bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant phaeochromocytoma and hypercalcaemia
Authors: Bridgewater J A , Ratcliffe W A , Bundred N J , Owens C W I
Published: December 2008

We describe a case of hypercalcaemia secondary to recurrent malignant phaeochromocytoma. Parathyroid-related protein (PTHrp 1-86) immunoreactivity was identified in plasma and PTHrp was identified by immunocytochemistry in tumour tissue.
Gastric acid secretion in typhoid fever
Authors: Khosla S N , Jain Navleen , Khosla Amit
Published: December 2008

Gastric acid secretion was studied in 20 patients with typhoid fever (Group A), ten patients with fever other than typhoid (Group B), and ten healthy adults of matched age and sex (Group C). Patients with typhoid showed reduced acid secretion at the time of fever and one week after subsidence of fever as compared to Group C. In uncomplicated patients (Group A1), these values rose thereafter but in complicated patients (Group A2) they remained low even 12 weeks after subsidence of fever. This suggests that these patients had pre-existing hypochlorhydria which predisposed them to a severe form of disease. There may be many factors playing a significant role in making typhoid patients more prone to develop complications but the importance of gastric acid levels has also to be considered.
A safe and simple technique for exchanging central venous catheters
Authors: Shimada Mitsuo , Matsumata Takashi , Wakiyama Shigeki , Maeda Takashi , Kanematsu Takashi , Sugimachi Keizo
Published: December 2008

A safe and simple technique for exchanging central venous catheters is herein described. Our technique is based on a modification of Seldinger's method, in which a new outer sheath is introduced over the previous catheter as a guidewire in order to simplify the exchange of central venous catheters. This technique can be successfully performed by new residents and can be applied to the exchange of clotted catheters.
Use of thrombolysis for acute myocardial infarction by general practitioners
Authors: Rule Simon , Brooksby Paul , Sanderson John
Published: December 2008

The early administration of thrombolytic agents significantly reduces mortality following a myocardial infarct and ideally they could be given by general practitioners when the patient is first seen. However, the diagnosis of myocardial infarction in the early stages can be very difficult especially if an electrocardiogram is not available. This may limit the use of thrombolytic drugs by general practitioners. We assessed the accuracy of diagnosis in general practice by asking general practitioners referring patients with chest pain, the likelihood that the event was due to a myocardial infarction and if they would use thrombolysis if it were available. Diagnostic accuracy and appropriate use of thrombolysis was analysed retrospectively, comparing the general practitioner with the admitting hospital doctor. One hundred consecutive patients were studied. The general practitioners accurately diagnosed myocardial infarctions in approximately 45% of cases and would have given thrombolysis inappropriately on 67% of occasions mainly because the final diagnosis in most of these patients was unstable angina rather than infarction. The hospital doctors administered streptokinase inappropriately to 33% of the patients and four had complications during treatment. Of those patients receiving thrombolysis, the average time delay from the general practitioner referring the patient to hospital to the patient being treated was 107 minutes.

This study confirms that the diagnosis of myocardial infarction in the early stages is difficult and that thrombolytic therapy may be given inappropriately (mainly to patients with unstable angina). We conclude that until the accuracy of diagnosis of myocardial infarction can be improved in general practice it would seem inappropriate for thrombolysis to be given in the community at the moment.
Ischaemic complications of graduated compression stockings in the treatment of deep venous thrombosis
Authors: Merrett Neil D , Hanel Kevin C
Published: December 2008

Graduated compression stockings are frequently used in the prevention of deep venous thrombosis and the treatment of venous insufficiency. Two patients are discussed who sustained ischaemic complications after application of graduated compression stockings. Review of the literature demonstrates that low cutaneous pressures significantly decrease local blood flow and that the amount of pressure exerted by graduated compression stockings increases significantly with increases in leg girth. Ischaemic complications associated with the use of these stockings also appears to be more common than previously thought and any policy of routine prescription to patients should be questioned.
Left ventricular wall thickness and disease duration in systemic sclerosis
Authors: Hegedüs Ida , Czirják László
Published: December 2008

Myocardial thickness, left ventricular functions, and right heart overloading were investigated in 80 patients with systemic sclerosis by echocardiography. Based on the left ventricular wall thickness, three groups were formed. Fifteen patients with asymmetrical left ventricular wall hypertrophy (Group 1) showed shorter mean disease duration with marked diastolic and mild systolic left ventricular functional impairment. The 25 patients with wall thinning (Group 3) had a slight increase in left ventricular diameters, impaired systolic functions and longer disease duration. Group 2 with wall thickness exhibited mixed changes. Patients with increased wall thickness tended to have a shorter disease duration than patients with wall thinning. Patients with systemic sclerosis showed systolic and diastolic function impairment as compared to the 18 control healthy individuals. Pericardial disease was found in 23 cases (28.7%).
Recurrent anaemia due to ischaemic colonic ulceration caused by cholesterol embolism
Authors: Grant David J , Sanders D S A , McMurdo Marion E T , Lyall M H
Published: December 2008

We describe an elderly patient with generalized atherosclerosis who presented with recurrent iron-deficiency anaemia. He underwent right hemicolectomy which revealed ischaemic colonic ulceration caused by cholesterol embolism. Surgery appeared to be curative. Cholesterol embolism should be considered as a possible cause of unexplained gastrointestinal blood loss in the elderly.
Clinic blood pressure measurements and blood pressure load in the diagnosis of hypertension
Authors: Lee D R , Sivakumaran P , Brown R
Published: December 2008

We have retrospectively compared the blood pressure load derived from 24 hour ambulatory blood pressure monitoring in patients with all clinic blood pressure readings elevated with those with only some elevated pressures to establish whether clinic readings alone are good predictors of blood pressure status. Fifty-seven patients attending a district general hospital hypertension clinic who were not on anti-hypertensive treatment were selected.

