bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival of twenty-two months in a patient with primary plasma cell leukaemia treated with melphalan and prednisolone
Authors: Walker J D , Kaczmarski R S
Published: December 2008

In the majority of cases plasma cell leukaemia is a rapidly fatal disease with a mean survival time of five months. There have been reports of increased survival using various regimens of chemotherapy although most cases eventually relapse. We describe a patient with primary plasma cell leukaemia who responded to a combination of oral melphalan and prednisolone with control of the disease in the bone marrow but relapsed with extramedullary disease in the central nervous system and testes, and died 22 months after diagnosis. Melphalan poorly penetrates the central nervous system and its testicular penetration is unknown.
Erythema induratum (of Bazin) in a patient with endometrial tuberculosis
Authors: De Silva H J , Goonetilleke A K E , De Silva N R , Amarasekera L R , Jayawickrama U S
Published: December 2008

We report erythema induratum in a patient who was found to have active endometrial tuberculosis. This case report emphasizes the importance of an exhaustive search for active tuberculosis in patients with erythema induratum, especially in countries where tuberculosis is prevalent, as the indiscriminate treatment of erythema induratum with steroids may be harmful.
Trends in splenectomy in the Trent region 1972-85
Authors: Fellows I W , Hart S , Toghill P J
Published: December 2008

During the period 1972-85, 3712 splenectomies were performed in the Trent region giving a mean splenectomy rate of 5.8 per 100,000 population per year. Of these, 37.4% were incidental to other surgical operations and 23.4% were as a result of trauma. During this period there was a marked reduction in the splenectomy rate in children aged under 10 years for trauma and for haematological diseases. No such reduction was observed in older patients for these indications. Splenectomy for lymphoma fell progressively after 1977.
Improving laboratory usage: a review
Authors: Young D W
Published: December 2008

Influencing the ordering of laboratory investigations, and in particular reducing unnecessary ones, is a vital concern to many hospitals. An account of the reasons why control is necessary is presented. The different methods evaluated are reviewed, including rationing, form design, resource management (budget control), education, protocols and decision support systems, incentives, feedback and case note appraisal. Methods of controlling the requesting of investigations are likely to be ineffective unless they take place in the correct environment. Elements of this include correct attitude and commitment by senior staff, a long term strategy, and different approaches for different groups of doctors.
The use of digoxin in 55 residential homes for elderly people
Authors: Weedle P B , Poston J W , Parish P A
Published: December 2008

Data relating to the use of digoxin from a descriptive epidemiological study of drug use in residential homes for elderly people were analysed. Of the 1,888 residents in the study homes, 212 were receiving cardiac glycosides. The ratio of females to males who received cardiac glycosides was 2.8:1; however, this was not statistically significant as it reflected the overall population. The median age of recipients of cardiac glycosides was 85.2 years and they were significantly older than non-recipients (P less than 0.001). The cardiac glycosides were almost exclusively prescribed as digoxin, the median dose was 125 micrograms with a range of 62.5 to 250 micrograms, and the median duration of treatment was 2.3 years, range less than 0.1 to 10.1 years. Digoxin was involved in a total of 152 potential drug interactions, 12 of which were potentially highly significant clinically.
Angiotropic large cell lymphoma (angioendotheliomatosis) presenting with protein-losing enteropathy
Authors: Al-Izzi M S , Sidhu P S , Garside P J , Menai-Williams R
Published: December 2008

A 73 year old female presented with progressive hypoproteinaemic oedema which was resistant to treatment. The cause was not established until post-mortem, when it was found that she had angiotropic large cell lymphoma involving the vessels of the large intestine with mucosal ulceration. To our knowledge, this is the first report of angiotropic large cell lymphoma, which usually presents with neurological and skin involvement, presenting with protein-losing enteropathy.
Idiopathic spontaneous haemoperitoneum
Authors: Sanderson P L , Davies M F P , Howat J M T
Published: December 2008

A case is described of bleeding arising from the falciform ligament which occurred in the absence of obvious local pathology. Spontaneous bleeding from this site hitherto has not been reported. Previously described cases of idiopathic spontaneous haemoperitoneum and factors implicated in the aetiology of this rare condition are reviewed.
Plasma lipids can be reliably assessed within 24 hours after acute myocardial infarction
Authors: Sewdarsen M , Vythilingum S , Jialal I , Nadar R
Published: December 2008

Total serum cholesterol and triglycerides were measured in 159 Indian patients (134 males) with acute myocardial infarction during their stay in hospital (days 1 and 2) and 3 months later in order to assess whether lipid levels measured soon after acute myocardial infarction represent basal values. Early and 3 month lipid levels were also compared according to the sex and glucose tolerance of the patients.

The mean total cholesterol levels on admission (day 1) were comparable to the 3 month values in both men (6.09 +/- 0.10 vs 6.18 +/- 0.09 mmol/l) and women (6.75 +/- 0.30 vs 6.44 +/- 0.22 mmol/l) irrespective of glucose tolerance. In the entire group cholesterol levels on day 2 were significantly lower than the admission and 3 month values. Nevertheless there was a significant correlation between day 2 and 3 month values (P less than 0.0005).

