bluuebunny/crossref_metadata_2025 huggingface dataset:
Radioactive iodine (131I) therapy for thyrotoxicosis at Groote Schuur Hospital over a 6-year period
Authors: Sagel J , Epstein S , Kalk J , Van Mieghem W
Published: December 2008

The case records of 262 patients who received 131I therapy during a 6-year period were analysed retrospectively. These included seventy-eight patients who received more than one therapeutic dose.

The major indication for 131I therapy was thyrotoxicosis occurring in patients aged 40 years and over. The racial incidence in this series is striking.

The effects on thyroid function of two low-dose schedules (4 mCi and 6 mCi) were compared. The major complication encountered was hypothyroidism. 4 mCi appears to be as effective as 6 mCi with the added advantage of producing less hypothyroidism.
Failure to thrive and anorexia nervosa
Authors: Smith Selwyn M , Hanson Ruth
Published: December 2008

A case study is reported of an anorexia nervosa mother who battered her elder male child (‘battered baby’) and in collusion with her psychopathic husband starved to death her 10-week-old daughter. The association of anorexia nervosa in the mother with death by starvation has not previously been reported in the literature. The possible underlying psychopathology is briefly discussed.
Hypertension following cadaveric renal transplantation
Authors: Coles G A , Jones G R , Crosby D L , Jones J H , McVeigh S
Published: December 2008

The incidence and aetiology of hypertension following cadaveric-donor renal transplantation have been investigated in twenty-four patients. Initially, the diastolic blood pressure was persistently above 100 mmHg in 52% of the patients. By 1 month after renal transplantation the incidence had fallen to 17% but it then increased rapidly, so that by 5 months 83% had hypertension.

Changes in blood pressure correlated poorly with changes in the dose of prednisone, extracellular fluid volume, exchangeable sodium, creatinine clearance and haemoglobin.

The recipient's original diseased kidneys were removed after transplantation in seven patients. The blood pressure fell to normal levels in three, remained unchanged in two and became easier to control with antihypertensive drugs in the other two patients. Measurements of plasma renin concentration were of no value in predicting the response to recipient nephrectomy.
Exogastric leiomyomata
Authors: Russell R C G , Wood B A
Published: December 2008

Two cases of exogastric leiomyoma are described indicating the difficulty in diagnosis of these tumours, and illustrating the success of total excision of the tumour in such cases.
The treatment of chronic pain with psychotropic drugs
Authors: Merskey H , Hester R A
Published: December 2008

The treatment is described of thirty patients with chronic nervous system lesion causing intractable pain. Moderately good relief of pain was obtained with a combination of phenothiazines (especially pericyazine), antidepressant drugs and antihistamines.

The theoretical implications of this are discussed and it is suggested that the drugs in question act partly by virtue of an effect on the multisynaptic neuronal systems whose activities are related to the experience of pain.
Slow recovery from carbon monoxide poisoning
Authors: Abbott D F
Published: December 2008

A case of accidental carbon monoxide poisoning due to the incomplete combustion of natural gas is reported. The patient had prolonged coma and decerebrate rigidity, but eventual recovery of neurological and intellectual function was almost complete.
Who sees a psychiatrist? A study of factors related to psychiatric referral in the general hospital
Authors: Pritchard Michael
Published: December 2008

A retrospective study was made of all patients admitted to the general wards of The London Hospital in 1968 who were coded on discharge as having a psychiatric diagnosis. Two hundred and fifty-two were selected as suitable for an investigation of factors associated with psychiatric referral. About one-third were seen by a psychiatrist and referral was found to be related to age, to type of psychiatric illness and the extent to which it was due to organic disease, to a suicidal attempt and to previous psychiatric contact. Referral rates also varied considerably between different medical consultants.
Augmenting the action of levodopa
Authors: Rao S K , Vakil S D , Calne D B , Hilson A
Published: December 2008

Various pharmacological approaches to potentiate the therapeutic actions of levodopa and reduce side-effects are reviewed.

Of currently available drugs, anticholinergic agents and amantadine have been studied extensively. Inhibition of extracerebral decarboxylase appears to be the most promising new area of investigation, though experience is at present limited.

Other methods discussed include inhibition of enzymes catechol-O-methyl transferase, monoamine oxidase and dopamine beta hydroxylase. Conflicting evidence on 3-O-methyldopa is discussed.
Tuberculomas of the brain in Britain
Authors: Maurice-Williams R S
Published: December 2008

Reports of three patients with tuberculomas of the brain are presented. The mode of presentation and clinical features of this condition are reviewed.
Recovery from severe paraquat poisoning
Authors: Galloway D B , Petrie J C
Published: December 2008

Recovery from poisoning with the herbicide, paraquat (20% concentrate—‘Gramoxone’) is rare (Malone et el., 1971). A patient is reported who survived despite ingesting an apparently fatal dose. Treatment consisted of forced diuresis and a single haemodialysis. Oxygen, steroids and immunosuppressives were not given.
The potential role of immunological adjuvants in influenza vaccines
Authors: Hobson Derek
Published: December 2008

Aqueous influenza vaccines seldom induce long-persistent protection against epidemic risk, and often fail to immunize up to one-third of the recipients, especially when there has been no previous immunological experience of the serotype of virus contained in the vaccine. Attempts to improve the situation by increasing the size or number of doses are limited by expense, toxicity and the time available in face of an oncoming epidemic. The future use of isolated viral antigens as vaccines may be limited by similar disadvantages.