Between two and six clinic readings were taken over a period of 1-6 months. Forty out of 57 patients had at least one clinic diastolic blood pressure reading of < 90 mmHg and, of these, 14 (35%) had a high blood pressure load and 26 (65%) had a normal blood pressure load. Patients with all diastolic blood pressure readings > 90 mmHg totalled 17 and of these 11 (65%) had high load and six (35%) had normal load. Patients with clinic diastolic blood pressure > 90 mmHg were significantly more likely to be truly hypertensive on the basis of blood pressure load than if one or more clinic readings was below 90 mmHg (P < 0.05). Diastolic pressures have some predictive power as to the blood pressure status defined by blood pressure load, but even consistently raised diastolic pressures do not necessarily indicate hypertension. Likewise one or more clinic diastolic blood pressure < 90 mmHg does not assuredly indicate normotension. Twenty-four hour ambulatory blood pressure monitoring may have an increasingly important role in the assessment of hypertension.
Recurrent confusion and hypopituitarism
Authors: Gutowski N J , Heron J R
Published: December 2008

Three women in late middle age had recurrent episodes of confusion which could not be explained solely on the basis of an associated infection. All three patients had latent hypopituitarism diagnosed on final presentation. Each patient had a previous history of a severe postpartum haemorrhage followed by two further pregnancies.

Experienced clinicians had not made a diagnosis of confusional episodes due to hypopituitary encephalopathy because the history was not immediately available in the confused patient, and the significance of deficient axillary and pubic hair was not given due emphasis.
Evaluation of a commercial enzyme-linked immunosorbent assay (ELISA) kit for serological diagnosis of Helicobacter pylori infection in a group of non-ulcer dyspepsia sufferers
Authors: Ching C K , Thompson S , Buxton C , Holgate C , Holmes G K T
Published: December 2008

Helicobacter pylori infection of the stomach is associated with gastritis and peptic ulceration and may be causative. A noninvasive test for this organism might be useful in managing some patients with dyspepsia without the need for further investigation. We have evaluated a new commercially available serological test (Helico-G ELISA, Porton Cambridge, UK) for this infection to assess its diagnostic accuracy in a retrospective study of 115 patients with non-ulcer dyspepsia. Sixty-three of these patients (55%) were found to have H. pylori infection and gastritis on histology. A sensitivity of 81% and specificity of 90% were obtained. No significant fall in the antibody titres was found in a subgroup of 15 patients who were selected to complete a course of triple therapy despite significant improvement in their dyspepsia score and confirmed eradication of H. pylori organism in 80% of these patients. We conclude that the test has limited value in aiding clinical decision of managing patients with dyspepsia.
Patients with atherosclerotic renovascular disease presenting to a renal unit: an audit of outcome
Authors: Scoble J E , Sweny P , Stansby G , Hamilton G
Published: December 2008

During a 6 year period 60 patients with atherosclerotic renovascular disease were followed by a single renal unit. Angiotensin converting enzyme inhibitors were being taken by 22% of patients at the time of diagnosis of the atherosclerotic renovascular disease. Intervention to revascularize renal tissue by surgery or angioplasty was performed in 32 patients. Revascularization was not undertaken because of unilateral disease, patient preference, poor operative risk or renal size. The mean age for the nonintervention group was 66.9 years and 63.4 years for the intervention group. Peripheral vascular, disease was common in both groups (96% nonintervention group versus 86% intervention group). There was a statistically significant difference in improvement in renal function in the intervention group (34.4% versus 10.7%) in spite of more patients being dialysis dependent in the intervention group (28.1% versus 14.3%). There was no statistically significant difference in survival between the two groups although the trend was for better survival in the group with intervention.

Patients presenting with impaired renal function and atherosclerotic renovascular disease can have useful improvement in renal function with revascularization without any detriment to survival.
Reversibility of myocardial dyskinaesia due to severe hypertension
Authors: Veen C , den Hartog F R , Verburgh C A , Dees A , de Leeuw P W
Published: December 2008

Two cases of acute left ventricular failure associated with severe essential hypertension are presented. On admission echocardiography indicated severe dyskinaesia of all wall segments of the heart. Anti-hypertensive treatment resulted in significant improvement in clinical and echocardiographic findings.
Hypercalcaemia and multiple osteolytic lesions in childhood acute lymphoblastic leukaemia
Authors: Soni P N
Published: December 2008

A 12 year old boy presenting with hypercalcaemia (calcium 3.25 mmol/l) and osteopaenia with multiple osteolytic lesions was found to have acute lymphoblastic leukaemia without lymph-adenopathy or organomegaly. Hypercalcaemia is a rare feature of acute leukaemia, but the patients previously described all show very similar characteristics, which were highlighted in this patient. These include age (10-20 years), severe osteolytic bone lesions, lymphoblastic leukaemia, and normal white cell count with absent or rare circulating blasts. Parathyroid hormone levels were normal in this patient, and response to induction therapy was good. This case demonstrates that acute lymphoblastic leukaemia may present in an atypical form without peripheral blasts but with hypercalcaemia and gross skeletal changes.
Microalbuminuria and coronary heart disease in non-diabetics
Authors: Buggy Donal , Feely John , Murphy John , O'Sullivan Cathal , Walsh Michael
Published: December 2008