Serum triglyceride levels on day 2 were influenced by glucose tolerance and were significantly lower than the 3 month values in patients with normal glucose tolerance but not in patients with abnormal glucose tolerance. However there with a significant correlation between day 2 triglyceride values in patients with both normal and abnormal glucose tolerance. These results suggest that serum cholesterol measured on admission after acute myocardial infarction may be reliably used to represent basal values in both men and women irrespective of glucose tolerance. Although cholesterol and triglycerides measured on day 2 vary with either the gender or glucose tolerance of the patients, these values are still a useful guide to the patients’ basal lipid state.
Frank rectal bleeding: a prospective study of causes in patients over the age of 40
Authors: Cheung P S Y , Wong S K C , Boey J , Lai C K
Published: December 2008

In order to determine the frequency of tumours in patients presenting with frank rectal bleeding, a prospective study was carried out in 337 patients over the age of 40 attending our Proctology Clinic. After making a clinical diagnosis, flexible sigmoidoscopy followed by barium enema was performed. Excluding 7 digitally palpable rectal cancers, there were 30 cancers (9.1%), 34 polyps (10.3%), 7 proctocolitis (2.1%) and 25 diverticula (7.6%) detected, giving a total diagnostic yield of 29.1%. A clinical diagnosis of bleeding sources other than haemorrhoids was made in 80% of the cancers. Flexible sigmoidoscopy detected 93.3% of the cancers and 88.2% of the polyps. Barium enema diagnosed the remaining cancers and polyps but there was a false-positive rate of 3.8%. From our results, we conclude that patients with frank rectal bleeding should be screened routinely for left-colon cancer irrespective of the clinical diagnosis. The flexible sigmoidoscope is a quick and useful tool. However, barium enema should be recommended to individuals with strong clinical suspicion of rectal bleeding other than haemorrhoids.
Fatal Stevens-Johnson syndrome following urography with iopamidol in systemic lupus erythematosus
Authors: Savill J S , Barrie R , Ghosh S , Muhlemann M , Dawson P , Pusey C D
Published: December 2008

A 46 year old white woman with active systemic lupus erythematosus developed a skin rash 8 hours after intravenous urography with the non-ionic contrast medium iopamidol. Severe Stevens-Johnson syndrome with erythema multiforme, intrahepatic cholestasis, pulmonary infiltrates and acute renal failure ensued, leading to her death. Although non-ionic contrast media are generally less toxic than traditional ionic agents, their use in patients with immunological disease may be hazardous.
Giant hamartoma of liver mimicking malignancy
Authors: Narasimharao K L , Narasimhan K L , Katariya S , Suri S , Kaushik S , Mitra S K
Published: December 2008

Two infants with mesenchymal hamartoma of the liver are reported. This lesion clinically simulates a malignant neoplasm very closely and awareness is essential to avoid unnecessary major hepatic resections. The cases were successfully treated with simple enucleation.
The relationship between age and duration of asthma and the presence of persistent obstruction in asthma
Authors: Connolly C K , Chan N S , Prescott R J
Published: December 2008

Persistent obstruction was assessed in 630 asthmatic subjects by measurement after bronchodilator of the maximum potential peak flow rate and forced vital capacity. Persistent obstruction was directly related to duration of asthma. The fit was slightly better after logarithmic transformation, suggesting that the early stages of asthma may be as important as the later ones in the development of persistent obstruction. On multivariate analysis age was an additional factor in males, but made no significant difference to females. Atopy did not prove relevant. Measurements of peak flow suggested a more rapid deterioration in males of social classes III, IV and V than classes I and II. Although current smokers had lower peak flow rate and vital capacity than non-smokers, there was no evidence of a steeper decline in smokers than non-smokers suggesting that the effect of cigarette smoking was at most additive to that of duration of asthma.
Giant duodenal ulcer: the hepatic intra-arterial chemotherapy variant
Authors: Goldin E , Peretz T , Libson E
Published: December 2008

Giant duodenal ulcers are extensive ulcers, more than 2.5 cm in diameter, that involve a large portion of the duodenal bulb. These atypical duodenal ulcers create serious problems to the patient and the physician, are frequently complicated by bleeding and penetration, and have a high mortality rate. Most of the reported cases were classified as a severe variant of the common peptic ulcer disease, others were associated with the Zollinger Ellison syndrome. We report here four patients with giant duodenal ulcers but with a different and definitive aetiology: hepatic intra-arterial chemotherapy infusion for liver metastase or primary hepatocellular carcinoma.
Occupational asthma
Authors: Newman Taylor A J
Published: December 2008

Occupational asthma is important both as a potentially curable and preventable cause of asthma and as a model of adult onset asthma. It is induced by sensitization to a specific agent inhaled at work; for many of its causes, including inhaled proteins and the low molecular weight chemicals acid anhydrides and reactive dyes, it is probably IgE dependent. The risk of developing specific IgE and associated asthma is markedly increased in cigarette smokers, probably as a consequence of non-specific damage to the respiratory mucosa. Asthma caused by several agents, which include some of its most frequent causes, isocyanates, colophony and plicatic acid (Western Red Cedar) persists in some 50% of cases for years, and possibly indefinitely, after avoidance of exposure. The development of chronic symptomatic asthma seems particularly to occur in those with longer duration of symptomatic exposure.
Systemic lupus erythematosus
Authors: Hughes G R V
Published: December 2008

