depression, as well as other abnormalities. The emphasis on the component of depressed mood artificially delineates the illness and tends to impede consideration of its wider implications.
Acute rheumatic fever following streptococcal wound infection
Authors: Popat K D , Riding W D
Published: December 2008

A case of acute rheumatic fever with pancarditis secondary to infection of abrasions on the hand with β-haemolytic streptococci is described.
An account of the treatment of five chronic asthmatic patients
Authors: Kamburoff P L , Prime F J
Published: December 2008

An account is given of the progress of five patients with intrinsic asthma who have received terbutaline continuously to control airways obstruction over a period of up to 2 years. One aim of this investigation was to find out whether there is any evidence of the development of tachyphylaxis to this drug. No such evidence was found. Two of the patients benefited from the administration of an α-blocking drug (indoramin).
Gout induced by L-dopa and decarboxylase inhibitors
Authors: Calne D B , Fermaglich J
Published: December 2008

Two cases of clinical gout are reported in parkinsonian patients receiving L-dopa in combination with a decarboxylase inhibitor. Blockade of decarboxylation leads to major changes in the pattern of L-dopa metabolites. It is suggested that hyperuricaemia may result from accumulation of L-dopa itself or a transaminated product.
Sideroblastic and megaloblastic change
Authors: Bagnall W E , Fairman M J
Published: December 2008

A case of primary sideroblastic anaemia is described in which megaloblastic changes in the bone marrow were found to be due to coincidental pernicious anaemia.

The importance is stressed of investigating all cases of macrocytic anaemia by iron staining of the marrow together with estimation of the serum B12 and folate levels.
A ‘bootstrap’ model of the renal medulla
Authors: Britton K E , Cage P E , Carson E R
Published: December 2008

The ‘bootstrap’ model of the handling of salt, water and urea by the renal medulla is based on the concepts and data of Stephenson (1972), and Kokko and Rector (1972), and adds support to them. Revision of the traditional counter current hypothesis is necessary since active transport of salt and urea is absent from the inner medulla. This advanced model is structured appropriately and demonstrates how events in the medulla interact and vary with time as change from a diuretic to an antidiuretic state proceeds.
Combination antifungal therapy for cryptococcal meningitis
Authors: Tobias J S , Wrigley P F M , Shaw Elizabeth
Published: December 2008

Two patients with Hodgkin's disease and cryptococcal meningitis are described. Both patients were treated with a combination of the two antifungal agents, amphotericin B and flucytosine. Nephrotoxicity was easily reversible in both patients and clinical improvement was seen with this combination therapy. Intrathecal therapy with amphotericin B was used in both patients. The optimal treatment of this disease may prove to be a combination of oral flucytosine, with amphotericin B given by intrathecal injection as well as rapid low dose intravenous injection.
An adsorbed surface-antigen influenza vaccine and its serological activity in volunteers
Authors: Brady M I , Furminger I G S , Stones P B
Published: December 2008

A highly purified vaccine prepared from surface antigens of influenza virus adsorbed on to aluminium hydroxide has elicited good antibody results to both haemagglutinin and neuraminidase components, and has been shown to induce resistance to homotypic challenge at a satisfactorily high level.
Vaccination in the control of influenza
Authors: Smith J W G , Fletcher W B , Wherry P J
Published: December 2008

Although killed influenza vaccine given by injection is protective, able to reduce sickness absence in industry and to control influenza in the armed forces, it has not so far been possible to demonstrate more than a small effect on the disease in otherwise healthy adults in industry and offices in the United Kingdom. The reasons are probably the poor rate of acceptance of vaccine, the relatively low incidence of clinical influenza in most years, and the incomplete protection given by the vaccine. Until major epidemics can be accurately forecast it is suggested that influenza vaccination may most usefully be used on a selective basis, namely for protecting those with illness predisposing to a severe effect from influenza; persons in institutions such as schools and homes for the elderly; key workers in the general population; and persons over the age of 65 years among whom considerable mortality occurs in winters when influenza is prevalent.
The common hyperlipidaemias
Authors: Lewis Barry
Published: December 2008

The treatment of primary hyperlipidaemic states is reviewed. While several metabolically distinct forms of hyperlipidaemia exist, it is possible to classify patients into three groups for the purpose of therapy.