Microalbuminuria (or urinary albumin excretion rates (AER) above normal limits) is associated with coronary heart disease (CHD) particularly in diabetics. To determine the sensitivity and specificity of AER for CHD in a non-diabetic population we prospectively studied 115 consecutive patients undergoing coronary angiography and 66 undergoing exercise electrocardiography (ECG). There was no relationship between AER and the severity of CHD determined by angiography (Gensini-scored). While microalbuminuria (AER > 20 micrograms/minute) was 91% specific it had low sensitivity (12%). Microalbuminuria is not a sensitive indicator of CHD in a non-diabetic population.
Serum soluble interleukin 2 receptor levels in anti-neutrophil cytoplasmic autoantibodies--positive systemic vasculitis
Authors: Lai Kar Neng , Lockwood C Martin
Published: December 2008

Systemic vasculitis is characterized by the presence of autoantibodies to neutrophil cytoplasmic antigens (ANCA). The role of T-lymphocytes in systemic vasculitis remains uncertain. In the present study, we attempted to explore the role of T-lymphocytes in systemic vasculitis by measuring the serum soluble interleukin 2 receptor (sIL2R) levels in seven vasculitic patients and comparing the sequential measurements with the titres of ANCA which satisfactorily reflect the disease activity. The serum levels of both ANCA and sIL2R were elevated at clinical presentation. Contrary to ANCA, the serum sIL2R remained elevated in most patients despite clinical remission following immunosuppressive therapy.

These findings suggest that T-lymphocytes may be activated in the acute phase of the disease. The finding of elevated serum sIL2R levels in most patients during clinical remission indicates that it is not a good measure of the disease activity and tends to argue against the role of T-lymphocytes as a major effector mediating inflammatory injuries in systemic vasculitis.
Gastro-duodenal injury associated with intake of 100-325 mg aspirin daily
Authors: Oren Ran , Ligumsky Moshe , Lysy Joseph , Gonzales Julio , Zimmerman Joseph
Published: December 2008

During the year 1991, 43 patients with upper gastrointestinal bleeding and one with severe epigastric pain associated with intake of non-steroidal anti-inflammatory drugs were admitted for emergency endoscopy to our unit. Fourteen patients (33%) had been treated with 100-325 mg aspirin daily, 11 of them for at least one year. The mean age of this group was 71. Only two patients had a previous history of peptic ulcer. Five patients used anticoagulants or antiplatelet drugs concomitantly with aspirin. The endoscopic diagnosis of the sources of bleeding was erosive gastritis in eight patients, gastric ulcer in four, duodenal ulcer in five and oesophageal ulcer in one. Our results support findings by other groups, showing that doses of aspirin as low as 75 mg daily should be used in the management of elderly patients with thrombo-embolic disease.
Cervical spondylotic myelopathy with occult foramen magnum meningioma--a case for MRI?
Authors: Chakravarty K , Scott D G I , Dick D , Visick J
Published: December 2008

A fatal case of occult foramen magnum meningioma is described which presented with features of cervical myelopathy confirmed by cervical myelogram. Surgical decompression led to initial improvement followed by progressive deterioration and death. Postmortem examination revealed a 4 cm diameter foramen magnum meningioma. The dangers of using only standard radiographic investigations of the cervical cord are discussed.
Bartter's syndrome in two generations of an Irish family
Authors: Crowe P , Ahmad A , O'Byrne K , Cullen M J
Published: December 2008

We report four cases of Bartter's syndrome in two consecutive generations of an Irish family. Diagnoses were made on the basis of characteristic clinical features, blood and urine biochemistry with additional evidence from renal biopsy in one case. The aetiology, treatment and inheritance of the syndrome are discussed.
Giant hydronephrosis masquerading as massive ascites
Authors: Singh N K , Jha B , Khanna R , Khanna N N
Published: December 2008

A case of unilateral giant hydronephrosis containing about 20 litres of old haemorrhagic fluid, clinically simulating massive ascites, is reported. The role of preceding abdominal trauma in the pathogenesis and the rapidity of the disease process is discussed.
Postpartum pain due to thrombosed varicose veins of the round ligament of the uterus
Authors: Al-Qudah Mohammed S
Published: December 2008

Postpartum thrombosis of varicose veins of the round ligament may present in a clinical picture similar to an irreducible inguinal hernia. Two such unusual cases are reported. One patient underwent surgery while the other, with a presumptive diagnosis of the same condition, was observed, with no complications occurring in both patients. This condition has not to my knowledge been previously reported. The increased incidence of both varicose veins and thrombosis in the postpartum period should alert the physician to the diagnosis of such conditions.
Transient regional osteoporosis presenting as a septic arthritis
Authors: McAlindon T E , Ward S A , MacFarlane D , Mathews J A
Published: December 2008

