bluuebunny/crossref_metadata_2025 huggingface dataset:
Sensorineural deafness—a new complication of ulcerative colitis?
Authors: Hollanders D
Published: December 2008

A case of sudden bilateral sensorineural deafness associated with active ulcerative colitis is reported. Evidence for an autoimmune basis for this condition is reviewed and the potential benefit of systemic corticosteroids emphasized. The condition may represent a recently recognized extra-intestinal complication of ulcerative colitis.
A patient with bulimia nervosa and profound folate deficiency
Authors: Eedy D J , Curran J G , Andrews W J
Published: December 2008

A case is reported of a young woman with bulimia nervosa who presented with profound folate deficiency. This association has not been reported before despite the increased theoretical possibility. Initially she has responded well to folic acid therapy and social support.
Primary carcinoma of the gall bladder associated with ulcerative colitis
Authors: O'Connor R , Harding B , Greene D , Coolican J
Published: December 2008

The report concerns a case of primary carcinoma of the gall bladder in a 53 year old man, who, 13 years previously underwent a pan-proctocolectomy for ulcerative colitis. Previous reports are reviewed, highlighting the difficulty of early diagnosis.
Cryofibrinogenaemia and acute gangrene in systemic sclerosis
Authors: Barrett M C , Prendiville J S , Pardy B J , Cream J J
Published: December 2008

A 49 year old man with systemic sclerosis developed ischaemia of his extremities with massive peripheral gangrene. High levels of circulating cryofibrinogen were detected in the plasma and the significance of these findings is discussed.
Hypercalcaemia due to sarcoidosis corrects with bisphosphonate treatment
Authors: Gibbs C J , Peacock M
Published: December 2008

We report a case of sarcoid hypercalcaemia treated with the bisphosphonate, APD [(3-amino-1-hydroxypropylidene)-1,1-bisphosphonate]. Investigations showed that the hypercalcaemia was associated with a high plasma 1,25 dihydroxy vitamin D concentration. A low dietary intake of calcium partially corrected the hypercalcaemia but APD rapidly normalized plasma calcium without reducing the elevated 1,25 dihydroxy vitamin D concentration. The case demonstrates that hypercalcaemia in sarcoidosis results from the effects of 1,25 dihydroxy vitamin D on bone as well as on calcium absorption and that prolonged suppression of the effect on bone occurs with APD treatment.
Rupture of a cerebral aneurysm associated with nifedipine treatment
Authors: Gill J S , Zezulka A V , Horrocks P M
Published: December 2008

We describe rupture of a cerebral arterial aneurysm in a 32 year old hypertensive woman following the introduction of nifedipine treatment. It is suggested this relationship is causal rather than coincidental and mediated through cerebral arterial vasodilatation.
Successful treatment of scleroderma renal crisis with enalapril
Authors: Milsom S R , Nicholls M G
Published: December 2008

A patient with scleroderma renal crisis is described. At presentation he had severe hypertension, deteriorating renal function, microangiopathic haemolytic anaemia, and elevated levels of renin, aldosterone and noradrenaline. Enalapril controlled blood pressure, stabilized renal function, lowered aldosterone and noradrenaline levels, and improved peripheral circulation. It appears that converting-enzyme inhibitors can favourably alter the outlook of this otherwise fatal disorder.
Pericarditis with pericardial effusion complicating chickenpox
Authors: Seddon D J
Published: December 2008

A girl with chickenpox is presented. She developed arthritis, pericarditis with pericardial effusion and meningism during the course of her illness. Pericarditis is an unusual complication of this disease, and in this instance was associated with characteristic electrocardiographic changes. Aspects of her case history are discussed.
No effect of verapamil on calcium stimulated calcitonin release
Authors: Amado J A , Gómez C , Pesquera C , Antón M A , Freijanes J , González Macías J
Published: December 2008

We investigated the effect of infusing 5 mg/h of verapamil on calcitonin release in normal males. After 60 minutes of infusion, ionized calcium and calcitonin levels were unchanged. At 60 minutes we infused 3 mg/kg of body weight of elemental calcium over 10 minutes and we found that calcitonin release was no different from when the subjects were receiving verapamil. These results suggest that, despite blocking calcium channels, acute hypercalcaemia produces normal calcitonin release.
Idiopathic oedema and diuretics
Authors: Dunnigan M G , Denning D W , Henry J A , de Wolff F A
Published: December 2008