Group 1 is defined as hypercholesterolaemia (due to raised levels of β-lipoprotein). In Group 2 the level of endogenous triglyceride is increased, with or without hypercholesterolaemia. In the rare Group 3, there is exogenous hypertriglyceridaemia. A satisfactory response can be attained in at least 90% of cases, using dietary and drug treatment.
A study of the wound environment during total hip arthroplasty
Authors: McLauchlan J , Smylie H G , Logie J R C , Smith G
Published: December 2008

Two hundred and seventeen total hip replacements were performed during a trial designed to assess the influence of a surgical isolator upon postoperative wound infection. The trial was controlled by performing 108 of the replacements in a standard plenum-ventilated theatre with twenty air changes/hr, which also housed the isolator procedures. Comparative postoperative wound infection rates were 6·4% for the isolator patients and 4·6% for those operated on in the plenum-ventilated theatre. There was intraoperative wound contamination in both groups of patients and, although the isolator reduced wound contamination at operation, this bore no relationship to eventual wound sepsis.
The effect of administered corticosteroids on the growth of children
Authors: Preece M A
Published: December 2008

The growth-inhibiting effect of exogenous corticosteroids has been reported in many papers. Most of them have concerned the clinical problems of asthma and rheumatoid arthritis but it is probable that the underlying disease is relatively unimportant in determining the effect on growth. Steroid therapy on alternate days seems to produce less undesirable effects than steroid treatment every day and corticotrophin may be preferable. Although the mechanisms are uncertain it seems likely that the action is peripheral and certainly exogenous growth hormone does not prevent the steroid effect. A minimal dosage of corticosteroids should always be used in replacement therapy for hypopituitarism.
Scleritis and temporal arteritis
Authors: Long R G , Friedmann A I , James D Geraint
Published: December 2008

Thirty consecutive patients with severe scleritis or episcleritis were admitted as in-patients to the Medical Ophthalmology Unit and assessed for systemic disease. There were seventeen women and thirteen men. The mean age was 53 with a median of 57 (range 23-83). Eighteen of the patients had scleritis: eleven of these had evidence of connective tissue disease and three of them had temporal arteritis. Twelve patients had episcleritis: six of them had a collagen disease and one of them developed temporal arteritis. This high incidence of temporal arteritis in association with scleritis has not been previously reported. It is important to diagnose and treat overt temporal arteritis early with parenteral steroids so that ischaemic papillopathy can be avoided. A higher incidence of collagen diseases than previously described is reported in episcleritis. It is thought that this is secondary to selection since patients with the usual self-limiting episcleritis are not normally referred for further in-patient investigation. In no patient was more than one significant diagnosis made. There was no significant medical illness in only 11% of patients with scleritis and 33% of patients with episcleritis. The majority of the non-collagen diseases (e.g. hypertension) were not previously recognized. In none of the patients with temporal arteritis was the diagnosis made before admission. It is concluded that full examination and investigation for underlying disease is indicated in both scleritis and severe episcleritis.
Drug-induced hyponatraemia in psychogenic polydipsia
Authors: Gossain Ved V , Hagen Garrett A , Sugawara M
Published: December 2008

Two patients with psychogenic polydipsia developed hyponatraemia, one in association with administration of hydrochlorothiazide and the other with that of tolbutamide. It is suggested that the increased fluid intake in such patients may make them more susceptible to the development of hyponatraemia from thiazide or sulphonylurea compounds.
Acute renal failure following copper sulphate intoxication
Authors: Chugh K S , Sharma B K , Singhal P C , Das K C , Datta B N
Published: December 2008