A 52 year old man developed a painful swollen left knee. Clinically there was an effusion and radiographs showed local osteoporosis. Sepsis was suspected but tests proved negative and the symptoms gradually settled. During the course of the following year he developed similar pain migrating from the left foot to the right knee then to the right foot. Investigations showed a right knee effusion and 'punctate' radiographic lucencies in the patellae thought to be erosions. A bone scan demonstrated increased uptake at all four sites and sepsis was once again suspected. Biopsies and culture proved negative and a computed tomographic scan confirmed that the lucencies were due to focal osteoporosis rather than erosions. This case of transient regional osteoporosis illustrates two unusual features of this condition which resulted in diagnostic difficulty with respect to sepsis.
Focal myositis: an unusual cause of bilateral upper eyelid swellings
Authors: Lim K L , Robson K , Powell R J
Published: December 2008

Focal myositis is considered a rare self-limiting inflammatory swelling of skeletal muscle. Focal involvement of individual muscle or muscle groups with severe myopathic and inflammatory changes characterizes the histology. We report the development of progressive focal myositis in both upper eyelids of a 34 year old man that responded to immunosuppressive therapy.
First use of G-CSF in chlorpromazine-induced agranulocytosis: a report of two cases
Authors: Kendra J R , Rugman F P , Flaherty T A , Myers A , Horsfield N , Barton A , Russell L
Published: December 2008

Chlorpromazine-induced agranulocytosis is an uncommon disorder associated with a high frequency of fatality. We describe two patients with chlorpromazine-induced granulocytosis in whom granulocyte colony stimulating factor (G-CSF) administration enhanced the speed of neutrophil recovery. No toxicity was noted with G-CSF and both patients made a successful recovery. We propose there is a role for such cytokine therapy in patients with life-threatening agranulocytosis in order to speed the recovery of neutrophils.
Detection of Epstein-Barr genome in the lymph nodes of Hodgkin's disease
Authors: Bellas C , Mampaso F , Fraile G , Molina A , Bricio T , Cuesta C
Published: December 2008

We have used the enzymatic in situ hybridization method to investigate the presence of Epstein-Barr virus (EBV) genome in lymph node tissues from patients with Hodgkin's disease. Also, 11 patients with persistent human immuno-deficiency virus-associated generalized lymphadenopathy as well as seven autopsy cases with no Hodgkin's disease, formed part of these studies.

EBV DNA-positive reaction was demonstrated in Reed-Sternberg cells and variants in seven of 16 cases and in the small accompanying lymphocyte cell population in 14 of the 16 cases. It was also found in eight of the 11 cases with persistent generalized lymphadenopathy but in none of the lymph nodes from negative selective autopsy cases.

Our results indicate that the colorimetric in situ hybridization technique is useful in EBV nucleic acid detection and cell-type localization in Hodgkin's disease. Additionally, the detection of EBV genome, not only in the diagnostic cells but in the small lymphocyte cell components, could provide new insights into the potential role of this agent in the pathogenesis of Hodgkin's disease.
Control of plasma glucose with somatostatin analogue (SMS 201-995) during surgical removal of insulinomas
Authors: Utas C , Kelestimur F , Boyaci A , Saglam A
Published: December 2008

Prevention of hypoglycaemia may sometimes be difficult in the operative period of insulinoma when parenteral volume overload is contraindicated due to severe cardiac failure. We investigated the effects of octreotide on hypoglycaemia during operations in two patients with insulinoma, one of whom had severe congestive heart failure. We found no hypoglycaemic values by using octreotide 100 micrograms administered subcutaneously one hour before surgery. Octreotide therapy can safely be used before surgery to prevent hypoglycaemia in patients with insulinoma.
The use of midazolam and flumazenil for invasive radiographic procedures
Authors: Roberts S P , Hargreaves J , Pollard B J
Published: December 2008

This study has examined the use of flumazenil to improve recovery following sedation with midazolam in elderly patients undergoing invasive radiological procedures. Forty patients received either flumazenil or placebo in a randomized double-blind fashion following midazolam sedation. Nalbuphine 10-15 mg was given for premedication. All but one of the patients in the flumazenil group were fully awake immediately following the reversal agents compared to only one in the placebo group (P = 0.016). This statistically significant difference remained after 20 minutes (P = 0.029). There were no adverse effects on heart rate, blood pressure, forced expiratory volume in one second, vital capacity or oxygen saturation. The majority of patients (78% overall) could not recall their procedure. All patients said that they would be willing to undergo a similar technique in the future.
Unusual manifestations of craniofacial fibrous dysplasia: clinical, endocrinological and computed tomographic features
Authors: Daly B D , Chow C C , Cockram C S
Published: December 2008

Clinical, endocrinological and computed tomographic features of three patients with unusual manifestations or complications of craniofacial involvement of fibrous dysplasia are presented. One patient with polyostotic fibrous dysplasia presented in late pregnancy with acute onset of bilateral optic nerve compression and blindness secondary to a rapidly expanding mass of fibrous dysplasia tissue involving the sphenoid, pituitary and optic chiasm regions. A second patient with polyostotic fibrous dysplasia developed thyrotoxicosis and probable gigantism/acromegaly in keeping with a rare form of McCune-Albright syndrome. Extensive bony distortion of the skull and facial bones by fibrous dysplasia made clinical recognition of these complications more difficult. A third patient had monostotic fibrous dysplasia with marked sclerosis of the sphenoid bone on plain radiographs which mimicked appearances of a meningioma and resulted in a negative craniotomy as computed tomography was not yet available at the time of presentation.

