bluuebunny/crossref_metadata_2025 huggingface dataset:
Exchange transfusion of a patient with fulminant Lassa fever
Authors: Cummins D , Bennett D , Machin S J
Published: December 2008

We report a patient with fulminant Lassa fever who responded dramatically to a 2.5-litre exchange transfusion of whole blood. On admission he was semicomatose with facial oedema and oral haemorrhage; his platelets showed markedly depressed aggregation to ADP; and his plasma inhibited the aggregation responses of normal platelets in vitro. Exchange transfusion resulted in rapid clinical improvement, recovery of platelet function, and disappearance of platelet-inhibitory activity in plasma. The patient died 2 weeks later from an acute encephalopathy. His initial response was sufficiently impressive to suggest that further evaluation of this therapeutic approach is justified in selected patients with overwhelming Lassa virus infection.
Bilateral papillitis with anti-neutrophil cytoplasmic antibodies associated with coeliac disease
Authors: Chan-Lam D , Balasubramanian V , Hogg R B
Published: December 2008

A 39 year old woman with untreated coeliac disease presented with some of its complications and bilateral papillitis. She was found to have antineutrophil cytoplasmic antibodies (ANCA) in high titres. Following institution of gluten-free diet the complications resolved. The papillitis, however, persisted and needed a course of prednisolone to resolve, and a fall in the ANCA titres was noted. We believe that this is the first report of an association of coeliac disease and ANCA.
Intraocular pressure and pupillary responses in patients with diabetes mellitus
Authors: al-Sereiti M R , Turner P , Gale E A M
Published: December 2008

Intraocular pressure (IOP) and the mydriatic responses to darkness in 38 diabetic patients have been compared with those of a matched control group of normal subjects. Overall, the diabetic patients had a significantly higher mean IOP than the control group, but this difference was not found in a sub-group of 13 diabetic patients with evidence of autonomic neuropathy. Those diabetic patients with evidence of autonomic neuropathy had a smaller mydriatic response to darkness than the control group, and this test may usefully be added to standard tests of autonomic function in the diagnosis of autonomic neuropathy.
Stercoral perforation of the colon proximal to an end colostomy
Authors: Serpell J W , Sen M , Giddins G , Nicholls R J , Bradfield W J D
Published: December 2008

Stercoral perforation of the colon is rare, and has not previously been reported as a postoperative complication, proximal to an end colostomy. Two such cases are reported; in addition in one the stercoral perforation was recurrent, emphasizing the multifocal nature of the disease. Both cases demonstrate the failure of standard techniques to deal with scybala in the loaded proximal colon. It is, therefore, suggested that intra-operative orthograde colonic lavage is indicated to protect a terminal colostomy from the risk of stercoral perforation in such cases.
Prolonged faecal excretion of poliovirus in a nurse with common variable hypogammaglobulinaemia
Authors: Misbah S A , Lawrence P A , Kurtz J B , Chapel H M
Published: December 2008

A nurse with common variable hypogammaglobulinaemia was found to excrete a non-vaccine strain type II poliovirus for almost a year following a bout of gastroenteritis. Attempts were made to halt intestinal carriage of the virus in view of the possible risk of spread to immunocompromised patients and the risk of paralytic poliomyelitis to the patient himself.

Three doses of killed Salk vaccine failed to stimulate salivary anti-polio antibodies. Excretion of the virus ceased spontaneously just before oral immunoglobulin containing high titres of antibodies to polio virus was used to halt virus excretion.
Percutaneous endoscopic gastrostomy in elderly patients
Authors: Finucane P , Aslan S M , Duncan D
Published: December 2008

Percutaneous endoscopic gastrostomy (PEG) was performed on 28 elderly patients (mean age 82 years) who were dysphagic and intolerant of naso-gastric feeding. Twenty-six patients were recovering from a stroke; the interval between the onset of stroke and PEG averaged 63 days. The procedure was successful and well tolerated by all patients. Nineteen (68%) still had a functioning PEG a median of 14 weeks after placement. One patient whose swallowing recovered had the tube removed 6 months after its insertion. Seven patients (25%) subsequently died from their underlying disease, a mean of 92 days following PEG. There was one procedure-related death from peritonitis. PEG is a useful alternative to surgical gastrostomy in selected elderly patients with dysphagia who are intolerant of naso-gastric feeding.
Misoprostol does not alter the pharmacokinetics of propranolol
Authors: Bennett P N , Fenn G C , Notarianni L J , Lee C E
Published: December 2008

Twelve healthy volunteers took part in a randomised, double-blind, balanced, cross-over study to investigate the effect of misoprostol on the pharmacokinetics of propranolol. The subjects took propranolol 80 mg twice daily by mouth plus either misoprostol 400 micrograms twice daily or placebo by mouth for 14.5 days, followed by a 2-week washout period, followed by the alternate treatment for 14.5 days. Misoprostol had no significant effect on the t/2, Cmax or AUC of propranolol either after a single dose or at steady state.
Marfan syndrome affecting four generations of a family without ocular involvement
Authors: Bridges A B , Faed M , Boxer M , Haining W M , Pringle T H , McNeill G P
Published: December 2008

Thirty eight relatives of a patient with Marfan syndrome were screened for the presence of this disorder. Marfan syndrome was newly diagnosed in living members of 4 generations in this family without evidence of ocular abnormality in any. After screening, 10 relatives were newly diagnosed as having definite, and 5 relatives as having possible, Marfan syndrome. Family screening has drawbacks as well as benefits for the patients. The main benefit is the identification and treatment of previously undiagnosed patients at risk of cardiac complications which are the major cause of mortality. The drawbacks include employment problems created for patients with Marfan syndrome as a direct consequence of our screening programme and the anxiety induced in previously asymptomatic family members who did not realize that they could be at risk. Also, the 4 adult patients with possible Marfan syndrome found it difficult to accept that a definite diagnosis could not be reached after they had been invited to attend a screening programme for a serious genetic disorder.