Systemic lupus erythematosus is a common disease--studies throughout the world broadly agree on a prevalence of 1 in 1000 women. Recently an important clinical advance has come from the description of a syndrome of recurrent thrombosis, recurrent abortion and neurological disease associated with antiphospholipid antibodies. The discovery that immunological mechanisms may apply in some cases of thrombosis has led to new insights into the aetiology and treatment of vascular disease in general.
The role of fibreoptic bronchoscopy in the investigation of pleural effusion
Authors: Heaton R W , Roberts C M
Published: December 2008

Published data on the role of fibreoptic bronchoscopy in the investigation of pleural effusions are sparse and conflicting. We have reviewed our experience from November 1980 to December 1986. Thirty-two patients were identified from bronchoscopy records as having undergone the procedure during the evaluation of an effusion. Fibreoptic bronchoscopy was diagnostic in 6 of the 32 cases, but less invasive procedures had given the diagnosis in 4, and in the other 2 cases radiological abnormalities other than the effusion suggested an underlying bronchial malignancy. We conclude that routine fibreoptic bronchoscopy is not justified in the evaluation of pleural effusions.
Comparison of the effect of oxitropium bromide and of slow-release theophylline on nocturnal asthma
Authors: Bellia V , Ferrara G , Cibella F , Cuttitta G , Visconti A , Insalaco G , Mirto M , Peralta G
Published: December 2008

The effects of a new inhaled antimuscarinic drug, oxitropium bromide, and of a slow-release theophylline preparation upon nocturnal asthma were compared in a placebo-controlled double-blind study. Two samples were studied: 12 patients received oxitropium at 600 micrograms (6 subjects) or at 400 micrograms t.i.d. (6 subjects) whereas 11 received theophylline at 300 mg b.i.d. Morning dipping, assessed by the fall in peak flow overnight, was significantly reduced in the periods when either active drug was taken, whereas no difference was noticed during the placebo administration. No significant difference was noticed between results obtained with either active drug, as well as with either dosage of oxitropium. No subject reported side effects of oxitropium, as compared to three subjects reporting nausea, vomiting and tremors after theophylline.

Oxitropium proves to be a valuable alternative to theophylline in nocturnal asthma, since it is equally potent, safer and does not require the titration of dosage.
Cerebral depression due to propylene glycol in a patient with chronic epilepsy--the value of the plasma osmolal gap in diagnosis
Authors: Lolin Y , Francis D A , Flanagan R J , Little P , Lascelles P T
Published: December 2008

A case of propylene glycol poisoning is described in a 39 year old woman which resulted in her admission to hospital in status epilepticus. She had had a long-standing history of uncontrollable epilepsy. The diagnosis of propylene glycol poisoning resulted directly from the finding of a high plasma osmolal gap on admission. This finding would have been missed if later samples only had been analysed. Plasma osmolality and the osmolal gap should be considered first line investigations in patients presenting with metabolic acidosis and cerebral signs and symptoms. Since her discharge from hospital a year ago the patient has had no further seizures.
Massive macroglossia, amyloidosis and myeloma
Authors: Jacobs P , Sellars S , King H S
Published: December 2008

A 74 year old man with light-chain myeloma developed amyloidosis with macroglossia after 10 years of therapy with alkylating agents. Over a 2-year period his tongue enlarged to persistently protrude from his mouth, inhibit his speech, interfere with normal swallowing and eventually threaten his airway. As a life-saving procedure the tumorous anterior two-thirds of the tongue was resected, with excellent primary healing. Within two weeks the patient’s speech became comprehensible and his ability to eat returned to normal. Although rare in amyloidosis, massive macroglossia may occur and surgical correction is easily achieved.
Inflammatory demyelinating polyneuropathy in a haemophiliac associated with human immunodeficiency virus infection, responding to high dose intravenous immunoglobulin
Authors: Panicker R , Bloom A L , Compston D A S
Published: December 2008

We describe what we believe to be the first case of chronic inflammatory demyelinating polyneuropathy (CIDP) occurring in a haemophiliac infected with the human immunodeficiency virus (HIV), and the first patient to show a clinical response to treatment with high dose i.v. immunoglobulin. A 55 year old, severe haemophiliac, known to be positive for HIV antibody, presented with a short history of motor weakness and variable sensory loss in both lower limbs. Clinical examination, electrophysiology and sural nerve biopsy confirmed a diagnosis of CIDP. He was treated with a 4-day course of high dose i.v. immunoglobulin, given as a daily infusion. This resulted in dramatic improvement in his neurological status which was evident both clinically and functionally. We conclude that CIDP can occur in HIV-positive haemophiliacs as it does in homosexuals and drug abusers infected with the virus. We also suggest that high dose i.v. immunoglobulin may be effective in the treatment of this condition, especially when practical difficulties preclude the use of plasmapheresis and the use of immunosuppressive drugs is considered hazardous.
Cervical Crohn’s disease with oesophago-pulmonary fistula
Authors: Steel A , Dyer N H , Matthews H R
Published: December 2008

We report what we believe to be the first case of Crohn’s disease involving the cervical oesophagus with an oesophago-pulmonary fistula to the apex of the lung. The proximal location of the disease prevented radical therapy and the patient eventually died from chronic sepsis.
Spontaneous expulsion per rectum of an ileal lipoma
Authors: Misra S P , Singh S K , Thorat V K , Gulati P , Malhotra V , Anand B S
Published: December 2008