Diuretic abuse has been invoked as the cause of idiopathic oedema. In this study, eight patients with idiopathic oedema were studied. Symptoms and weight variation continued despite the proven absence of diuretics in seven of them as determined by urinary chromatograms. Idiopathic oedema cannot therefore be attributed to diuretic use alone.
Insulinoma presenting as alcoholic stupor
Authors: Dandona P , Fonseca V A , Mikhailidis D P , Menon R K
Published: December 2008

We report a case of prolonged loss of consciousness due to hypoglycaemia following ethanol abuse in a non-diabetic. The patient also reported symptoms compatible with hypoglycaemia following heavy manual work. Further investigations revealed a pancreatic insulinoma, which was successfully removed surgically. The patient remains asymptomatic 18 months later, despite occasional episodes of ethanol abuse. This case illustrates how heavy exercise and/or alcohol abuse can aggravate spontaneous hypoglycaemia.
Calcium channel blockers cannot prevent pure vasospastic myocardial infarction
Authors: Depelchin P , Degre S
Published: December 2008

Coronary artery spasm is a recognized cause of myocardial infarction. This report describes a case of myocardial infarction attributed to pure coronary spasm which was halted by a double perfusion with streptokinase and nitroglycerin. Further coronary artery spasm leading to a myocardial infarction could not be avoided several weeks later, although the patient was left on calcium channel blocker therapy. The two attacks were not preceded by warning angina pectoris, contrary to accepted belief. The best objective of end-point drug therapy and its assessment in vasospastic angina are discussed.
Prostatic involvement in Wegener’s granulomatosis
Authors: Tung K T , Woolf A , Falzon M
Published: December 2008

Prostatic involvement is an unusual complication of Wegener’s granulomatosis. We report two cases with this complication and emphasize the importance of recognizing this manifestation in diagnosis and management of the disease condition.
Pancytopenia and folate deficiency in alcoholics
Authors: Weston C F M , Hall M J
Published: December 2008

Three alcoholic patients are reported who presented with pancytopenia and macrocytosis due to acute folate deficiency. While folate deficiency is a common finding in alcohol abusers due to abnormalities in diet, intestinal absorption, internal metabolism and excretion, this life-threatening complication has not been well documented.
Bilateral submandibular gland lymphoma in Sjögren’s syndrome
Authors: Law N W , Leader M
Published: December 2008

Salivary gland lymphoma is associated with Sjögren’s syndrome. A case of bilateral submandibular gland and sublingual gland lymphoma, arising in Sjögren’s syndrome, is presented. A lymphoma involving more than one salivary gland may occur in Sjögren’s syndrome, and there is an increased risk of developing an extrasalivary lymphoma.
Comparison of nifedipine, prazosin and hydralazine added to treatment of hypertensive patients uncontrolled by thiazide diuretic plus beta-blocker
Authors: Ramsay L E , Parnell L , Waller P C
Published: December 2008

In 93 patients with hypertension uncontrolled by bendrofluazide 5 mg plus atenolol 100 mg daily, the effects of adding nifedipine (up to 60 mg/day, n = 31), prazosin (up to 20 mg/day, n = 31), or hydralazine (up to 200 mg/day, n = 31) were compared in a 6 month open random parallel group study. The three drugs did not differ significantly as regards antihypertensive effect, withdrawal rate, total number of side effects, or effect on serum biochemical variables. The pattern of side-effects differed. Headache, flushing and oedema were common with nifedipine, tiredness and drowsiness with prazosin, and headache with hydralazine. Nifedipine is an acceptable third-line antihypertensive drug which may have some advantage over hydralazine and prazosin.
The ventilatory response to hypoxia: how much is good for a mountaineer?
Authors: Milledge J S
Published: December 2008

Methods for measuring the ventilatory response to hypoxia (HVR) are reviewed. The criteria for success as a high altitude mountaineer are defined as freedom from acute mountain sickness (AMS) and ability to perform well at extreme altitude.

