bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute sacral epidural abscess following local anaesthetic injection
Authors: Rustin M H A , Flynn M D , Coomes E N
Published: December 2008

Spinal epidural abscesses are uncommon infections of the central nervous system. Delay in making the diagnosis increases the morbidity and mortality because irreversible neurological damage occurs during this time. We report a 45-year-old male who developed an acute sacral epidural abscess following a local anaesthetic injection given for the relief of low back pain. We believe this is the first documented case of a local anaesthetic injection causing an acute sacral epidural abscess.
Hemichorea—a late sequel of an extradural haematoma
Authors: Sandyk R
Published: December 2008

Hemichorea developed several weeks after evacuation of a traumatic extradural haematoma. The abnormal movements were confined to arm and leg on the side opposite the surgery. No other causes of chorea were found. The connection between the extradural haematoma and the late onset hemichorea is not well understood; mechanical pressure on basal ganglia structures, vascular disturbances of the anterior choroidal artery as well as biochemical alterations are all possible mechanisms.
Ménétrièr’s disease and trichobezoar of stomach—an unusual association
Authors: Chakrabarti A K , Singh T D , Joshi K , Malik A K
Published: December 2008

Hypertrophic gastropathy (Ménétrièr’s disease) is a clinical and pathological curiosity. It is often seen in association with a variety of other disease processes. The authors here present a previously undescribed association of Ménétrièr’s disease with trichobezoar in the stomach and small intestine.
Occult pulmonary thromboembolism presenting as diffuse interstitial pneumonitis in cancer patients
Authors: Needleman S W , Aschenbrener C A , Armitage J O
Published: December 2008

The prompt and accurate recognition of non-malignant complications is of critical importance in the care of cancer patients. Pulmonary thromboembolism is particularly important because it is common, treatable and frequently difficult to diagnose. Two patients are presented who died of recurrent pulmonary thromboemboli which were unrecognized because open lung biopsies showed diffused interstitial pneumonitis. The association of pulmonary thromboembolism and interstitial inflammation has been recognized at autopsy, and there are a number of plausible mechanisms which could link these processes. Interstitial pneumonitis should be added to the numerous protean manifestations with which pulmonary thromboembolism is associated.
Phaeochromocytoma of the urinary bladder localized by selective venous sampling and computed tomography
Authors: Miller J L , Immelman E J , Roman T E , Mervis B
Published: December 2008

Clinical and biochemical evidence of a catecholamine-secreting tumour was documented in a 19-year-old female presenting with malignant hypertension. The tumour was successfully localized to the pelvis by means of plasma noradrenaline assay from multiple sites, after previous attempts at localization had failed. Subsequently, computed tomographic (CT) scan allowed correct pre-operative localization to the urinary bladder.
Fractures of the pelvis
Authors: Eid Abulfotooh M
Published: December 2008

Pelvic fractures in this series constituted 3.3% of all traumatic admissions and 5.7% of all fractures.

A classification of pelvic fractures was adopted in which five types were identified. Type I (24.2%) comprised fractures without a break in the pelvic ring. Type II (17.7%) comprised those with a single break in the pelvic ring. Fractures with a double break of the pelvic ring constituted Type III (23.6%). Multiple fractures of the pelvis were identified as Type IV (10.8%). Fractures of the acetabulum were grouped separately as Type V (23.7%). On the basis of blood loss, mortality and potential disability, Types I and II constituted the ‘minor’ fractures of the pelvis. Types III, IV and V were the ‘major’ fractures of the pelvis, of which Type IV were the worst.

The commonest fracture encountered was that of a single pubic ramus. The pubic area was involved in 43.0% of the cases.

Associated injuries were common (2.19 per patient). Some of these lesions were the result of the causative trauma. Some others, however, were related to certain types of pelvic fractures.
Bleomycin in verrucous squamous cell carcinoma of the oesophagus
Authors: Sakurai Toshihiro , Fuchigami Tadahiko , Omae Teruo , Iwashita Akinori , Kume Kazuhiro , Asano Shozo
Published: December 2008

A case of verrucous squamous cell carcinoma of the oesophagus treated with bleomycin is reported. Bleomycin brought prompt reduction of the tumour and relief of symptoms. There have been no previous reports on experience with anti-cancer agents for verrucous carcinoma of the oesophagus. Administration of bleomycin might be an effective treatment for verrucous carcinoma of the oesophagus.
Axillary lymphadenitis due to Mycobacterium avium-intracellulare
Authors: Colley E W , Cox Rosamond A
Published: December 2008

A 5-year-old girl presented with a swelling in the right axilla from which Mycobacterium avium-intracellulare was cultured. The gland was excised and she made an uneventful recovery.
Granulomatous peritonitis caused by glove starch
Authors: Michowitz M , Stavorovsky M , Ilie B
Published: December 2008

Corn starch particles are used as a surgical glove lubricant. At present there is no better alternative for this lubricant. Implantation of corn starch particles into the peritoneal cavity can induce foreign body reactions, starch peritonitis and starch granulomata, and may cause adhesions and intestinal obstruction. Starch peritonitis should be treated conservatively.
Problems of haemostasis in burns surgery
Authors: Hazarika E , Mason J
Published: December 2008

