bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathophysiology of achalasia of the cardia
Authors: Misiewicz J J
Published: December 2008

The symptoms and signs of achalasia are due to the loss of ganglion cells in the body of the oesophagus, leading to dilatation and loss of peristaltic activity. The data pertaining to the lower oesophageal sphincter are still somewhat conflicting. The ganglion cells may be absent, but pharmacological evidence suggests denervation to be pre-ganglionic. The classical view of a normotensive, non-relaxing achalasic sphincter has been challenged by recent observations which suggest the presence of a hypertensive, partially relaxing sphincter, which is supersensitive to gastrin and acetylcholine.
Achalasia: symptoms and radiology
Authors: Edwards D A W
Published: December 2008

A radiographic and symptomatic study of 280 patients with achalasia before and after treatment is presented including diagnostic features of the symptom pattern and radiographic findings.
Carcinoma of the oesophagus and cardia—endoscopy
Authors: Roesch W
Published: December 2008

Oesophagoscopy will establish a definite preoperative diagnosis of a radiologically suspected malignancy by guided biopsy and/or brush cytology. The rigid instruments should only be used for photodocumentation since the hazards are considerably greater compared with the fibre-endoscopes. In obstructing lesions of the lower third of the oesophagus where a primary gastric cancer is suspected a passage of the instrument into the stomach should be attempted since a positive biopsy is easier obtained after a U-turn manoeuvre.
Radiotherapy
Authors: Jelliffe A M
Published: December 2008

The author examines the place of radiotherapy in the management of oesophageal cancer. Many of these tumours are locally curable with radiotherapy. This is so particularly with the proliferative, poorly differentiated tumour. The upper and middle thirds of the oesophagus are the most suitable sites for attempted cure by radiotherapy; surgery is always the better method in the lower third.

Before adopting a definitive treatment policy it is important to eliminate metastatic spread as far as is possible. The overall prognosis is poor: long unnecessary courses of treatment or extensive operations should be avoided unless there is a reasonable chance of long-term cure.
Lead poisoning with low blood lead levels
Authors: Torkington P , Bhalla K K
Published: December 2008

Two cases are reported in which symptomatic lead poisoning coincided with normal haemoglobin concentrations and blood lead levels below 80 μg/100 ml. Urinary coproporphyrins and amino laevulinic acid concentrations were elevated. These latter tests are useful for confirmation of clinical diagnoses and for the screening of industrial lead workers.
Spontaneous cholecystectomy
Authors: McGregor J C , Sammon D J
Published: December 2008

A young female, who presented with acute appendicitis and peritonitis, is described. Following laparotomy she developed a series of intraperitoneal abscesses. After drainage of a subphrenic abscess a necrosed gallbladder was discharged several days later through the drainage wound in the abdominal wall.
Antepartum diagnosis of vasa praevia—report of a case causing sudden foetal death
Authors: Pallewela C S
Published: December 2008

A case of sudden foetal death due to vasa praevia is reported. The main problem is early ante-partum diagnosis. Three methods are discussed.

(1) Tests to recognize foetal blood as a routine in ante-partum haemorrhage;

(2) amnioscopy before amniotomy; in foetal irregularity or bradycardia; in ante-partum haemorrhage;

(3) tests for foetal bradycardia in early labour as a part of the routine abdominal examination.
The treatment of priapism by corpus-saphenous by-pass
Authors: Foley R J E , De Jode L R
Published: December 2008

Two cases of priapism treated by corpus-saphenous by-pass are presented. Priapism responded to treatment successfully in both cases. Satisfactory erection and sexual intercourse followed 6 weeks after operation in one case. The second patient failed to have further erections. It was thought that this was due to the length of time (6 weeks) between onset of priapism and operation.
Problems in the management of mediastinal tumours
Authors: Lallemand R C , Keates J R W
Published: December 2008

Five cases of anterior mediastinal tumour are presented. Two cases were asymptomatic, being discovered by routine chest radiography. The remainder presented with dyspnoea, dysphagia and a sinus over the manubrium.

Each case provided a lesson in the management of the mediastinal mass. Pathologies included haemangioma, teratoma, secondary carcinoma from the kidney and a malignant thymoma which caused cardiac tamponade.

Features of interest in the presentation, treatment and pathology are discussed.

It is concluded that a full investigation of mediastinal swellings is needed before mediastinoscopy is performed; that incision of swellings in the base of the neck should be avoided; and it is suggested that the management of asymptomatic mediastinal haemangioma in adults may be expectant.
Prognostic factors in the rehabilitation of patients with spinal problems
Authors: Richardson Alan E , Tupper Annemarie D
Published: December 2008

One hundred patients undergoing intensive rehabilitation for painful spinal lesions were studied. They were divided into three groups in relation to result, these being ‘good’, ‘moderate’ or ‘poor’. Seventy-eight per cent were regarded as ‘good’ or ‘moderate’. The ‘poor’ group showed significantly raised neuroticism scores measured by the Middlesex Hospital Questionnaire, particularly sub-scores for ‘depression’ and ‘somatic concomitants of anxiety’ in women and ‘free floating anxiety’, ‘depression’ and ‘obsessionality’ in men. Other factors associated with poor outcome were long history, multiple operations and a nonspecific diagnosis of ‘low back pain’. It is suggested that this group can be identified early and might benefit from a combined physical rehabilitation and psychotherapy programme. A controlled study to test this is planned.
Leukaemoid reactions associated with fulminating ulcerative colitis
Authors: Colvin B T , Suggett A J , Lancaster-Smith M J , Fisher D J H
Published: December 2008