The evidence for a brisk HVR being protective against AMS and associated with successful high altitude performance is reviewed. The contrary evidence of blunted HVR in high altitude residence and some elite climbers is discussed. The effect of a brisk HVR in producing periodic breathing when asleep at altitude is noted.

It seems that there is an optimum HVR for different circumstances and peoples. A brisk HVR is a benefit in lowlanders going to altitude for the first time whereas a blunted HVR is appropriate for high altitude residents and possibly for very experienced elite climbers.
Effect of acetazolamide on blood gases and 2,3 DPG during ascent and acclimatization to high altitude
Authors: Milles J J , Chesner I M , Oldfield S , Bradwell A R
Published: December 2008

Blood gases and red cell 2,3 DPG concentrations were measured during ascent and a stay for 6 days at 4846 m in 20 subjects. Acetazolamide improved Pa,O2 and reduced pH and Pa,CO2. 2,3 DPG concentrations were lower in the acetazolamide group during ascent and at high altitude. However, 2,3 DPG concentrations were significantly greater at high altitude in both the acetazolamide and placebo groups compared with low altitude. The acetazolamide group remained different from the placebo group during the stay at high altitude with higher Pa,O2, lower PaCO2, lower pH and lower 2,3 DPG concentrations.
The effect of acetazolamide on breath holding at high altitude
Authors: Morrissey S C , Keohane K , Coote J H
Published: December 2008

The effect of altitude and acetazolamide on breath holding was studied in 20 individuals. Breath holding time was reduced progressively during ascent. There was an additional reduction in the acetazolamide group at low but not at high altitude. The initial difference between the two groups may have been related to a lower CSF pH when on acetazolamide. At high altitude the finding of similar breath holding times in the two groups may have been due to acclimatization in the placebo group.
Hepatic metastasis from intracranial meningioma
Authors: Jenkinson M L , Watson A J M , Boyle S
Published: December 2008

A 38 year old man presented with a hepatic mass which biopsy showed to be a metastasis from an intracranial meningioma. The meningioma originally followed cranial radiotherapy. Previous reports of extracranial metastases are reviewed.
Recurrent hyperparathyroidism: a study of 3 cases with evaluation of some pathogenetic and clinical aspects
Authors: Mazzuoli G , Minisola S , Scarda A , De Matteis A , Tabolli S , Bigi F , Valtorta C , D’Erasmo E
Published: December 2008

Three patients with recurrent hyperparathyroidism (15, 8 and 3 years respectively, after the first operation) are described in order to establish the causes and define the clinical characteristics of the disease.

The observation that in the present series recurrent hyperparathyroidism was associated either with an adenoma (two cases) or a carcinoma (one case), appears to stress the possibility of the pathological involvement of one gland even though recurrent hyperparathyroidism should be considered due to the chronic extrinsic stimulation of the parathyroid glands. The severity of the clinical and metabolic picture observed at the time of the first diagnosis and/or at the time of recurrence together with the simultaneous presence of bone and stone disease in the patients described is of particular interest.

The cases reported underline the importance of carrying out careful metabolic investigations in patients with hyperparathyroidism not only before but also for a prolonged period of time after operation.
Chronic perianal fistula: beware of rectal duplication
Authors: Narasimharao K L , Patel R V , Malik A K , Mitra S K
Published: December 2008

A child with cystic duplication of the rectum containing ectopic duodenal mucosa and aberrant pancreatic tissue presenting as a chronic perianal fistula is reported. The duplication was removed by subtotal excision of the cyst along with mucosal sleeve resection from the common septum with the rectal wall.
Calcium and calcitonin responses to calcium infusion in type I diabetes mellitus
Authors: Amado J A , Gomez C , Obaya S , Otero M , Gonzalez-Macias J
Published: December 2008