A 26-year-old male patient, with full thickness burs to 35% of his body surface area, was treated by excision and meshed split-skin grafting on the 7th day post-burn. Postoperatively, he developed persistent bleeding which was finally halted by clot removal, bipolar coagulation of bleeding points, replacement of the meshed skin graft and the application of a layer of oxidised regenerated cellulose. The treatment was effective and the patient made an otherwise uneventful recovery. The authors are unaware of the previous use of oxidised regenerated cellulose for the control of haemorrhage from 50% of the body surface area, with success.
Haemostasis and cleft palate surgery
Authors: Walters F J M
Published: December 2008

Previous workers have reported blood loss during cleft palate surgery to range from 45 ml to 280 ml in children up to 3 years of age (Tempest, 1958; Jennings et al., 1980). It rarely decompensates the patient except perhaps in the small infants. Even in this group, if the basic cardiovascular parameters are monitored and the blood loss carefully measured, it can simply be replaced. However, for the surgeon, operating accurately under a pool of blood in a small mouth can become impossible, making a successful repair difficult. Ideally therefore, even the smallest amount of bleeding should be prevented.
Difficult tracheal intubation; improvements in translaryngeal guide wire techniques
Authors: Blogg C E , Ward M E
Published: December 2008

Many solutions have been proposed for achieving tracheal intubation in patients with anatomical abnormalities which preclude the conventional use of a laryngoscope. The use of a guide passed in a retrograde direction into the mouth via the larynx (Waters, 1963) or trachea (Ramsay and Salyer, 1981) has proved useful by allowing the tracheal tube to be guided over the guide from the mouth or nose into the larynx. Greater control is achieved by the use of a relatively rigid wire (Ramsay and Salyer, 1981; Roberts, 1981; McLean, 1982) but passage of the tube into the trachea is impeded by the guide protruding through the skin of the neck. If the guide is removed, the risk of displacing the tracheal tube as it is advanced is increased.
Blood pressure in black, white and Asian factory workers in Birmingham
Authors: Cruickshank J K , Jackson S H D , Bannan L T , Beevers D G , Beevers M , Osbourne V L
Published: December 2008

A screening survey was conducted among factory workers, aged 15-64 years, in Birmingham, England to investigate ethnic differences in blood pressure. One-thousand and forty-nine subjects (784 men, 265 women) were screened, representing 79% of the eligible population.

Mean systolic and diastolic blood pressures generally did not differ between men of black West Indian (n = 173), local white (n = 439) or Asian (n = 172) origin, when matched by 10-year age groups. Analysis of covariance using age as the covariate revealed that, overall, Asian men had significantly lower systolic but higher diastolic pressures than the other ethnic groups. The proportion of men arbitrarily defined as hypertensive (greater than or equal to 160 mmHg systolic or greater than or equal to 95 diastolic or blood pressures below this figure whilst receiving antihypertensive therapy) was 26% of West Indians, 22% of whites and 17% of Asians, but these were not significantly different when age was accounted for.

Black West Indian women (n = 101) did have higher diastolic pressure than white women (n = 164), but this difference was dependent on body mass index. Overall, systolic pressures in women were not significantly different.

These findings differ from those consistently reported from the United States.
A blood pressure clinic in a developing country
Authors: Ahmed M E K
Published: December 2008

There are few studies of hypertension in Sudan. In this report, 124 patients attending a newly established hypertension clinic are studied, most of whom were taking irregular treatment initially. Seventy-three (59%) had a strong family history of hypertension. There was a very low incidence of cigarette smoking (13.7%), and alcohol consumption (4.8%).

As with blacks in the U.K. and the U.S.A., the commonest complications were cerebrovascular accidents and congestive cardiac failure. Most of the patients had moderately elevated blood pressures on the first visit, which fell significantly after 3 and 6 months of clinic attendance. Methyldopa and thiazides were the commonest drugs used, but a small pilot survey demonstrated that beta-blockers were effective. The high cost and poor availability of drugs contribute to poor compliance in these patients.
Does parasitic infestation protect the rural African from atheroma? (Abstract)
Authors: Howells D P M
Published: December 2008

Parasitic infestation is associated with an increase in the mast cell population of tissues. Heparin is released from the mast cell to activate lipoprotein lipase and may influence fat metabolism. Depletion of the mast cell population may be a characteristic of a parasitic free, atheroma prone ‘Western’ population.
Anaemia in Asians in London
Authors: Britt R P , Hollis Yvonne , Keil J E , Weinrich M , Keil Barbara W
Published: December 2008

Many Asian subjects were seen in London in the early 1970s with megaloblastic anaemia; in a majority of cases, this was dietary in origin. Pernicious anaemia occurs in Asians, but the incidence is probably lower than in Caucasians. Megaloblastic anaemia is now less common in this group, but a population survey in Punjabi females in the late 1970’s showed anaemia in 32%, and one or more features of iron deficiency in 76%.
Rheumatic diseases in blacks, whites and Asians—some comments
Authors: Bacon P A
Published: December 2008

The aetiology of rheumatic diseases is unknown but in many of them it appears that there are one or more trigger factors which induce inflammatory rheumatic disease against the genetic background of the patient. Both trigger factors and genetic background may differ in different parts of the world. Ethnic differences can therefore modulate rheumatic diseases in many ways which will appear as differences in disease prevalence as well as in disease expression. This appears to be true of all rheumatic diseases which have been examined in detail, from the common ones to the rarer forms of connective tissue disease.
A comparison between a combination of ipratropium bromide plus fenoterol in a single metered dose inhaler (Duovent) and salbutamol in asthma
Authors: Flint K C , Hockley B , Johnson N McI
Published: December 2008