The association between fulminating ulcerative colitis and the presence of primitive white cells in the peripheral blood is reported in three patients. Some of the diagnostic problems encountered are discussed.
Reversible myopathy induced by clofibrate
Authors: Geltner D , Shapiro M , Chaco M
Published: December 2008

A 49-year-old man was given clofibrate in the treatment of hypercholesterolaemia. A myopathy developed accompanied by laboratory enzyme changes and a pathological electromyographic pattern. After ceasing the medication the clinical picture of myopathy disappeared and the enzyme and EMG changes reverted to normal. The EMG changes were once again produced by a short challenge with clofibrate.
Sex determination and differentiation in mammals: hints from nature
Authors: Polani P E
Published: December 2008

There are a number of experiments that nature has carried out, in man and other animals, that have helped us considerably in achieving the present understanding of sex determination and differentiation. Some of the key experiments are concerned with:

(1) The origin of the germ cells from the wall of the extraembryonic gut, to an understanding of which the W mutants in the mouse have contributed well.

(2) The maintenance of the germ cells which in mammals demands not only the ‘right’ gonadal ambient but also its correct chromosomal make-up and correspondence with that of the germ cells (see below).

(3) The key role of the Y chromosome in sex determination (namely gonad formation). This was established from the discovery of the sex chromosome anomalies in man (and the mouse), the XO (45, X) and XXY (47,XXY) complements. Other ‘experiments’, in man, with chromosome deletions, would suggest that the sex-determining factor(s) of the Y is on the short arm of this chromosome, now known to be that which associates at meiosis with the X chromosome. Studies, in embryos of the very frequent and very lethal 45,X condition, have uncovered the fact that an ovary develops with a single X chromosome (i.e. does not need the second X) which thus is not a sex determining chromosome, as far as we know, but that its ‘inert variant’ (the X-chromatin, or Barr-body, forming X) is essential for ovarian upkeep and function and thus for continued oögenesis. Yet other experiments (the XX male in man, the goat and the mouse, and the XO male mouse) suggest that ‘switch’ genes for testicular development may exist on the autosomes and be capable of working without a Y, i.e. they may take over its function in unison with two Xs, or (not surprisingly) better still with a single X. But this arrangement is not fully satisfactory as far as the production of competent mature germ cells is concerned.
Fatal neonatal meningitis due to Group B streptococci
Authors: Chattopadhyay B
Published: December 2008

A case of fatal neonatal meningitis due to Group B β-haemolytic Streptococcus is described. Early diagnosis and institution of vigorous antibiotic therapy were of no avail. Although the mortality rate is very high in comparison to many other neonatal bacterial infections reported so far, it is difficult to explain the fact that there are so few references to it as a pathogen in the British literature.
Problems of myocardial biopsy
Authors: Harmjanz D
Published: December 2008

It seems easy to talk about the problems of a new technique, especially in the case of a technique for obtaining human myocardial tissue in vivo. Surprisingly, the main problems do not lie in the technique itself, but rather in the decision whether such a biopsy is indicated in a certain case or not.
Biochemical studies on biopsies from normal and diseased cardiac tissue
Authors: Peters T J , Bloomfield F J , Oakley C M
Published: December 2008

The introduction of a technique for closed biopsy of the ventricular wall has permitted the morphological and biochemical properties of cardiomyopathic tissue to be studied. Morphological investigations have revealed varied pathological changes but have failed to demonstrate a clearly defined lesion in most of the cardiomyopathies.
Discussion
Authors: Black Douglas
Published: December 2008

Chairman: Whereas Drs Weston and Vesin appear to have had little success with diuretics in the management of renal failure, and indeed consider them to be possibly harmful, Dr Rodés had a much more satisfactory experience when diuretics were combined with plasma expansion. Have other groups combined diuretics with plasma expanders?
Discussion
Authors: Sherlock Sheila
Published: December 2008

Dr. P. Vesin (Paris): I was impressed by the finding of Dr Davidson that the reinfusion technique improved renal function in the cases of diuretic-induced uraemia but not in the case of spontaneous functional renal failure. This point is central to our understanding of renal failure in cirrhosis, namely that plasma expansion will not improve renal perfusion in the spontaneous type of renal failure, but when it is diuretically induced such expansion is nearly always successful in reversing it.
Inappropriate secretion of antidiuretic hormone in pneumonia
Authors: Charles Richard , Rees J Russell
Published: December 2008

Non-tuberculous pneumonia is an extremely rare cause of the syndrome of inappropriate secretion of antidiuretic hormone (ADH). A patient is described who had lobar pneumonia presenting as an acute confusional state due to hyponatraemia resulting from this cause.
Lead in teeth during the perinatal period
Authors: Burkitt A J , Nickless G , Stack M V
Published: December 2008

In a survey of the paediatric significance of environmental lead there was evidence that part of the maternal intake of lead may influence the fetus’ (Barltrop, 1969). Lead is incorporated in calcified tissues, and the studies of Altshuller, Halak and Landing (1962) and of Needleman, Tuncay and Shapiro (1972) indicate that the primary teeth provide evidence of lead exposure during infancy, a typical concentration being 10 p.p.m. The measurement of lead in developing teeth of fetuses would indicate uptake during the earliest period.
The current status of lead poisoning in children
Authors: Alexander F W
Published: December 2008