Each case demonstrated rare complications of craniofacial fibrous dysplasia and highlighted the wide spectrum of appearances in which it may manifest, often resulting in overlap and diagnostic confusion with other disease processes. The value of computed tomography in assessment is emphasized.
Persistent monoarthritis and occult coeliac disease
Authors: Borg A A , Dawes P T , Swan C H J , Hothersall T E
Published: December 2008

Arthritis is a recognized complication of untreated coeliac disease. Symptoms and signs usually respond to the institution of a gluten-free diet. We report a case of occult coeliac disease presenting as a monoarthritis. Severe and progressive erosive damage has occurred in his talo-navicular joint despite a response to the institution of a gluten-free diet.
Cardiac involvement (Wolff-Parkinson-White syndrome) in tuberous sclerosis
Authors: Ijaola Olajide , Festus-Abibo L C , Lawani Olu , Kuku Sonny F
Published: December 2008

A surface electrocardiogram showing type B Wolff-Parkinson-White syndrome pattern was part of the cardiac findings in a female of 24 with florid features of tuberous sclerosis. She had cardiomegaly but no intracardiac tumour was demonstrated. Wolff-Parkinson-White syndrome, though rare, has previously been described in association with tuberous sclerosis in children but not before in adults.
Chronic active hepatitis in the type I polyglandular autoimmune syndrome
Authors: Michele Theresa M , Fleckenstein Jacqueline , Sgrignoli Anita R , Thuluvath Paul J
Published: December 2008

Type I polyglandular autoimmune syndrome is characterized by the triad of hypoparathyroidism, Addison's disease and chronic mucocutaneous candidiasis. Chronic active hepatitis has been associated with this syndrome but its incidence and severity have not been well documented.

We describe a sibship of two patients with type I polyglandular autoimmune syndrome who presented with autoimmune chronic active hepatitis. The first patient presented to us with advanced disease and died despite an emergent liver transplant, while the second patient responded to steroids.

Autoimmune chronic active hepatitis, a major cause of mortality in this syndrome, can present without symptoms or physical signs of liver disease. We suggest periodic screening of liver enzymes in subjects with this syndrome.
Consultant views on the use of aspirin in acute cerebrovascular disease: implications for clinical trials
Authors: Kent James , Bamford John
Published: December 2008

A questionnaire was sent to all 155 consultant physicians and geriatricians in the Yorkshire region who routinely admit patients with acute stroke in order to ascertain: (a) current opinion regarding the prescription of aspirin to patients with various manifestations of cerebrovascular disease, in particular the timing of initial treatment; and (b) the perceived role of computed tomography (CT) scans in relation to such therapy.

The response rate was 81% (126/155). Aspirin was reported to be prescribed routinely by 75% (95/126) of physicians for patients with completed stroke. Amongst those prescribing aspirin, treatment was reported to be initiated routinely within 48 hours of the onset of symptoms by 63% (60/95). Only 10% (6/60) of these physicians reported that they would withhold aspirin therapy until the result of a cranial CT scan was known, although 43% (26/60) thought a CT scan was desirable.

Our survey, which for logistical reasons is one of opinion rather than actual practice, suggests that aspirin is probably being prescribed acutely (less than 48 hours) after stroke to a significant number of patients and often without a pretreatment CT scan. As with patients who have had a CT scan, the balance of risks and benefits of this practice are unknown. We conclude that it would be ethical for acute treatment trials to allow randomization to aspirin without prior CT scan.
A comparison of intravenous and subcutaneous hydration in elderly acute stroke patients
Authors: Challiner Yvonne C , Jarrett D , Hayward M J , al-Jubouri M A , Julious S A
Published: December 2008

The aim of this study was to compare the effectiveness of subcutaneous and intravenous fluid therapy in hydrating, elderly acute stroke patients. Thirty-four such patients, needing parenteral fluids because of impaired consciousness or dysphagia, were randomly allocated to receive either subcutaneous or intravenous fluids (2 litres of dextrose-saline/24 hours). Serum osmolality was measured before starting fluid therapy (Day 1) and on Days 2 and 3. An analysis of covariance of the osmolalities showed no statistical difference between the two groups (P = 0.12). The total cost of cannulae used over the 3 days for the subcutaneous route was approximately a third of that for the intravenous route. Complication rates were similar for the two groups. The results suggest that subcutaneous fluid therapy is an effective alternative to the intravenous route.
Glossopharyngeal schwannoma presenting as gagging dysphagia
Authors: Tay H L , Swanston A R , Lumley J S P
Published: December 2008

A case of cervical glossopharyngeal schwannoma presenting with gagging dysphagia is presented. Treatment was by total excision of the schwannoma following which the patient made a good recovery. To our knowledge, this is the first report of gagging dysphagia associated with a glossopharyngeal schwannoma.
A case of isolated TSH deficiency presenting as infertility
Authors: Balen Adam H , Manning Patrick J
Published: December 2008

We report a case of late-onset isolated thyroid stimulating hormone deficiency in a woman who presented with oligomenorrhoea and secondary hyperprolactinaemia. Hypothalamic and pituitary radiology and function was otherwise normal. The underlying aetiology of this condition is thought to be due to an inborn defect in the thyrotroph and treatment is with standard thyroid replacement therapy.
Bacterial oesophagitis in an immunocompromised patient
Authors: Radhi Jasim M , Schweiger Franzjosef
Published: December 2008