The efficacy of a single metered dose inhaler containing a combination of fenoterol (100 micrograms/puff) and ipratropium bromide (40 micrograms/puff) has been assessed in 12 asthmatics. We conclude that the bronchodilator effect of 2 puffs of the combination inhaler was significantly greater than that achieved by 2 puffs of salbutamol (100 micrograms/puff).
Carcinoid tumour of ampulla of Vater associated with viscero-cutaneous neurofibromatosis
Authors: Kapur B M L , Sarin S K , Anand C S , Varma K
Published: December 2008

A case of carcinoid tumour of the ampulla of Vater with viscero-cutaneous neurofibromatosis is reported together with a review of the literature.
Adventures and excursions in bioassay—the stepping stones to prostacyclin
Authors: Vane J R
Published: December 2008

Physiology has spawned many biological sciences, amongst them my own field of pharmacology. No man has made a more important contribution to the fields of physiology and pharmacology than Sir Henry Dale (1875-1968, Nobel Laureate in Physiology and Medicine in 1936). Dale had a great influence not only on British pharmacology in general but also on my own scientific endeavours. Indeed, I can put forward a strong case for considering myself as one of Dale’s scientific grandchildren. My early days as a pharmacologist were influenced not only by Dale himself but also by his own school of colleagues, including Burn, Gaddum and von Euler. It was Burn who taught me the principles and practice of bioassay. Some of Gaddum’s first publications were on the development of specific and sensitive methods for biological assay and he maintained a deep interest in this subject for the rest of his life (1). In 1964 he said “the pharmacologist has been a ‘jack of all trades’ borrowing from physiology, biochemistry, pathology, microbiology and statistics—but he has developed one technique of his own, and that is the technique of bioassay” (2).
HLA antigens and necrobiosis lipoidica diabeticorum—a comparison between insulin-dependent diabetics with and without necrobiosis
Authors: Soler Norman G , McConnachie Peter R
Published: December 2008

To investigate whether HLA-A, -B, -C, and -DR alloantigen frequencies are different in diabetic patients with and without necrobiosis lipoidica diabeticorum we studied 37 insulin-dependent (Type I) diabetics, 15 with and 22 without necrobiosis, and 96 normal control subjects. Compared to controls Type I diabetics had increased frequencies of B8, CW3, and DR4 and decreased frequencies of DR5 and DR7. Diabetics with necrobiosis differed from diabetics without necrobiosis only in that HLA-A2 was significantly less frequent in patients with necrobiosis. It is suggested that the lack of major differences between patients with and without necrobiosis argues in favour of the role of metabolic and/or vascular rather than genetic factors in the aetiology of necrobiosis.
Comparison of propranolol and propranolol LA in hypertension using 24-hr noninvasive blood pressure monitoring
Authors: Rustin M H A , Coomes E N
Published: December 2008

The technique of non-invasive blood pressure monitoring was used to compare the 24-hr control of blood pressure in 10 patients with essential hypertension taking either twice daily propranolol or a once daily long-acting formulation of propranolol (propranolol LA). Both drug regimes produced smooth control of blood pressure and heart rate through the 24 hours and significantly reduced blood pressure and heart rate on bicycle ergometry tests. There was no significant difference between the two treatments. The non-invasive oscillometric method of measuring 24-hr control of blood pressure provides an alternative to ambulatory intra-arterial monitoring.
A case of congenital triple valve disease
Authors: van Besouw J P , Shepherd N A , Orr G , Jackson S H D
Published: December 2008

We report a case of congenital triple valve stenosis with dominant pulmonary valve disease, sparing the aortic valve, presenting at the age of 51 years with progressive shortness of breath and central cyanosis. At post mortem, no intracardiac right to left communication could be demonstrated.
IgE myeloma associated with plasma cell leukaemia
Authors: West N C , Smith A M , Ward R
Published: December 2008

A patient presented with plasma cell leukaemia and was found to have an IgE secreting multiple myeloma. IgE myeloma is very rare with only 18 cases recorded. However, this case is the fifth recorded of IgE myeloma associated with plasma cell leukaemia. Since plasma cell leukaemia only occurs in 1.6% of all cases of myeloma, it seems certain that this is a significant association.
Acute polyarthritis following the use of Corynebacterium parvum vaccine (Coparvax) for malignant pleural effusion
Authors: Lever A M L , Forsythe J , Oxford P
Published: December 2008

A 77-year-old man with a malignant pleural effusion was treated by aspiration of fluid and injection of Corynebacterium parvum vaccine for pleurodesis. Within 24 hr he had developed a temperature and a neutropenia followed by an acute crippling polyarthritis of his hands and wrists which subsequently responded to oral steroids and non-steroidal antiinflammatory drugs.
Chlormethiazole in the treatment of neonatal status epilepticus
Authors: Miller P , Kovar I
Published: December 2008

A pre-term neonate with status epilepticus resistant to conventional treatment but who responded to a chlormethiazole infusion is reported. Nineteen days of continuous infusion was required before treatment could be discontinued and oral phenytoin substituted. Chlormethiazole should be considered in the treatment of resistant convulsions in the newborn.
Lessons from falling coronary heart disease mortality in the United States
Authors: Epstein F. H.
Published: December 2008

