bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors influencing mortality from infective endocarditis in two district general hospitals
Authors: McGivern D , Ispahani P , Banks D
Published: December 2008

Factors influencing mortality were studied in 92 consecutive cases of infective endocarditis admitted to two district general hospitals between January 1975 and April 1982. Thirty two patients died, an overall mortality of 35%, 13 patients died before diagnosis and 19 despite aggressive antimicrobial therapy. Bactericidal antibiotic levels were monitored in 39 cases but these did not appear to influence outcome.

Mortality was lowest for Streptococcus viridans infection (15%) but rose to 50% for infections with S. faecalis and other less common organisms. Most deaths were in patients over 50. Cardiac failure on admission was a poor predictor of mortality, although this was the principal cause of death during treatment (14 cases). Eight patients had emergency valve replacement and 3 died post-operatively.

When the diagnosis was missed during life (13 cases) arterial embolus was a common presenting feature (46%). Classical signs of endocarditis, other than pyrexia, were absent. A cardiac murmur (always mitral incompetence) was noted in only 6 cases and considered to be insignificant.
Cyanotic tetralogy of Fallot in a 77 year old man
Authors: Thomas S H L , Bass P , Pambakian H , Marigold J H
Published: December 2008

We report the clinical details of a 77 year old man with classical tetralogy of Fallot. The patient had clubbing and cyanosis at birth, and exertional squatting in childhood. He was asymptomatic as an adult until the seventh decade, when he developed biventricular failure and had an episode of bacterial endocarditis. He finally died of cerebral infarction and bronchopneumonia following abdominal surgery.

In spite of investigations, the diagnosis was not made in life, but only discovered at post-mortem. A persistent ductus arteriosus was also found. Increased pulmonary blood flow via the ductus is believed to have facilitated this patient’s unusual longevity.
Hemlock water dropwort poisoning
Authors: Ball M J , Flather M L , Forfar J C
Published: December 2008

Severe plant poisoning is relatively uncommon in adults. We report two adults who ingested hemlock water dropwort roots, having mistaken them for wild parsnip. One developed prolonged convulsions, severe metabolic acidosis and respiratory distress requiring mechanical ventilation. The toxin--oenanthotoxin--was detected in the gastric aspirate and measured by high performance liquid chromatography.
Isolated colonic tuberculosis
Authors: Wang Y A , Yu W Y
Published: December 2008

Two cases of isolated colonic tuberculosis are reported, and recent literature on this field is reviewed. Isolated colonic tuberculosis is defined as a tuberculosis which exists in the colon except for ileocaecum, without focus in any other organ.

The morphological changes are tuberculous granulation primarily located to the submucosa layer of the colon with smooth surfaces of both mucous and serous membrane. Its clinical features are atypical, just like those on X-ray examination, and even on frozen biopsy, it may sometimes be misdiagnosed. The treatment of choice is resecting the diseased segment of colon combined with anti-tuberculosis therapy.
Amoebic peritonitis in pregnancy in the United Kingdom
Authors: Constantine G , Menon V , Luesley D
Published: December 2008

We describe a woman who developed hepatic amoebic abscesses during pregnancy, and subsequently amoebic peritonitis. We believe this to be the first such recorded case in the United Kingdom, and unusual in that the patient had never been abroad.
Condom ileus: result of a practical joke
Authors: Woods W G A
Published: December 2008

Ingestion of toy balloons and condoms filled with drugs is well recognized. A case is reported in which a fluid filled condom ingested as a result of a practical joke caused intestinal obstruction.
Systemic lupus erythematosus presenting with cardiac tamponade due to a haemorrhagic pericardial effusion
Authors: Rudra T , Evans P A , O’Brien E N
Published: December 2008

A 14 year old girl presented with cardiac tamponade due to a haemorrhagic pericardial effusion. Systemic lupus erythematosus was diagnosed. Pericardial stripping was performed due to recurrence of the effusion despite pericardiocentesis and steroid therapy.
Epstein’s syndrome: case report and survey of the literature
Authors: Standen G R , Saunders J , Michael J , Bloom A L
Published: December 2008

A diagnosis of Epstein’s syndrome was made in a young female with congenital macrothrombopathic thrombocytopenia, a nephropathy and mild sensorineural deafness. Previous case reports of this rare disorder are briefly reviewed and attention is drawn to the frequent association between inherited thrombocytopenia and renal disease.
Prolonged increase in digital blood flow following iloprost infusion in patients with systemic sclerosis
Authors: Rademaker M , Thomas R H M , Provost G , Beacham J A , Cooke E D , Kirby J D
Published: December 2008

Thirteen patients with Raynaud’s phenomenon secondary to systemic sclerosis received three 8-hour infusions of a synthetic prostacyclin analogue (Iloprost) on consecutive days and were followed-up over a period of 10 weeks during the winter of 1985/86. Six weeks after infusion, digital peripheral vascular resistance had fallen (P less than 0.05) and dicrotic notch proportion of pulse amplitude increased (P less than 0.05). Digital blood flow and pulse amplitude (measured by photoplethymography) were also increased but did not reach statistical significance. The trend of improvement in these blood flow parameters was still evident after 10 weeks.