This report illustrates the importance of screening all the relatives of a patient with Marfan syndrome to identify previously undiagnosed cases. However, before screening a family, the physician should be aware that a clear diagnosis may not be reached in all patients, and financial, psychological or social problems may arise as a result of the screening programme.
Cervical intraepithelial neoplasia and squamous cell carcinoma of the anus in sexually active women
Authors: Dixon A R , Pringle J H , Holmes J T , Watkin D F L
Published: December 2008

Twenty-five patients with squamous cell carcinoma (SCC) of the anus have presented over an 8 year period; 18 were female. Six of 9 patients aged under 50 years were female. Five of these women had been treated for a previous cervical malignancy (2 invasive) and 4 practised anal intercourse; human papillomavirus (HPV) type 16 DNAs were isolated from their arcival anal/cervical paraffin sections. Signals were confined to the nuclei of the invasive anal SCC cells and the transformation zone of the cervix. HPV 6, 11 and 18 DNAs were not identified. Young women with cervical intraepithelial (CIN) III or invasive cervical SCC found in association with HPV infection are at risk of developing anal SCC (P<0.001; Fisher's exact).
Colonic involvement in Fabry's disease
Authors: Jack C I A , Morris A I , Nasmyth D G , Carroll N
Published: December 2008

The case of a 54 year old man with Fabry's disease and extensive jejunal and colonic diverticulosis causing colonic stricture is presented. Histological examination of the resected colon revealed evidence of ceramide trihexose deposition in the myenteric nerve plexus. Colonic involvement in Fabry's disease has not been reported before.
Cardioversion of atrial fibrillation of recent onset with flecainide
Authors: Carr B , Hawley K , Channer K S
Published: December 2008

Twenty-eight patients with atrial fibrillation of less than 1 month's duration were given a single intravenous bolus of flecainide (2 mg/kg). Nineteen patients (68%) were successfully converted to sinus rhythm. Of the 19 patients with atrial fibrillation of less than 72 hours duration, 18 (95%) were successfully converted. Failure to cardiovert was associated with cardiomegaly on chest X-ray and larger left atrial diameter measured echocardiographically. Of the 9 patients who failed to convert, 2 had biochemical evidence of thyrotoxicosis and chronic obstructive pulmonary disease. Of the 19 patients successfully cardioverted, the atrial fibrillation complicated acute myocardial infarction in 3 cases and a pulmonary embolism in one. Six cases occurred post-operatively and in 3 out of 6 the patient was ventilated. No side effects were observed.

The use of intravenous flecainide should avoid the need for electrical DC conversion even in sick patients. Failure of conversion is associated with covert underlying predisposing factors and duration of atrial fibrillation of more than 72 hours.
A new hypothesis for the aetiology of Crohn's disease–evidence from lipid metabolism and intestinal tuberculosis
Authors: Roediger W E W
Published: December 2008

The stimulus for the immune response in Crohn's disease is unknown. In each of 19 cases of Crohn's disease evaluated by electron microscopy, epithelial cells of the ileum contained phagolysosomes with lamellar layers of lipid. These structures, now termed R or reactant bodies, are the proffered antigenic stimulus. They are proposed to be an amalgam of lipid (cholesterol esters, or phospholipids) and bacterial fragments (mycoplasma, mycobacteria or streptococci), which in combination are hypothesized to produce a powerful immunological response analogous to the adjuvant effect. For disease expression to occur, lipids and specific bacterial populations are needed in the bowel lumen. These factors may account for the success of elemental diets that are low in fat in the treatment of Crohn's disease and for the regional distribution of disease along the intestinal tract.
Delayed haemolytic transfusion reactions in patients with sickle cell disease
Authors: Cummins D , Webb G , Shah N , Davies S C
Published: December 2008

We describe two cases which illustrate the difficult diagnostic and therapeutic problems posed by delayed haemolytic transfusion reactions in patients with sickle-cell disease. The cases emphasize the need for meticulous phenotypic and serological assessment of sickle-cell patients prior to transfusion therapy.
Dose response to inhaled salbutamol in chronic obstructive airways disease
Authors: Teale C , Morrison J F J , Page R L , Pearson S B
Published: December 2008

High dose inhaled salbutamol is increasingly used in the management of chronic obstructive airways disease. To determine the range of doses to achieve optimal bronchodilatation and the proportion of patients requiring high dose therapy we have studied 23 patients with chronic obstructive airways disease. Cumulative dose responses were measured to six incremental doses of salbutamol (0.2 to 1.2 mg) delivered by metered dose inhaler. Results were analysed by polynomial regression to calculate the smallest dose required to produce 90% maximal bronchodilatation in each patient. While 5/23 (22%) required < 1 mg the majority, 14/23 (61%), achieved 90% maximal bronchodilation with salbutamol 0.6 mg or less. The 8 patients with severe airflow limitation (FEV1 ⩽ 1 litre) showed a similar pattern of response.