The marked decline in coronary heart disease mortality in the United States since the late 1960s is most likely due in large part to successful efforts at primary prevention, attributable in turn to improved eating habits, better control of blood pressure and a reduction in smoking. Another part of the decline can probably be explained by an improvement in prognosis. It remains to be established if there has been a reduction in morbidity as well as mortality. There are other countries which have experienced declines, though of a lesser degree, while several countries have recorded increases in coronary heart disease mortality. These downward and upward turns, in general, are likewise compatible with the theory that they are caused by corresponding favourable or unfavourable changes in life styles.
Trends in major risk factors. Cigarette smoking
Authors: Simpson D.
Published: December 2008

The object of this paper is to examine the role of smoking as a risk factor in coronary heart disease, starting with a brief history of smoking in the U.K. and a reminder of the epidemiological evidence linking smoking and cardiovascular disease. This is followed by a more detailed look at the trends in consumption of tobacco and the major factors influencing those trends, together with an outline of the main components of a smoking control policy designed to combat our epidemic of smoking-induced disease.
Hypertension and the prevention of coronary heart death in general practice
Authors: Hart Julian Tudor
Published: December 2008

A major attack on the main risk factors of coronary heart disease is essential in order to control it.

In general practice, there is a real opportunity to control high blood pressure and smoking; unfortunately coronary risk factors are closely related to social class and unemployment. Major new strategies will be needed both by government and the medical profession in order to achieve a reduction in the commonest single cause of death in the U.K.
Cardiac failure, hepatic congestion and increased level of serum carcinoembryonic antigen
Authors: Pönkä Antti , Forslund Terje
Published: December 2008

A 65-year-old woman undergoing chronic haemodialysis for chronic nephritis had transiently elevated serum carcinoembryonic antigen levels, up to 26 ng/ml for nearly 3 months. This elevation was most probably due to cardiac failure with hepatic congestion and pulmonary oedema, because the antigen level returned to normal when the cardiac failure was properly treated, and comprehensive examinations revealed no other cause. During follow-up for 18 months, the carcinoembryonic antigen level has remained normal.
Treatment of severe localized pulmonary interstitial emphysema by selective bronchial intubation
Authors: Oliver J. E. , Smith I. J.
Published: December 2008

A pre-term infant being ventilated for respiratory distress syndrome developed severe localized pulmonary interstitial emphysema which was successfully treated by selective bronchial intubation.
Benign Leydig cell tumour and germ cell carcinoma in situ in a young man with gynaecomastia
Authors: Fink R. S. , Mann M. S. , Hopewell J. P. , Ginsburg Jean
Published: December 2008

A 21-year-old man presented with a 16-year history of recurrent pyrexial episodes and a 5-year history of gynaecomastia. Blood and urinary oestrogen levels were elevated and a mass was found in the upper pole of a retractile right testis.

After orchidectomy, oestrogen levels fell, gynaecomastia regressed and the pyrexial episodes ceased.

Histological examination of the right testis showed a benign Leydig cell tumour in the upper pole and a germinal cell carcinoma in situ in the remaining part of the testis. Thus a potentially lethal condition was detected at an early pre-malignant phase by virtue of a benign, endocrinologically active tumour. This would seem to be the first report of the co-existence of a Leydig cell tumour and germ cell carcinoma in the same testis.
Acute post-streptococcal glomerulonephritis following ear piercing
Authors: Ahmed-Jushuf I. H. , Selby P. L. , Brownjohn A. M.
Published: December 2008

A case of post-streptococcal glomerulonephritis following ear-piercing is reported. It illustrates a rare but life-threatening complication of a cosmetic procedure carried out under unhygienic conditions.
Simultaneous presentation of two cerebral arterial aneurysms
Authors: Thomas A. M.
Published: December 2008

A case of subarachnoid haemorrhage due to rupture of a middle cerebral artery aneurysm followed by immediate enlargement of a carotid intra-cavernous aneurysm is described. The enlargement of the second aneurysm was due to a rise in blood pressure caused by the subarachnoid haemorrhage. Although multiple aneurysms are common, this phenomenon is very rare and the reasons for this are discussed.
Bi-atrial myxomas presenting as recurrent pulmonary emboli in a girl
Authors: Hanly John , de Buitleir Michael , Shaw Keith , Maurer Brian , FitzGerald M. X.
Published: December 2008

A 14-year-old girl whose sole presenting features were symptoms of pulmonary embolism, was found to have bi-atrial myxomas. The diagnosis was made preoperatively, and the patient had a successful outcome following elective surgery. The absence of other features such as systemic embolism, atrioventricular valvular obstruction, fever and constitutional symptoms makes this a most unusual case. Right atrial myxoma should be considered in any patient presenting with pulmonary embolism for which there is no obvious source.
Hypocalcaemic cataract as a presenting symptom of renal insufficiency
Authors: Kazi G. Q. , Phillips C. I. , Lambie A. T. , Winney R. J.
Published: December 2008

A young man of 17 years presented with bilateral reduced vision because of cataracts. Investigations showed a low level of serum calcium along with other evidence of renal failure. The cataracts were mainly in the posterior pole (cupulliform); faint peripheral cortical opacities were also present—in the form of about a dozen half-loops straddling the equator and extending about half way towards the axial centre of the lens.
Occult ruptured spleen—two unusual clinical presentations
Authors: Moore P. G. , Gillies J. G. , James O. F. , Saltos N.
Published: December 2008