We studied calcium and calcium and calcitonin responses to intravenous calcium infusion (3 mg of elemental calcium/kg of body weight in 10 minutes) in 21 type I diabetic males and 17 age-matched normal males. Baseline total calcium, parathyroid hormone and calcitonin levels were normal in the diabetic group, but ionized calcium was lowered. Cortical bone status and osteocalcin levels were normal, suggesting a normal osteoblastic function. Total calcium and ionized calcium responses to calcium infusion were lowered in the diabetic group. Despite these lowered calcaemic responses, calcitonin secretion was normal.
‘Apathetic’ thyrotoxicosis presenting with hypercalcaemia and spurious normalization of serum thyroid hormone levels
Authors: Ralston S H , Fraser W D , Soukop M , McKillop J H
Published: December 2008

A patient with thyrotoxicosis presented with weight loss and hypercalcaemia, leading to an erroneous diagnosis of occult malignant disease. Intercurrent illness and drug treatment of hypercalcaemia in this patient caused a depression of circulating thyroid hormone levels, leading to a delay in diagnosis. Radionuclide studies of thyroid function, in contrast, consistently suggested a thyrotoxic state. It is suggested that in this situation, radionuclide studies may give a more accurate assessment of thyroid status than biochemical tests, which may be difficult to interpret in the presence of non-thyroidal illness.
Bone marrow granulomas in mononucleosis
Authors: Fiala M , Colodro I , Talbert W , Ellis R , Chatterjee S
Published: December 2008

Two patients with mononucleosis, one due to cytomegalovirus (CMV), and the other due to Epstein-Barr virus (EBV), presenting with high fever, malaise and hepatitis, had granulomas in the bone marrow but not in the liver. In patients who have unexplained fever, bone marrow granulomas may be a clue to CMV or EBV infection and need not initially raise the fear of prognostically more severe illness.
Somatostatin analogue SMS 201-995 long term therapy for vipoma
Authors: Juby L D , Burke D A , Axon A T
Published: December 2008

The definitive treatment of a pancreatic tumour secreting vasoactive intestinal polypeptide is surgical removal of the tumour, but when curative resection is not possible symptomatic treatment of the endocrine hyperfunction is important. Streptozotocin, although effective for palliation, can involve unpleasant side effects. We report the long term use of subcutaneous somatostatin analogue SMS 201-995 in an elderly man presenting with severe watery diarrhoea and anaemia due to a pancreatic vipoma. Good symptomatic improvement has been achieved with no side effects over a period of 24 months. We suggest there is a use for subcutaneous SMS 201-995 in elderly patients with inoperable pancreatic gut hormone producing tumours with metastases and in those where surgery would carry a high operative risk.
Benign recurrent intrahepatic cholestasis--25 years of follow-up
Authors: Putterman C , Keidar S , Brook J G
Published: December 2008

Only 70 cases of recurrent intrahepatic cholestasis have been reported in the literature since the original description of this entity in 1959.

The benign nature of the disease has been questioned, some authors suggesting progression to biliary cirrhosis. We report our follow-up of one such patient for over 25 years with no adverse physical consequences or histological deterioration. Sequential liver biopsies were obtained during this period. A conservative approach to diagnosis and treatment is therefore indicated.
Membranous nephropathy caused by mercury-containing skin lightening cream
Authors: Oliveira D B G , Foster G , Savill J , Syme P D , Taylor A
Published: December 2008

A 46 year old woman developed membranous nephropathy following the use of a mercury-containing skin lightening cream. This association has not been reported in the literature for over a decade and apparently never from this country. It is important that clinicians are aware of this usually eminently treatable cause of the nephrotic syndrome as it is likely to be missed unless specifically enquired for.
Lymphomatoid granulomatosis mimicking bronchial carcinoma
Authors: Paramsothy Y , Ilchyshyn A , Sidky K , Byrne J P
Published: December 2008

This report concerns a patient with lymphomatoid granulomatosis who presented with multiple ulcerated skin nodules, a solitary pulmonary mass and a cerebral mass. Biopsies taken from the skin and lung lesion showed necrotic tissue only. This combination of physical signs and the initial non-specific histological changes suggested a diagnosis of primary bronchial carcinoma with secondary spread. However, the subsequent temporary improvement and a further histological examination enabled a diagnosis of lymphomatoid granulomatosis to be made and this was confirmed at post-mortem. This report emphasizes the difficulty in obtaining diagnostic material in lymphomatoid granulomatosis and highlights the need to consider this diagnosis in a patient with suspected carcinoma when biopsy material shows necrotic tissue only.
Consequences of fluid loss in patients treated with ACE inhibitors
Authors: McMurray J , Matthews D M
Published: December 2008