Bacterial oesophagitis is an uncommon and poorly described entity affecting particularly the immunosuppressed patient. The diagnosis rests on the demonstration of bacterial invasion of the oesophageal wall in the absence of other pathological processes. The causative organisms usually are Gram-positive cocci and there may be associated bacteraemia. The case report describes a leukaemic patient with bacteraemic bacterial oesophagitis.
Haemodynamic management in ruptured abdominal aortic aneurysm
Authors: Brimacombe J , Berry A
Published: December 2008

Ruptured abdominal aortic aneurysm currently accounts for about 1 in 200 deaths and is a critical surgical emergency with an average hospital mortality of 50%. The combination of acute massive haemorrhage in an elderly patient with pre-existing medical disease is highly lethal and a major challenge for any health care system. This article outlines the general principles of management and discusses the problems of haemodynamic assessment and preclamping fluid resuscitation.
Pharmacokinetics of naftopidil, a novel anti-hypertensive drug, in patients with hepatic dysfunction
Authors: Farthing M J G , Alstead E M , Abrams S M L , Haug G , Johnston A , Hermann R , Niebch G , Ruus P , Molz K H , Turner P
Published: December 2008

The pharmacokinetics of naftopidil, a novel alpha-1 adrenoceptor-blocking antihypertensive, were investigated in ten patients (9M/1F) with hepatic dysfunction after oral administration (50 mg, tablet) and after an intravenous infusion of 5.0 mg over 2 minutes. Results were compared to a control group of 12 healthy subjects (6M/6F) of a previous investigation, which was carried out according to the identical study protocol.

The pharmacokinetic parameters obtained for the i.v. administration were comparable in both groups (half life 3.6 +/- 3.4 hours in liver-impaired subjects versus 3.3 +/- 2.1 hours in controls; clearance 11.9 +/- 4.7 ml/minute/kg versus 11.0 +/- 1.6 ml/minute/kg).

Following oral administration the plasma levels and half-life times of naftopidil were significantly increased in liver impairment (t1/2 16.6 +/- 19.3 hours versus 5.4 +/- 3.2 hours in controls; P = 0.012). Mean values for the absolute bioavailability in patients with hepatic dysfunction were significantly higher (mean 75%, median 53%, range 13.4-211.0%) compared to healthy subjects (mean 17%, median 16%, range 6.7-29.6%, P = 0.001).

Reduction of functional hepatic blood flow in chronic liver disease or, as evidenced in one case as a consequence of shunt surgery, is the probable cause of the observed alteration in naftopidil kinetics. This phenomenon occurred only following the oral 50 mg dose whereas the intravenous 5 mg dose obviously still could be normally handled. Naftopidil demethylation and hydroxylation were both less and non-uniformly affected.

The pharmacokinetic findings suggest that in patients with severe hepatic impairment or evidence for marked changes in hepatic blood flow the dose of naftopidil may require adjustment to the lower end of the therapeutic range and/or may be limited to once daily. However, before definite conclusions can be drawn, further steady-state studies are required. Despite the pharmacokinetic discrepancies no difference in drug tolerability was seen between patients and healthy subjects.
Duodenal plasmacytoma: a rare extramedullary localization simulating carcinoma of the head of the pancreas
Authors: Schoretsanitis G , Livingstone J I , el-Japour J N , Watkins N , Wastell C
Published: December 2008

Plasmacytomas occurring in extramedullary sites are rare tumours, particularly so when located in the gastrointestinal tract. We report the case of a solitary extramedullary plasmacytoma arising in the duodenum and simulating a carcinoma of the head of the pancreas. Diagnostic and treatment options are discussed.
Retroperitoneal lymphadenopathy: an extrahepatic feature of chronic active hepatitis
Authors: Hayek Tony , Markel Arie , Goldfeld Moshe , Ben-Arie Yehudit , Brook Gerald J
Published: December 2008

We report a patient with chronic active hepatitis in whom one of the initial findings was retroperitoneal lymphadenopathy, detected by abdominal ultrasound examination. Extrahepatic presenting findings of chronic active hepatitis may include arthritis, urticaria, pleurisy and pericarditis, while abdominal lymphadenopathy has been only rarely described. Chronic active hepatitis should be included in the differential diagnosis of abdominal lymphadenopathy.
The changing clinical spectrum of liver abscess: the Jerusalem experience
Authors: Yinnon A M , Hadas-Halpern I , Shapiro M , Hershko C
Published: December 2008

A retrospective study was conducted of all 31 patients with liver abscess admitted to Shaare Zedek Medical Center between 1979, the year computed tomographic scan and ultrasound were introduced, and 1992. Fever and abdominal pain were the most common symptoms. Duration of symptoms was short: 81% of patients had symptoms for < or = 5 days and none had symptoms for more than 3 weeks. Amoebic abscess was found in one patient only, the remainder were pyogenic. Biliary tract pathology remains the most common cause of liver abscess (39%). The diagnosis was made by ultrasound in 22/31 (71%) and by computed tomographic scan in 9/31 (29%) of patients. Treatment consisted of intravenous antibiotics and percutaneous drainage under ultrasound guidance in 24/31 patients (77%). Four patients died (13%), three of whom had underlying malignancies.