Case reports of two patients with occult rupture of the spleen are presented. In one, blunt trauma appeared to involve only the neck and upper chest, resulting in two distinct tracheal injuries and no clinical indication of abdominal injury. On the 5th day after injury this patient strangulated an indirect inguinal hernia. At subsequent surgery, a ruptured spleen was also found. The second patient gave no history of trauma and presented in cardiac and respiratory failure after a 2-month illness characterized by abdominal pain. On clinical and biochemical assessments, he was considered to have pancreatitis complicated by pseudocyst formation. Laparotomy revealed intra-abdominal haemorrhage and a ruptured spleen. The diagnosis and complications of occult ruptured spleen are discussed.
Neuroenteric cyst of the cerebellum
Authors: Mehta V. S. , Chowdhury Chitra , Bhatia R.
Published: December 2008

Intracranial neuroenteric cysts are rarely encountered and no more than 13 cases have been reported in the literature. This paper reports another case located in the cerebellum. These occur mostly in adults and there is no typical clinical presentation. The computed tomographic scan shows them as low attenuating lesions with no peripheral contrast enhancement. These cysts are believed to be developmental in origin.
High serum thyroxine-binding globulin—an important cause of hyperthyroxinaemia
Authors: Leahy Bernard C. , Davies Derek , Laing Ian , Walton Leslie
Published: December 2008

Four patients are described who had a significant elevation of serum thyroxine-binding globulin (TBG). Review of these patients indicated that inappropriate therapy for thyrotoxicosis had been given in three cases. A study of our laboratory records revealed that significant TBG elevation was a relatively common phenomenon which occurred in approximately 0.45% of our hospital population. Patients with this abnormality have serum thyroxine levels which are comparable to those with clinical thyrotoxicosis. Tri-iodothyronine is frequently elevated though less so than in patients with clinical thyrotoxicosis. Measurement of TBG is indicated in all cases of hyperthyroxinaemia in which the clinical features of thyrotoxicosis are doubtful. The TRH test was found to be most useful in evaluating the thyroid status of these patients.
Acute pancreatitis—presentation as a discoloured lump in the groin
Authors: Dennison Ashley R. , Royle Gavin T.
Published: December 2008

Pancreatitis presenting as a mass in the inguinal region is extremely rare. Such a case in an adult male is presented and the diagnostic problems discussed.
Does hyperthyroidism predispose to thioridazine-induced hyperpyrexia and cardiac arrhythmias?
Authors: Murphy Michael B. , FitzGerald Muiris X.
Published: December 2008

Treatment with thioridazine resulted in hyperpyrexia and ventricular tachycardia in a young woman who was later shown to have thyrotoxicosis. The reasons why hyperthyroidism may enhance thioridazine toxicity are reviewed.
Effect of introduction of colposcopy into a district general hospital
Authors: Pill C. F. , Letchworth A. T. , Noble A. D.
Published: December 2008

Management of cervical intra-epithelial neoplasia, in a district general hospital, was examined for two 22-month periods before and after the introduction of colposcopy. This technique enables the clinician to evaluate the extent and severity of pre-malignant change, and makes treatment, using less radical destructive techniques, possible. The method of conservative treatment in this hospital was diathermy, and the cure rate of cases so treated was 97%. The use of diathermy treatment resulted in a 75% reduction in the incidence of cone biopsy in women below the age of 40 years.

A further advantage of colposcopy has been recognized, which is that some women with "mild or moderate changes" are discovered to have more severe lesions, and receive appropriate treatment without delay. It follows that all patients with an abnormal smear should be referred for colposcopy, unless there is an obvious local cause of the abnormality, such as easily treatable infection, and that the post-treatment smear reverts to normal.

In this hospital the cost of establishing a colposcopic service was low, and the cost benefits, as well as the improved management of cervical intraepithelial neoplasia suggests that the service should be introduced in all district general hospitals.
Idiopathic midline destructive disease—case report and review of the literature
Authors: Robinson Anne C. R. , Fraser Ian , Bailey Denis , O’Halloran M. J.
Published: December 2008

A case of idiopathic midline destructive disease (IMDD) in a 39-year-old male is described. Clinical features and diagnosis are discussed. The value of radiotherapy in management is highlighted.
Addison’s disease and thyrotoxicosis presenting simultaneously
Authors: Newrick P. G.
Published: December 2008

The simultaneous presentation of two endocrinological diseases is uncommon. A case is discussed in which Addison’s disease and thyrotoxicosis were discovered in an individual following presentation as an emergency neurological problem.
Cholecystitis associated with myelomatosis
Authors: Sherlock D. , Jones B.
Published: December 2008

A case of myeloma presenting as acute cholecystitis unresponsive to conventional management is reported. The impairment of the immunological response is a well-known aspect of myeloma, although this usually takes the form of recurrent respiratory infections. It is unusual for acute on chronic cholecystitis, a predominantly Gram-negative infection, to present in this way.
Spontaneous bacterial peritonitis due to Campylobacter jejuni
Authors: McNeil N. I. , Buttoo S. , Ridgway G. L.
Published: December 2008

A patient with alcoholic cirrhosis complicated by ascites developed spontaneous bacterial peritonitis. Campylobacter jejuni—(a microaerophilic bacillus)—was isolated from ascitic fluid and blood.
Transient electrocardiographic changes during two episodes of relapsing brucellosis
Authors: Gur Hanan , Gefel Dov , Tur-Kaspa Ran
Published: December 2008