Three patients are described in whom haemodynamic collapse and acute renal failure occurred following intercurrent gastrointestinal fluid loss during treatment with an angiotensin converting-enzyme inhibitor. The possible consequences of blockade of the formation of angiotensin II during fluid loss are discussed.
Jervell and Lange-Nielsen syndrome in a middle aged patient
Authors: Behera M
Published: December 2008

A case of Jervell and Lange-Nielsen syndrome is reported in a 50 year old woman presenting with repeated ventricular tachycardia terminating fatally. The case is interesting in view of the fact that this syndrome has not previously been reported in a middle-aged patient.
A life-threatening respiratory complication of gastro-oesophageal reflux in a patient with tetraplegia
Authors: Donald I P , Gear M W L , Wilkinson S P
Published: December 2008

Recurrent attacks of life-threatening dyspnoea and choking occurred in a patient with tetraplegia. Conventional investigations for gastro-oesophageal reflux were normal, but 24-hour oesophageal pH recording revealed gross reflux in association with an attack of dyspnoea. Surgical correction of the reflux abolished the attacks. The possibility of autonomic dysreflexia as the mechanism linking reflux and respiratory symptoms in this patient is discussed.
Comparison of the efficacy of nicardipine, a new calcium channel blocker, with nifedipine in the treatment of mild to moderate essential hypertension
Authors: Armstrong C , Garnham J , Blackwood R
Published: December 2008

Thirty-nine patients with mild to moderate essential hypertension participated in a parallel, single-blind study comparing 6 weeks’ treatment of nicardipine hydrochloride (90 mg/day) with nifedipine (40 mg/day). Nicardipine-treated patients commenced therapy with a significantly higher mean supine diastolic blood pressure than the nifedipine-treated patients. There was a statistically significant fall in blood pressure (systolic and diastolic) on both treatments at the 3 and 6 week follow-up visits. On adjusting the results for the baseline inequality, no statistically significant differences were found between treatment groups.

Seven patients withdrew from nifedipine therapy and six patients withdrew from nicardipine therapy due to adverse events.

The results show that nicardipine hydrochloride at 90 mg/day is an effective anti-hypertensive agent. The incidence and nature of adverse events were similar on the two treatments.
A study of the use of intravenous cannulas for medical emergencies in Newham--implications for financial savings
Authors: Mason A C , Thomas H J W , Barras C , Kopelman P G
Published: December 2008

A study of intravenous (i.v.) cannula usage for medical emergencies admitted to hospitals in the Newham Health District was undertaken during two defined periods (24 and 35 days). Almost half the cannulas inserted (47%) were not flushed following an initial bolus injection of heparinized saline. The duration that cannulas remained in a vein ranged from 24 hours to 8 days (median 2 days) and inflammation around the cannula site was related to the length of time since insertion but unrelated to whether the cannula was flushed regularly or to the type of fluid used. Our findings indicate a substantial wastage of i.v. cannulas due to difficulties with insertion and suggest that isotonic saline, without heparin, is effective in maintaining cannula patency for 48 hours.

It is concluded that these findings are not unique to the Newham Health District and worthwhile financial savings should be achieved throughout the NHS if clinicians reconsider the indications and use of i.v. cannulas for their patients.
Pitfalls in the ultrasonographic diagnosis of gallbladder diseases
Authors: Fitzgerald E J , Toi A
Published: December 2008

Ultrasonography is rapidly replacing radiological techniques of gallbladder investigation. While ultrasonography is highly accurate, there are technical, anatomical and diagnostic pitfalls which will trap the unwary. This presentation highlights the pitfalls which we have encountered, reviews the literature in this area and suggests techniques whereby these pitfalls may be avoided.
The breast pain clinic: a rational approach to classification and treatment of breast pain
Authors: Griffith C D M , Dowle C S , Hinton C P , Blamey R W
Published: December 2008

Three hundred and fifty women complaining of breast pain symptoms of sufficient severity to interfere with their normal lifestyle were reviewed in a special breast pain clinic over a 5 year period.