We conclude that in chronic obstructive airways disease there are wide individual variations in the dose of inhaled salbutamol producing 90% maximal bronchodilatation with only a minority requiring high dose therapy.
Diverticulum of the rectum due to a rectal leiomyosarcoma
Authors: Hutchinson R , Gardner R D
Published: December 2008

A 78 year old woman with a rectal leiomyosarcoma is presented. The case is of interest because of very unusual radiological and operative features of a large rectal diverticulum. As a result of the difficulty in making the correct diagnosis pre- or intraoperatively, a simple, but possibly suboptimal, resection was performed. Although the patient has done well, the long-term outlook is uncertain. The problems of optimum management and prediction of outcome in this uncommon condition are discussed.
Changes in birth – cohort pattern of peptic ulcer mortality in England and Wales
Authors: Katschinski B D , Logan R F
Published: December 2008

Previous epidemiological studies have described the secular trends in peptic ulcer mortality in England and Wales as being characteristic of a cohort phenomenon. The most recent data on ulcer mortality, however, show increasing mortality rates from duodenal ulcer in women over 65 and from gastric ulcer in women over 75 years. While the rise in mortality rates in the oldest age groups is partly explained by their greater life expectancy, the increase in mortality from duodenal ulcer in older women shows evidence of an environmental (period) effect being superimposed on female cohorts born between 1895 and 1925. This effect could partly be due to the increasing consumption of non-steroidal anti-inflammatory drugs which coincides with the rise in mortality rates.
Asian endoscopies: is there a difference?
Authors: Harvey J M , Battcock T M , Wicks A C B
Published: December 2008

In 1988 2062 adults had their first oesophagogastroduodenoscopy at Leicester General Hospital, of whom 224 (10.9%) were Asian. A greater proportion of the Asian patients were less than 45 years old (46% vs 24%), which reflects the age distribution of the local population. When the findings at oesophagogastroduodenoscopy were analysed in two age groups (less than or older than 45) there were no differences between the races in the younger group. However, in the older group duodenal disease was significantly more common in the Asians (P < 0.001) whereas gastric disease was more common in Caucasians (P < 0.05). The incidence of cancer was much lower in the Asians.
Hiatal hernial ulcers: clinical features and follow-up
Authors: Boyd E J S , Penston J G , Russell R I , Wormsley K G
Published: December 2008

We describe the clinical features and therapeutic outcome in 49 patients in whom benign gastric ulceration of an hiatal hernia was demonstrated endoscopically. Hiatal hernia ulcers accounted for 10% of all benign gastric ulcers. The typical patient was an elderly female with a history of dyspepsia who was receiving non-steroidal anti-inflammatory drugs. Twenty-seven (55%) patients had evidence of haemorrhage (acute in 15; chronic in 12) from the hiatal hernial ulcer at presentation. In 16 (33%) patients, symptoms attributable to haemorrhage constituted the sole clinical evidence of the hiatal hernial ulcer. Acute haemorrhage from hiatal hernial ulcers was associated with non-steroidal anti-inflammatory drug (NSAID) treatment (P < 0.05). Chronic blood loss from hiatal hernial ulcers was associated with female gender (P < 0.005) but not with NSAID treatment.

Hiatal hernial ulcers healed slowly in response to medical treatment with H2-receptor antagonists (median time to healing 12 weeks). Surgical treatment may be the therapy of choice for hiatal hernial ulcers because of the high complication rate, poor response to medical therapy, and the apparent predominance of mechanical aetiological factors.
Polymyositis complicating d-penicillamine treatment
Authors: Aydintug A O , Cervera R , D'Cruz D , Ramírez G , Asherson R A , Khamashta M A , Hughes G R
Published: December 2008

Although there is good evidence that d-penicillamine can induce polymyositis, the exact pathogenic mechanism remains unclear. We report two patients with psoriatic arthritis and primary biliary cirrhosis respectively, who developed polymyositis while receiving d-penicillamine treatment for their primary diseases. Whether d-penicillamine treatment was the sole cause of polymyositis or acted as a trigger for the development of a secondary autoimmune disease is discussed.
Antibiotic therapy, clinical features and outcome of 36 adults presenting to hospital with proven influenza: do we follow guidelines?
Authors: Jones A , Macfarlane J , Pugh S
Published: December 2008

The impact of the 1989/1990 influenza epidemic on the Nottingham hospitals was assessed in a retrospective survey. Thirty-six cases of proven influenza were identified, 14 of whom died. Non-survivors were more likely to be confused, uraemic and to lack focal chest signs and symptoms. Antibiotic therapy both prior to admission and following hospitalization was not optimal and, in many cases, failed to follow previously published guidelines. Such guidelines need emphasis during influenza epidemics.
Helicobacter pylori: a Jordanian study
Authors: Latif A H , Shami S K , Batchoun R , Murad N , Sartawi O
Published: December 2008

The prevalence of Helicobacter pylori in patients with upper gastrointestinal symptoms in the north of Jordan was studied prospectively. The occurrence of H. pylori was documented histologically and bacteriologically in 169 patients attending endoscopy for upper gastrointestinal symptoms. Our results showed that H. pylori was present in 70% of patients with acute gastritis, 73% of patients with chronic gastritis, 68% of patients with acute on chronic gastritis, 83% of patients with duodenal ulceration, 75% of the patients with gastric ulceration, 64% of patients with no pathology, and 68% of patients regardless of the pathology found. There was a sharp rise in the prevalence of H. pylori with age, up to the age of 40 years with an annual increase in the prevalence of 2%. This study shows that the prevalence of H. pylori in Jordan is similar to that seen in other developing countries with infections occurring at a lower age and with the annual infection rate being double that seen in developed countries.
A five year audit of the role of parathyroid hormone assays and thallium–technetium isotope subtraction scanning in the preoperative investigation of primary hyperparathyroidism
Authors: Livingstone J I , Tellez M , Burke M , Ashby P J , Rinsler M G
Published: December 2008