Clinical features were compared with those from a similar series of 36 cases with liver abscess reported from Jerusalem predating ultrasound and computed tomographic scan (1967-1977). Several major changes have occurred. First, the relative incidence of amoebic abscess has dramatically decreased. Second, ultrasound and computed tomographic scan have facilitated earlier diagnosis and percutaneous drainage, contributing to improved survival and lower morbidity.
Pituitary apoplexy after stimulation tests
Authors: Vassallo Michael , Rana Zubair , Allen Steve
Published: December 2008

Pituitary apoplexy occurs after infarction of a non-neoplastic pituitary or sudden expansion of an adenoma following haemorrhage or infarction. It usually occurs spontaneously but can follow a number of causes including pituitary stimulation tests. Since this complication is potentially life-threatening, the benefits of subjecting patients who might have pituitary tumours to such tests should be considered.
Systemic amyloidosis and ovarian carcinoma
Authors: Fernandez-Miranda C , Mateo S , Gonzalez-Gomez C , Ballestin C
Published: December 2008

A case of ovarian carcinoma and systemic amyloidosis in a 64 year old woman with nephrotic syndrome is reported. Immunohistochemical study of renal and rectal biopsy specimens revealed the presence of amyloidosis AA antigens, consistent with secondary amyloidosis. The absence of chronic inflammatory or infectious disease suggested the presence of a neoplasm. The gynaecological sonogram showed a solid mass located behind the uterus. Laparotomy confirmed a poorly differentiated ovarian carcinoma. The association of systemic amyloidosis and ovarian carcinoma has not to our knowledge been described previously.
Secondary polycythaemia associated with bilateral renal lymphocoeles
Authors: Burton I E , Sambrook P , McWilliam L J
Published: December 2008

A patient with a 15 year history of secondary polycythaemia due to renal erythropoietin hypersecretion is presented. Subsequent spontaneous development of bilateral renal lymphocoeles, which contained high erythropoietin levels, was shown by computerized tomography. The lymphocoeles were successfully treated by bilateral peritoneal marsupialization. No cause for the persistent polycythaemia or lymphocoeles was found at laparotomy or on renal biopsy.
Prevalence of antibodies to hepatitis C virus after blood transfusion in heart surgery
Authors: Barcena R , Gonzalez A , Martin-de-Argila C , Ulibarrena C , Graus J , Grande L A Gil
Published: December 2008

We studied the frequency and time of appearance of antibodies to the hepatitis C virus (HCV) retrospectively in the sera of 127 patients who underwent heart surgery between 1983 and 1986. They received blood from volunteer donors hepatitis B surface antigen (HBsAg) negative with normal serum alanine-aminotransferase levels. A prospective follow-up was carried out every 15 days for at least 6 months from the moment of the transfusion.

Of the ten patients who developed biochemical criteria of post-transfusional non-A non-B hepatitis, six seroconverted to anti-HCV (60%). Of the other 117, two were already positive before transfusion (1.51%), one patient showed antibodies only in the first post-transfusional serum (passive transfer), and another two patients with no evidence of post-transfusional hepatitis developed HCV antibodies on the 90th day, remaining indefinitely (afterwards seroconversion without hepatitis); both patients' earlier sera were anti-HCV negative.

Four (40%) of the ten patients with post-transfusional hepatitis did not develop any serum markers to known hepatotropic agents. Although these findings do not exclude a viral infection by these viruses, they are consistent with the involvement of an unidentified non-A, non-B, non-C agent.
Recurrent chylothorax in a woman with primary amenorrhoea
Authors: Sridhar Mangalam , Boyle Iain , Banham Stephen
Published: December 2008

A 47 year old woman receiving oestrogen replacement therapy for primary amenorrhoea presented with recurrent chylothorax. The clinical and radiological features of her illness were characteristic of pulmonary lymphangio-leiomyomatosis, a rare hormone-dependent disease. The condition was treated with pleurodesis and withdrawal of oestrogen therapy.
Continuing clinically severe vitamin D deficiency in Asians in the UK (Leicester)
Authors: Iqbal S J , Kaddam I , Wassif W , Nichol F , Walls J
Published: December 2008

Deprivational vitamin D deficiency began to be noted in immigrant Asians in the early 1960s. Although there have been suggestions that the level of this problem may be declining, we describe a number of clinical cases seen over a consecutive 3 1/2 year period. Musculoskeletal symptoms were the commonest though there were a variety of medical presentations requiring hospital referral. Most of the cases were Hindu vegetarians. There is likely to be significant underdiagnosis of this condition.

In spite of the extensive medical, social and political attention this condition has received, our study shows that vitamin D deficiency continues to persist in certain Asians in a clinically florid fashion. An effective preventative policy is long overdue.
Microembolism from aortic aneurysm and ventricular thrombus: a complication of intravenous streptokinase
Authors: Abraham John S , Wilson Moira , Scripcariu Viorel , Barnes Peter C , Marcuson Roger W
Published: December 2008

Two patients sustained the rare complication of skin infarction following administration of intravenous streptokinase for acute myocardial infarction. We report evidence that dissolution of thrombus from an unsuspected source and subsequent microembolization of the skin may be responsible for this complication. In patients known to have an aortic aneurysm or ventricular thrombus, careful consideration should be given to the use of intravenous streptokinase following myocardial infarction.
Aggressive management of doxorubicin-induced cardiomyopathy associated with 'low' doses of doxorubicin
Authors: Sriskandan S , O'Brien M E R , Smith I E , Collins P , Gore M E
Published: December 2008