The number of cutaneous lesions (digital ulcers, etc) fell from 26 lesions before infusion to only 7 lesions by the end of the study, confirming the subjective improvement reported by the patients.
The epidemiology of the haemoglobin level--a study of 1057 subjects in general practice
Authors: Forrest R D , Jackson C A , Yudkin J S
Published: December 2008

A prospective survey of the level of haemoglobin (Hb) has been carried out in 1057 subjects (607, 57.4% women) over the age of 40 randomly selected from the age-sex register of a North London group practice. Mean Hb levels were 15.04 +/- s.d. 1.41 g/dl in men and 13.54 +/- s.d. 1.32 g/dl in women (P less than 0.001). In men, Hb levels did not differ between the ethnic groups represented, but women of Mediterranean origin had significantly lower Hb levels than other women (P less than 0.001). There was no social class difference in Hb levels. Women under age 50 had significantly (P less than 0.001) lower Hb levels than older women. Smokers had significantly higher Hb levels than non-smokers (P less than 0.002) and there was a weak correlation with numbers of cigarettes smoked (men rs = 0.07, P = 0.07; women rs 0.14, P less than 0.001). Haemoglobin levels correlated with diastolic blood pressure in both men (r = 0.07, P less than 0.05) and women (r = 0.23, P less than 0.001). Thirty eight subjects (3.6%), 25 women and 13 men, were found to be anaemic (Hb less than 11.5 g/dl in women or less than 12.5 g/dl in men). Anaemia could be confirmed in only six of 19 subjects in whom repeat levels were measured. Screening for anaemia did not uncover any serious disease.
Myopathy in acute hypothyroidism
Authors: Kung A W C , Ma J T C , Yu Y L , Wang C C L , Woo E K W , Lam K S L , Huang C Y , Yeung R T T
Published: December 2008

Hypothyroid myopathy has so far been reported in long standing cases of hypothyroidism. We describe two adult patients with myopathy associated with acute transient hypothyroidism. Both presented with severe muscle aches and cramps, stiffness and spasms. Muscle enzymes were markedly elevated and electromyography in one patient showed myopathic features. Histological changes were absent in muscle biopsy, probably because of the short duration of metabolic disturbance. The myopathy subsided promptly when the hypothyroid state was reversed.
Candida albicans vertebral osteomyelitis in chronic renal failure
Authors: Neale T J , Muir J C , Mills H , Horne J G , Jones M R
Published: December 2008

Invasive candidal infections are encountered with increasing frequency in compromised hosts but bone infection is uncommon. A woman with systemic lupus erythematosus and end-stage renal failure managed by continuous ambulatory peritoneal dialysis developed a painful thoracic kyphosis and a lytic lesion in the vertebral bodies of T10 and T11. Blood cultures were sterile but bone biopsy material contained Candida albicans which also grew on culture. Circulating immune complexes were measured in high levels and contained candida antigens and specific anti-candida antibody as determined by isoelectric focusing, immunoblotting and immunoprinting techniques. Pain persisted after anti-fungal therapy had sterilized the lesion necessitating surgical excision of affected vertebrae, kyphosis correction and iliac crest bone grafting. The titres of circulating immune complexes and anti-candidal precipitins closely paralleled the clinical course.
Intracranial haemorrhage in a 26 year-old woman with idiopathic thrombocytopenic purpura
Authors: Awerbuch G , Sandyk R
Published: December 2008

Intracranial haemorrhage (ICH), a rare complication of idiopathic thrombocytopenic purpura (ITP), described only once previously in an adult, is usually fatal. We report a previously healthy 26 year old woman with chronic ITP in whom spontaneous ICH developed. The eventual favourable outcome in this case despite severe initial neurological deficit makes this case unusual. The importance of aggressive management in an ITP associated ICH is stressed and a plan for management is suggested.
Respiratory distress during endoscopy–report of an unusual case
Authors: Narendranathan M , Kalam A
Published: December 2008

A 30 year old man developed severe respiratory distress during upper gastrointestinal endoscopy. He had a short oesophagus and part of the stomach was intrathoracic. Air-insufflation during endoscopy caused distension of the stomach inside the chest leading to respiratory distress. When part of the stomach is intrathoracic, the endoscopist should be cautious and the possibility of respiratory embarrassment kept in mind during air-insufflation.
Transient atrial fibrillation precipitated by hypoglycaemia: two case reports
Authors: Collier A , Matthews D M , Young R J , Clarke B F
Published: December 2008

We describe two insulin-dependent diabetic females who presented with severe hypoglycaemia associated with atrial fibrillation which reverted to sinus rhythm after intravenous dextrose. Atrial fibrillation has not previously been reported as a complication of hypoglycaemia in insulin-dependent diabetic patients.
Cryptococcal choroidoretinitis and immunodeficiency
Authors: Church W H , Palace J , Dick D J , Gould F K
Published: December 2008

A 30 year old man with Hodgkin’s disease, clinically in remission, presented with blurred vision in one eye due to a choroiditis. He developed headaches 10 days after commencing oral steroids and was subsequently found to have cryptococcal meningitis. The meningitis and choroiditis resolved on antifungal medication. This is the first case of cryptococcal choroiditis recorded in the United Kingdom.
Immediate versus deferred treatment for early prostatic cancer
Authors: Smith P H , Armitage T G
Published: December 2008

The diagnosis of early (non-metastatic) prostatic cancer is dependent upon the patient presenting himself with symptoms or for routine rectal examination or ultrasound screening. Diagnosis in the absence of symptoms is more common outside the United Kingdom and as a result the opportunity to treat such patients occurs more commonly in other countries.