An audit has been performed of the value of parathyroid hormone assays and thallium–technetium isotope scanning in the pre-operative investigation of 67 hypercalcaemic patients referred for surgery over a 5 year period. Parathyroid hormone assay by region-specific technique was found to have a diagnostic sensitivity of 75% (n = 52) whilst the more recent assay for the intact molecule was 97% sensitive (n = 34). Thallium-technetium isotope scanning was only 64% sensitive overall (n = 59), due in part to the small size of adenomata now being referred for surgery. This study confirms the role of the intact parathyroid hormone assay but questions that of thallium–technetium isotope scanning in standard protocols of investigation for hypercalcaemia.
Absenteeism and sickness absence
Authors: McEwan I M
Published: December 2008

The majority of time lost from work as a result of absenteeism is classified as due to sickness although only a small proportion of the total can be regarded as a result of unfitness for work for medical reasons. An occupational health service assists a business in minimizing absenteeism by promoting an early return to work, assists general practitioners and hospital specialists in tailoring return to work packages, and assists employees by liaising with both management and their medical specialists to facilitate a return to normal work.
Staphylococcal infection of the odontoid peg
Authors: Keogh Sean , Crockard Alan
Published: December 2008

An epidural abscess secondary to osteomyelitis of the odontoid peg produced a sudden left-sided weakness. Appropriate antibiotics, transoral evacuation of the pus and subsequent posterior atlanto-axial fusion were associated with a full recovery.
Hyperpyrexia due to meningococcal septicaemia treated with cold peritoneal lavage
Authors: Khan Izhar H , Henderson Iain S , Mactier Robert A
Published: December 2008

An 18 year old male presented with fulminant meningococcal septicaemia and renal failure. He subsequently developed hyperpyrexia which failed to respond to conventional methods of treatment. Cold peritoneal lavage was employed which resulted in rapid lowering of his core temperature and helped manage his renal failure. The possible causes of the late onset of hyperpyrexia and the use of cold peritoneal lavage to treat refractory hyperpyrexia are discussed.
Ocular hazards of nebulized bronchodilators
Authors: Mulpeter K M , Walsh J B , O'Connor M , O'Connell F , Burke C
Published: December 2008

Three cases of pupillary dilatation associated with the development of acute glaucoma, precipitated by the use of nebulized bronchodilators are described. We suggest measures to reduce the risk of this complication.
Testotoxicosis: gonadotrophin-independent male sexual precocity
Authors: Aziz Arif Abdul , Jafri S M W , Haque Naeem Ul
Published: December 2008

In this era of rapidly developing investigational tools and pharmacology, the pathophysiology of precocious puberty is becoming well defined. What was previously thought to be a form of gonadotrophin releasing hormone (GNRH)-dependent central precocious puberty is now classified as GNRH-independent familial testotoxicosis. We present two such cases and review the clinical features, pathophysiology and treatment of testotoxicosis.
Lymphocytic adenosine deaminase activity in typhoid fevers
Authors: Khosla S N , Kumar Dinesh , Singh V
Published: December 2008

Lymphocyte adenosine deaminase (L-ADA) activity, a measure of lymphocyte activity, was estimated in 10 healthy controls and 30 patients with typhoid fever (20 uncomplicated and 10 complicated) at the time of admission, at onset of complications and weekly until recovery. Mean L-ADA activity in healthy controls was 20.49 +/- 3.62 mU/10(6) cells. In uncomplicated patients L-ADA activity was 36.33 +/- 5.09 mU/10(6) cells at time of admission, which is significantly raised as compared to controls. It remained high at the height of the fever and at defervescence. In complicated patients L-ADA activity was significantly low at admission (15.33 +/- 2.35 mU/10(6) cells) and fell further with development of complications (7.86 +/- 4.07 mU/10(6) cells). At defervescence L-ADA activity increased significantly above the control activity (31.24 +/- 5.37).

Serial L-ADA activity can be of prognostic significance. A cut-off value of 24 mU/10(6) cells is suggested to predict prognosis and severity of disease. Activity below this indicates a probability of a severe, prolonged course and may help in instituting early and energetic treatment.
Life threatening hypophosphataemia in a patient with Philadelphia chromosome-positive chronic myelogenous leukaemia in acute blastic crisis
Authors: Ra'anani P , Lahav M , Prokocimer M , Poles L , Theodor E
Published: December 2008

Life-threatening hypophosphataemia developed in a 47 year old woman with blastic crisis of chronic myelogenous leukaemia. The patient's hospitalization was characterized by reciprocal relationship between her white cell count and the serum phosphorus levels. The patient did not demonstrate any of the usual causes of profound hypophosphataemia. The postulated mechanism of this patient's hypophosphataemia is uptake by the rapidly dividing leukaemic cells. To the best of our knowledge this is the first case in the English literature of hypophosphataemia associated with blast crisis of Philadelphia chromosome-positive chronic myelogenous leukaemia.
Portal vein thrombosis in a complicated case of Crohn's disease
Authors: Crowe A , Taffinder N , Layer G T , Irvine A , Nicholls R J
Published: December 2008