Introduction

In 1964, Moncrieff et al. recorded a normal range for the level of lead in blood as 24 μg%±4·9 μg%, with an upper limit of normal of 36 μg%. There has been discussion ever since as to the level of blood lead which denotes poisoning. A blood lead level of 80 μg% was designated as a toxic level for children, requiring urgent and immediate treatment (U.S. Surgeon General, 1971). Barltrop (1971) presumed that 60 μg% was an acceptable level below which symptoms did not occur. The Department of Public Health of Massachusetts (1973) took 50 μg% as their upper limit of acceptability. More recently, Betts, Astley and Raine (1973) have shown a significant correlation between haemoglobin levels and blood lead concentrations in the range 37–60 μg%; levels which were previously accepted as harmless.
Hypercalcaemia and parathyroid hyperplasia associated with renal adenocarcinoma
Authors: Jung A , Schneider Ph , Millet R , Walton R J
Published: December 2008

A patient with recurrent renal adenocarcinoma had progressive hypercalcaemia associated with hypophosphataemia and inappropriately high circulating levels of immuno-reactive parathyroid hormone. At post-mortem, there was no evidence of bone metastases but hyperplasia of all four glands was found. It is suggested that the malignant tissue was producing a parathyroid-stimulating substance.
Host defence mechanisms against influenza infection. II. Protection of mice with vaccines against A/Port Chalmers/1/73 and B/Hong Kong/5/72
Authors: Ennis F A , Wells M A , Barry D W , Daniel S , Manischewitz J
Published: December 2008

Influenza virus strains A2/Port Chalmers/1/73 (H3N2) and B/Hong Kong/5/72 were adapted to mice by serial passage of virus infected mouse lungs. The adapted viruses were used to challenge mice after they had been immunized with serial dilutions of several bivalent vaccines, containing both A/Port Chalmers and B/Hong Kong antigens. Vaccines included both whole virus and split-product preparations disrupted by Tween 80 and ether (ET) or tri-N-butyl phosphate (TBP).

These bivalent vaccines induced antibodies and conferred protection to mice against challenge with approximately 30 LD50 of the adapted A2/Port Chalmers virus. Significant protection against lethality (P<0·01) was observed in groups of mice which developed haemagglutinin-inhibition antibody titres of ≥1:16 following immunization. Protection was not statistically significant in groups of mice which developed antibody titres of ≤1:8 to the A/Port Chalmers/1/73 virus following immunization with higher dilutions of certain vaccines.

In a similar fashion, current bivalent vaccines containing B/Hong Kong/5/72 stimulated antibodies and conferred significant protection to immunized mice against lethal challenge with the adapted B/Hong Kong virus. Protection was demonstrated against approximately 30 LD50 of adapted virus in groups of mice which developed mean antibodies of ≥1:16. Groups of mice, which developed antibody titres of <1:8 following immunization with certain dilutions of these vaccines, were not significantly protected. These studies confirm and extend observations made with formerly circulating influenza viruses, i.e. immunization with a specific inactivated vaccine in adequate dosage confers protection against a challenge dose of virus lethal to unimmunized mice.
Preparation and immunogenicity of a purified influenza virus haemagglutinin and neuraminidase subunit vaccine
Authors: Laver W G , Webster R G
Published: December 2008

A vaccine was prepared containing the haemagglutinin and neuraminidase subunits from the A/Port Chalmers. 1/73 (H3N2) strain of influenza virus. The virus particles were disrupted with ammonium deoxycholate and the matrix protein, which was insoluble in this detergent, was removed by centrifugation. Following removal of deoxycholate, the haemagglutinin and neuraminidase subunits aggregated by their hydrophobic ends, forming mixed clusters. These were then freed from nucleocapsids by electrophoresis.

The haemagglutinin and neuraminidase subunits were as effective as intact inactivated virus (at equivalent concentration) in eliciting a late primary antibody response when injected in saline into rabbits.

In humans also, the subunits were as immunogenic as intact inactivated virus particles at equivalent concentration. Many people, however, responded only to the ‘common’ antigenic determinant(s) on the haemagglutinin subunit of Port Chalmers/73 virus and did not respond at all to the ‘specific’ determinant(s). Sera from these people contained antibodies which reacted equally as well with Hong Kong/68 virus as with the Port Chalmers/73 strain and none which reacted exclusively with the latter virus.
Concepts and controversies about the prevention of coronary heart disease
Authors: Blackburn Henry
Published: December 2008

Congruent evidence from several medical disciplines provides compelling argument for a preventive approach to atherosclerotic diseases. Intervention trials and community health education programmes are under way. Reasonable, safe and practical approaches are available for hygienic interventions within the medical system. But major impediments to medical and community researches and action in prevention include professional controversy and public confusion about risk factors and their management. It is suggested here that most of this controversy and confusion is unnecessary and much of it due to professional attitudes and experience. These attitudes appear to result from failure to distinguish adequately the risk, diagnosis and therapeutic decisions appropriate to a culture, in the population-at-large.
Genetics of ischaemic heart disease
Authors: Epstein Frederick H
Published: December 2008