Immunological adjuvants may make a valuable contribution in decreasing the minimum effective dose of antigen, thereby reducing the toxicity and expense of the vaccine, and increasing its availability. Adjuvant vaccines used in the past have been shown to induce higher mean titres of circulating virus-neutralizing or HI antibody in a higher proportion of the population than have aqueous vaccines, and the duration of immunity has been prolonged. The choice of adjuvants and the avoidance of untoward side-effects are discussed in this review.
Addison's disease without pigmentation
Authors: Goodwin T J , Kind P R N , Bogomoletz V W
Published: December 2008

Four cases of Addison's disease are described that presented without pigmentation. These cases were seen within an 8-month period in one hospital group.
Fatal pulmonary embolism following compression sclerotherapy for varicose veins
Authors: McMaster P , Everett W G
Published: December 2008

A case of fatal pulmonary embolism following compression sclerotherapy treatment of varicose veins is reported. This is the first death following this form of treatment recorded.
The epidemiology of Q fever
Authors: Hart R J C
Published: December 2008

Q fever was first described in Australia and has since been reported from many countries. Rickettsia burneti infects numerous species of mammals and has been isolated from ticks. Infected cattle, sheep and goats remain healthy but excrete the organism, which is present in high concentration in products of conception and survives in dust for long periods. The ways in which humans may become infected are considered. Many of these infections do not cause symptoms, but some are fatal and the prevention of this disease remains a challenge.
The clinical aspects of anthrax
Authors: Christie A B
Published: December 2008

Cutaneous anthrax is usually easy to diagnose provided the doctor thinks of anthrax. The lesion most likely to be confused with anthrax is accidental vaccinia. Orf lacks the characteristic central eschar. Cutaneous anthrax responds to antibiotic therapy: rare complications are meningitis and hypoxic hypertension. Pulmonary anthrax is highly fatal: its incidence is related to the number and size of anthrax-containing particles which are inhaled. Artificial mists containing lethal doses of anthrax bacilli can be manufactured. Intestinal anthrax may present as gastroenteritis or as ulceration of the intestine with obstruction and perforation.
Behaviour therapy of psoriasis—a hypnoanalytic and counter-conditioning technique
Authors: Waxman David
Published: December 2008

In the case described, an account is given of psoriasis in a female aged 38 who presented with a history of a rash of increasing severity for 20 years, originating during a period of severe emotional stress in a susceptible personality type.

During the whole of this period, there was never a time when she had been clear, and exacerbations had been most severe during her two pregnancies.

She was treated under hypnosis by a six-point schedule. This involved analysis and discussion, with interpretive (insight) psychotherapy and desensitization by reciprocal inhibition as described by Wolpe.

As well as the disappearance of the rash, overall improvement in personality was a notable impression gained from the self-rating Personality Schedule score at the end of treatment.
Blood carboxyhaemoglobin changes during tobacco smoking
Authors: Russell M A H
Published: December 2008

Using multiple samples collected via an indwelling venous cannula changes in blood carboxyhaemoglobin (COHb) were studied in five subjects before, during and up to 2½ hr after smoking. On average the smoking, with inhalation, of one cigarette in 6½ min raised the % COHb by 1·6, compared with 2·2 for 24 min of inhaled cigar smoking and only 0·2 for 20 min of non-inhaled pipe smoking. It is suggested that it may be paradoxically safer to smoke high rather than low nicotine cigarettes as those with a high nicotine content will tend to be inhaled less.
Tic convulsif: The association of trigeminal neuralgia and hemifacial spasm
Authors: Maurice-Williams R S
Published: December 2008

Both trigeminal neuralgia and hemifacial spasm are sometimes caused by a posterior fossa mass lesion. When these two disorders co-exist, a rare association known as ‘tic convulsif’, a lesion involving the fifth and seventh cranial nerves in the cerebellopontine angle is extremely likely. Twenty-eight cases of tic convulsif have been mentioned in the literature and two more case are reported here. They are of interest in that both cases many years elapsed between specialist opinion being first sought and the discovery of the underlying lesion.
Stereotactic limbic leucotomy: surgical technique
Authors: Richardson Alan
Published: December 2008

The requirements for modern psychosurgery are safety and accuracy.

Stereotactic techniques give the geometric accuracy and stimulation gives physiological information, which is important in determining lesion sites or at least lesion symmetry.

The process whereby focal brain destruction is produced is ideally by a freezing probe, but equally effectively by coagulation. A number of small lesions is thus required. This at present is unavoidable if side effects are to be obviated. Careful continuing assessment of results is necessary to validate any surgical procedure.
The effect of leucotomy in intractable adolescent weight phobia (primary anorexia nervosa)
Authors: Crisp A H , Kalucy R S
Published: December 2008

Anorexia nervosa is best construed as a phobic avoidance response to the psychosocial maturational implications of adolescent weight. Within this state, surrender to the impulse to eat and consequent weight gain is associated with panic, depression and sometimes specific intense fear of loss of control. So long as the avoidance posture can be maintained the experience of such turmoil is largely avoided.