Portal vein thrombosis is a rare complication of ulcerative colitis and is invariably fatal. This report describes a patient with severe Crohn's disease who underwent elective surgery complicated by an anastomotic disruption with faecal peritonitis. Following emergency laparotomy he developed left hypochondrial pain which was a manifestation of splenomegaly consequent upon portal vein thrombosis. Anticoagulation was successful in preventing further spread of the thrombosis as monitored by colour Doppler ultrasound. Severe active disease, surgery and sepsis have been recognized as predisposing factors for thromboembolic complications in inflammatory bowel disease and this patient was exposed to all three. It is conceivable that portal vein thromboses occur more commonly than suspected and ultrasound scanning could ascertain the prevalence if performed prospectively.
Late presentation of a congenital gastric diverticulum causing pyloric obstruction
Authors: Hale P C , O'Flynn W R
Published: December 2008

We report a case of adult pyloric obstruction caused by the delayed presentation of a congenital gastric diverticulum. The derivation, classification and treatment of these abnormalities are discussed.
Inguinal bladder hernia associated with vesico-ureteric reflux
Authors: Noble J G , Christmas T J , Chapple C R , Rickards D
Published: December 2008

The urinary bladder is frequently found as a component of inguinal herniae. This report describes a case of 'bladder hernia' associated with vesico-ureteric reflux. The current methods of investigation and subsequent treatment for this condition are reviewed along with the possible underlying cause of vesico-ureteric reflux in this case.
Experience with tracheostomy in medical intensive care patients
Authors: Gunawardana R H
Published: December 2008

Thirty-four intensive care patients who received elective tracheostomies were studied to determine the incidence and nature of complications associated with tracheostomies. Indication for tracheostomy was long-term ventilation. Adverse consequences occurred in 47% of the patients. The most frequent problem was pneumonia. There were no intraoperative complications. Two deaths occurred due to delayed haemorrhage. Some complications of tracheostomy were influenced by the preceding period of endotracheal intubation. In patients requiring prolonged mechanical ventilation, tracheostomy carries a considerable risk. Optimal airway care only will reduce the incidence of complications.
'Chest epilepsy' in a child
Authors: Gulati Sanjeev , Kumar Lata
Published: December 2008

Pain is a most unusual manifestation of epilepsy, and it is rarer still for chest pain to be the primary manifestation of a seizure disorder. We report here a 6 year old boy with epileptic chest pain--'chest epilepsy'--an entity not previously described in children.
Infusion rate and pharmacokinetics of intravenous pamidronate in the treatment of tumour-induced hypercalcaemia
Authors: Dodwell D. J. , Howell A. , Morton A. R. , Daley-Yates P. T. , Hoggarth C. R.
Published: December 2008

We report the results of two consecutive randomized studies in the treatment of malignant hypercalcaemia with intravenous pamidronate. Overall normocalcaemia was achieved in greater than 90% of patients and a single infusion of 60 mg pamidronate given over 2 hours was as effective in restoring normocalcaemia as infusions given over 4, 8 or 24 hours. Similarly duration of normocalcemia after treatment with pamidronate and the control of the symptoms of hypercalcaemia were independent of infusion rate. Study of the pharmacokinetics of pamidronate in the treatment of hypercalcaemia show this drug to have a very high clearance due to calcified tissue retention and renal excretion. The initial half life of the drug in plasma is very short and most of the drug is cleared before distribution equilibrium is achieved. Short infusions of pamidronate are as safe and effective as infusions given over a longer time and are therefore to be preferred because of their greater convenience.
Carotid sinus syndrome after carotid artery surgery
Authors: Dees A. , Batenburg de Jong R. J. , Meeuwis C. A. , de Boer M. F. , de Leeuw P. W.
Published: December 2008

A 63 year old woman had been intensively treated for recurrent carcinoma of the neck. Following acute vascular surgery of the carotid artery, she developed the vasodilatory type of the carotid sinus syndrome. The presentation of this type of the syndrome was remarkable, since it is usually associated with primary or metastatic carcinoma in the neck region. Previous cancer treatment may have modified the course of disease in this patient, which ultimately had a lethal outcome.
A late complication of pectus excavatum repair
Authors: McWilliams R. , Hooper T. , Lawson R.
Published: December 2008

We report a late complication of pectus excavatum repair which highlights the importance of a chest X-ray in evaluating chest pain in patients who have had previous chest surgery. It also raises the question of whether or not implanted wires should be electively removed following bony union.
Eradication ofHelicobacter pylori: therapies and clinical implications
Authors: O'Connor Humphrey J
Published: December 2008

This review presents a critical evaluation of the role of Helicobacter pylori eradication in the management of peptic ulcer disease and non-ulcer dyspepsia. On current evidence, H. pylori eradication therapy seems likely to emerge as the most rational and cost-effective treatment for duodenal ulcer. The role of H. pylori eradication in the treatment of gastric ulcer and non-ulcer dyspepsia is unclear and requires further study. The emerging problem of antibiotic resistance in H. pylori is of major clinical importance and a prime cause of treatment failure. There is increasing evidence of a link between H. pylori and gastric cancer but it is premature to recommend large-scale eradication of H. pylori as a valid strategy for the primary prevention of gastric cancer. The search continues for the ideal H. pylori eradication regimen.
One year experience in the treatment of familial hypercholesterolaemia with simvastatin
Authors: Quiney J , Watts G F , Kerr-Muir M , Slavin B , Lewis B
Published: December 2008