Cardiac involvement in the course of acute brucellosis is rare and, when present, is usually manifested by endocarditis. Myocarditis is very infrequent and in the few reported cases, the course of the disease was fulminant. A patient with recurrent brucellosis who presented transient electrocardiographic T wave changes during two episodes of acute illness is reported. It is suggested that the patient had minor asymptomatic myocarditis in the course of recurrent brucellosis.
Acquired hypogammaglobulinaemia and sarcoidosis
Authors: Lee Christine A.
Published: December 2008

A syndrome has been described in which hypogammaglobulinaemia is associated with splenomegaly and haemolytic anaemia and also non-caseating granulomata in lymph nodes, liver, spleen and skin. This report describes a patient with this syndrome who in addition had a positive Kveim and elevated serum angiotensin converting enzyme (SACE), suggesting the diagnosis of sarcoidosis.
Neurological aspects of insulinomas
Authors: Daggett Peter , Nabarro Sir John
Published: December 2008

Neurological involvement occurred in every one of a series of 30 patients with an insulinoma. The episodic nature of the hypoglycaemia caused symptoms and signs to fluctuate and often led to delay in diagnosis (mean length of history was 3 years). The commonest feature at first presentation was confusion (20 instances), but as the illness evolved, coma (16 instances) and convulsions (8 instances) became more frequent. Objective weakness was found in 7 patients, with 3 examples of hemiparesis and 2 each of paraparesis and monoparesis; in all, the weakness resolved over a period of 1 hr to 3 days when normoglycaemia was maintained. Other neurological features included subjective visual disturbances, headache, dysarthria and ataxia.

220 patients with an insulinoma from 7 series in the literature were reviewed. The high incidence of neurological features was confirmed, with confusion (152 cases), coma (82 cases) and convulsions (58 cases) predominating. Visual disturbances were common, though not accurately quantified in some series. Objective evidence of weakness on the other hand was reported in only 6 of the 222 patients. Other less common symptoms included headache (18 instances) and peripheral paraesthesiae (14 instances). In the 7 series reviewed, as in our own, it was found that in any one patient, each episode of hypoglycaemia was accompanied by the same symptom complex.

The presence of an insulinoma should be considered in any patient with unusual, or inexplicable neurological features, particularly when they are intermittent. The diagnosis can be confirmed by demonstrating an inappropriately high circulating insulin level, for the ambient blood glucose concentration.
Hypothalamic hypopituitarism in a patient with a basal encephalocoele—treatment with luteinizing hormone-releasing hormone
Authors: Morris D. V. , Mason W. P. , Wilson-Holt N. , Adams J. , Keene M. , Tanner J. , Jacobs H. S.
Published: December 2008

A 20-year-old patient presented with primary amenorrhoea and growth hormone deficiency caused by a basal encephalocoele. She was found to have developed diabetes insipidus in the 8 years following diagnosis. Gonadotrophin release in response to bolus injection of luteinizing hormone-releasing hormone (LHRH) was normal, as was thyrotrophin and adrenocorticotrophin (ACTH) secretion. Pulsatile administration of LHRH by the subcutaneous route resulted in normal ovulation and subsequent menstruation. The investigation and management of patients with basal encephalocoeles are discussed in the light of these findings.
Thymoma presenting as a middle mediastinal mass
Authors: Bradford R. , Cohen S. L. , McLlelland J. , Goldstraw P.
Published: December 2008

A case of a middle mediastinal mass which proved to be a thymoma is presented. The diagnostic difficulties that middle mediastinal masses produce and the investigations used to delineate them are discussed.
Hodgkin’s disease presenting as idiopathic thrombocytopenic purpura
Authors: Murphy W. G. , Allan N. C. , Perry D. J. , Stockdill G.
Published: December 2008

A case of Hodgkin’s disease presenting as idiopathic thrombocytopenic purpura in a 23-year-old male is reported. This is a rare presentation of Hodgkin’s disease having been previously described in only two cases.
Toxoplasmosis associated with digital vasculitis and immunodeficiency—a dilemma in diagnosis
Authors: Ellis M. E. , Webb A. K. , Dunbar E. M.
Published: December 2008

We present a case of acquired toxoplasmosis associated with severe digital vasculitis—a previously unreported finding. The rise in Toxoplasma gondii antibody titres may have been attenuated by impaired cellular immunity, and this poses a problem for diagnosis.
Renal carcinoma in Lindau’s disease
Authors: Nagendran Vasantha , Dimond A. H.
Published: December 2008

A case of Lindau’s disease is presented where renal carcinoma was detected 2.5 years after surgical removal of a cerebellar haemangioblastoma. This patient had no retinal lesions. The importance of screening for renal carcinoma in patients showing one or more manifestations of the disease and screening relatives is emphasized.
Vulval adhesions causing urinary incontinence
Authors: Parkinson Derek J. , Alderman Brian
Published: December 2008

An elderly patient complained of urinary incontinence which was found to be due to vulval fusion. Surgical division followed by local oestrogen cream was curative.
Haemodialysis and charcoal haemoperfusion in acute inorganic mercury poisoning
Authors: Worth D. P. , Davison A. M. , Lewins A. M. , Ledgerwood M. Jill , Taylor Andrew
Published: December 2008

A 29-year-old gardener developed acute renal failure following the ingestion of 'Mersil', a combination of mercurous and mercuric chloride, achieving a plasma mercury concentration of 22,000 nmol/litre (400 micrograms/litre). Haemodialysis and charcoal haemoperfusion were ineffective in removing mercury despite prior treatment with the chelating agent dimercaprol. The acute renal failure resolved after 10 days and there are no residual sequelae.
Giant cell arteritis presenting with peripheral neuropathy
Authors: Mulcahy Fiona , Juby Linda D. , Chandler Geoffrey N.
Published: December 2008