Complicated ritualistic behaviour may arise to promote and secure the posture. However, its unrewarding and lonely nature still increasingly leaves the individual liable to the experience of depression. Established treatment procedures often assist recovery from the illness but intractable cases arise and it is amongst these that the majority of deaths occur either from inanition or suicide.

The basis for the changes characteristically induced by leucotomy is complex. The procedure often leads to reduced tension and release of appetitive behaviour. This is taken to be due to some direct effect of the cerebral lesion and possibly the intervention may also be construed by some patients as a licence to behave differently. In patients with anorexia nervosa such appetitive release can be expected to promote considerable weight gain. However, the adverse psychological implications of such weight gain for the patient do not appear always to be so immediately or easily relieved.

They may still experience panic, shame or depression and new patterns of social avoidance, or vomiting behaviour may develop. Intensive help of a psychotherapeutic and rehabilitative kind is then still required if the patient is to have the best chance of adjusting healthily to her newly found potential for a more normal nutritional status. Four patients who have undergone such treatment are described in this paper. It is concluded that leucotomy has a small but definite place in the treatment of patients with intractable anorexia nervosa.
Triamcinolone-augmented glucose tolerance in non-diabetic patients with chronic pancreatitis
Authors: Joffe B I , Jackson W P U , Bank S
Published: December 2008

Seven non-diabetic patients with chronic pancreatitis were shown to have a diminished acute insulin secretory response after intensive beta cell and intravenous tolbutamide stimulation. In an attempt to unmask their ‘latent’ diabetic state, triamcinolone-augmented glucose tolerance tests were performed some days after documenting normal standard 50 g oral glucose tolerance tests. A matched group of non-diabetic controls was similarly investigated. Although the steroid-augmented glucose tolerance tests showed marked impairment in the patients, becoming frankly diabetic in three cases, the normal control subjects reacted in a similar though less striking fashion. There was no significant difference between the mean glucose values in the two groups. The ability of patients with chronic pancreatitis to maintain normal glucose tolerance in the face of diminished insulin output is commented on. We conclude that, as an ancillary investigation for diagnosing chronic pancreatitis, the triamcinolone glucose tolerance test is unreliable.
Coeliac disease and autoimmunity
Authors: Lancaster-Smith M J , Swarbrick E T , Perrin J , Wright J T
Published: December 2008

Among fifty-seven patients with proven coeliac disease three also had thyrotoxicosis, two insulin dependant diabetes, three fibrosing alveolitis and one each had vitiligo, rheumatoid arthritis and cryptogenic cirrhosis. Autoantibodies were demonstrated in twelve of thirty-one patients tested, seven of these twelve had one of the above associated conditions. Antireticulin antibodies were found in seven of twenty-three patients tested, and there was a significant association with dietary gluten. These findings appear to support that coeliac disease is associated with disturbed immunity and that a predisposition to autoimmunity may exist.
Combination products
Authors: Cromie B W
Published: December 2008

Drugs that do not have a critical dosage and are commonly used together, can justifiably be combined in a single product. Such combinations are more convenient to doctor and patient and have reduced risk of treatment error and drug interaction.

Combination products include more than one active drug, each of which has its own chemical and physical properties, so that they are complex formulations. Copies of combination products are, therefore, even less likely to have comparable performance than copies of single drugs.

Generic copies are encouraged by pharmacopoeial monographs and the current inclusion of complex formulations and combinations in the BP may allow a new era of clinical non-equivalence from products considered to be generically equivalent.
The digoxin affair
Authors: Shaw T R D
Published: December 2008

The cardiac glycosides are potentially dangerous medicines and consistent preparations are necessary. However, presently used tablets of digoxin differ markedly in the fraction of the dose which is absorbed. Measurement of plasma digoxin levels by radioimmunoassay show that absorption from the Lanoxin brand has varied considerably in recent years due to changes in manufacturing technique. Other brands marketed in the U.K. form a wide range of bio-availability. Hazards to the patient are not entirely avoided by brand name prescribing and it is suggested that new pharmacopoeial standards are needed.
Clinical pharmacology and therapeutics of the oesophagus and the lower oesophageal sphincter
Authors: Misiewicz J J
Published: December 2008

Oesophageal function can be studied with intraluminal manometry, indwelling pH electrodes or with in vitro methods using isolated tissue. Radiology and endoscopy are the main diagnostic procedures. Innervation of the body of the oesophagus is mainly cholinergic, but the lower oesophageal sphincter appears to be affected by a wide range of biogenic substances, such as autonomic transmitters, polypeptide hormones and prostaglandins. Most drugs used in the treatment of oesophageal disorders act by modifying the action of the naturally occurring agents.
A comparison of beta adrenergic blocking drugs in the treatment of hypertension
Authors: Morgan T O , Anavekar S N , Sabto J , Louis W J , Doyle A E
Published: December 2008

Beta adrenergic blocking drugs were found to be effective hypotensive agents in the long-term treatment of patients with hypertension. In 40% of patients they appeared to be an extremely satisfactory antihypertensive agent. The fall in blood pressure was confirmed in a double blind study which also indicated that propranolol, prindolol, alprenolol and MK 950 (timolol) had similar antihypertensive properties. Propranolol and timolol reduced the pulse rate more than prindolol and alprenolol but the fall in blood pressure induced by the four drugs was not significantly different. The incidence of volunteered side effects was low, but when questioned specifically a large number of patients has disturbance of their dream pattern. This was more frequent and severe with prindolol and alprenolol. In this study bronchospasm was associated with the use of propranolol and timolol but not with that of prindolol and alprenolol.