We report a case of spontaneous expulsion of a lipoma in a 32 year old male patient who presented with recurrent attacks of subacute intestinal obstruction. During one such episode the patient developed unusually severe abdominal pain and expelled a fleshy mass per rectum which, on histopathology, was found to be a lipoma attached to a necrosed portion of the small intestine. The pain disappeared immediately; a subsequent barium meal examination revealed normal appearances and the patient has remained completely symptom free 10 months after the incident.
Ten Tanzanian transplants: problems and perspectives
Authors: Basinda S L , Maro E E , McLarty D G , Young A E , Wing A J
Published: December 2008

A strategy of live related donor kidney transplantation coupled to the briefest possible preparatory period of haemodialysis was adopted as the most cost effective treatment for a selected group of 9 Tanzanian patients who received a total of 10 grafts. Patient and donor selection and preparation were carried out at Muhimbuli Medical Centre, Dar es Salaam, and the transplant procedure and first few months of follow-up were done at St. Thomas’ Hospital, London. There was a high incidence of complications which drew attention to particular risk factors in the group treated. The high cost of treating these individuals emphasizes the need for research into chronic communicable and non-communicable diseases in Africa and highlights the dilemma of appropriate use of resources in serving the world’s medical needs.
Myasthenia gravis and Schmidt syndrome
Authors: McAlpine J K , Thomson J E
Published: December 2008

We describe a 47 year old woman with a 30-year history of generalized myasthenia gravis whose condition had been stable and well controlled on a combination of pyridostigmine and ephedrine until she presented. At this time she gave a 2 month history of weakness, nausea, vomiting and more recently intermittent confusion. Investigations confirmed both primary hypothyroidism and primary adrenal failure (Schmidt syndrome). The autoimmune aetiology of these three conditions was confirmed by positive acetylcholine receptor, adrenal and thyroid microsomal antibodies.
Persistent chorea as a manifestation of thyrotoxicosis
Authors: Javaid A , Hilton D D
Published: December 2008

We report a case of persistent chorea as a manifestation of thyrotoxicosis. The chorea was severe and persisted after the patient was rendered euthyroid. Dopamine antagonists only partially suppressed the involuntary movements during the first few months. It was eventually controlled with haloperidol, but whenever she discontinues the treatment the chorea has returned during the 16 months since she first presented.
Jaccoud’s arthropathy--diagnostic and therapeutic implications
Authors: Thakur R , Gupta L C , Misra M , Saran R K , Hasan M
Published: December 2008

A case of isolated chronic severe aortic regurgitation with Jaccoud’s arthropathy involving the foot is presented. The interesting feature of the case is the absence of history of acute rheumatic arthritis at any stage of the illness. The diagnostic and possible therapeutic significance of this otherwise uncommon and benign condition are discussed.
Gas gangrene in a diabetic after intramuscular injection
Authors: Kershaw C J , Bulstrode C J K
Published: December 2008

A 47 year old male insulin-dependent diabetic developed two synchronous life-threatening Clostridium perfringens infections under unusual circumstances. Numerous sterile abscesses were also present, being the result of regular pentazocine intramuscular injections. Extensive surgical debridement and parenteral antibiotic therapy proved effective in treating the septicaemia and the large soft tissue abscesses in the buttock and thigh. The patient made an excellent functional recovery. The pathogenesis of gas gangrene after injection is discussed with particular reference to the diabetic patient.
Hepatic abscess and cystic fibrosis
Authors: Canny G J , Roberts E A , Liu P , Reisman J , Levison H
Published: December 2008

Extrapulmonary infection is rare in cystic fibrosis. We describe two adult patients with cystic fibrosis whose course was complicated by the development of liver abscesses. The possible aetiology of these abscesses is discussed and the diagnosis, treatment and prognosis of pyogenic hepatic abscess is briefly reviewed.
Incidence and types of acute viral hepatitis in Newcastle upon Tyne
Authors: Hosker H S R , Lindsay D C , Game F , Codd A A , Dale G , Record C O
Published: December 2008

The incidence and types of viral hepatitis in the city of Newcastle upon Tyne have been studied by serological analysis of (a) all blood samples sent to the virological laboratory for hepatitis testing and (b) all blood samples sent by general practitioners to the biochemical laboratory for liver function testing. The annual detection rate of acute viral hepatitis was found to be 31.5 cases/100,000 population, of which 9.1 were hepatitis B. Only three sporadic cases of non-A non-B hepatitis were identified. The incidence of hepatitis is at least four-fold greater than suggested by notification rates and may be substantially higher as general practitioners rarely requested laboratory confirmation of household contacts of index cases.
Effect of nifedipine and mefruside on renal reserve in hypertensive patients
Authors: Notghi A , Anderton J L
Published: December 2008