A 76-year-old woman with giant cell arteritis who presented with peripheral neuropathy is described.
Eosinophilic fasciitis in an African—possible benefit of chloroquine treatment
Authors: Allen S. C.
Published: December 2008

A 58-year-old black woman with eosinophilic fasciitis is reported, this being the first report to our knowledge of the condition from Africa. The patient showed a subjective and objective improvement in symptoms on two occasions when treated with chloroquine.
Asymptomatic gonorrhoea in a male patient
Authors: Chattopadhyay B. , Teli J. C.
Published: December 2008

A case of asymptomatic gonorrhoea in a male patient is described. Failure to isolate Neisseria gonorrhoea from his wife possibly demonstrates inhibitory effect of Candida albicans in vivo on the former organism.
Extreme hypernatraemia in association with renal failure following caecocystoplasty
Authors: Walker W. S. , Thurston C. J.
Published: December 2008

A case of extreme hypernatraemia (serum sodium 212 mmol/l) occurring in association with renal failure following a caecocystoplasty procedure is reported. The causative factors in extreme hypernatraemia are reviewed and an unusual reabsorptive mechanism via the transposed intestinal segment is proposed to explain the degree of hypernatraemia present in this case.
Heavy proteinuria following urinary diversion
Authors: Short C. D.
Published: December 2008

Two patients are described, both of whom developed heavy glomerular proteinuria in excess of 10 g/24 hr after urinary diversion operations.
Hyperprolactinaemia in male diabetics
Authors: Mooradian A D , Morley J E , Billington C J , Slag M F , Elson M K , Shafer R B
Published: December 2008

We recently investigated two patients with diabetes and elevated serum prolactin levels in whom no cause of hyperprolactinaemia could be found. For this reason we measured fasting serum prolactin levels in 72 diabetic males and compared the results with those of 63 healthy males and 90 nondiabetic males attending an Impotence Clinic. The diabetic group had significantly higher serum prolactin levels (13.1 ± 0.9 ng/ml) than the two control groups (9.9 ± 0.6 ng/ml for normal males and 7.7 ± 0.3 ng/ml for the non-diabetic impotent group). Eighteen percent of the diabetics studied had serum prolactin levels above the normal range for males (> 20 ng/ml). There was no correlation between serum prolactin levels and duration of diabetes, glycosylated haemoglobin level or presence of clinically apparent retinopathy. The correlation between serum prolactin level and fasting plasma glucose was weak though statistically significant (r = 0.26, P < 0.05).
Is Nd-Yag laser treatment for upper gastrointestinal bleeds of benefit in a district general hospital?
Authors: Homer A C , Powell S , Vicary F R
Published: December 2008

104 consecutive patients with upper gastrointestinal bleeding admitted to a district general hospital over a period of 20 months were considered for laser photocoagulation. 58 patients were found to have peptic ulcers, of which 42 had stigmata of recent haemorrhage accessible to laser photocoagulation. 17 were treated with a Nd-YAG laser and 25 were managed conservatively. There was no significant difference in the number of patients who re-bled and required surgery, mortality rate, length of stay in hospital or the amount of blood transfusion required in either group. We suggest that the routine use of a laser for bleeding peptic ulcers in a district general hospital is not justified.
Survival after profound hypocalcaemia with tetany complicating severe haemorrhagic acute pancreatitis
Authors: Jones P A
Published: December 2008

A patient is reported who developed severe haemorrhagic pancreatitis, without hyperamylasemia, which was complicated by gross hypocalcaemia presenting as tetany. Tetany is very uncommon in acute pancreatitis and is a grave prognostic indicator, recovery being exceptionally rare. The mechanisms responsible for disordered calcium homeostasis associated with acute pancreatitis are reviewed. CT scanning was an important feature of this patient's management and its role in severe pancreatitis is discussed.
Symptomatic hypercalcaemia precipitated by magnesium therapy
Authors: Nanji A A
Published: December 2008

A patient with Crohn's disease receiving vitamin D and calcium had normal serum calcium levels when serum magnesium was low. Hypercalcaemia was precipitated when supplemental magnesium was given. The reason why serum calcium was initially normal is probably related to the effect of magnesium deficiency in reducing serum calcium level.
Extrinsic duodenal obstruction by congenital bands in an adult patient
Authors: Górnacz G E , Lewis A M
Published: December 2008

An adult patient with congenital malrotation of the gut, presenting as duodenal obstruction is reported.
Hypothyroidism presenting as destructive arthropathy of the fingers
Authors: Gerster J C , Quadri P , Saudan Y
Published: December 2008

A patient presenting with destructive arthropathy of the proximal interphalangeal (PIP) joints of the hands is described. She was initially believed to have rheumatoid arthritis but non-steroidal anti-inflammatory drugs were of no help. The patient was subsequently found to have hypothyroidism and erosive osteoarthritis of the fingers. Joint swelling, pain and stiffness responded dramatically to thyroid hormone substitution. The PIP joint spaces reappeared on the radiographs within 9 months.