Seventy-two patients (21%) had spontaneous resolution of breast pain and they required reassurance only before discharge. Of the remaining 278 patients, accurate classification of breast pain syndromes was achieved in 89%, the commonest syndrome being cyclical breast pain which accounted for 54% of the women followed up. The remaining womens’ breast pain was classified as trigger zone (14%), continuous (8%), Tietze’s disease (5%), spinal root (4%), duct ectasia (4%) and psychological depression (2%). In the remaining 25 patients (9%) the breast pain could not be classified.

The experience from this clinic is that a majority of women complaining of severe breast pain symptoms can be accurately classified and appropriate therapy instituted.
Colobomata associated with Noonan’s syndrome
Authors: Kleanthous L , D’Cruz D , Graham E , Efthimiou J
Published: December 2008

A patient with Noonan’s syndrome and fundal colobomata in both eyes is described. To our knowledge, this is the first report of the association of colobomata with Noonan’s syndrome. Although the patient had poor sight since early childhood and dyspnea on exertion as a teenager, the diagnosis of Noonan’s syndrome was not made until early adulthood. We hope this report will encourage recognition of this syndrome and its implications at an earlier stage.
Candidal endophthalmitis: a manifestation of systemic candidiasis
Authors: Patel B C K , Kaye S B , Morgan L H
Published: December 2008

Two patients on total parenteral nutrition who developed endophthalmitis secondary to Candida albicans are described. Candidal endophthalmitis as a manifestation of systemic candidiasis is discussed and its early diagnosis by bedside fundal examination in patients at risk is stressed.
A giant thyroid cyst
Authors: Howel-Evans W , Sykes D
Published: December 2008

The case report describes a female of 82 who presented with a very large goitre caused by a solitary thyroid cyst that was successfully treated by aspiration.
Successful termination of combined rapid atrial flutter/fibrillation and ventricular tachycardia by intravenous sotalol
Authors: Ramsdale D R , Peterson C
Published: December 2008

Combined rapid atrial flutter/fibrillation and recurrent ventricular tachycardia occurred in an 82 year old man with acute myocardial infarction. Both arrhythmias were promptly terminated by intravenous sotalol, suggesting another use for this unique drug in the absence of hypotension, heart block or cardiac failure.
Granulomatous mastitis--a rare cause of erythema nodosum
Authors: Adams D H , Hubscher S G , Scott D G I
Published: December 2008

Granulomatous mastitis is a recently described, rare condition of unknown aetiology. It occurs in young, parous women as a tender extra-areolar breast lump and therefore needs to be differentiated from carcinoma. Histologically, a discrete granulomatous lobulitis is seen and because of morphological similarities to granulomatous thyroiditis it has been suggested it may be immunologically mediated. We present a patient in whom granulomatous mastitis presented with periarthritis and erythema nodosum, an association not previously described.
Regional lipiodolized chemotherapy for cholangiocarcinoma associated with oral contraceptives
Authors: McAleer J J A , Dickey W , Clarke R , Johnston G W , Callender M E
Published: December 2008

We describe a case of cholangiocarcinoma in a young woman, who presented with cholestatic jaundice following oral contraceptive ingestion. Following diagnostic laparotomy she received intra-arterial ‘lipiodolized’ chemotherapy. Intravenous mitozantrone was given for 2 years and she is asymptomatic, with computed tomographic evidence of tumour response, 27 months after diagnosis. We suggest that this form of treatment is of value for cholangiocarcinoma.
Staphylococcus aureus endocarditis presenting as acute scrotal pain
Authors: Watanakunakorn C
Published: December 2008

A previously healthy 17 year old boy had Staphylococcus aureus endocarditis presenting as acute scrotal pain. There was no trauma or evidence of scrotal or epididymal infection. The pain subsided after therapy for endocarditis was started.
Nocturnal convulsions and insulin-induced hypoglycaemia in diabetic patients
Authors: Fisher B M , Frier B M
Published: December 2008