Changes in glomerular filtration rate and effective renal plasma flow following a protein meal were measured in seven patients with essential hypertension on no treatment and after 6 weeks’ treatment with nifedipine and mefruside. Glomerular filtration rate and effective renal plasma flow increased significantly following a protein meal in patients on no treatment (P less than 0.01 and P less than 0.05 respectively). The response to a protein meal was lost following antihypertensive treatment (P less than 0.5 and P less than 0.1 respectively). Although there was some increase in the fasting values of glomerular filtration rate and effective renal plasma flow this was less pronounced and more difficult to demonstrate when only fasting values were compared. We propose that the loss of response to a protein meal is due to recruitment of renal reserve function and that protein meal challenge is a sensitive test for detecting changes in renal function.
Myocarditis complicating ethylene glycol poisoning in the absence of neurological features
Authors: Denning D W , Berendt A , Chia Y , Morgan S H
Published: December 2008

The consequences of ethylene glycol intoxication are described in a 42 year old man who presented with a profound metabolic acidosis, cardiogenic shock and renal failure. The clinical and electrocardiographic findings suggested a myocarditis and this was confirmed by endomyocardial biopsy. The striking absence of neurological features in this patient delayed diagnosis, which was not suspected until calcium oxalate crystals were demonstrated at renal biopsy. Retrospective analysis of serum retained at his admission to hospital confirmed toxic levels of ethylene glycol. Following a period of intensive cardio-respiratory support and peritoneal dialysis he made a good recovery with cardiac and renal function returning to normal.
Association of small intestinal diverticulosis with chronic pancreatitis leading to severe malabsorption. Report of three cases
Authors: Mahida Y R , Chapman R W , Jewell D P
Published: December 2008

Three cases of chronic pancreatitis occurring in patients with small intestinal diverticulosis and bacterial overgrowth are reported. In two of the cases, pancreatic supplements were therapeutically beneficial (the third being unable to tolerate them). Two of the patients also developed diverticular perforation. The possible nature of the association between small intestinal diverticulosis and chronic pancreatitis is discussed.
Primary appendicitis epiploicae mimicking acute appendicitis
Authors: McMahon A J , Hansell D T
Published: December 2008

We report two cases of primary appendicitis epiploicae, caused by torsion, whose presentation mimicked acute appendicitis.
Addison’s disease presenting as anorexia nervosa in a young man
Authors: Tobin M V , Morris A I
Published: December 2008

A young man with a long history of obsessional traits and food fads presented with anorexia, vomiting and marked weight loss. He showed little concern for his physical state and his vomiting was frequently witnessed as self-induced. A diagnosis of anorexia nervosa was made and he took his own discharge from hospital. He was readmitted one month later, severely cachectic and with biochemical abnormalities consistent with advanced Addison’s disease which was subsequently confirmed. He responded dramatically, both mentally and physically, to corticosteroid therapy. It is likely that anorexia nervosa, relatively rare in males, was a manifestation of the psychological abnormalities commonly seen in severe Addison’s disease.
Blood alcohol levels in acute elderly admissions to hospital
Authors: Penn N D , Corrado O J , Pitchfork L J , Evans R T , Mascie-Taylor B H
Published: December 2008

Blood alcohol levels were estimated in 141 patients admitted acutely over a one month period to a geriatric unit. Only four (2.8%) had alcohol detectable in their blood. The levels were low, suggesting that alcohol intoxication is not a major factor in the admission of the elderly to hospital.
Renovascular hypertension in neurofibromatosis
Authors: Pollard S G , Hornick P , Macfarlane R , Calne R Y
Published: December 2008

We present two patients with renovascular hypertension in association with neurofibromatosis. In both cases the diagnosis was established by angiography. The first patient suffered occlusion of the right renal artery combined with intrarenal arterial lesions. Treatment was by autotransplantation. The second patient suffered bilateral intrarenal arterial lesions alone and was treated medically. In both patients, control of the hypertension was established. We discuss the aetiology of renovascular hypertension in neurofibromatosis and consider its treatment.
Ulceration of the entire small intestine accompanied by rash, hepatitis and pancytopenia
Authors: Park R H R , Mills P R , Danesh B J , Russell R I , Kennedy D H , McArdle C , Lee F D
Published: December 2008

A case of acute mucosal ulceration of the entire small intestine accompanied by skin rash, hepatitis and marrow suppression is reported. Recovery was complicated by a severe protein losing enteropathy and small intestinal strictures and the patient died post-operatively of a pulmonary embolism. The aetiology remains unknown.
Fatal theophylline toxicity precipitated by in situ pulmonary artery thrombosis
Authors: Davies R J , Hawkey C J
Published: December 2008

A 57 year old man developed theophylline toxicity in association with acute pulmonary artery thrombosis. The plasma half life of theophylline was prolonged suggesting impaired metabolism secondary to acute right heart failure.
Angiofollicular lymph node hyperplasia with amyloidosis
Authors: West K P , Morgan D R , Lauder I
Published: December 2008

Two cases of angiofollicular lymph node hyperplasia are described, one of the solitary plasma cell type the other of the multicentric hyaline vascular type. Both cases illustrate the wide ranging clinical and pathological findings associated with this condition but both also have unusual features. The solitary plasma cell lesion had an exceptional 32 year clinical history and was associated with systemic amyloidosis of AL type. The multicentric hyaline vascular case was associated with coexistent multiple myeloma and amyloid deposition also of AL type. These cases are presented with a review of the relevant literature.
Listeria monocytogenes meningitis in previously healthy adults
Authors: Hearmon C J , Ghosh S K
Published: December 2008