Patients with heterozygous familial hypercholesterolaemia (FH) have a substantially increased risk of atherosclerosis due to very high plasma levels of cholesterol. Recent evidence has shown that coronary heart disease in these patients may regress with lipid-lowering therapy. In this study the efficacy and safety of simvastatin, an inhibitor of the enzyme 3-hydroxy-3-methylglutaryl coenzyme A, was investigated in 30 patients with FH over a period of one year. Substantial reductions in the plasma concentrations of total cholesterol (-28%), low-density lipoprotein (LDL) cholesterol (-32%), intermediate-density lipoprotein (IDL) cholesterol and apolipoprotein (apo) B (-33%) were achieved with 20 mg/day of simvastatin; there were no significant changes in triglycerides high-density lipoprotein cholesterol or apo A. In contrast to previous studies, 40 mg/day of simvastatin did not result in a further statistically significant fall in LDL cholesterol, IDL cholesterol or apo B in the group as a whole. The drug was well tolerated and no adverse clinical or laboratory events were recorded. In particular, no ophthalmological, hepatic or renal disorders were observed and there were no sleep disturbances. We conclude that simvastatin is an efficacious and safe drug to treat patients with heterozygous FH and that rarely will the dose need to be increased above 20 mg/day.
Cardiovascular complications of parenteral nutrition
Authors: Naidoo Datshana P , Singh B , Haffejee A
Published: December 2008

During a 3 year period, 1987-1989, we encountered three major complications associated with parenteral nutrition leading to congestive cardiac failure--acute beriberi, right atrial and superior vena caval thrombosis, and fungal endocarditis. Unrecognized, these are invariably fatal. Persistent vomiting from intestinal obstruction led to the development of thiamine deficiency in the patient with beriberi. Recurrent catheter tip sepsis probably accounted for thrombosis and endocarditis in the second and third cases, respectively. These conditions are preventable with careful attention to nutritional replenishment and aseptic technique. In patients with catheter-related sepsis early, repeated blood culture is of diagnostic value. Patients with Staphylococcus aureus catheter-associated bacteraemia require at least 4 weeks of appropriate antibiotic therapy. Recurrent sepsis, especially when associated with pulmonary embolic phenomena, is an indication for echocardiography.
Chronic idiopathic anhydrosis--a rare cause of heat stroke
Authors: Dann Eldad J , Berkman Neville
Published: December 2008

A 27 year old man presented with heat stroke following exposure to a humid, hot environment in the absence of physical exertion. Investigation revealed the presence of generalized anhydrosis without evidence of an associated disease. Although chronic idiopathic anhydrosis is rare, this entity should be considered in cases of unexplained heat intolerance and heat stroke.
Idiopathic hypereosinophilic syndrome presenting as childhood hemiplegia
Authors: Kumar K Ashok , Anjaneyulu A , Murthy J M K
Published: December 2008

A case of childhood hemiplegia due to idiopathic hypereosinophilic syndrome is reported. There was no cardiac lesion. The neurological complications associated with hypereosinophilic syndrome and the pathophysiological mechanism of neurotoxicity of human eosinophils are discussed. It is likely that the neurological deficit was due to eosinophilic neurotoxicity.
Mycobacteria as a cause of infective exacerbation in bronchiectasis
Authors: Chan Christopher H S , Ho Andrew K C , Chan Raphael C Y , Cheung H , Cheng A F
Published: December 2008

In 91 patients with bronchiectasis seen over 6 years, a positive mycobacterial culture was obtained in 12 cases (13%). The organisms isolated were Mycobacterium tuberculosis in nine cases, Mycobacterium avium in two cases and Mycobacterium tuberculosis and chelonei were obtained on separate occasions in one case. Computed tomography and/or bronchography showed that the bronchiectatic changes commonly involved the lower lobes and to a lesser extent, the middle and lingula lobes. In none of these 12 cases was tuberculosis strongly suspected on clinical or radiological grounds.

We conclude that mycobacterial infections are common in patients with bronchiectasis and sputum should be cultured for mycobacteria periodically in these patients. In doubtful cases, bronchoscopy may be helpful to obtain a positive mycobacterial culture.
Splenic rupture following splenic vein thrombosis in a man with protein S deficiency
Authors: Williams N , Gerrand C , London N J , Chapman C , Bell P R F
Published: December 2008

We present a case of spontaneous splenic rupture in a man with splenic vein thrombosis. The splenic vein thrombosis appears to have been caused by protein S deficiency. We are not aware of this having been described before.
Developing medical education
Authors: Coles Colin
Published: December 2008

This article reviews the current state of undergraduate and postgraduate medical education, and suggests changing the educational methods used rather than rearranging the content of courses. A learner centred approach is described, and its applications to postgraduate medical education discussed. Some research and development implications are considered.
Cervical ribs: a cause of distal and cerebral embolism
Authors: Bearn P , Patel J , O'Flynn W R
Published: December 2008

The thoracic outlet syndrome occurs when the neurovascular structures are compressed as they traverse the thoracic outlet. Degenerative changes can occur in the subclavian artery and the vessel may become a source of embolism with the risk of acute or chronic upper limb ischaemia. Rarely, distal thromboembolism in the thoracic outlet syndrome may be associated with retrograde flow when there is the added risk of cerebral thromboembolism.
Pulmonary alveolar microlithiasis presenting with chronic cough
Authors: Türktas Ipek , Saribas Sezen , Balkanci Ferhun
Published: December 2008