The treatment options for the different stages are reviewed and the evidence for their effectiveness is considered.

A review of the literature yields conflicting evidence of the efficacy of and the necessity to institute early therapy. This basic gap in our current knowledge should be filled when the results of the existing Medical Research Council (MRC) clinical trial of immediate and deferred orchidectomy are available.
Development of a sarcoma in a surgical scar
Authors: Sherlock D J , Rickards H , Gardecki T I M , Hamer J D
Published: December 2008

The development of a malignant soft tissue tumour (malignant fibrous histiocytoma) in a surgical wound is reported. Although rare, this occurrence has important diagnostic implications and the management is discussed.
Toxic megacolon in cryptosporidiosis
Authors: Connolly G M , Gazzard B G
Published: December 2008

A 33 year old man with acquired immunodeficiency syndrome developed a toxic megacolon. The patient was admitted with a two month history of diarrhoea. Cryptosporidia were isolated from all stool specimens. Clinically and radiographically he developed toxic dilatation of the colon which responded to conservative management.
Severe thiazide-induced hyponatraemia during treatment with enalapril
Authors: Collier J G , Webb D J
Published: December 2008

A patient is described who developed mild hyponatraemia on two occasions when treated with bendrofluazide alone, but severe hyponatraemia when treated with the combination of enalapril and bendrofluazide.
Hypoglycaemia following treatment of hyperkalaemia with insulin and dextrose
Authors: Williams P S , Davenport A , Bone J M
Published: December 2008

We describe four patients who developed symptomatic hypoglycaemia following treatment of hyperkalaemia with insulin and dextrose. Two patients had a delayed onset of hypoglycaemia, between 5 and 6 hours after treatment despite use of a ‘soluble’ type of insulin. A review of the literature revealed a variety of insulin and dextrose regimes but no research to assess the metabolic effects of such therapy in patients with renal failure. The possibility of significant hypoglycaemia following use of insulin and dextrose in the recommended dosages is rarely mentioned. The cases we describe demonstrate that there is no ‘correct’ dose of insulin and dextrose to suit every circumstance. Regular blood glucose estimations should be performed in all patients receiving such therapy for hyperkalaemia.
Anorexia nervosa in a 67 year old woman
Authors: Ramell M D , Brown N
Published: December 2008

The case is described of anorexia nervosa arising in a 62 year old woman with symptoms persisting over the following 5 years.
Concomitant alveolar haemorrhage and cytomegalovirus infection in a patient with systemic lupus erythematosus
Authors: Kwong Y L , Wong K L , Kung I T M , Chan P C K , Lam W K
Published: December 2008

We report a 37 year old Chinese woman with systemic lupus erythematosus complicated by concomitant cytomegalovirus pneumonia and alveolar haemorrhage. The cytomegalovirus pneumonia may have been causally related to the alveolar haemorrhage.
Adrenal cysts--report, review and classification
Authors: Davenport M , Pollard K , Smith S E W , MacMahon M J
Published: December 2008

A case of a giant adrenal pseudocyst is reported. The clinico-pathological features are reviewed and a classification is proposed.
Collagenous colitis with rapid response to sulphasalazine
Authors: Rokkas T , Filipe M I , Sladen G E
Published: December 2008

A case of collagenous colitis in a young female with a rapid response to sulphasalazine both symptomatically and histologically is reported. This is only the third such response to be reported. In most published accounts, collagenous colitis fails to respond to treatment and runs a very prolonged course.
Disseminated mucormycosis due to Cunninghamella bertholletiae in a liver transplant recipient
Authors: Nimmo G R , Whiting R F , Strong R W
Published: December 2008

Disseminated mucormycosis occurred in a 19 year old female following orthotopic liver transplantation for fulminant Wilson’s disease. The causative organism Cunninghamella bertholletiae has previously been described in ten clinical cases, but never before in this setting.
The diagnosis and classification of scleroderma (systemic sclerosis)
Authors: Barnett Alfred J , Miller Marian , Littlejohn Geoffrey O
Published: December 2008

Difficulty in the diagnosis of the disease scleroderma may occur at the early stage prior to the development of obvious skin sclerosis. A presumptive diagnosis may be made if Raynaud’s phenomenon is accompanied by a positive ‘neck test’, ‘scleroderma’ capillary changes in the nailfolds or antinuclear antibodies. Definitive diagnosis may have to be delayed for several years from the onset of Raynaud’s phenomenon until definite characteristic skin changes are seen. Ten cases in which an earlier diagnosis of scleroderma was not substantiated are listed. The earlier incorrect diagnosis would have been avoided by use of the methods described in this paper.