Eleven out of a series of twenty-nine patients (37-9%) with acute copper sulphate poisoning developed acute renal failure. Intravascular haemolysis appeared to be the chief factor responsible for renal lesions in these patients. Histological lesions observed in the kidney varied from those of mild shock to well established acute tubular necrosis. In one case, granulomatous lesions were seen in response to tubulorrhexis. Renal failure was the chief indication for dialysis in ten patients, whereas one patient was dialysed primarily for removal of copper. Notwithstanding the adequate control of uraemia by dialysis, only six of the eleven patients recovered. Septicaemia was responsible for death in three, hepatic failure in one and methaemoglobinaemia in another. It is postulated that release of copper from haemolysed red cells during acute haemolytic episodes may initiate, or contribute to, the development of renal damage.
Paget's disease of bone—a clinical and genetic study
Authors: Galbraith H J B , Evans E C , Lacey J
Published: December 2008

An unselected series of 285 patients with Paget's disease of bone has been studied, of whom 54% were male and 46% female. The youngest was aged 25 years at diagnosis and the oldest 95. Of the patients 109 (38-2%) had never suffered serious symptoms. These diagnosed cases certainly represent only a small proportion, perhaps 10-15%, of all those with Paget's disease in the community from which they came. Few of the undiagnosed cases are likely to be suffering from serious symptoms or complications so it is apparent that the majority (probably over 80 or 90%) of those with the pathological state are relatively untroubled by their disease. The most common complication (8-8%) was pathological fracture. The fracture involved the shaft of the femur in 62% occurring in this section of the bone almost seven times more frequently in the patients with Paget's disease than in the general population. Because of the large number of undiagnosed cases in the community, the true incidence of pathological fracture and of sarcoma of bone in all patients with Paget's disease is probably only 1% and 0-1% respectively. Simultaneous estimates of the serum alkaline phosphatase and ESR were made in 128 of the patients. It was shown that the ESR is valueless as a measure of activity or extent of the disease. In many patients the level of the serum alkaline phosphatase changed very little over periods of several years. A history of the disease in one or more close relatives was found in three families, a lower incidence than was expected from previously recorded studies. The ABO blood groups were determined in 215 of the patients; 50% were of group A compared with 46% in a control group. The difference in distribution of blood groups in the two series of subjects is small and well within chance limits. The secretor status of 138 patients was investigated; 77% were secretors. This is similar to the proportion in control series. There is evidence to suggest that the degree of severity of Paget's disease does not vary, once it has developed in any particular individual, and that the more severe and extensive forms may have a stronger genetic basis.
Prognostic importance of ventricular extrasystoles in acute myocardial infarction
Authors: Talbot S
Published: December 2008

Ventricular arrhythmias were recorded in 233 patients in a prospective study of patients with acute myocardial infarction. In over 95% of patients antiarrhythmic therapy was not given until the onset of ventricular tachycardia, ventricular fibrillation, or persistent idioventricular rhythm. There was a mortality of 18% during the patients' stay in hospital. The most important features of ventricular ectopic activity, which preceded these severe ventricular arrhythmias in the first 48 hr, were multiformity, variation of coupling intervals of larger or equal to 0-1 sec, the R-on-T phenomenon, double ventricular extrasystoles and ventricular bigeminy. The number of a single ventricular extrasystoles per minute was related to the probability of these severe ventricular arrhythmias but to a lesser degree. It was found that if all the patients with the first two prognostic features that if all the patients with the first two prognostic features were removed, the number of single ventricular extrasystoles was not of significant import and the other features were less important. Three-quarters of the severe arrhythmias occurred in the first 24 hr and during this period 60% were preceded by either multiform ventricular extrasystoles or extrasystoles with variable coupling. The importance of these findings in relation to prophylactic therapy is discussed.
Transverse myelitis complicating Mycoplasma pneumoniae infection
Authors: Nicholson G
Published: December 2008