A retrospective study of four sporadic cases of Listeria monocytogenes meningitis is reported. Contrary to the conventional epidemiology these patients were adults who were not immuno-compromised. Although all four cases produced positive cerebrospinal fluid cultures, in three, listeria was not microscopically identified. Protein and glucose contents of cerebrospinal fluids were variable and all samples showed lymphocytic pleocytosis. All four had neutrophil leucocytosis in peripheral blood. The unwary may dismiss lymphocytic meningitis as being of ‘viral’ origin, thereby making an important diagnostic misjudgement of vital therapeutic importance. Intravenous ampicillin is the drug of first choice for treatment of listeria meningitis; third generation cephalosporins are ineffective.
Occupational medicine as a specialty
Authors: Slattery D A D
Published: December 2008

Occupational medicine is one of the more recently accepted specialties and is best defined by the social context in which it is practiced. The current structure of the specialty is more easily understood in the light of its historical background. Occupational medicine brings together knowledge from a wide spectrum of disciplines which is reflected in its academic and research bases. A great variety of activities and environments are covered and this has posed problems in defining and organizing higher specialist training. Occupational considerations impact on almost every aspect of medical practice and there is a need for wider understanding of occupational medicine principles in the profession as a whole both in this country and abroad.
Psychosis in mycoplasma infection
Authors: Moor S , Skrine H
Published: December 2008

This report describes a patient with psychosis due to a Mycoplasma pneumoniae infection. Although he received specific treatment for this infection, the diagnosis was only confirmed after clinical recovery. The neuropsychiatric complications of mycoplasma infection are discussed.
Hypothalamic disease in association with dysgenesis of the corpus callosum
Authors: Page S R , Nussey S S , Jenkins J S , Wilson S G , Johnson D A
Published: December 2008

We describe two cases of dysgenesis of the corpus callosum demonstrated by magnetic resonance. The first patient presented with chronic hyponatraemia. Investigation demonstrated re-setting of the osmoreceptor and thirst centres. The calculated threshold for arginine vasopressin (AVP) release was reduced at 252 mosmol/kg while severe thirst was perceived at a plasma osmolality of 260 mosmol/kg. Insulin-induced hypoglycaemia produced an exaggerated AVP response. The second patient presented with hypothermia. The calculated threshold of AVP release was 296 mosmol/kg with increased sensitivity of AVP response to hypertonic saline. The plasma AVP response to insulin-induced hypoglycaemia was absent. Both cases had normal anterior pituitary function and psychological assessment showed a similar prefrontal defect. Specific tests of callosal function were normal. These cases illustrate the importance of undertaking complete neuroradiological assessment of cases of unexplained hypothalamic disease regardless of the age of presentation to avoid overlooking this rare congenital association.
Alopecia totalis in a patient with Crohn’s disease and its treatment with azathioprine
Authors: Goddard C J R , August P J , Whorwell P J
Published: December 2008

A patient with Crohn’s disease and alopecia totalis is described. Despite relative inactivity of the Crohn’s disease, treatment with azathioprine was commenced. This led to complete regrowth of hair which was lost when the drug was discontinued. Re-institution of azathioprine restored hair to normal again and the patient has since declined to try stopping the drug despite the knowledge of potential side effects.
Temporary transvenous cardiac pacing: 6 years experience in one coronary care unit
Authors: Jowett N I , Thompson D R , Pohl J E F
Published: December 2008

The role of temporary percutaneous endocardial pacing has been examined in a retrospective analysis of all paced patients admitted to one coronary care unit over a 6 year period. The majority of 162 cases (84.6%) were paced for complete heart block complicating acute myocardial infarction. These patients had a higher incidence of previous hypertension, myocardial infarction and diabetes, compared to matched controls (P less than 0.05, less than 0.02 and less than 0.001, respectively). Admission blood glucose levels were also higher (P less than 0.05). The in-hospital mortality was high (46.7%), especially for those with anterior myocardial infarction (74.5%). Twenty-five (15.4%) patients without recent myocardial infarction were paced for symptomatic brady-dysrhythmias, usually due to chronic complete heart block (Lenegre’s disease) or sick sinus syndrome. Most later required permanent pacing. Complications of temporary pacing were more frequent in those who died, the most common being dysrhythmias during pacemaker insertion. Review of our cases suggests that whilst facilities for temporary pacing were extremely valuable, many cases treated were not haemodynamically compromised and probably did not require pacing. Guidelines should be established on coronary care units to prevent the unnecessary morbidity, mortality and expense of the procedure.
Hyperkalaemic periodic paralysis: a rare presentation of Addison’s disease
Authors: Sowden J M , Borsey D Q
Published: December 2008

A 44 year old man with longstanding diabetes mellitus gave a 6-month history of periodic attacks of flaccid quadriplegia. Following one of these episodes he was admitted for assessment. In view of persistent hyperkalaemia, hypoadrenalism was suspected and Addison’s disease was confirmed biochemically. Adrenal replacement therapy restored the potassium levels to normal and resulted in no further attacks of paralysis.
Septicaemia in a granulocytopenic patient caused by Corynebacterium striatum
Authors: Dall L , Barnes W G , Hurford D
Published: December 2008