A case of a 10 year old boy with pulmonary alveolar microlithiasis is presented. Although most children with this disease are asymptomatic, our patient had persistent cough for more than 3 years. It is likely that his chronic cough was a direct consequence of the disease.
Polyglandular autoimmune syndrome type III associated with coeliac disease and sarcoidosis
Authors: Papadopoulos Konstantin I , Hallengren Bengt
Published: December 2008

A female patient demonstrating a previously not reported constellation of polyglandular autoimmune syndrome type III (including autoimmune thyroiditis, Graves' ophthalmopathy, insulin-dependent diabetes mellitus and vitiligo), coeliac disease and sarcoidosis is described. This may be a random association but might also indicate a common immunological and/or genetic disturbance.
Comparison of nisoldipine and nifedipine as additional treatment in hypertension inadequately controlled by atenolol
Authors: Hoffbrand B I , Earle K A , Nievel J G , Restrick L J , Simmonds N J
Published: December 2008

Twenty-eight patients (11 Caucasian, 17 black) whose blood pressure was more than 160/96 mmHg after 4 weeks on placebo added to atenolol 100 mg/day were randomly given, in addition, nisoldipine 10 mg or nifedipine 20 mg each twice a day for 8 weeks in a double-blind cross-over study. There was a statistically significant (P < 0.001) fall in blood pressure with no change in heart rate, both supine and erect, on both drugs. There were no significant differences between nisoldipine and nifedipine. Adverse effects were recorded in 15%, 17% and 35% of the patients available for safety comparison for placebo, nisoldipine and nifedipine, respectively. There were no significant differences between the black and Caucasian patients in blood pressure responses, although the study had only a low power to detect these. However, the fasting serum triglyceride levels at the end of both calcium antagonist treatment periods were highly significantly lower in the black patients compared with the Caucasian patients. Nisoldipine, which has a higher coronary vascular selectivity and less negative inotropism than nifedipine, is as effective and as well tolerated as nifedipine in patients whose hypertension is inadequately controlled on atenolol. It may have a special role in hypertensive patients with impaired left ventricular function.
Resistance to recombinant human erythropoietin due to aluminium overload and its reversal by low dose desferrioxamine therapy
Authors: Yaqoob M , Ahmad R , McClelland P , Shivakumar K A , Sallomi D F , Fahal I H , Roberts N B , Helliwell T
Published: December 2008

Seventeen severely anaemic and transfusion-dependent haemodialysis patients with a haemoglobin less than 7 g/dl were treated with recombinant human erythropoietin (r-Hu-EPO). Aluminium toxicity was diagnosed by a positive desferrioxamine (DFO) test and bone biopsy. Seven out of eight patients without aluminium toxicity responded to r-Hu-EPO therapy. Similarly all patients with aluminium toxicity (n = 4) but pre-treated with standard dose of DFO prior to r-Hu-EPO therapy responded but none of the patients with untreated aluminium toxicity (n = 5) responded to r-Hu-EPO therapy. In order to achieve adequate response in these patients, r-Hu-EPO and DFO had to be given in combination. The dose of desferrioxamine used to reverse r-Hu-EPO resistance was less and also used for a short time. We therefore confirm r-Hu-EPO resistance owing to aluminium overload and report its successful and safe reversal with low dose DFO therapy.
Gait disturbances in the acute medically ill elderly
Authors: Steiger M J , Berman P
Published: December 2008

The characteristics of acute deterioration in truncal movements, posture and gait were studied in patients admitted with acute non-neurological disease. Reversible gait abnormalities with characteristics of a 'lower-half parkinsonism' were associated with a disorder of axial movement, disability (as assessed by an activities of daily living score), and low mental test score. There was no association of gait dysfunction with tests of upper limb apraxia.

An 'at risk' sub-group of elderly patients was identified who during an acute illness lose their walking independence, of whom some also have great difficulty performing axial movements. Furthermore, any assessment of locomotor and axial movement in elderly patients must consider that any impairment may be the result of an acute medical illness.
Primary liposarcoma of the omentum
Authors: Okajima Y , Nishikawa M , Ohi M , Fukumoto Y , Kuroda K , Shimomukai H
Published: December 2008

This report is of a 54 year old female with omental liposarcoma. Diagnosis was made by ultrasonography, computed tomography, angiography and operation. The patient was treated by surgical excision. The histological examination revealed that the tumour was round cell liposarcoma. This is the first report to our knowledge of round cell liposarcoma of the omentum.
IgA nephropathy in hereditary angioedema
Authors: Srinivasan Jayashri , Beck Peter
Published: December 2008

Hereditary angioedema is an autosomal dominant disorder of the complement system in which there is a deficiency of the inhibitor of the activated first component of complement. We have previously reported on three generations of a family with classic hereditary angioedema. Three members of this family have now developed IgA nephropathy. The association of hereditary angioedema with various immunoregulatory disorders has been previously reported but this is the first report of IgA nephropathy in association with this condition.
A patient with recurrent hypothermia associated with thrombocytopenia
Authors: Chan Kin Ming , Beard Keith
Published: December 2008