Coronary heart disease, especially when it affects younger individuals, tends to cluster in families. Known risk factors occur in 50-75% of patients with myocardial infarction. Yet commonly occurring risk factors are not strongly inherited, and the familial aggregation of coronary heart diseas may not be attributable to familial resemblance in serum cholesterol and blood pressure levels. Alternatively, such aggregation may be due to unknown familial risk factors. Nevertheless, screening of relatives of individuals with evident risk factors is of importance, and environmental manipulation is likely to be of value in prevention of coronary heart disease.
Carcinoid tumour of the ampulla of Vater associated with cutaneous neurofibromatosis
Authors: Barber P V
Published: December 2008

A case of carcinoid tumour of Vater's ampulla is described from a patient with widespread cutaneous neurofibromatosis. The literature concerning the few known cases of carcinoids occurring at this site is briefly reviewed and the presentation, prognosis and treatment discussed, together with the possible significance of such a clinical association.
Chemoprophylaxis in surgery
Authors: Hobbs K E F
Published: December 2008

The literature on the prophylactic use in surgery of disinfectants, antibiotics and the chemotherapeutic agents is reviewed. It is concluded that there is little place for the routine use of antibiotics or chemotherapeutic agents except in a very few conditions. Disinfectants do have a part to play in skin sterilization and in the reduction of postoperative wound infection. However, none of the compounds yet replaces careful technique and standard surgical procedure.
Co-existent chronic lymphatic leukaemia with polycythaemia vera
Authors: Taberner D A , Chang J , Otridge B W
Published: December 2008

A patient presenting with chronic lymphocytic leukaemia and iron deficiency anaemia who, following oral iron therapy, developed the clinical and pathological features of polycythaemia vera is reported. The relationship between these two diseases when co-existing is discussed.
Carcinoid tumour of the cervix
Authors: Daw E
Published: December 2008

A case of non-metastatic carcinoid tumour of the cervix is described from a patient without the carcinoid syndrome. The rarity of carcinoid tumour involving gynaecological structures other than the ovaries is discussed and a bried review of carcinoid disease presented.
Betamethasone valerate compared with sodium cromoglycate in asthmatic children
Authors: Ng S H , Dash C H , Savage S J
Published: December 2008

A double-blind, cross-over study was undertaken to compare inhalation of betamethasone valerate (BV, 800 microgram daily) with sodium cromoglycate (SCG, 80 mg daily) in twenty children requiring bronchodilators for perennial asthma. Each treatment period lasted 4 weeks but statistical comparisons were made only in respect of the last 14 days of each therapy. When the children were using BV they required not only less of the bronchodilator drugs but had fewer symptoms and higher daily peak expiratory flow rates when taking SCG. Statistically, all these differences were highly significant. For 2 weeks before the main trial each child was given a placebo aerosol (single-blind) to assess severity of asthma. In comparison with this period, SCG was associated with a significantly increased peak expiratory flow rate a lower symptom score by day but not by night, but their usage of bronchodilators followed a similar pattern. When the BV period was compared with the placebo period, patients had an even more significant rise in peak expiratory flow rate, less day and night symptoms, and took hardly any bronchodilators. The response to the two drugs did seem to depend upon which was given first. No monilial infections were found, nor any measurable defect in adrenal response from either treatment. Betamethasone valerate is considered to be superior to sodium cromoglycate as a treatment for childhood asthma insufficiently controlled on bronchodilators.
Recent advances in the identification of hepatitis viruses
Authors: Dienstag J L , Purcell R H
Published: December 2008

Resulting directly from the discovery of virus-related antigens, rapid progress has marked the last decade of viral hepatitis research. The hepatitis B virion has been tentatively identified as a DNA virus with an endogenous DNA polymerase, and new serological markers for type B hepatitis have been discovered. Hepatitis A antigen has been identified on a virus-like particle thought to be the hepatitis A virion. Progressively more sophisticated assays for hepatitis antigens and antibodies have been applied to the study of viral hepatitis epidemiology and biochemical-biophysical characterization of the agents. Most recently, knowledge learned from such studies has been exploited to develop a prototype non-infectious but immunogenic hepatitis B vaccine using hepatitis B surface antigen (HBsAg) purified in large quantities from chronic HBsAg carriers. Especially exciting is the prospect, suggested by serological studies of viral hepatitis, that hepatitis viruses besides hepatitis A and B viruses will be identified.
The embryological basis of craniofacial dysplasias
Authors: Poswillo D E
Published: December 2008

Craniofacial dysplasia of a syndromic pattern can usually be classified into one of two easily identifiable groups. In the first group are those malformations of the craniofacial skeleton and soft tissues that are asymmetrical in form and in the other, those that are principally symmetrical. Clinical studies have demonstrated that affected subjects in the symmetrical group frequently improve in terms of facial appearance as growth and development proceed to maturity, while those with asymmetrical defects often deteriorate in this respect. Embryological studies on animal models of these malformations have shown that asymmetrical lateral facial dysplasia and symmetrical mandibulofacial dysplasia exhibit discrete and widely disparate causal mechanisms of malformation. Analysis of these mechanisms and their effects on subsequent growth and development has suggested significant variations in the timing and technique of reconstructive procedures which will enable the surgeon to produce the most effective results when used for the rehabilitation of the afflicted.
Oedema and vasodilatation in inflammation: the relevance of prostaglandins
Authors: Williams T J
Published: December 2008