This case suggest that hypothyroidism may induce destructive arthropathy of the finger joints. As thyroxine replacement may reverse the rheumatic complaints, hypothyroidism should be considered in the differential diagnosis of a destructive arthropathy of unclear aetiology.
Jejunal perforation secondary to metastatic bronchogenic carcinoma
Authors: Quayle A R , Holt S , Clark R G
Published: December 2008

A case of peritonitis secondary to the perforation of a bronchogenic small bowel metastasis is reported. To our knowledge this is only the fourth case in which peritonitis was the presenting feature of a squamous cell carcinoma of the bronchus. The publications to date are reviewed and the need to biopsy every small bowel perforation found at laparotomy is stressed.
Alpha-1-antitrypsin associated liver disease in rheumatoid arthritis
Authors: Teh L G , Steven M M , Capell H A
Published: December 2008

Two cases of alpha-1-antitrypsin associated liver disease occurring in patients with rheumatoid arthritis are described. Both presented with abnormal liver function tests and the true diagnosis was only apparent after liver biopsy and detailed serological studies. The concurrence of these two conditions is noteworthy because of the postulated role of proteolytic enzymes in producing the characteristic cartilaginous erosions of rheumatoid arthritis.
Yersinia colitis associated with Crohn's disease
Authors: Treacher D F , Jewell D P
Published: December 2008

A previously healthy patient developed serologically-proven Yersinia pseudotuberculosis enterocolitis and made a complete recovery. Over a year later, further gastrointestinal symptoms developed and Crohn's disease was diagnosed. The possible relevance to the aetiology of Crohn's disease is discussed.
Puerperal ovarian vein thrombophlebitis
Authors: Tang L C H , Woo J S K , Choo Y C
Published: December 2008

A 16 year old Chinese female with puerperal ovarian vein thrombophlebitis following uneventful vaginal delivery is reported. This infrequent, but potentially fatal, complication in the febrile postpartum patient may present as a surgical emergency. Non-invasive diagnostic procedures and conservative treatment with heparinization and antibiotics have been suggested. However, early exploratory laparotomy for ovarian vein or caval ligation may be life-saving if the diagnosis is in doubt or the response to conservative treatment is unsuccessful.
Metoprolol in the aged hypertensive: a comparison of two dosage schedules
Authors: Martin A , Browning R C
Published: December 2008

Thirty-one patients aged 65 y or over suffering from moderate hypertension were studied for 16 weeks using a cross-over design in which metoprolol 100 mg daily and metoprolol 200 mg daily were compared. Both treatment regimes were effective in controlling hypertension and no difference was found between the two with regard to efficacy. The 100 mg regime was, however, better tolerated and we propose this as the preferred metoprolol dose for the aged hypertensive.
Parathyroid carcinoma presenting as tertiary hyperparathyroidism
Authors: Sherlock D J , Newman J , Holl-Allen R T J
Published: December 2008

A case of malignant transformation in established secondary hyperparathyroidism presenting as tertiary hyperparathyroidism is reported. Although rare, this occurrence has important medical and surgical implications.
Tuberculous perforation of the small bowel
Authors: Aston N O , de Costa A M
Published: December 2008

Small bowel perforation occurs in up to 2 percent of patients with abdominal tuberculous. Patients present with an acute abdomen. Resection of the diseased segment and 18 months treatment with anti-tuberculosis drugs is recommended.
Severe Coombs positive autoimmune haemolytic anaemia associated with ulcerative colitis
Authors: Wodzinski M A , Lawrence A C K
Published: December 2008

We describe a case of severe autoimmune haemolytic anaemia developing in newly diagnosed ulcerative colitis of moderate severity. Full immunosuppression with steroids and azathioprine failed to bring about a full remission and a splenectomy was performed which resulted in a remission enabling immunosuppression to be discontinued. This case is compared with three previously described cases of autoimmune haemolytic anaemia associated with severe colitis requiring splenectomy.
Erythema multiforme (Stevens-Johnson) precipitated by Fansidar
Authors: Adams S J , Broadbent J , Clayden L M , Ridley C M
Published: December 2008

A case of Stevens-Johnson syndrome precipitated by the sulphonamide-containing anti-malarial drug, Fansidar, is described.
Immune complex-mediated cutaneous vasculitis in a scar–the importance of local anatomical factors
Authors: Karp S J , Winter R J D , Ridley C M
Published: December 2008

A vasculitic rash developed on the legs and arms of a 47 year old woman. Similar vasculitic lesions also erupted in a scar sustained ten years previously. Circulating immune complexes consisting of IgG were detected by Clq binding. We discuss the factors involved in the localization of vasculitic lesions, and in particular stress the role of microvascular injury.
Smoking and myocardial infarction: secondary prevention
Authors: Perkins J , Dick T B S
Published: December 2008

This prospective study examines the question ‘Is it too late to stop smoking cigarettes once you have had a myocardial infarction?’

One hundred and nineteen cigarette smokers (90 men, 29 women) who survived their first myocardial infarction for one month were followed for five years or until their death if earlier. The age corrected mortality rate of men who continued to smoke cigarettes was 2.2 times the age corrected mortality rate of those who stopped smoking after their infarct. The women who continued to smoke had 2.4 times the age corrected mortality of those who stopped smoking. The age and sex corrected mortality rates for the combined group of men and women show that those who stopped smoking after their infarction have 55% of the mortality of those who continued to smoke (P < 0.05). These results suggest that smoking is not merely a ‘risk factor’ for myocardial infarction but is also a causal factor whose effects can be avoided by both men and women after an initial myocardial infarction.