Various terms have been used to denote subdivisions of scleroderma. These include acrosclerosis, diffuse scleroderma and CREST. We have used the terms Type 1, Type 2 and Type 3 based on the early extent of the skin sclerosis where Type 1 (limited extent) indicates sclerodactyly only, Type 2 (moderate extent) indicates sclerosis proximal to the metacarpophalangeal joints but excluding the trunk and Type 3 (extensive) indicates diffuse skin sclerosis including the trunk. The clinical value of this simple classification is reviewed and contrasted to other classifications which appear to be poorly defined and of limited use.
Ehlers Danlos syndrome — masquerading as primary muscle disease
Authors: Banerjee Gautam , Agarwal Ravinder Kumar , Shembesh Noori M , El Mauhoub Mansoor
Published: December 2008

A 9 year old Libyan boy presented with a history of delayed walking and abnormal gait. The presence of marked muscle under-development with hypotonia led to the initial diagnosis of primary muscle disease; later, he was found to have hyperelastic, fragile skin and hypermobile joints-the cardinal features of Ehlers Danlos syndrome. In this instance the disease seems to have been inherited in an autosomal recessive manner.
Treatment of hypercalcaemia in thyrotoxicosis with aminohydroxypropylidene diphosphonate
Authors: Tan T T , Alzaid A A , Sutcliffe N , Gardner M D , Thomson J A , Boyle I T
Published: December 2008

Two patients had symptomatic hypercalcaemia accompanying thyrotoxicosis, despite initial treatment with volume repletion, beta blockade and antithyroid drugs. They were further managed with intravenous infusions of aminohydroxypropylidene diphosphonate resulting in rapid normalization of the serum calcium, with relief of symptoms. Aminohydroxypropylidene diphosphonate effectively suppressed the increased bone resorption of thyrotoxicosis without any undesirable adverse effects.
Cranial diabetes insipidus secondary to arrested hydrocephalus
Authors: Menzies D G , Shaw J F , Kean D M , Campbell I W
Published: December 2008

An unusual case is described linking cranial diabetes insipidus with longstanding arrested hydrocephalus. The latter was demonstrated by computed tomographic (CT) and nuclear magnetic resonance (NMR) scans and cerebrospinal fluid pressure measurements. The increasing use of CT and NMR scans may result in this association of cranial diabetes and hydrocephalus being better defined.
Fulminant hepatic failure in nephrotic syndrome related to withdrawal of immunosuppressive therapy
Authors: Onwubalili J K
Published: December 2008

Two patients with nephrotic syndrome developed fatal fulminant hepatitis B following withdrawal of prednisolone or cyclophosphamide. Immunosuppressive therapy probably enhanced hepatitis B virus (HBV) replication and widespread infection of hepatocytes; its withdrawal permitted a return of immune competence resulting in massive destruction of infected hepatocytes. Prior screening of all patients for hepatitis B surface antigen, gradual withdrawal of immunosuppressive drugs with careful monitoring, and prompt intervention with corticosteroids at the first clinical or biochemical signs of liver cell damage may prevent this complication.
Serious hypernatraemia in a hospital population
Authors: Bhatnagar D , Weinkove C
Published: December 2008

Severe hypernatraemia in a hospital population should be an avoidable problem. We have looked at its causes and incidence over one year and have shown that serious hypernatraemia (serum sodium greater than 160 mmol/l) as a manifestation of severe dehydration is associated with a high morbidity and mortality. Failure to maintain adequate fluid intake, intentional or unintentional, was the most frequent cause. Nursing and medical staff must be made more aware of this problem and encouraged to initiate early treatment of dehydration.
Jugular vein thrombosis associated with distant malignancy
Authors: Carrington B M , Adams J E
Published: December 2008

We describe two patients who developed internal jugular vein thrombosis associated with primary malignant disease arising outside the neck, and in one patient it was the presenting feature. Computed tomography was performed and the findings characteristic of internal jugular vein thrombosis are illustrated. We conclude that malignant disease should be considered in patients presenting with spontaneous internal jugular vein thrombosis with no other predisposing factors and that computed tomography is of value in confirming the diagnosis.
Solitary non-parasitic liver cyst treated by cyst-gastrostomy
Authors: Chang D
Published: December 2008

A 66 year old female presented with a symptomatic solitary non-parasitic liver cyst. This was treated by a cyst-gastrostomy following which the patient has remained well without complications for 12 years. Given an appropriate anatomical relationship of cyst and stomach, this would appear to be a safe and effective operation.
Chronic renal failure; an important feature of the Laurence-Moon-Biedl syndrome
Authors: Williams B , Jenkins D , Walls J
Published: December 2008

Two cases of end stage renal failure occurring in association with the Laurence-Moon-Biedl syndrome are reported. Abnormalities in renal function and morphology are increasingly recognized in these patients in whom uraemia is an important cause of morbidity and early mortality. The presence of renal impairment, occurring as frequently as any of the pentad of features that characterize the syndrome, has important implications for the prognosis and long term management of these patients.
Some connective tissue disorders of the lung
Authors: Turner-Warwick M
Published: December 2008

Many connective tissue disorders involve the lungs. The same clinical syndrome may be associated with several distinctive types of pathology in different patients. Fibrosing alveolitis is a common feature of a number of different syndromes. An hypothesis is set out in schematic form which may help to account for some of these differences and emphasizes the potential importance of the pulmonary vasculature in pathogenesis.
Sarcoidosis: the clinical problem
Authors: Neville E
Published: December 2008

This paper reviews the clinical manifestations of acute and chronic sarcoidosis. The indications for measuring serum angiotensin converting enzyme and for performing pulmonary function tests, bronchiolo-alveolar lavage and gallium scans are discussed and the modern indications for performing a Kveim Siltzbach test are also considered. The main treatment available for patients with sarcoidosis is systemic steroids and the indications in the various systems for using these drugs are discussed.
Autoimmunity in chronic lymphocytic leukaemia
Authors: Lischner M , Prokocimer M , Zolberg A , Shaklai M
Published: December 2008

Seventy-nine patients with chronic lymphocytic leukaemia were evaluated for the presence of autoimmune diseases and autoantibodies. One patient has polymyositis and two additional patients presented with features suggestive of pernicious anaemia and chronic active hepatitis.