The role of prostaglandins in inflammation is still disputed. Some workers have attempted to fit prostaglandins into a simple model, i.e. inflammatory leads to chemical mediator leads to vascular response. Recent work has shown that this approach may be misleading. An alternative model is proposed, involving the interaction of two chemical agents, i.e. a vascular permeability-increasing mediator (such as histamine or bradykinin) and a vasodilator (prostaglandin) which potentiates the plasma exudation produced by the permeability-increasing mediator. The results obtained in testing this model support the further proposal that non-steroidal anti-inflammatory compounds suppress inflammatory swelling by inhibiting vasodilatation.
Aplasia and leukaemia following chloroquine therapy
Authors: Nagaratnam N , Chetiyawardana A D , Rajiyah S
Published: December 2008

Three patients with aplastic anaemia following chloroquine therapy are described. In two, chloroquine had been administered in large doses over a long period. One of them subsequently developed acute myeloblastic leukaemia. The third received only a small dose and pancytopenia with aplasia followed three weeks after ingestion of the drug. The mechanism(s) of chloroquine-induced marrow injury is not known. A parallel to chloramphenicol-induced blood dyscrasias is drawn, but remains unproved.
The place of the hyperlipidaemias
Authors: Truswell A S , Lloyd June K , West Richard J
Published: December 2008

Of the primary hyperlipidaemias, familial hypercholesterolaemia (hyerbetalipoproteinaemia, type II) is always expressed in childhood and carries a high risk for the early development of coronary heart disease. The diagnosis can be established with a high degree of certainty by estimating the serum cholesterol concentration in selected children in whom the genetic risk is known to be great, e.g. if a parent or other first-degree relative is known to have the disease, or if a parent has had an attack of ischaemic heart disease at a young age. Screening of the general population in order to detect this disorder is not advocated. Treatment by either diet or drugs will lower serum cholesterol but long-term compliance is poor and the effect of treatment on the atherosclerotic process has not been evaluated. Follow-up studies must be maintained.

Familial hypertriglyceridaemic states are rarely fully expressed during childhood, and screening for them at this age is not practicable. Control of co-existent obesity and dietary treatment are usually successful in lowering serum lipids but long-term results have not yet been evaluated.

In a childhood population, single estimations of serum cholesterol or triglyceride should be interpreted with caution. Percentile rank correlations for serum cholesterol are of the order of 0·61 and for triglyceride of 0·31. Prediction of adult values cannot therefore be assured in childhood and the place of hyperlipidaemia in the childhood population as a risk factor for coronary heart disease in adult life is not established. Thus population screening of serum lipids in children cannot be justified. Evidence that a change in the diet of children which would be expected to lower serum lipids will also delay the development of atherosclerosis in general and coronary heart disease in particular is lacking. Nevertheless the dietary changes which have been recommended for adults can safely be followed by children, and changes in eating habits are perhaps more likely to succeed if promoted on a family basis rather than for individual sections of the population.
Auto-immune neutropenia in an infant
Authors: Thompson D S , Stableforth P , Darlow B , Brazier D M
Published: December 2008

A case of neutropenia in an infant is described, associated with repeated minor infections which responded to treatment with antibiotics. A granulocyte agglutinin was detected in the serum. Following treatment with prednisolone the neutropenia remitted, the antibody disappeared and the infections ceased. Treatment was discontinued after three months and the child remained well five months later. Reports of similar cases are reviewed and the significance of the antibody discussed.
Incidence of congestive cardiomyopathy
Authors: Torp A
Published: December 2008

In a stable population of 250 000, the diagnosis of congestive cardiomyopathy could be firmly established in fifty-nine cases during a period of 8 years. This gives an incidence of the disease of 3/100 000/year. If cases disclosed at post-mortem during the same period are included, the frequency of the disease will equal 5/100 000/year.
Persistence in herpes simplex virus infections
Authors: Longson M
Published: December 2008

Diseases of man caused by the virus of herpes simplex fall into two broad categories. The primary disease occurs only once in any individual's life and is caused by transmission of virus from an already infected human. Thereafter, the individual may be subject to recurrent herpetic disease, the manifestations of which are different from the primary disease. Recurrent disease varies in severity from trivial, to incapacitating and frankly lethal (as in diseases resulting from the virus's neurotropic and oncogenic properties). The source of the virus in recurrent herpetic disease has never been conclusively resolved, but is almost certainly endogenous to the patient. Theories, case reports and experiments exist to show that endogenous virus may, in periods of clinical quiescence, be latent (or persistent) at the site of the recurrent lesions itself, or more remotely in nerve tissues related to the site of recurrence.
Teething complications, a persisting misconception
Authors: Swann I L
Published: December 2008

Fifty children were admitted to hospital with symptoms of illness that were attributed, by the parent or general practitioner, to the process of teething in the course of one year.