In general, there is little difference between the various beta adrenergic blocking drugs in the treatment of hypertension, but in a few patients one or other may have advantages over the remainder. The dose ratios of the four drugs closely reflected their reported potency in producing beta adrenergic blockade. However, their exact mechanism of action is unknown, though it is probable that part of their effect is mediated via the central nervous system.
The use of anticoagulants in bacterial endocarditis
Authors: Kanis John A
Published: December 2008

Early experience in the treatment of bacterial endocarditis with penicillin suggested that the addition of anticoagulants might improve results. This paper reports a patient with bacterial endocarditis who died from embolic cerebral damage after initiation of treatment with heparin. The evidence suggests that anticoagulants were responsible for her death and that bacterial endocarditis is a relative contra-indication to anticoagulant therapy.
Pathology with reference to the bile retention syndrome
Authors: Emery J L
Published: December 2008

The pathological significance of giant cells, inspissitated bile plugs and hepatic fibrosis in the liver of infants is critically reviewed. Evidence is presented suggesting that a wide variety of pathological change in the paediatric liver results from the interaction of the effects of growth, metabolic maturity, genetic metabolic variability and infection. Understanding of the bile retention syndromes might increase if the diagnosis of ‘Neonatal Hepatitis’ and ‘biliary atresia’ as finite conditions, were to cease and their pathogenesis considered in such a multifactorial way.
Bile salts and liver disease in childhood
Authors: Javitt Norman B
Published: December 2008

Recognition of neonatal liver disease has been heavily dependent on the occurrence of jaundice. In most instances the jaundice is related to specific disturbances in bilirubin transport and other tests of liver function are normal. In contrast, hepatitis and other liver diseases not specifically affecting bilirubin transport often go undetected unless jaundice occurs.

The development of practical methods for the estimation of bile acids in serum has permitted an evaluation of hepatic excretory function in neonates and children independent of bilirubin excretion. Since bile acid excretion by the liver each day greatly exceeds bilirubin excretion it was not surprising to find that elevations in serum bile acids occur regularly in anicteric hepatitis. Because the excretion of bile acids generates canalicular bile flow a reduction in the capacity to excrete bile acids intimates the presence of cholestasis. Early cholestasis is not associated with hyperbilirubinaemia but as cholestasis becomes more severe, jaundice occurs and the possibility of biliary atresia arises in neonates. Serum bile acid patterns in neonates being evaluated for biliary atresia indicate two distinctive patterns. Those infants with severe cholestasis and patent bile ducts usually have pre-dominantly cholic acid in serum. This observation is consistent with the bile acid patterns found in intrahepatic and extrahepatic cholestasis occurring in adult life. Infants found to have extrahepatic biliary atresia have marked elevations in the proportion of chenodeoxycholate in serum. Since elevations of chenodeoxycholate in serum are associated with hepatitis, the findings are consistent with the view that extrahepatic atresia is a rare sequalae of hepatitis.

Studies of bile acid metabolism and excretion give promise of providing further insight on the pathogenesis of cholestatic liver disease.
Abnormal fatty acid composition and human atherosclerosis
Authors: Kingsbury K J , Brett C , Stovold R , Chapman A , Anderson J , Morgan D M
Published: December 2008

Eighty patients with aorto-iliac / femoro-popliteal atherosclerosis were collected to examine in detail their plasma cholesteryl ester fatty acid compositions and to compare them with the incidence of ischaemic heart disease through a 4-year follow-up. Various other biochemical and rheological parameters were also measured to see if these might explain any association between the abnormal fatty acid pattern and ischaemic heart disease.

The abnormal fatty acid pattern was specifically and generally similar to that found in essential fatty acid (EFA) deficient animals and children as shown by the increase of the specific trienoic acid (C.20: 3ω9) by reduced linoleic acid concentrations, and by an increase of C.18 and C.16 monoenoic acids (oleic and palmitoleic), but not of their corresponding saturated forms, stearic and palmitic. The results suggest that the abnormal fatty acid composition resulted from an increased synthesis of monoenoic acids and monounsaturase activity, coupled with a relative inadequacy of linoleic acid.

The patients with a reduced concentration of linoleic acid (<35%) subsequently had a higher incidence of myocardial infarction. No significant correlations were found between the fatty acid concentration and various other biochemical or rheological parameters except marginally between linoleic acid and platelet adhesiveness. Only the linoleic acid concentration distinguished between the patients with and without myocardial infarction.