A 64 year old woman with metastatic endometrial carcinoma was admitted to the hospital after three grand mal seizures. Blood cultures yielded Corynebacterium striatum. The patient responded to parenteral ampicillin therapy. This is believed to be the first case of sepsis caused by this organism.
Concurrent preputial calculi and penile carcinoma--a rare association
Authors: Mohapatra T P , Kumar S
Published: December 2008

A case of concurrent preputial calculi and carcinoma of the penis is reported. The causal relationship of both the lesions is still controversial and the possible common aetiopathogenesis of the entity is discussed.
The influence of social factors on the control of asthma
Authors: Connolly C K , Chan N S , Prescott R J
Published: December 2008

The relationships of pulmonary function with age, duration of asthma and social factors were studied in 630 asthmatics. Pulmonary function was assessed by peak flow rate at routine attendance (actual function). Persistence of obstruction was demonstrated by a trial of corticosteroids where necessary. The best obtainable peak flow rate was recorded (maximum function). Unrelieved potentially reversible obstruction was assessed by actual/maximum function. Age and duration of asthma were directly associated with poor control of reversible wheeze as well as with persistent obstruction. In addition poor control of potentially reversible wheezè was related to lower social class, current cigarette smoking and lack of central heating. Persistent obstruction was related to life time amount smoked, passive smoking and lack of central heating.
Lead encephalopathy from an imported Toby mug
Authors: Zuckerman M A , Savory D , Rayman G
Published: December 2008

Encephalopathy is an unusual manifestation of lead poisoning in an adult, the more common presentation being abdominal colic, anaemia and limb palsy.

We report a case of adult lead encephalopathy and describe the use of a simple screening test for lead poisoning together with the increasing number of cases associated with imported ceramics.
Fatal torsade de pointes following jaundice in a patient treated with disopyramide
Authors: Schattner A , Gindin J , Geltner D
Published: December 2008

A case of fatal torsade de pointes in a 53 year old patient treated with disopyramide is described. The arrhythmia followed the development of acute hepatocellular dysfunction and may have been due to failure of the liver to efficiently degrade the drug to its metabolites.
Carotid body disease and the physician--chronic carotid glomitis
Authors: Heath D , Khan Q , Nash J , Smith P
Published: December 2008

There are three types of histological change in the carotid bodies which appear to have physiological and clinical associations. A prominence of the dark variant of chief cells with their contents of met-enkephalin and other peptides appears to be associated with acute exposure to hypoxia. Proliferation of sustentacular cells around the clusters of chief cells appears to be related to ageing and also to systemic hypertension.

Recently we have described a new condition of chronic carotid glomitis which is characterized by follicles of lymphocytes and may have a basis in auto-immunity. In the present review we report for the first time plasma cell activity in the carotid bodies of an elderly man, especially around nerve fibrils and unmyelinated axons ensheathed in sustentacular cells. Such appearances are consistent with the view that ageing nerve fibrils may be the antigenic stimulus for the development of chronic carotid glomitis.
The effects of low dose intravenous 99-126 atrial natriuretic factor infusion in patients with chronic renal failure
Authors: Woolf A S , Mansell M A , Hoffbrand B I , Cohen S L , Moult P J A
Published: December 2008

The aim was to study the renal and hormonal effects of intravenous 99-126 atrial natriuretic factor (ANF) infusion in a mixed group of patients who had moderate to severe chronic renal failure (CRF) and who were not treated with dialysis. The peak mean plasma level of ANF achieved during the experiment was at the upper limit of an absolute range of basal values previously recorded in a larger group of patients with similar degrees of renal impairment. A significant tissue effect was confirmed by rises in plasma and urinary cyclic guanosine monophosphate, the ‘second-messenger’ of ANF. ANF infusion increased sodium excretion rate by a mean of 68% compared with a fall of 40% in a placebo group, and significant increases in urinary albumin excretion occurred during the peptide infusion. Thus, the high levels of plasma ANF found in CRF may have a role in the maintenance of sodium balance. In addition, the proteinuric effect may be detrimental to long-term renal function.
Lack of effect of spironolactone on hair shaft diameter in hirsute females
Authors: McLellan A R , Rentoul J , MacKie R , McInnes G T
Published: December 2008

Because of its anti-androgenic activity spironolactone 50-200 mg daily is advocated widely for the management of female hirsutism but this practice lacks adequately controlled experimental support. In a double-blind placebo controlled study of the efficacy of spironolactone 100 mg daily in idiopathic hirsutism we were unable to demonstrate objective benefit from spironolactone treatment. The mean effect of spironolactone given over a 9 month period was to increase hair shaft diameter by +15% with 95% CI (-0.4% to +29%). In addition there were no changes in circulating serum androgen concentrations.
Thoracic disc herniation in acromegaly
Authors: Chhang W H , Sharma B S , Dash R J , Kak V K
Published: December 2008

Herniation of a thoracic disc in an acromegalic giant is reported. Degenerative changes in the spine in association with dorsal kyphosis, and the additional strain, resulted in the disc prolapse.
Tumours of the pancreas as a sequel to abdominal irradiation
Authors: Rokkas T , Palmer T J , Sladen G E
Published: December 2008