In all but 2 cases an organic cause, other than teething, could be found and the most serious conditions were meningitis in one patient and febrile convulsion in 11.
Myocardial infiltration with immature cells in hypereosinophilic syndrome
Authors: Scott D G I , Leatherdale B A
Published: December 2008

A case of hypereosinophilic syndrome is reported. Investigation failed to reveal any precipitating cause or evidence of leukaemia. Death was due to intractable cardiac failure, and post-mortem examination showed infiltration of the myocardium with sheets of immature cells. The relevance of these cells is discussed and further investigation such as cardiac biopsy is suggested for similar cases.
Adult systemic oxalosis presenting as acute renal failure
Authors: Oli H , Davison A M
Published: December 2008

A case is reported of an adult who presented with acute renal failure and who was subsequently found to have widespread deposition of oxalate in many tissues.
Leiomyoma of the duodenum—an unusual presentation of a rare tumour
Authors: Anderson J R , Ford M J
Published: December 2008

A case of leiomyoma of the duodenum presenting with sub-acute intestinal obstruction and a palpable abdominal mass is described. Both the siting of the lesion in the duodenum and a presentation other than gastro-intestinal bleeding are unusual for this type of tumour.
Systemic opportunistic fungal infections
Authors: Vanbreuseghem R , Vroey C D
Published: December 2008

The clinical manifestations of ‘opportunistic’ fungal infections in compromised hosts, asthenomycoses, differ from those caused by the same fungus in otherwise normal people. Examples are given on the field of dermatophytoses, aspergillosis, candidiasis and cryptococcosis.
Sensitivity of strains of Candida albicans to jaritin, haloprogin, clotrimazole and miconazole
Authors: Langsadl L , Jedlickova Z
Published: December 2008

The antifungal activity of jaritin and haloprogin against Candida albicans is similar. In vitro they had less activity than clotrimazole and miconazole, but the activity was independent of inoculum size.
SimultaneousListeria monocytogenessepticaemia in mother and pre-term infant
Authors: Burgess P , Smith C S , Ben-Musa A , Harris F
Published: December 2008

Although infection by Listeria monocytogenes during pregnancy with subsequent infection of the fetus is well known, it is uncommon to encounter acute maternal septicaemia with the onset of premature labour and delivery of an infected infant. Such a case is described of maternal septicaemia with an infected liveborn preterm infant who was successfully treated and recovered.
Demonstration of lesions of cerebral toxoplasmosis by computerized tomography
Authors: Summerfield G P
Published: December 2008

A patient who was treated for 11 years with cytotoxic drugs for Hodgkin’s disease developed cerebral toxoplasmosis. Discrete lesions including an occipital abscess were visualized in the brain by computerized tomography (CT). This permitted a brain biopsy to be taken but the appearances were non-specific. At post-mortem pseudocysts of Toxoplasma gondii were found in several sites within the CNS. The recognition of these CT appearances as being due to toxoplasmosis should in future prompt serological investigation and urgent treatment of this potentially curable condition, despite negative biopsy material.
Beta-adrenoceptor-blocking drugs, growth hormone and acromegaly
Authors: Feely J
Published: December 2008

Chronic treatment with oxprenolol or propranolol in active hypertensive patients was associated with elevation of serum growth hormone (GH). Propranolol, 80 mg orally, caused a marked rise in GH in 3 of 4 acromegalic patients.
Crohn’s disease in Wales, 1967–1976; an epidemiological survey based on hospital admissions
Authors: Mayberry J F , Rhodes J , Newcombe R G
Published: December 2008

One thousand and ninety-eight patients from Wales were treated in hospital for Crohn’s disease between 1967 and 1976, which gave an overall ‘period prevalence’ for the disease of 40 cases/10(5) of the total population. The data were analysed for each of the 8 counties and for rural as well as urban populations of different sizes. The disease was significantly more common in the urban counties of Gwent and the 3 parts of Glamorgan compared with the remainder of Wales. The highest prevalence was in South Glamorgan (54 cases/10(5)) and the lowest in Dyfed (30/10(5)). There was a relatively small but highly significant difference in the prevalence for urban populations larger than 10 000 (47/10(5)) compared with smaller communities which were chiefly rural (34/10(5)).
Thyrotoxicosis presenting as orthostatic hypotension
Authors: Blum I , Barkan A , Yeshurun D
Published: December 2008

The patient described, whose symptoms were masked initially by the lack of steroids, illustrates an unusual case of orthostatic hypotension due to secondary adrenal insufficiency, caused by thyrotoxicosis.
Severe hypokalaemia with paralysis induced by small doses of liquorice
Authors: Cumming A M , Boddy K , Brown J J , Fraser R , Lever A F , Padfield P L , Robertson J I
Published: December 2008

A patient, who presented with a flaccid quadriplegia due to profound hypokalaemia, is described. Hypokalaemia and myoglobinuria were caused by the ingestion of small amounts of liquorice contained in a laxative preparation. Subsequent controlled administration of small amounts of this preparation induced marked hypokalaemia. This was associated with sodium retention and potassium loss confirming a mineralocorticoid-like action. The sodium retention was associated with suppression of plasma levels of renin and aldosterone.
Opportunities for change in the quantity and fatty-acid composition of carcass and milk fats
Authors: Jollans J L
Published: December 2008

Reduction of the amount of fat in carcasses has been in process for many years and will continue in response to consumer demand. With milk and dairy products, however, the demand for fat continues and available technology will only be used if the market changes. Some increase of the polyunsaturated: saturated ratio (P/S) of carcass fat will automatically accompany reduction in quantity of fat, particularly with pigs. Further change is technically possible but might bring consumer resistance and shelf-life problems. With milk fat, the P/S ratio could be increased by the feeding of protected, polyunsaturated oils although such an expensive approach could be avoided by changing the laws on dairy product nomenclature.
Life-threatening Mycoplasma pneumoniae infection
Authors: McGonigle R , Wagstaff J K
Published: December 2008