A marked inverse correlation was found, however, between the monoenoic and linoleic acid concentration, without parallel changes in other fatty acids. It seems that as in animals, a balance exists between EFA and monoenoic pathways which are known to compete for the same desaturase systems and acyl sites. It appears that human EFA requirements and effects need to be considered not only by their intake and metabolism, but also through individual factors which vary the monoenoic concentrations and monounsaturase activity. Since these factors include several currently associated with human atherosclerosis the question arises of whether the EFA-monoenoic balance is one link between them and the pathology of the arterial occlusions and myocardial infarction.
Verapamil in the treatment of paroxysmal supraventricular tachycardia
Authors: Krikler Dennis M , Spurrell Roworth A J
Published: December 2008

Verapamil is a novel antiarrhythmic agent which appears to act as a calcium-ion antagonist, blocking calcium transport across the myocardial cell membrane. It was given intravenously, in a dose of 10 mg, to thirty-two patients suffering from paroxysmal supraventricular tachycardia, and sinus rhythm was achieved promptly in all. Identical results were obtained in a further ten patients with supraventricular tachycardias associated with the Wolff-Parkinson-White or other pre-excitation syndromes. In a separate group of eighteen patients in whom A-V junctional tachycardias were induced during intracardiac electrography, conversion to sinus rhythm was achieved in fifteen patients, with prolongation of the cycle length in the others. Circus-movement tachycardias were induced in eight patients with the Wolff-Parkinson-White syndrome, and conversion to sinus rhythm was achieved in seven. The results were less consistent in patients with other supraventricular arrhythmias including ectopic atrial tachycardia and atrial flutter, and, in the single patient with supraventricular and ventricular tachycardia, only the former was controlled. In the single patient with atrial fibrillation complicating the Wolff-Parkinson-White syndrome who received verapamil, sinus rhythm was restored. Side effects were few and mild, with rare exceptions of profound hypotension, bradycardia and asystole; their management is discussed, and reasons are advanced why their occurrence is likely to be related either to the concomitant administration of beta-adrenergic blockers or to the presence of sinoatrial disease. It appears that verapamil is particularly suitable for the treatment of supraventricular tachycardias due to a circus movement as calcium antagonism is likely to be most effective in the N region of the atrioventricular node.
Gastro-bronchial fistula
Authors: Missen Anthony J B , Pemberton James , Boon Andrew
Published: December 2008

1. Gastro-bronchial fistula is a rare condition occurring most commonly as a complication of a subphrenic abscess.

2. Other causes include trauma and necrosis within an infiltrating neoplasm.

3. The treatment of those fistulae which are secondary to a subphrenic abscess should be by drainage of the abscess, jejunal tube feeding and continuous gastric aspiration.
Acute ethanol poisoning treated by haemodialysis
Authors: Elliott R W , Hunter P R
Published: December 2008

A non-alcoholic patient with severe ethanol poisoning who was deteriorating clinically despite adequate supportive therapy was successfully treated by haemodialysis.
The use of sodium nitroprusside as a hypotensive agent in plastic surgery
Authors: Hester J B
Published: December 2008

Sodium nitroprusside was used to induce hypotensive anaesthesia in twelve fit patients undergoing plastic surgery. Marked individual variation in response occurred, steady low levels of blood pressure being difficult to maintain. Response to halothane, posture and increased airways pressure was also studied.
Aetiology of duodenal ulcer: an investigation into the buffering action and effect on pepsin of bran and unrefined carbohydrate foods
Authors: Tovey Frank I
Published: December 2008

It is unlikely that any possible protective action of wheat or rice bran or certain unrefined grains against peptic ulceration is due to any acid or pepsin lowering effect. Although these substances contain significant amounts of buffer, they also act as antral stimulants resulting in increased acid output. They also have no inhibitory effect on pepsin activity.
Malignant mesothelioma invading the spinal canal
Authors: Cooper D
Published: December 2008

A case of diffuse malignant pleural mesothelioma presenting as acute paraplegia is described. Autopsy revealed the presence of metastatic tumour within the spinal cord. An alveolar cell carcinoma coexisting with the mesothelioma and giving a distinct histological pattern was also present. There was no histological evidence of asbestos exposure.
Haematuria of unknown origin
Authors: O’Reilly Patrick H
Published: December 2008

Sixty-four cases of haematuria of unknown origin are reviewed. The results are compared with findings from other centres and discussion follows regarding the management of these patients.
Comparative clinical trial of diazepam with other conventional drugs in tetanus
Authors: Vassa Nalini T , Yajnik V H , Joshi K R , Doshi H V , Shah S S , Patel S H
Published: December 2008

Results of therapeutic trial of diazepam in tetanus are presented. The trial included 200 cases of tetanus—167 non-neonates and thirty-three neonates. The patients were divided into two groups and were matched as regards age, sex and severity of the disease. The cases of group I received standard treatment while the cases of group II received diazepam in addition. Over-all mortality in group I was 54% and in group II, 26%. The results were statistically significant in non-neonates and in severe degree of tetanus. The drug was well tolerated and side effects were not observed.
Gonococcaemia with arthritis, dermatitis and myocarditis
Authors: Fraser H S , Figueroa J P , James O B O’L , Liburd A L , Nicholson G A , Whitbourne F , Alleyne G A O
Published: December 2008

Six cases of gonococcaemia seen at the University Hospital of the West Indies are described. All presented with polyarthritis and all but one had skin lesions. They varied widely in severity and chronicity and included one case with rigors and myocarditis. Emphasis is placed on the diagnostic value of the scanty skin lesions, and the importance of repeated examination of cervical swabs.
Bumetanide—acute and long term studies of a new high potency diuretic
Authors: Murdoch W R , Auld W H R
Published: December 2008