A 23-year-old man developed transverse myelitis following an infection with Mycoplasma pneumoniae. Neurological complications following infection with this organism are uncommon but the prognosis appears to be good.
Pseudo-obstruction and a sprue-like syndrome from stronglyloidiasis
Authors: Bartholomew C , Butler A K , Bhaskar A G , Jankey N
Published: December 2008

Symptomatic disease from Strongyloides stercoralis has been recognized for the first time in Trinidad. Five cases are reported, all showing clinical features suggestive of a sprue-like syndrome. Subtotal jejunal villous atrophy was seen in one case and partial villous atrophy in two. Three patients had laparotomies because of suspected partial intestinal obstruction. A sprue-like syndrome in certain Caribbean immigrants should arouse a suspicion of S. stercoralis.
Zinc metabolism and thyroid status
Authors: Bremner W F , Fell G S
Published: December 2008

Urinary zinc excretion was found to be increased in patients with thyrotoxicosis when compared to euthyroid individuals. This increase did not appear to be due to an increase in creatinine clearance and was found to be strongly correlated with an index designed to assess the severity and acuteness of the metabolic response of the body to hyperthyroidism. The potential clinical significance of this finding is discussed.
Paravertebral and peripheral ligamentous ossification: an unusual association of hypoparathyroidism
Authors: Adams J E , Davies M
Published: December 2008

A 62-year-old man with idiopathic hypoparathyroidism and extensive paravertebral and ligamentous ossification is reported. The clinical and radiological findings of this, and other reported cases, are discussed and compared with other causes of paravertebral ossification.
Symptomatic hyponatraemia associated with tolbutamide therapy
Authors: Darlow B A
Published: December 2008

A case of hyponatraemic coma occurring in a patient with diabetes mellitus treated with tolbutamide is described. Although chlorpropamide is known to cause water retention in some circumstances, this is a less well recognized complication of tolbutamide therapy.
Necrotizing fasciitis
Authors: Tehrani M A , Ledingham I M
Published: December 2008

The author's experience of fourteen patients with necrotizing fasciitis is reviewed. The pathognomonic feature of this condition is an extensive necrosis of subcutaneous tissue caused by a vicious cycle of infection, local ischaemia and reduced host defence mechanisms. The diagnosis can only be confirmed by immediate exploratory incision.

The reported mortality of 30-40% reflects the inadaquacy of conservative surgery in the treatment of this serious condition. Mortality can be reduced by early recognition followed by radical excision of the necrotic fascia and overlying skin. The preservation and subsequent use of the excised skin has the advantage of economy in the use of donor areas and reduction in morbidity. Hyperbaric oxygen therapy does not halt the spread of the necrotizing process and is not a substitute for radical surgery.
Treatment of acute hepatic encephalopathy with L-dopa
Authors: Chajek T , Berry E M , Friedman G , Abramsky O
Published: December 2008

A clinical report of a 30-year-old woman who developed acute hepatic failure in the fifth month of pregnancy is presented. L-dopa administration resulted in a marked improvement in both level of consciousness and electroencephalogram. The literature dealing with L-dopa therapy in hepatic encephalopathy is reviewed.
Gynaecomastia associated with gonadotrophin-secreting carcinoma of the lung
Authors: Fairlamb D , Boesen E
Published: December 2008

A 67-year-old man developed dermatomyositis. Investigation revealed an oat cell carcinoma of the lung. When he developed unilateral gynaecomastia this tumour was found to secrete gonadotrophins. The gynaecomastia disappeared after treatment with an anti-oestrogen—tamoxifen. This use of tamoxifen has not previously been described. Partial tumour regression was obtained with several cytotoxic drug regimes. His dermatomyositis responded to this treatment and remains in remission.
Polyradiculoneuritis and Mycoplasma pneumoniae infection
Authors: Holt S , Khan M M , Charles R G , Epstein E J
Published: December 2008