The Coombs’ direct test was positive in 7% and immune thrombocytopenia was present in 8.1% of patients. Five (7%) patients had M-protein in the serum. No increased frequency of other autoantibodies was noted in our study group.

We conclude that the propensity to develop antibodies is restricted only to the haematopoietic system and that there is no increased frequency of non-haematological autoimmune diseases in chronic lymphatic leukaemia.
Haematological, neurological and psychiatric complications of chronic hypothermia following surgery for craniopharyngioma
Authors: Griffiths A P , Henderson M , Penn N D , Tindall H
Published: December 2008

A patient is described who became poikilothermic following surgery for removal of a craniopharyngioma. Episodes of disturbed behaviour, neurological abnormalities, pancytopenia and deranged liver function could be correlated with episodes of more profound hypothermia on a background of a chronically lowered core temperature. The association of pancytopenia and neuropsychiatric disturbances with hypothermia is discussed with reference to reported cases of periodic spontaneous hypothermia.
Glomerulonephropathy of Laurence-Moon-Biedl syndrome
Authors: Cheng I K P , Chan K W , Chan M K , Kung A , Ma J , Wang C
Published: December 2008

A patient with Laurence-Moon-Biedl syndrome and nephrotic range proteinuria is presented. Radiological investigation of the urinary tract revealed clubbed calyces but no evidence of obstruction or vesicoureteric reflux. Renal biopsy revealed occasional sclerotic glomeruli, extensive foot-process fusion and segmental glomerular basement membrane abnormalities with negative immunofluorescence for immunoglobulins and complement. Nephrotic proteinuria responded to steroid therapy but mild proteinuria persisted. The findings were consistent with minimal change nephropathy superimposed on the glomerular lesions of Lawrence-Moon-Biedl syndrome.
Trichinosis diagnosed by computed tomography
Authors: Kreel L , Poon W S , Nainby-Luxmoore J C
Published: December 2008

Trichinosis is a worldwide disease contained by good husbandry and culinary practice, presenting unexpectedly in individual cases or mini-epidemics. The disease varies greatly in its manifestation and severity although when marked can be recognized by fever with myositis and periorbital oedema. Antibody tests are specific but the appearance on computed tomography of the brain are sufficiently characteristic to allow a confident diagnosis. Two cases where such appearances led to the diagnosis are reported.
Comparative evaluation of investigations for colorectal carcinoma in symptomatic patients
Authors: Kalra L , Hamlyn A N
Published: December 2008

We studied 154 patients presenting with significant colonic symptoms and subsequently diagnosed to have colorectal carcinoma. They were investigated by faecal occult blood tests, fibresigmoidoscopy, double contrast barium enema (DCBE) and colonoscopy. Faecal occult blood tests (Haemoccult) alone were positive in 26% of patients with Dukes’ A, in 69% with Dukes’ B and in 64% with Dukes’ C lesions. DCBE alone identified the lesion in 32% of Dukes’ A, 79% of Dukes’ B and 81% of Dukes’ C carcinomas. Fibresignoidoscopy diagnosed colorectal malignancy in 84% of patients with Dukes’ A, 90% with Dukes’ B and 81% with Dukes’ C stage. A diagnostic yield of 88% for Dukes’ A, 96% for Dukes’ B and 100% for Dukes’ C carcinomas was seen with colonoscopy. Detection rate for all stages of carcinoma was greater than 95% when fibresigmoidoscopy and DCBE were used together. Faecal occult blood tests and DCBE alone are inadequate in diagnosing early malignancy in symptomatic patients. Fibresigmoidoscopy and DCBE used in conjunction compare favourably with the technically difficult procedure of colonoscopy and should routinely be undertaken in these patients before malignancy can confidently be excluded.
Sudden death from perforation of a benign oesophageal ulcer into a major blood vessel
Authors: Mo K M , Craig G M , Clark J V , Champ C
Published: December 2008

Two cases of sudden death due to perforation of a benign oesophageal ulcer into a major blood vessel are reported. In one man, anaemia and aspiration pneumonitis dominated the clinical picture. He had an oesophageal stricture and a chronic peptic ulcer associated with an incarcerated hiatus hernia. Death was due to haemorrhage caused by perforation of the ulcer into the thoracic aorta. The second patient presented with confusion and falls, backache and indigestion. She had a hiatus hernia and a large benign chronic oesophageal ulcer. Death was due to perforation of the ulcer into the left pulmonary vein. The cases are presented for their rarity, to illustrate the complex and late presentation of problems in geriatric medicine, and as a reminder that reflux oesophagitis can be dangerous.
Left ventriculo-colic fistula--a late complication of colonic interposition for the oesophagus
Authors: Pantelides M L , Fitzgerald M D
Published: December 2008

An 18 year old man developed recurrent haematemesis 12 years after colonic interposition for corrosive injury to the oesophagus. A colonic ulcer close to the cologastric anastomosis appeared to have fistulated into the cavity of the left ventricle. This so far unreported complication needs to be considered when patients who have had coloesophageal substitution present with gastrointestinal bleeding.
Reversible acute renal failure due to Churg-Strauss syndrome
Authors: Davenport A , McDicken I , Goldsmith H J
Published: December 2008