Convulsions may occur as a consequence of insulin-induced hypoglycaemia. We report three patients with insulin-dependent diabetes, who presented with generalized tonic-clonic seizures associated with nocturnal hypoglycaemia. None of the patients had experienced hypoglycaemia during waking hours and the convulsions were mistakenly diagnosed as idiopathic epilepsy. Recognition of the possible hypoglycaemia aetiology of these convulsions permitted appropriate alteration of the insulin regimens with no recurrence of convulsions. In one case, the seizure was associated with bilateral fractures of the neck of the humerus. Unrecognized hypoglycaemia should be considered as a possible cause of convulsions in insulin-dependent diabetic patients.
Macroamylasaemia in association with the acquired immunodeficiency syndrome
Authors: Greenberg R E , Bank S , Singer C
Published: December 2008

A patient with macroamylasaemia in association with the acquired immunodeficiency syndrome is described. Patients with the acquired immunodeficiency syndrome commonly have gastrointestinal symptoms that often prompt serum amylase determination. Macroamylasaemia has been found to occur in a variety of diseases including various autoimmune disorders. The marked immunological abnormalities and increased circulating immunoglobulins associated with the acquired immunodeficiency syndrome may have predisposed this patient to macroamylase formation. Macroamylasaemia is a benign condition that requires no treatment and must be excluded in the patient with unexplained hyperamylasaemia to avoid unnecessary diagnostic tests and treatment.
Disappearing hypercalcaemia
Authors: Wood G M , Sidhu B , Saunders W A , Zalin A M , Heath D A
Published: December 2008

Four women presented with symptomatic hypercalcaemia and raised concentrations of serum parathyroid hormone (PTH). In each case, serum calcium returned spontaneously to normal. In two patients serum PTH also fell to the normal range and biochemical relapse has not occurred despite prolonged follow-up. In the others, serum PTH remained elevated and subsequent symptomatic hypercalcaemia necessitated parathyroidectomy. In the first two cases, autoparathyroidectomy is the most likely explanation; the initial fall in serum calcium in the other two patients is unexplained. Large fluctuations in serum calcium may occur in some patients with hyperparathyroidism and prolonged and careful observation is required when this occurs.
Incidence of overt and covert neurological damage in children with sickle cell disease
Authors: Hindmarsh P C , Brozovic M , Brook C G D , Davies S C
Published: December 2008

We studied 25 patients with sickle cell disease (15 with HbSS; 8 with HbSC and 2 with HbS beta degree) using neurological examination as a marker of overt and computed tomographic (CT) scan as a marker of covert neurological damage. Of the 25 patients, 5 (20%) had evidence of cerebral infarcts on CT scan, but only 4 of these 5 patients had neurological signs. Neurological problems were only seen in patients with HbSS. We could not identify any haematological risk factors, but in this small group of HbSS patients a crisis rate greater than 1 per year of follow up was associated with a significant risk of neurological damage.
Cyclosporin A in steroid-sensitive nephrotic syndrome with frequent relapses
Authors: Chan M K , Cheng I K P
Published: December 2008

Eight patients with steroid-sensitive nephrotic syndrome which frequently relapsed despite cyclophosphamide treatment were given cyclosporin A (7.5 mg/kg/day to 10 mg/kg/day) for 8 to 12 weeks. Six had minimal change glomerulonephritis and two had focal segmental glomerulonephritis. Cyclosporin A was given to 5 patients when their nephrotic syndrome was in relapse and to 3 patients when the nephrotic syndrome was in remission. Cyclosporin A induced a transient remission in only one patient.
The significance of pancytopenia in miliary tuberculosis
Authors: Hunt B J , Andrews V , Pettingale K W
Published: December 2008

Patients with miliary tuberculosis accompanied by a pancytopenia rarely survive their disease. If the peripheral blood picture does recover it has been taken as an indication that there is no underlying haematological disease, and so re-examination of the bone marrow is not performed. A case is described where resolution of the pancytopenia occurred but a persisting haematological disease remained. Aspects of haematological disease associated with tuberculosis are discussed.
Paraneoplastic papilloedema in neuroblastoma
Authors: Kennedy M J , Eustace P , O’Briain D S , Daly P A
Published: December 2008