A patient with severe Mycoplasma pneumonia developed polyradiculoneuritis and respiratory failure. The acute phase of the illness was complicated by a myocarditis, and recovery of neurological function was slow. Residual left hemidiaphragmatic paralysis was present 1 year after onset of the illness.
Catabolic disorders of complex carbohydrates
Authors: Spranger J W
Published: December 2008

The various disorders caused by heritable defects in complex carbohydrate catabolism comprise two groups: (A) The mucopolysaccharidoses, six main and several subtypes are described. (B) The mucolipidoses (oligosaccharidoses), at least nine types being recognized. Whilst most of these are now well defined by clinical and biochemical studies, much of the sequence of events from the intrinsic metabolic error to their clinical features remains obscure. Most are transmitted as autosomal recessive conditions, a mode of inheritance often, as with these disorders, associated with enzymic deficiencies. All patients display the Hurler phenotype, but this, as also the characteristic bone changes, varies widely in severity both within and between the specified types of disease. The radiological abnormalities—dysostosis multiplex—indicate the broad disease complex and are rarely type-specific; diagnostic precision needing knowledge of both clinical and biochemical examinations. In several types mental development is normal and bone changes are mild, so permitting confusion with other forms of bone dysplasia or disease.
Diagnosis of Chagas' cardiomyopathy. Non-invasive techniques
Authors: Puigbó J J , Valecillos R , Hirschhaut E , Giordano H , Boccalandro I , Suárez C , Aparicio J M
Published: December 2008

The natural history of Chagas' disease and its manifestations when the heart is involved are detailed clinically and pathologically. Three phases are recognized: the acute phase, lasting from 1-3 months, the latent phase, which may last from 10-20 years, and the chronic phase, which has the most serious manifestations. This phase is subdivided into three clinical stages. An analysis of the varied cardiac manifestations on 235 patients is included.
Maternal genital chlamydial infection as a cause of neonatal conjunctivitis
Authors: Hobson D , Rees E
Published: December 2008

Infections of the cervix with Chlamydia trachomatis are common, at least in those groups of sexually active women of child-bearing age who are seen in STD (sexually-transmitted diseases) clinics. Persistent untreated infection presents a hazard to the women themselves during pregnancy and to their infants who may develop chlamydial conjunctivitis. The clinical and laboratory findings in 1009 women and in 103 infants with conjunctivitis are presented. Practical problems of diagnosis and control of neonatal chlaymdial conjunctivitis are described. A possible association between prematurity and chlamydial infection is discussed.
Toxoplasmosis in the perinatal period
Authors: Williams H
Published: December 2008

Although many of the fundamental biological features of toxoplasmosis are today well appreciated, the practical problem of prevention of its most serious consequence—disabling congenital disease, remains unsolved. The reasons vary in different communities, but are concerned with detection of the chief mode of spread, assessment of incidence, delineation of vulnerable antenatal women in latently infected populations, and assessment of the risks of therapeutics. The results of some of the approaches to these problems in Scotland are reported and discussed.
Listeriosis
Authors: Robertson M H
Published: December 2008

The incidence, clinical picture, natural history, epidemiology and sequelae of perinatal listeriosis are discussed along with treatment and diagnosis.
The coagulopathy associated with aortic aneurysms
Authors: Gétaz E P , Louw J H
Published: December 2008

The authors in this article record their experience with eight-four patients with abdominal aortic aneurysms. Twenty-seven patients (32%) presented with ruptured aneurysms with an overall mortality of 56%. Of the unruptured aneurysms, 67% were operable with a mortality of 5.3%. The highest mortality amongst the patients with ruptured aneurysms was in the group who was shocked. In the group with ruptured aneurysms, of those in whom platelet counts were performed, 50% were abnormally low, and 56% had evidence of abnormal coagulation. Seventy per cent of those with coagulation abnormalities died. In the unruptured group 28.2% had thrombocytopenia but no other abnormalities of coagulation. All patients undergoint aneurysm resection should have a platelet count and a full clotting screen. Therapy should be directed to normalization of the coagulation system.
Perianal Paget's disease
Authors: Lock M R , Katz D R , Parks A , Thomson J P
Published: December 2008