The properties of a new diuretic, bumetanide, were investigated in ten normal volunteers, and sixty-eight patients with fluid retention. It had a rapid action virtually complete in 4 hr with an effect on water and electrolyte excretion similar to that of frusemide. It was highly potent, 1 mg producing an effect comparable to 48 mg frusemide in normal subjects, and about 40 mg in oedematous subjects in controlled short-term experiments. In long-term studies in forty-eight patients extending over periods up to 51 weeks it was found to be effective in controlling oedema. There was a low incidence of electrolyte complications and no other biochemical abnormalities or haematological complications were attributed to the drug. Bumetanide was well tolerated by patients. A drug rash was observed in two cases.
Prostaglandin levels in blood plasma during asthmatic attacks in patients with aspirin idiosyncrasy
Authors: Delaney J C , Smith J B , Silver M J
Published: December 2008

It has been suggested that prostaglandin release is an important factor in the pathogenesis of bronchial asthma. Aspirin inhibits prostaglandin synthesis, yet there are a group of patients, with aspirin idiosyncrasy, who develop asthma after ingestion of aspirin. We measured prostaglandin levels in seven individuals with this syndrome. Only trace amounts of PGE2 and PGF2α were found in plasma during asthmatic attacks provoked by aspirin.
Primary biliary cirrhosis in brothers
Authors: Bown R , Clark M L , Doniach D
Published: December 2008

This is the first report of two brothers who demonstrated the classical clinical course, histology, biochemistry and auto-antibodies of primary biliary cirrhosis. Both also exhibited an associated keratoconjunctivitis sicca and, in one, renal tubular acidosis resulted in severe systemic acidosis after lactulose therapy and with a subsequent intraperitoneal variceal rupture.

Screening of the relatives recalled a high incidence of ‘auto-immune’ disease and auto-antibodies.
Metabolic responses to selective β-adrenergic stimulation in man
Authors: Goldberg R , Joffe B I , Bersohn I , van As M , Krut L , Seftel H C
Published: December 2008

The responses of plasma free fatty acid, glucose, lactate, insulin and growth hormone to intravenous administration of the predominantly β-2 stimulant, salbutamol, were studied in nine normal subjects. Four subjects received the predominantly β-1 blocking agent, practolol, together with salbutamol.

Salbutamol produced a marked rise in free fatty acid levels and there was also an appreciable increase in insulin values; lactate levels rose moderately and glucose values increased slightly; growth hormone levels were not affected. Practolol did not alter the free fatty acid response; it diminished but did not appear to abolish the insulin response, and it appeared to suppress the lactate and glucose rises.

Tentative proposals are made regarding the nature of the β-receptor subtypes responsible for mediating these effects; most definite is the suggestion that lipolysis is subserved by β-2 receptors. Possible clinical implications are briefly discussed.
The response to luteinizing hormone-releasing hormone in normal men
Authors: Shahmanesh M , Ellwood M , Nelson Eva , Boyns A R , Groom G V , Hartog M
Published: December 2008

Synthetic luteinizing hormone-releasing hormone (LH-RH) was given in doses of 11-100 μg to normal men. Doses of 50 and 100 μg caused a two- to ten-fold rise in serum LH in all subjects, but in only 40% was the serum follicle-stimulating hormone (FSH) elevated. A significantly higher LH response to LH-RH was seen in subjects in whom a rise in serum FSH could be detected. Although there was a wide variation in the serum gonadotrophic hormone response, the test was reproducible in individual subjects. A significant rise of serum LH was seen following the injection of 1 μg LH-RH and a linear log-dose response occurred over the range 0·25 to 4 μg. There was no rise in serum FSH with the lower doses of LH-RH. Two injections of LH-RH 90 min apart produced comparable rises of serum LH and FSH. The rise of serum LH following a second injection of LH-RH was blunted when the two injections were given 30 or 45 min apart.
Primary thyroid failure presenting as a pituitary tumour
Authors: Daggett P , Kuku S F , Harsoulis P , Pearse E E , Fraser T R
Published: December 2008

A 20-year-old female was referred as a pituitary tumour with failure to grow. Primary hypothyroidism from the age of 8 had been diagnosed at the age of 11, when the patient was put on thyroid replacement therapy. Routine investigations showed normal anterior pituitary function, and confirmed the diagnosis of primary hypothyroidism. A needle biopsy of the pituitary gland revealed an empty fossa. The possible relation of the empty sella with the primary hypothyroidism is discussed. A chromosome anomaly, deletion of the short arm of an X chromosome, was found and its contribution to the delayed growth is discussed.
The flora of the respiratory tract in chronic disease
Authors: May J Robert
Published: December 2008

Assessment of the significance of the presence or absence of pathogenic bacteria in sputum specimens is made difficult by a number of factors which are discussed. It is now generally accepted that Haemophilus influenzae is the organism most commonly responsible for recurrent or persistent sputum purulence in chronic lower respiratory disease. The close association between this organism and chronic bronchitis has been confirmed by studies of precipitin antibodies. In patients with cystic fibrosis precipitin antibodies to Pseudomonas aeruginosa and Staphylococcus aureus are frequently present: they are less commonly found in patients with bronchiectasis and very rarely in patients with chronic bronchitis.
The cardiomyopathy associated with methylsalicylate
Authors: Ojiambo Hillary P
Published: December 2008