Renal disease in Churg-Strauss syndrome is generally thought to be benign in nature, thereby distinguishing this rare condition from other necrotizing vasculitides. We report a case in which acute renal failure developed during the aggressive vasculitic phase of the illness requiring dialysis therapy. After one week of daily haemodialysis treatment the patient had become encephalopathic associated with marked peripheral eosinophilia. Treatment with prednisolone resulted in a marked improvement in both clinical condition and renal function.
Angina-like chest pain: a joint medical and psychiatric investigation
Authors: Colgan S M , Schofield P M , Whorwell P J , Bennett D H , Brooks N H , Jones P E
Published: December 2008

Sixty three patients with chest pain typical of angina and who had normal coronary angiograms were investigated for left ventricular, oesophageal and psychiatric abnormalities. An additional 21 patients, age and sex matched, who had angina and significant coronary artery disease were also studied. Eighty six per cent of the 63 patients without evidence of coronary artery disease could be demonstrated to have a physical abnormality (left ventricular dysfunction in 35%, oesophageal disorder 51%). There was, however, a wide variation in the incidence of psychiatric morbidity between the diagnostic subgroups-18% in left ventricular dysfunction, 29% in those with coronary artery disease and 59% in patients with oesophageal disorders (P less than 0.01). Thus failure to identify left ventricular dysfunction and inclusion of such subjects in psychological assessments of ‘angiogram-negative’ chest pain might give misleading results. This study confirms that patients with angina and normal coronary angiography have a high incidence of oesophageal disorders. However psychiatric illness is also common in this group of subjects and management needs to take both these factors into account.
Chlortenoxicam pharmacokinetics in young and elderly human volunteers
Authors: Ankier S I , Brimelow A E , Crome P , Johnston A , Warrington S J , Turner P , Ferber H P
Published: December 2008

The pharmacokinetics of chlortenoxicam, a new non-steroidal anti-inflammatory drug, have been compared in young and elderly healthy human volunteers. Chlortenoxicam was found to have a relatively short mean elimination half-life of about 4 hours, with considerable inter-subject variability, but there was no significant difference between young and elderly subjects. There was no evidence of accumulation with repeated administration. No unchanged chlortenoxicam was found in urine from any subject, suggesting that it undergoes extensive metabolism in man.
Light chain deposition disease presenting with hepatomegaly: an association with amyloid-like fibrils
Authors: Pelletier G , Fabre M , Attali P , Ladouch-Badre A , Ink O , Martin E , Etienne J P
Published: December 2008

We report an unusual case of lambda light chain deposits without overt plasma cell dyscrasia. The clinical presentation was hepatomegaly without biochemical sign of renal involvement. Portal hypertension, spontaneous rupture of the spleen and fracture of the 12th thoracic vertebra occurred during the course of the disease. Ultrastructural studies showed that lambda light chain deposits were associated with amyloid-like deposits. This case suggests that light chain deposition disease and amyloidosis could be two expressions of the same disease.
Ginseng--is there a use in clinical medicine?
Authors: Chong S K F , Oberholzer V G
Published: December 2008

Panax ginseng occupies an important place among the tonic remedies of Oriental medicine. Pharmacological investigations show that crude ginsenosides can increase non-specific resistance of an organism to various untoward influences. The effects of purified derived derivatives have only recently become better studied in immunological and cell growth studies in animals and in man. This has now provided some evidence to suggest that ginseng is a drug that contains many derivatives with different pharmacological properties, which could be useful in clinical medicine.
Follicular carcinoma of the thyroid following radioactive iodine treatment for Graves’ disease
Authors: Staffurth J S , Holl-Allen R T J
Published: December 2008

A 67 year old man presented with a well differentiated follicular carcinoma of the thyroid 17 years after he had been given radioactive iodine for Graves’ disease. As this was insufficient to cure him he had continued to take propylthiouracil regularly. The tumour, which had completely replaced the thyroid, was apparently maintaining thyrotoxicosis. The implications of this management are discussed and it is concluded that antithyroid drugs should not be given on a long term basis after therapeutic radioiodine has been administered.
Henoch-Schönlein purpura and Hodgkin’s disease
Authors: Ng J P , Murphy J , Chalmers E M , Hogg R B , Cumming R L , Peebles S
Published: December 2008

A 39 year old man who presented with classical Henoch-Schönlein purpura was shown to have mediastinal nodular sclerosing Hodgkin’s lymphoma. The Henoch-Schönlein purpura resolved after treatment of the lymphoma.
Non-Hodgkin’s lymphoma presenting as ‘chronic active toxoplasmosis’
Authors: Dudley N J , Balfour A H
Published: December 2008

We report the case of a 58 year old man in whom an unusually prolonged infection with Toxoplasma gondii was the presenting feature of an underlying non-Hodgkin’s lymphoma. This case demonstrates the particular usefulness of the IgM ELISA test in monitoring disease activity.
Portal hypertension secondary to azathioprine in myasthenia gravis
Authors: Fonseca V , Havard C W H
Published: December 2008

A 52 year old man with myasthenia gravis and normal liver function was treated with neostigmine, prednisolone and azathioprine. Three years after starting azathioprine he developed clinical evidence of portal hypertension. A liver biopsy showed nodular regenerative hyperplasia (NRH). The development of NRH following azathioprine treatment in a patient with myasthenia gravis strengthens the case for a causal role of azathioprine in producing NRH and portal hypertension.
Nephrotic syndrome and hepatitis in early syphilis
Authors: Tang A L , Thin R N T , Croft D N
Published: December 2008