Paget's disease involves the ducts of apocrine glands and the overlying epidermis and is considered to be locally neoplastic. It is capable of developing into invasive carcinoma and in this event the prognosis is poor.

The perianal skin may be affected by Paget's disease. This is a rare disorder and the four patients who have been seen with this disease at St Mark's Hospital since 1930 are described.
Acute myocardial infarction and arterial embolectomy
Authors: Stavorovsky M , Morag B , Iellin A , Lichtenstein D
Published: December 2008

Emboli of a main artery cause serious complications in patients suffering from acute myocardial infarction, in whom the surgical risk is high. In order to save the limb, embolectomy is indicated and should be considered.

Early diagnosis and prompt surgical intervention with the use of the Fogarty catheter simplify the embolectomy procedure and enable restoration of circulation to the ischaemic limb.

Thirty-two embolectomies were performed in twenty-eight patients suffering from acute myocardial infarction. Patients with cardiac compensation survived the surgery and recovered. However 50% of the patients in whom acute myocardial infarction was accompanied with congestive heart failure and arrhythmias died. The cause of death was the underlying disease. Considering the severity of the acute myocardial infarction this group of patients represents the expected mortality.
Furosemide and acute renal failure
Authors: Borirakchanyavat V , Vongsthongsri M , Sitprija V
Published: December 2008

High dose of intravenous furosemide (2 g/24 hr) was given to six patients with acute renal failure due to leptospirosis. The results, based on urine flow, changes in serum creatinine and creatinine clearance, were compared with a control group of eight patients with the same disease and comparable degree of renal failure. Excellent diuresis was observed following furosemide therapy but renal function and the clinical course of the disease were unaltered. The duration of renal failure was the same in both groups.
Cerebral haemorrhage in haemophilia
Authors: Bennett M , Sills J A
Published: December 2008

A young male haemophiliac child is here described in whom intracerebral haemorrhage required craniotomy and the subsequent insertion of a ventriculo-peritoneal shunt. These procedures can now be attempted in severe haemophilia A because of the ease in clotting factor replacement therapy.
Effect of insulin in the induction and regression of experimental cholesterol atherosclerosis in the rabbit
Authors: Marquié G
Published: December 2008

A study was undertaken to determine the effects of long-term insulin therapy on the development and regression of lipid perturbations and experimental cholesterol atherosclerosis in rabbits:

(1) Insulin administration for 15 days significantly reduced plasma lipid levels and free fatty acids in rabbits fed a high-cholesterol diet; it also inhibited the effects of a single dose of cholesterol. Paradoxically, continued insulin treatment led to the reinforcement of lipaemia through the stimulation of mobilization. Insulin administration during the development of atherosclerosis significantly aggravated the fatty infiltration of the aortic tissue and the lesions of the vessels, and also increased the frequency of coronary lesions.

(2) In rabbits fed a cholesterol enriched diet during two months and then a normal diet, insulin treatment accelerated the rate of reduction of hypercholesterolaemia, but aggravated the lipid infiltration of the artery walls, and also prevented regression of coronary atherosclerosis.
Essential fatty acids and the vulnerability of the artery during growth
Authors: Ball K P , Cranford M A , Hassam A G , Rivers J P W
Published: December 2008

Essential fatty acids not only control blood lipid levels, but are the precursors of prostaglandins responsible for regulation of platelet aggregation. Dietary deficiency of essential fatty acids may play an important role in the development of coronary heart disease, particularly during the early growth period.
Possible prevention and treatment of steroid-induced osteoporosis
Authors: Condon J R , Nassim J R , Dent C E , Hilb A , Stainthorpe E M
Published: December 2008

Patients with steroid-induced, juvenile and senile osteoporosis were studied using balance techniques.