Dogs challenged with toxic doses of methylsalicylate developed acute myocardiopathy. Metabolic manifestations of uncoupling of oxidative phosphorylation by methylsalicylate (MS) were observed. Oxygen consumption increased two-fold. The haemodynamic abnormalities produced by intervention were minimal. The measured metabolic parameters indicated profound derangement. A net efflux of orthophosphate, lactate and potassium was observed from the myocardium. Marked hyperkalaemia occurred terminally. Morphological changes were observed on electron microscopy.
The possibility of dietary protective factors in duodenal ulcer
Authors: Tovey F I , Jayaraj A Paul , Clark C G
Published: December 2008

Rats fed on a supplement of raw cabbage, brinjal, dhal or powdered milk given in addition to a staple rice or laboratory stock diet show a high degree of protection against experimental ulceration following pyloric ligation. Wheat bran and ragi (a millet) conferred some protection, whereas rice bran and maize conferred no protection. The protection conferred by raw cabbage was destroyed by cooking. The lettuce used conferred no protection. The significance of such findings with regard to the geographical distribution of duodenal ulcer in India and Africa is discussed.
Serum lipid changes following the completed stroke syndrome
Authors: Hollanders F D , Shafar J , Burton P
Published: December 2008

Levels of serum cholesterol and M-particle lipoprotein have been monitored in twenty-six patients after the onset of the completed stroke syndrome. Measurements were made regularly over the first 4 weeks and again at 3 months. A steady fall in serum cholesterol was noted which evened out after the ninth day and returned to the original level by the third month. M-particle lipoprotein showed no change in the first 4 weeks but a significant rise over the original level was demonstrated at 3 months.

Some implications of these findings are discussed and it is concluded that, if required, valid serum cholesterol measurements can be made following the completed stroke syndrome provided the blood sample is withdrawn within 24 hr of the acute episode. These findings accord well with those after myocardial infarction.
Carpal tunnel syndrome in patients on intermittent haemodialysis
Authors: Warren D J , Otieno L S
Published: December 2008

Twenty-three out of thirty-six patients using a forearm arteriovenous fistula for dialysis reported symptoms of carpal tunnel syndrome in the fistula hand during dialysis. By contrast with other reported groups of patients with the syndrome, symptoms were common in male patients, and confined to the non-dominant (fistula) hand. Predialysis venous pressure in the hand and hand volume were increased on the side of the fistula, and increasing hand volume during dialysis was associated with the development of symptoms of carpal tunnel syndrome. Severe symptoms during dialysis necessitated carpal tunnel decompression in two male patients. Measures to reduce the incidence of this complication of arteriovenous fistulae in dialysis patients are discussed.
Effect of hypocalcaemia on glucose tolerance, insulin release and free fatty acid levels in human subjects
Authors: Bansal S , Rizvi S N A , Rao M B , Vaishnava H
Published: December 2008

Eight patients with hypocalcaemia who presented with frank or latent tetany due to parathyroid insufficiency or nutritional osteomalacia were studied. Their serum calcium ranged from 6·85 to 7·7 mg/100 ml (mean 7·33±0·36 mg/100 ml). In six of them, serum calcium after treatment varied from 8·4 to 9·2 mg/100 ml. In ten healthy normal subjects the serum calcium levels were 9·0-10·2 mg/100 ml (9·50±0·47 mg/100 ml). The blood glucose levels during a 3 hr oral GTT were significantly elevated during hypocalcaemia and returned to normal levels after treatment. Serum insulin levels were low at 60 and 120 min after the administration of glucose in hypocalcaemia but returned to normal once the serum calcium levels were above 8·4 mg/100 ml. The FFA levels were high during the low calcium state and reached normal levels after treatment. The above studies suggest that an optimal level of serum calcium is essential for glucose-induced insulin release.
Clinical types and drug therapy of renal impairment in cirrhosis
Authors: Rodés J , Bosch J , Arroyo V
Published: December 2008

Four separate types of renal failure in cirrhosis are described: functional renal failure; diuretic induced uraemia; acute tubular necrosis; chronic intrinsic renal disease.

Functional renal failure may arise spontaneously or be precipitated by such factors as haemorrhage, surgery, or infection. It carries a poor prognosis but preliminary results of treating this condition with plasma volume expansion in combination with high doses of furosemide are encouraging.
Renal failure in obstructive jaundice—clinical aspects
Authors: Dawson J L
Published: December 2008

The patient with obstructive jaundice has an increased risk of developing renal failure. The commonest clinical situations in which this is seen is after surgical operation, as a result of percutaneous cholangiography or in association with severe ascending cholangitis. The risk of acute renal failure is decreased by ensuring adequate hydration and maintaining a high urine flow, if necessary using mannitol or some other osmotic diuretic. In patients undergoing percutaneous cholangiography, prophylactic antibiotics are probably indicated. Early surgery to control severe ascending cholangitis may be life saving and also prevent the development of renal failure.
Renal failure in obstructive jaundice—pathogenic factors
Authors: Wardle E N
Published: December 2008