Two cases of tumours arising in or near the pancreatic head are reported in patients previously treated with abdominal irradiation for testicular tumours. These are only the third and fourth such cases to be reported and they suggest that second cancers may develop as a result of abdominal irradiation for malignant disease.
Hyperammonaemic coma in ureterosigmoid urinary diversion
Authors: Oliver R M , Talbot S , Raman G V
Published: December 2008

We report on a patient with ureterosigmoid anastomosis, who presented with recurrent episodes of confusion, agitation and aggressive behaviour, culminating in coma. Investigations revealed profound hyperammonaemia, which responded to treatment with sodium benzoate and sodium phenylacetate. No definite cause was found for the abnormality, apart from possible urinary tract infection. The patient remains well on a protein restricted diet with mildly elevated levels of plasma ammonia.
Yield of the admission complete blood count in medical inpatients
Authors: Mozes B , Haimi-Cohen Y , Halkin H
Published: December 2008

The clinical efficacy of routine admission complete blood count was evaluated in 302 patients admitted to internal medicine wards of a university teaching hospital. Patient medical problems, physical findings and medication history were evaluated by preset criteria to determine the proportion of tests performed for screening and the proportion of test results directly influencing patient management. Of the 282 complete blood counts performed, 80% were ordered routinely with no medical indications (screening tests). An haemoglobin abnormality was found in 16.7% of the patients, leucocyte abnormality in 16.1% and platelet abnormality in 4.6%. However, these results directly influenced patient management in only one case (0.14%). It is concluded that the utility of screening admission complete blood counts in medical inpatients is negligible.
Strychnine poisoning as an unusual cause of convulsions
Authors: Burn D J , Tomson C R V , Seviour J , Dale G
Published: December 2008

A fatal case of strychnine poisoning is presented. The patient vomited then suffered a series of tonic convulsions which were triggered by tactile stimulation. In between paroxysms he was initially alert. Eventually the patient became comatosed due to anoxia and had a cardiac arrest. He presented with a marked metabolic acidosis and rapidly developed renal failure caused by acute rhabdomyolysis. This clinical picture is classical for strychnine poisoning and the complications which the intoxication produces. Attention is drawn to the fact that survival can even follow the ingestion of very large doses of strychnine providing there is no delay in diagnosis and treatment.
Painless giant cell thyroiditis
Authors: Piazza I , Girardi A
Published: December 2008

We describe an atypical case of subacute thyroiditis affecting a 50 year old patient with long lasting fever, weight loss, malaise and a high erythrocyte sedimentation rate. Cytological examination of the thyroid gland showed the classic granulomas with giant cells. However, the patient had neither painful enlargement of the gland nor thyrotoxicosis. This case, as well as others previously described, probably represents a new subtype of subacute thyroiditis, painless giant cell thyroiditis. The presence of painless giant cell thyroiditis should be considered in any patient with undiagnosed pyrexia, weight loss and elevated ESR.
Goodpasture’s syndrome in a patient with two endocrine tumours
Authors: McMahon R F T , Lawler W , O’Donoghue D J , Ballardie F W
Published: December 2008

We describe the occurrence of two anatomically separate and histologically distinct endocrine tumours of bronchus and pancreas in a 64 year old woman with biopsy and serology proven Goodpasture’s syndrome. The association between anti-glomerular basement membrane antibody disease and multiple endocrine tumours has not been reported previously; possible pathogenetic mechanisms are discussed.
The Vogt-Koyanagi-Harada syndrome: association with hypothyroidism and diabetes mellitus
Authors: Jaggarao N , Voth D , Jacobsen J
Published: December 2008

A 45 year old Saudi male with poliosis, alopecia areata, vitiligo, anterior uveitis, inflammatory changes in the posterior pole of the retina and paraparesis presented with features of the Vogt-Koyanagi-Harada syndrome, uncontrolled diabetes mellitus and hypothyroidism. To the best of our knowledge the association of diabetes mellitus and hypothyroidism in this syndrome has not been reported previously.
Simultaneous occurrence of systemic lupus erythematosus and coeliac disease-like features
Authors: Varkel Y , Braester A , Suprun H , Nusem D , Horn Y
Published: December 2008

Involvement of the gastrointestinal tract in systemic lupus erythematosus is well documented but small intestinal malabsorption is a rare event. We report a 27 year old woman with systemic lupus erythematosus who had malabsorption and coeliac-like changes on intestinal biopsy. This is the eighth reported case of this association the significance of which is discussed.
The association between sequential changes in serum antineuronal antibodies and neuropsychiatric systemic lupus erythematosus
Authors: Hanly J G , Behmann S , Denburg S D , Carbotte R M , Denburg J A
Published: December 2008

To determine the significance of changes in serum antineuronal antibody levels in systemic lupus erythematosus, 9 patients who had a rise and 11 patients who had a fall in neuronal antibody titre over a mean duration of 2.1 years (range 0.25-5.2) were identified. These changes were examined in the light of concurrent changes in other serological variables, overall disease activity, neuropsychiatric disease and neuropsychological tests.

Changes in antineuronal antibodies were frequently associated with concurrent changes in anti-DNA antibodies and overall disease activity. When neuropsychiatric disease or cognitive dysfunction were present, their course showed a close correlation with changes in antineuronal antibody levels. The results support the association between antineuronal antibodies and neuropsychiatric-systemic lupus erythematosus, but suggest that their measurement will provide useful information of disease status in only a subpopulation of patients.