There is a dose-effect relationship between doxorubicin and the incidence of symptomatic cardiac failure. It is generally thought that doses below 500-550 mg/m2 are safe but, when objective measures of cardiac function are used, it becomes apparent that degrees of cardiac failure occur at doses below this. We present here the case histories of two patients who developed very severe cardiac failure at cumulative doses well below 500 mg/m2 but who survived their initial cardiac illness due to aggressive intervention. In one case, the patient was successfully treated by orthotopic cardiac transplantation.
Osteoporosis and genetic influence: a three-generation study
Authors: Kahn S A , Pace J E , Cox M L , Gau D W , Cox S A , Hodkinson H M
Published: December 2008

We have studied 27 triads of mother, daughter and grandmother for possible genetic influence on distal and proximal forearm bone density, measured by single photon absorptiometry.

We found a significant correlation of bone density at the proximal forearm between the mothers and grandmothers (r = 0.499, P < 0.01). There was also a weak correlation between proximal forearm bone densities of mothers and daughters (r = 0.327, P < 0.1).

Significant correlations were found between the three generations for grip strength, pedometry, height and triceps skinfold thickness. There was also significant correlation between mother and grandmother for alcohol intake. There was no correlation for contraceptive pill use, smoking, dietary calcium intake, body weight or body mass index.

The study concludes that, although there are similarities in bone mineral content between the three generations, genetic factors cannot be conclusively proven to be the major determinant of bone density. Lifestyle and environmental factors may have a bearing on achieving the peak bone mass and subsequent development of osteoporosis.
Creatine kinase isoform electrophoresis for the early confirmation of myocardial infarction detected by timed sequential CK slope analysis
Authors: Chattington Paula , Clarke D , Neithercut W D
Published: December 2008

Creatine kinase (CK)-MM and -MB isoforms were evaluated for the early diagnosis of myocardial infarction in patients aged over 65 years admitted to a district general hospital with acute chest pain.

Samples were collected for standard cardiac enzymes, timed CK slope analysis, and CKMM and CKMB isoform analysis from 48 patients admitted with acute chest pain. CKMM and CKMB isoform analyses were conducted using a Helena Rep electrophoresis system under standard conditions supplied by the company. In addition to the results of the biochemical tests the discharge diagnosis of the patients were also recorded.

CKMM isoform analysis resulted in three false-negative classifications of patients and one false-positive. The predictive value of this test was 100% for a positive result and 94% for a negative result. CKMB isoform analysis was less accurate and there were six false-negative results and five false-positive results. The predictive value of a positive result was 75% and 85% for a negative result. CK isoform analysis became unreliable when mean total CK levels in serum were 210 IU/l (+/- 171).

CK isoform analysis may be of use in the investigation of patients whose samples have a total CK concentration greater than the reference range but was no better than timed CK slope analysis for the detection of myocardial infarction in patients aged more than 65 years.
Hyponatraemic rhabdomyolysis in Addison's disease
Authors: Egan J J , Davies A J , Jones M K
Published: December 2008

This case describes a novel association of rhabdomyolysis with severe normovolaemic hyponatraemia resulting from previously unrecognized Addison's disease in a 63 year old female.
The use of capsaicin cream in a case of erythromelalgia
Authors: Muhiddin K A , Gallen I W , Harries S , Pearce V R
Published: December 2008

We present a case of erythromelalgia in a 68 year old lady who responded, within 48 hours, to a twice daily topical application of capsaicin cream 0.025%. Capsaicin cream was stopped after 2 months, and 6 months later the patient continued to have the symptomatic relief she experienced initially.
Orthostatic hypotension and anti-hypertensive therapy in the elderly
Authors: Fotherby M D , Potter J F
Published: December 2008

The effect of withdrawing or continuing anti-hypertensive therapy on orthostatic blood pressure change in elderly hypertensive subjects was examined. Subjects meeting criteria for therapy withdrawal had supine and standing blood pressure measurements taken on treatment, and at 1, 3, 6, 9 and 12 months off treatment whilst receiving standard non-pharmacological advice to lower blood pressure. Subjects not meeting blood pressure criteria for treatment withdrawal or were unwilling to stop treatment had blood pressure measurements taken after 6 and 12 months whilst also receiving non-pharmacological advice. Orthostatic hypotension was defined as a mean systolic blood pressure fall > or = 20 mmHg on standing from a supine position.

Forty-seven subjects (median age 76 years, range 65-84 years) had treatment withdrawn. Thirteen subjects (median age 73 years, range 68-82 years) continued on their treatment. Twelve months after treatment withdrawal there was a significant reduction in the number demonstrating orthostatic hypotension from 11 (23%) to four (11%) (P < 0.05), whilst the group continuing on treatment showed no change. In the withdrawal group those with orthostatic hypotension on treatment (n = 11) were older (79 versus 74 years, P = 0.05), had higher prewithdrawal systolic blood pressure (164 +/- 21 versus 147 +/- 17 mmHg, P = 0.02) compared to those without, although there was no difference in body mass index, gender, number or type of anti-hypertensive drugs taken. In elderly hypertensive subjects withdrawal of anti-hypertensive therapy and institution of non-pharmacological treatment can over several months reduce the prevalence of orthostatic hypotension.