A 54 year old man presented with features of acute hepatitis and the nephrotic syndrome. A diagnosis of active syphilis was only made by chance after extensive investigation. Syphilis should be considered in the differential diagnosis of both acute hepatitis and the nephrotic syndrome occurring separately as well as together.
Post-operative respiratory failure due to bilateral phrenic nerve palsy
Authors: Burgess R W , Boyd A F , Moore P G , Oldfield G S
Published: December 2008

A 65 year old female patient developed a large left pleural effusion and a sternal split dehiscence following aorto-coronary artery bypass grafting. A second operation was performed to investigate and drain the pleural effusion and to repair the sternum. Subsequent to this operation the patient was in acute respiratory failure due to bilateral phrenic palsy. It is probable that the left phrenic nerve was damaged in the initial operation and the right nerve in the second. The patient’s subsequent progress is described.
Massive haematemesis--presenting symptoms of cystadenocarcinoma of the pancreas
Authors: Baruch Y , Levy Y , Goldsher D , Munichor M , Eidelman S
Published: December 2008

A 43 year old woman presented with attacks of abdominal pain, haematemesis and hyperamylasaemia. Gastrointestinal X-rays and repeated upper gastrointestinal endoscopy failed to reveal the source of bleeding. Ultrasound and computed tomographic scan demonstrated a calcified mass in the tail of the pancreas. Surgical exploration revealed a solitary mass in the pancreas and histological examination showed cystadenocarcinoma. The patient died 2 years later because of local recurrence, but haematemesis and melaena did not recur. This case presents an unusual manifestation of cystadenocarcinoma of the pancreas with massive bleeding from the tumour via the pancreatic duct and associated pancreatitis. Other possible reasons for bleeding with cystadenocarcinoma of the pancreas are discussed.
Protracted systemic illness and interstitial nephritis due to minocycline
Authors: Wilkinson S P , Stewart W K , Spiers E M , Pears J
Published: December 2008

A severe hypersensitivity-like illness with acute renal failure, lymphadenopathy and skin rash is reported following minocycline treatment in a 16 year old male. Following haemodialysis and steroid therapy his illness remitted, only to recur on withdrawal of the steroids. With further steroid treatment he recovered completely. Lymphocyte function tests, performed in an attempt to positively incriminate minocycline, were inconclusive due to a general suppression of the patient’s lymphocytes to in vitro stimulation. Hypersensitivity reactions attributed to minocycline include skin rashes, lymphadenopathy and one previous case of acute interstitial nephritis.
A comparison of the acute-phase response in middle aged and elderly patients
Authors: Woo J , Arumanayagam M , MacDonald D , Woo K S
Published: December 2008

The acute phase response in middle aged and elderly patients was compared by measuring the ratio of the peak C-reactive protein to peak creatine kinase level during the three day period after acute myocardial infarction. No difference in ratio was observed between a middle aged group of 14 patients (10.2 +/- 4.0 mean +/- s.e.), and an elderly group of 13 patients (9.1 +/- 1.5). C-reactive protein levels in two groups of middle aged and elderly control patients were similar (10.1 +/- 0.04 mg/l and 11.8 +/- 0.10 mg/l respectively). Production of C-reactive protein does not appear to be impaired in the elderly.
Acute splenic sequestration crisis in a young woman with homozygous sickle cell anaemia
Authors: Sarma P S A
Published: December 2008

Acute splenic sequestration crisis in a 20 year old female with homozygous sickle cell anaemia (Hb SS) is described. The resemblance of this complication to that of splenic vein ligation is discussed. This is the first case report known to the author of acute splenic sequestration crisis in an adult with homozygous sickle cell anaemia treated successfully.
Brachial plexitis complicating disseminated gonococcal infection
Authors: Maroun B , Rimon D , Cohen L
Published: December 2008

A patient with brachial plexitis associated with disseminated gonococcal infection is presented. This is, to the best of our knowledge, the first case to be reported of this association.
Chronic gastrointestinal haemorrhage controlled by antifibrinolytic agents
Authors: Willoughby J M T
Published: December 2008

Antifibrinolytic agents are used chiefly for control of acute haemorrhage. Their applicability to chronic bleeding from inflammatory lesions of the gastrointestinal tract is illustrated by two case histories.
Effect of treatment with botulinum toxin on spasticity
Authors: Das T K , Park D M
Published: December 2008

Botulinum toxin, a product of Clostridium botulinum, produces presynaptic neuromuscular block by preventing release of acetylcholine from nerve endings. The toxin was injected directly into the skeletal muscles of six patients with severe spasticity due to stroke-related hemiplegia. It produced both subjective and objective improvement. The toxin injections were well tolerated and no significant side effect was reported.
Toxic gases
Authors: Matthews G
Published: December 2008

An overview of the widespread use of gases and some volatile solvents in modern society is given. The usual circumstances in which undue exposure may occur are described. The most prominent symptoms and general principles of diagnosis and treatment are given and are followed by more specific information on the commoner, more toxic materials. While acute poisonings constitute the greater part of the paper, some indication of chronic disorders arising from repeated or prolonged exposure is also given.
Subarachnoid haemorrhage in Plasmodium falciparum malaria
Authors: Murugavel K , Saravanapavananthan S , Anpalahan A , James R F
Published: December 2008