A 69 year old woman had 13 hospital admissions because of hypothermia attributed to self-neglect. On each occasion she was found to be thrombocytopenic, and the platelet count always returned to normal with rewarming. The case records of all patients admitted to the Victoria Infirmary between 1986 and 1990 with a primary diagnosis of hypothermia were reviewed. Two other patients of the 75 assessed were found to have had thrombocytopenia linked to hypothermia, but neither showed a recurrent relationship.
Thrombotic thrombocytopenic purpura associated with pregnancy in two sisters
Authors: Alqadah Farouq , Zebeib Mohammed Amin , Awidi Abdalla S
Published: December 2008

Two sisters suffered from thrombotic thrombocytopenic purpura late in their first pregnancies. HLA typing of the patients and their immediate family members demonstrated no obvious relationship. Hereditary aspects, association with pregnancy, prognosis and management of pregnant women with TTP are discussed.
Portal vein thrombosis due to Candida albicans associated with hepatic cirrhosis
Authors: Torres G , Gil Grande L A , Boixeda B , Martín-de-Argila C , Barcena R , Garcia Hoz F
Published: December 2008

A case of portal vein thrombosis due to Candida albicans in a patient with alcoholic hepatic cirrhosis in the absence of hepatocarcinoma is described. Infection is a known cause of portal vein thrombosis but thrombosis by Candida albicans has not to our knowledge been previously reported.
Imprint cytology--a cheap, rapid and effective method for diagnosing Helicobacter pylori
Authors: Misra S P , Dwivedi M , Misra Vatsala , Gupta S C
Published: December 2008

To compare the efficacy of imprint cytology, histology and CLO-test (for biopsy urease) in detecting Helicobacter pylori infection, antral biopsies were taken from 239 patients undergoing upper gastrointestinal endoscopy. Both imprint cytology and histology showed the presence of H. pylori in 215 (90%) patients. The sensitivity and specificity of imprint cytology vis-à-vis histology was noted to be 100%. The CLO-test was performed in 165 patients and was positive in 130 (79%) patients. The sensitivity and specificity of the CLO-test were 89% and 95%, respectively. The median time required for the CLO-test to become positive and for imprint was 60 minutes for each. The sensitivity of the CLO-test was reduced further in patients receiving colloidal bismuth subcitrate. Of the 27 patients receiving the drug the sensitivity of the CLO-test was only 9% after 4 weeks of therapy. However, the specificity was 100%. The sensitivity and specificity of imprint cytology were unaffected by the antimicrobial therapy and after 4 weeks of treatment were still 100%.

It is concluded that the CLO-test has a lower sensitivity and specificity for diagnosing H. pylori infection compared to imprint cytology, which had a sensitivity and specificity equal to that of histology. Imprint cytology may be prepared as an adjunct to histology in patients in whom antral biopsies are taken as it offers a relatively quick diagnosis of H. pylori infection, is considerably cheaper than the CLO-test and does not require additional biopsy material.
Osteoporosis and the Marfan syndrome
Authors: Gray J R , Bridges A B , Mole P A , Pringle T , Boxer M , Paterson C R
Published: December 2008

Fourteen patients with Marfan syndrome, defined according to present criteria, had bone mineral content of the distal forearm measured by single photon absorptiometry. Patients were matched for age and sex with a large local group of healthy volunteers. While further work is needed with other methods of densitometry with measurements at other sites, our results provide no evidence that there is an increased incidence of osteoporosis in Marfan syndrome. Previous reports of an association were probably due to incorrect clinical diagnosis or confusion with clinically similar syndromes known to cause osteoporosis.
A comparison of 10 MHz ultrasound and 201-thallium/99m-technetium subtraction scanning in primary hyperparathyroidism
Authors: Gallacher S J , Kelly P , Shand J , Logue F C , Cooke T , Boyle I T , McKillop J H
Published: December 2008

Both high resolution (10 MHz) ultrasound and 201-thallium/99m-technetium subtraction scanning (Tl/Tc) were carried out preoperatively in 25 patients with primary hyperparathyroidism.

Operative findings were the standard against which these two imaging methodologies were compared. Tl/Tc scanning showed a sensitivity of 42% and a specificity of 97%. By comparison, sensitivity of ultrasound was 38% and specificity 89%. Both techniques were positive together in nine instances and correctly localized the parathyroid adenoma in eight of these. In 44% of cases, however, both methods together failed to localize any abnormal parathyroid tissue.

The ability of these modalities to localize abnormal parathyroid tissue correctly tended to vary with gland size. Where both ultrasound and Tl/Tc scans were negative, median gland size was smaller at 170 mg (range 50-2,500 mg), compared with where Tl/Tc scanning was correct (750 mg, 150-6,820 mg; P < 0.03), ultrasound was correct (960 mg, 100-6,820 mg; P < 0.03) and both techniques together were correct (980 mg, 600-6,820 mg; P = 0.002).

These results suggest that neither Tl/Tc scanning or ultrasound has sufficient sensitivity or specificity to be used routinely in the preoperative evaluation of patients with primary hyperparathyroidism.
Parathyroid crisis and acute viral hepatitis B infection
Authors: Mulcahy Hugh E , Murray Frank E , Freaney Rosemarie , Hegarty John E
Published: December 2008

The simultaneous development of acute hyperparathyroidism and viral hepatitis B infection in a 72 year old male is described. Resolution of the hepatitis was accompanied by improvement in the parathyroid hormone mediated hypercalcaemia. It is postulated that antibodies to the hepatitis B virus may have altered the calcium 'set point' allowing uncontrolled synthesis and release of parathyroid hormone during the acute illness.