Pneumonia due to Mycoplasma pneumoniae is common, but it is rarely life-threatening. A case is reported in a previously healthy adult whose illness was severe enough to require treatment with intermittent positive pressure ventilation (IPPV) for 14 days and which resolved after treatment with corticosteroids.
Effect of treatment with cimetidine for one year on gastrin cell and parietal cell function and sensitivity to cimetidine in patients with duodenal or gastric ulcers
Authors: Festen H P , Lamers C B , Tangerman A , van Tongeren J H
Published: December 2008

Twenty-two duodenal and 16 gastric ulcer patients were treated with 400 mg cimetidine twice daily for one year after their ulcers had healed. No change in gastric acid secretion was observed before and after treatment in 20 duodenal and 13 gastric ulcer patients. Similarly, the inhibitory effect of 200 mg cimetidine on gastric acid secretion was unaltered in 11 duodenal and 6 gastric ulcer patients studied and cimetidine blood concentration were unchanged in 9 duodenal and 4 gastric ulcer patients after one year. In 7 duodenal and 6 gastric ulcer patients the serum gastrin response to a standard test meal before and after treatment was identical.
The patient’s subjective attitude towards screening for breast cancer. Should screening be extended to other forms of cancer?
Authors: Taylor T V , Rimmer S , Forrest A P
Published: December 2008

A sample of 500 consecutive women without symptoms of breast disease attending a breast screening clinic were investigated regarding their attitude to breast screening and to the extension of the screening programme to other forms of cancer. Attendance at the screening clinic was found to be reassuring by 94.2%, and 96.4% felt that the screening programme should be extended to include other forms of malignancy. There was a history of either respiratory or alimentary tract symptoms, and of smoking, or a family history of cancer in 41% of these women. The study shows that Edinburgh women are enthusiastic for breast screening and for its extension to include other forms of cancer.
Giant ovarian dermoid masked by obesity
Authors: Monk B E , Isaacs A J , Bayliss R
Published: December 2008

A 37-year-old female, weighing 194.1 kg, is described. Her gross obesity was in part due to a massive ovarian dermoid cyst weighing at least 42 kg, which had been overlooked in the past. A dermoid tumour of this size has not previously been reported. The possible presence of cystic ovarian tumours should be considered in patients presenting with severe generalized obesity.
Chronic Salmonella eimsbuettel septicaemia presenting with intermittent sweats and haematuria
Authors: Lowes J A , Clark A J , Britten K E
Published: December 2008

An unusual presentation is reported of salmonellosis, frank haematuria and chronic septicaemia arising during an outbreak of food poisoning caused by Salmonella eimsbuettel. The patient whose gut was colonized gave a history of chronic pyrexia and weight loss and suffered an intermittent urinary infection but had no gastroenteritis.
Polyhydramnios and acute renal failure
Authors: Hamilton D V , Kelly Moira B , Pryor J S
Published: December 2008

Acute renal failure secondary to ureteric obstruction is described in a primigravida with twin gestation and polyhydramnios. Relief of the obstruction occurred on drainage of the liquor and return to normal renal function following delivery.
Thyroid function tests during carbimazole therapy
Authors: Scott D L , Tymms D J , Taylor M A , Chapman C
Published: December 2008

Changes in plasma thyroxine (T4), triiodothyronine (T3), free thyroxine index (FT4I) and thyroid stimulating hormone were studied in 100 patients with Graves’ disease treated with carbimazole. During therapy plasma T3 concentrations were disproportionately high compared to those of T4, the T4 : T3 ratio was low, and many patients were clinically euthyroid with a normal plasma T3 but low T4 concentration. Although there was considerable individual variation in response, the order of response was always the same with plasma T4 falling to normal or low levels before T3. Plasma T3 was the best indicator of clinical status and the best predictor of the impending change; additional information of changes in thyroid status was obtained from plasma T4 and FT4I estimation, especially when these were followed sequentially. Single measurements of T4 or FT4I only are not recommended for assessing thyroid function during carbimazole therapy.
‘Pulse’ methylprednisolone and cyclophosphamide therapy in idiopathic rapidly progressive glomerulonephritis
Authors: Friedman G , Granot H , Koplovic Y , Friedlander M
Published: December 2008

The clinical report of a 31-year-old man who developed acute renal failure due to idiopathic rapidly progressive glomerulonephritis is presented.

Intravenous pulse methylprednisolone therapy in combination with cyclophosphamide resulted in marked improvement in renal function. The literature dealing with pulse therapy is reviewed.
Neurological complications of Legionnaires’ disease
Authors: Pearson S B , Dadds J H
Published: December 2008

A case is reported of Legionnaires’ pneumonia in a 49-year-old woman, associated with severe and permanent disability resulting from damage to the brain stem believed to be the result of an encephalitic process.
Herpes encephalitis and herpetic corneal disease
Authors: Webb A K , Levy I
Published: December 2008

A case of herpes encephalitis is reported in a patient who had cranial irradiation and high dose steroids for a cerebral neoplasm. Before radiotherapy the patient had had herpetic infections of the skin and eye.
Relationships of the platelet aggregate ratio to serum cholesterol concentration, smoking and age
Authors: Davis James W , Lewis H Daniel , Phillips Phyllis E , Davis Rebecca F
Published: December 2008