A 41 year old man with cerebral malaria was found to have numerous bilateral retinal haemorrhages and very high parasitaemia. Despite intensive treatment his condition deteriorated and he died. Autopsy showed subarachnoid haemorrhage, which has not been previously described in cerebral malaria.
Immobilization hypercalcaemia responding to intravenous pamidronate sodium therapy
Authors: McIntyre H D , Cameron D P , Urquhart S M , Davies W E
Published: December 2008

A 16 year old male developed symptomatic hypercalcaemia of immobilization on day 47 following a diving accident which had resulted in incomplete C4 tetraplegia. Following initial reduction in serum calcium with salmon calcitonin 100 U/day, symptomatic hypercalcaemia recurred. A single dose of 30 mg pamidronate sodium, given intravenously, caused serum calcium to fall within 48 hours. Initial mild, asymptomatic hypocalcaemia was followed by a return to sustained normocalcaemia. No major adverse reaction was encountered, and if further clinical experience confirms its efficacy, pamidronate sodium will warrant consideration as first-line therapy for immobilization hypercalcaemia.
Parathyroid hyperplasia associated with thymoma
Authors: Byrne D J , Gunn A , Davidson D L W , Paterson C R
Published: December 2008

The case of a 65 year old female with myasthenia gravis and hypercalcaemia is presented. Failure of medical control of the myasthenia necessitated thymectomy at which time parathyroid exploration was also carried out. This revealed parathyroid hyperplasia and a thymoma. This association has not been previously documented in the literature.
Drug-induced acute liver disease
Authors: Lee M G , Hanchard B , Williams N P
Published: December 2008

Fifty-three patients with drug-induced acute liver disease are reported. There were 35 females and 18 males with a mean age of 41 years. All but one patient had jaundice or hyperbilirubinaemia and 51 had abnormal liver enzymes. Histologically 38 patients (72%) had cholestatic injury while 15 had cytotoxic parenchymal damage. Methyldopa, chlorpropamide, chlorpromazine, halothane and the contraceptive pill accounted for 60% of cases. Fifty-one patients recovered after drug withdrawal while 2 died of hepatic failure. Drug-induced liver injury must be considered in patients presenting with evidence of hepatic disease as the majority will recover on withdrawal.
Papilloedema delaying diagnosis of Wernicke’s encephalopathy in a comatose patient
Authors: Mumford C J
Published: December 2008

A case of acute Wernicke’s encephalopathy due to hyperemesis gravidarum is described. Florid bilateral papilloedema was present, resulting in diagnostic uncertainty and delay in treatment. Attention is drawn to the rare occurrence of papilloedema in Wernicke’s encephalopathy, and possible underlying mechanisms for this physical finding are considered.
A study of the dental health of patients undergoing heart valve surgery
Authors: Rogers S N
Published: December 2008

The mouth is a possible source of infection in patients receiving prosthetic heart valves. In this study, the dental health of such patients was found to be very poor. Whilst most of the patients were asymptomatic, only two were dentally fit and 65% required the extraction of one or more teeth. On average, patients had not attended a dental practice for more than 9 years.

This level of dental neglect, in a group of patients particularly at risk, is alarming and this study indicates that a higher standard of oral care is still required and that a lack of symptoms does not indicate dental fitness.
Adenotonsillar hypertrophy and cor pulmonale: clinical and echocardiographic correlation
Authors: Kumar E B , Jaggarao N S V
Published: December 2008

It is well recognized that upper airways obstruction by adenotonsillar hypertrophy can lead to cor pulmonale, but delays in diagnosis still occur, leading to an appreciable morbidity and even occasional mortality. In the case presented, echocardiographic recognition of right ventricular enlargement and abnormal pulmonary valve motion served to complement and confirm the clinical diagnosis. Following surgical relief of the airways obstruction, the echocardiographic examination usefully documented the regression in right ventricular size and the return to normality of pulmonary valve motion.
Intracranial abscess complicating diverticulitis with CT scan mimicking primary glioma
Authors: Dixon A R , Holmes J T , Waters A
Published: December 2008

The case of a 64 year old woman with diverticulitis complicated by a metastatic cerebral abscess is reported. Presentation was atypical and investigations were misleading; the computed tomographic scan was interpreted as showing a glioma. This case demonstrates that malignancy should never be assumed and the importance of making a histological diagnosis. Once the abscess was drained the patient made a full recovery with resolution of her neurological deficits.
Meningeal infiltration by non-myelomatous IgD-secreting plasma cell dyscrasias
Authors: Yebra M , Manzano L , de la Torre A , Hornedo J , Albarran F , Menéndez J L
Published: December 2008

Two cases of meningeal invasion by non-myelomatous plasma cell dyscrasias--a plasma cell leukaemia and an extramedullary plasmacytoma--are described. Both were secretors of IgD paraprotein and both were diagnosed in life, characteristics which we have not found in any other published case of plasma cell leptomeningitis. Analysis of our patients and of another 25 cases suggests as predisposing factors of meningeal invasion the male sex, presentation in the form of plasma cell leukaemia, presence of the IgD paraprotein and tumoral involvement of pleura, lung, pericardium and testicles.

Aggressive treatment of this neurological complication controlled the meningeal disorder in some cases. However, the majority died of disseminated disease in spite of systemic chemotherapy. Until an effective treatment can be found, able to maintain remission or cure the systemic disease, prophylaxis of the central nervous system in plasma cell dyscrasias does not appear to be advisable.