In the patient with obstructive jaundice, preliminary dehydration, combined with the toxic effects of free bilirubin and serum bile acids, together with factors which cause inhibition of fibrinolysis, determine a high degree of renal susceptibility to ischaemia. Evidence from animals and man suggests that intravascular coagulation determined by endotoxaemia from the obstructed biliary system occurs at the onset of acute renal failure. Endotoxin is unique in being able to produce all those factors which separately cause a primary increase of renal arteriolar constriction.
Treatment of ascites by reinfusion of concentrated peritoneal fluid—a review of 318 procedures in 210 patients
Authors: Lévy V G , Pauleau N , Opolon P , Caroli J
Published: December 2008

A modified plate dialyser (Rhône-Poulenc) was used 318 times to concentrate ascites for reinfusion in 210 patients, most of them having longstanding ascites refractory to diuretic treatment.

The advantages of this method of treatment are its rapidity and efficacy, ascites being reduced in a mean time of 21±13 hr. Hyponatraemia is easily corrected by a sodium load during reinfusion. There was improvement in renal function in 11 of 37 cases. Adverse effects are fever, pulmonary oedema, peritoneal infections and coagulation disorders. Ascites recurred in 84% of the cases, but the procedure shortens hospital stay and reduces the cost of the treatment.
Ascites reinfusion using the Rhodiascit apparatus—clinical experience and coagulation abnormalities
Authors: Wilkinson S P , Henderson J , Davidson A R , Williams Roger
Published: December 2008

The results of twenty-four ascitic reinfusions in twenty patients, using the Rhodiascit procedure, are reported. The procedure was of no value in the management of patients with spontaneous functional renal failure, but was of considerable value in accelerating hospital discharge of patients with tense ascites but good renal function. Complications of the procedure were few, but tests of blood coagulation became abnormal, the most likely cause of which was deposition of fibrin on to the filtration membrane.
Haemorrhoids—postulated pathogenesis and proposed prevention
Authors: Burkitt D P , Graham-Stewart C W
Published: December 2008

The very high prevalence of haemorrhoids in the most economically developed countries is contrasted with their low prevalence in rural communities in developing countries. Traditional concepts of causation are shown to be no longer tenable. It is argued from epidemiological, clinical and experimental evidence that the fundamental cause of piles is straining at viscid stools which are the result of fibre-depleted diets.
Surgical emphysema, bilateral pneumothorax, pneumomediastinum and pneumoperitoneum complicating intubation for anaesthesia
Authors: Scott J K , Viner J
Published: December 2008

A combination of surgical emphysema, bilateral pneumothorax, pneumomediastinum and pneumoperitoneum complicating anaesthesia using endotracheal intubation has been reported only once before. Its occurrence twice in a recent period of 4 months at one hospital suggests that it may not be rare. Recognition of the early signs should enable steps to be taken before irreversible cerebral damage has occurred.
Small intestinal biopsy in childhood coeliac disease
Authors: Risdon R A , Wadbrook D G , Meinhard E A , Keeling J W
Published: December 2008

Small intestinal biopsies from children with treated and untreated coeliac disease have been analysed morphometrically and compared with controls. Two methods have been used; one, described by Dunnill and Whitehead (1972) provides indices of surface-to-volume ratio and of mucosal volume. The other, described by Meinhard, Wadbrook and Risdon (1965), involves tracing the microscopic image of the biopsy on to computer data cards to produce measured encoded data for direct analysis with a computer.

Biopsies from untreated coeliacs were clearly distinguished from control specimens by both techniques. Comparison of these two groups by computer card morphometry shows the mucosal lesion in coeliac disease to be associated with a spatial redistribution of the tissue components rather than a change in their absolute amounts. No difference in the total mucosal volume was found so that a true mucosal atrophy does not occur in this condition.

Surface-to-volume (c: lh) ratios were measured in twenty-eight children treated empirically with a gluten-free diet for suspected coeliac disease, in biopsies taken before and after a gluten challenge. By this means the diagnosis of coeliac disease was confirmed in eighteen of these patients.

In morphologically normal biopsies correlation of c: lh ratios with age showed significantly smaller values in younger children. Slight changes in biopsies from young children should, therefore, be interpreted cautiously and should not necessarily be regarded as pathological on the evidence of the villous pattern alone.
Cell counting in the human brain: traditional and electronic methods
Authors: Corsellis J A N , Alston R L , Miller A K H
Published: December 2008

Whether or not a proportion of nerve cells disappears from the human brain during adult life remains a controversial question 80 years after it was first asked. In this paper the authors review briefly the reasons for this uncertainty and describe an attempt to find an answer in so far as the cerebellar Purkinje cells are concerned. A loss of about 2·5% per decade was identified. The problems raised by cell counting in the cerebral cortex are outlined and a new method is described which may prove suitable for neuronal counting in these regions using an image analysing system.
The effect of lead on the red cell membrane
Authors: Selhi H S , White J M
Published: December 2008

Conformational changes have been shown in the proteins of the red blood cell membrane, induced by lead poisoning. Evidence that the change in spatial arrangement of proteins is believed to be responsible for inhibition of the sodium (Na+)/potassium (K+) ATPase of the RBC membrane is presented.