The changes in calciun and phosphorus balance associated with glucocorticoid therapy were corrected with vitamin D and bendrofluazide given in combination. No hypercalcaemia occurred in osteoporotic patients who continued to receive glucocorticoids. Calcium and phosphorus balance was also improved in the osteoporotic subjects not receiving steroids, but these patients became hypercalcaemic during treatment.

It is suggested that vitamin D, bendrofluazide and steroids antagonize the actions of one another on the renal tubule, gut and bone and in this way prevent the increased calciuria which occurs with glucocorticoid therapy. Since the increased calciuria and negative calcium balance induced by glucocorticoids is considered to be the result of excessive bone resorption, an adequate dose of bendrofluazide and vitamin D in combination might prevent the development of, or even reverse, steroid-induced osteoporosis.
Analgesic nephropathy and transitional cell carcinoma
Authors: Moshakis V , Hooper A A
Published: December 2008

A case of transitional cell carcinoma of the kidney associated with long-term phenacetin intake is described and the practical implications discussed.
Streptoccocus faecalis endocarditis: an emerging problem?
Authors: Welsby P D
Published: December 2008

The clinical features of 16 patients with Streptococcus faecalis endocarditis are reviewed and the currently favoured antimicrobial regimens for such infections are detailed.
Anticholinergic drugs, buccal ulceration and mucosal potential difference
Authors: Huston G J , Abrams S M L , Turner P
Published: December 2008

Measurement of changes in buccal mucosal potential difference produced by contact with drug formulations may provide a means of predicting their mucosal toxicity and ulcerogenic activity.
Skin closure with polyglycolic acid (Dexon)
Authors: MacKinnon A E , Brown S
Published: December 2008

Cosmetically satisfactory scars were achieved in 94.5% of skin crease orchidopexy wounds sutured with subcuticular polyglycolic acid. Of twenty-seven similar wounds closed with interrupted black silk sutures 18.5% developed hypertrophy at the medial end.
Inappropriate secretion of antidiuretic hormone associated with cerebellar and cerebral atrophy
Authors: Hamilton D V
Published: December 2008

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is described in a 67-year-old man with cerebellar and cerebral atrophy. This is the first reported case of this association.
Treatment of congestive cardiomyopathy
Authors: Abelmann W H
Published: December 2008

Although the majority of patients with cardiomyopathy are in the category of primary or idiopathic cardiomyopathy, for which therapy is symptomatic and non-specific, there are a number of secondary forms of cardiomyopathy for which specific therapy is available, thus giving impetus to prompt and accurate diagnosis. Among inflammatory lesions, brucellosis, psittacosis and toxoplasmosis are examples. Treatable metabolic causes include thyrotoxicosis and thiamine deficiency, the latter as well as calorie-protein malnutrition are also preventable. There is presumptive evidence that the cardiomyopathy of haemochromatosis is benefited by repeated phlebotomies. Symptomatic relief of obstructive cardiomyopathy is achieved by beta-adrenergic blockade, although resection of obstructing myocardium still has a place.

The therapeutic approach to the vast majority of cases of congestive cardiomyopathy is non-specific, comprising controlled activity, sodium restriction, digitalis and diuretics. Vasodilators and, occasionally, beta-adrenergic blockade may be beneficial. Pacemakers may be life-saving, whereas the place of anti-arrhythmics remains uncertain. Transplantation warrants further application. Valve replacement has little to offer.

Primary prevention, comprising balanced nutrition, vaccines and genetic counselling, merits wider application. In individuals at risk or already afflicted, programmes of secondary prevention should include good nutrition, abstinence from alcohol and protection from drugs and toxins.