The platelet aggregate ratio has been found to be decreased in some patients with vascular diseases suggesting the presence of increased circulating platelet aggregates. It has also been reported that hypercholesterolaemia is associated with an enhanced response of platelets to aggregating agents in platelet-rich plasma. The primary purpose of this investigation was to determine correlation of the platelet aggregate ratio with the serum cholesterol concentration of men with vascular diseases. For 52 men referred because of known or suspected coronary artery disease, cerebrovascular disease, or venous thromboembolism, the correlation coefficient of 0·06 suggested that the serum cholesterol concentration within the range observed (135-360 mg/dl) was not a factor influencing the platelet aggregate ratio. There was not a statistically significant difference between the mean platelet aggregate ratios or the mean serum cholesterol concentrations of the 21 non-smokers and the 31 smokers studied. A correlation coefficient of 0·03 between the platelet aggregate ratio and age of the patient suggested that the platelet aggregate ratio was independent of age in men with occlusive vascular diseases.
Anticonvulsant intoxication precipitated by azapropazone
Authors: Roberts C J C , Macfarlane D , Daneshmend T K , Dieppe P A
Published: December 2008

A patient is reported who developed a hitherto unrecognized drug interaction between azapropazone and anticonvulsants which led to toxicity with the latter. The mechanism of this interaction is discussed.
Coronary and peripheral vascular occlusion due to rheumatoid arteritis
Authors: Rudge S R , Jones J K Lloyd , Macfarlane A
Published: December 2008

A case of severe progressive rheumatoid arteritis leading to bilateral lower limb amputation and death from myocardial infarction is described.
Overwhelming post-splenectomy infection with group B Streptococcus
Authors: Finnegan O C , Hawkey P M
Published: December 2008

A case of overwhelming post-splenectomy infection is described. This occurred 10 years after splenectomy in an otherwise normal male adult. The infecting organism, β-haemolytic Streptococcus Group B, is usually of low pathogenicity, but in this case caused profound hypotension, jaundice and the shock lung syndrome. Overwhelming post-splenectomy infection with this organism has not previously been reported.
Rupture of the cervix during prostaglandin termination of pregnancy
Authors: El-Etriby E K , Daw E
Published: December 2008

A case of uterine rupture following extra-amniotic prostaglandin E2 with a subsequent obstetrical complication is reported.
Aldosterone-producing microadenoma in a patient with primary aldosteronism
Authors: Kaneshige H , Endoh M , Nomoto Y , Sakai H , Arimori S
Published: December 2008

A 54-year-old patient was found to have an aldosterone-producing microadenoma measuring 2.5 mm in diameter. Although adrenal venography by selective catheterization had failed to demonstrate the tumour, adrenal scintiscan using 131I-19-iodocholesterol accurately localized the functional tumour in the right adrenal gland; a dexamethasone-modified adrenal scintiscan revealed complete suppression of radioactivity in the right adrenal gland. These findings suggest that adrenal scintiscan, together with adrenal vein blood analysis, is capable of detecting a small adenoma before surgery, and that dexamethasone suppression of an adrenal scintiscan does not exclude an adenoma.
Nodular regenerative hyperplasia of the liver with membranous glomerulonephritis
Authors: McCulloch A J , Morley A R , Wilkinson R , Lesna M
Published: December 2008

Nodular regenerative hyperplasia of the liver is an uncommon disorder, the main consequence of which is portal hypertension, hepatocellular decompensation being uncommon. A case associated with membranous glomerulonephritis is reported, in which death was caused by fulminant hepatic failure.
Cerebral aspergilloma
Authors: Partridge Betty M , Chin A T L
Published: December 2008

This is the report on a fatal case of aspergilloma with intracranial mycotic aneurysm associated with Aspergillus flavus infection, confirmed by culture and serology. Drug therapy is discussed.
Diabetic ketoalkalosis due to ectopic ACTH production from an oat cell carcinoma
Authors: Pearson D W M , Thomson J A , Kennedy A C , Toner P G , Ratcliffe J G
Published: December 2008

A diabetic patient is described who presented with the bizarre biochemical association of hyperglycaemia, ketosis and severe alkalosis. Investigation revealed hypercortisolaemia due to ectopic adrenocorticotrophic hormone secretion from an oat cell carcinoma of the bronchus and post-mortem studies demonstrated clinically unsuspected resolving pancreatitis. a possible mechanism for the metabolic upset is discussed.
Encephalitis and polyneuritis complicating varicella zoster infection
Authors: Twomey J Aidan , Jefferson David
Published: December 2008

A 70-year-old patient is described who developed symptoms and signs of a Guillain-Barré-type neuropathy and encephalopathy beginning 6 weeks after a cutaneous varicella zoster eruption. The patient made a complete symptomatic recovery over a period of 4 months. It is suggested that the delayed onset neuropathy and encephalopathy in this patient may have been due to an allergic inflammatory response to an antigen common to peripheral and central myelin.
Hydrallazine alone in acute left ventricular failure
Authors: Clark A J L , McMichael H B
Published: December 2008

A patient presented with severe acute left ventricular failure and was treated with hydrallazine and oxygen alone. He made a rapid and full recovery as judged by clinical, radiological and blood gas evidence.