We report a case of bilateral papilloedema in an adult male with neuroblastoma, in the absence of hypertension or detectable intracranial disease. This complication has not previously been described in the English-speaking literature. Possible mechanisms are discussed.
Lightning injury causing prolongation of the Q-T interval
Authors: Palmer A B D
Published: December 2008

This case report describes the development of temporary prolongation of the Q-T interval in a patient struck by lightning. A variety of electrocardiographic changes have been documented previously in association with lightning injury; however, the changes in this patient have not previously been reported.
Adult Gaucher disease in association with acute leukaemia
Authors: Corbett G M , Darbyshire P J , Besley G T N , Parker A C
Published: December 2008

A non-Jewish patient diagnosed as having Gaucher disease at the age of 67 is described. Fourteen months after presentation he was diagnosed as having acute myeloid leukaemia. A possible association between Gaucher disease and acute myeloid leukaemia is suggested.
Recurrent gastric outlet obstruction due to an inguinal hernia
Authors: Naraynsingh V , Sieunarine K , Raju G C
Published: December 2008

Although gastric strangulation in an inguinal hernia has been reported on three previous occasions, recurrent gastric outlet obstruction due to this hernia has not been previously documented. Prolonged traction on the distal stomach by omentum and transverse colon can draw the antrum and pylorus into the hernia and produce gastric outlet obstruction.
Colonic stricture secondary to blunt abdominal trauma--report of a case and review of the aetiology
Authors: Davidson B R , Everson N W
Published: December 2008

A 24 year old man sustained multiple injuries including blunt abdominal trauma in a motor cycle accident. Five months following the accident he developed a large bowel obstruction. Barium enema examination revealed a stricture of the sigmoid colon which, following surgical resection, was found to consist of a fibrous stenosis. The aetiology of such strictures following blunt abdominal trauma is likely to be a combination of mural haemorrhage and ischaemia.
High fever (greater than 39 degrees C) as a clinical manifestation of pulmonary embolism
Authors: Watanakunakorn C , Hayek F
Published: December 2008

This is a review of seven patients with pulmonary emboli manifested as high fever (temperature greater than 39 degrees C) seen over a 3 year period by an infectious disease consultant for unexplained fever. The patients’ ages ranged from 16 to 81 years. Bed confinement was the underlying condition of all but one patient. Fever resolved with intravenous heparin therapy in three patients and one patient recovered without heparin therapy. Three patients died. Regardless of the degree of fever, pulmonary emboli should be among the list of differential diagnoses in patients with unexplained fever, especially in those who are confined to bed.
Acute inflammatory demyelinating polyradiculoneuropathy following varicella
Authors: Murthy J M K
Published: December 2008

Four cases of acute inflammatory demyelinating polyradiculoneuropathy following varicella are described. The role of immunosuppression as a contributing factor in triggering an autoimmune disease of the peripheral nervous system following viral infection is discussed.
Intranasal squamous cell carcinoma in a renal transplant recipient on long term immunosuppression
Authors: Pace-Balzan A , Timms M S
Published: December 2008

An increased risk of developing malignant disease after renal transplantation and immunosuppression with azathioprine and corticosteroids is well documented. We report a case of intranasal carcinoma occurring in a renal transplant recipient. The possible role of immunosuppression on the development and on the outcome of treatment of this tumour is discussed.
Angiodysplasia of the small bowel; a ‘brilliant’ technique for localizing the quiescent lesion
Authors: Scott S D , Royle G T
Published: December 2008

Intraoperative transluminal endoscopic illumination is of benefit to locate angiodysplasias of the small bowel at laparotomy in the quiescent non-bleeding phase.
Autonomic neuropathy in an alcoholic population
Authors: Barter F , Tanner A R
Published: December 2008

Autonomic nervous system integrity has been assessed in 30 alcoholic subjects and 30 age-sex matched controls using five simple tests of cardiovascular responses. There was evidence of parasympathetic neuropathy alone in five of the alcoholic subjects (16%) and of combined parasympathetic and sympathetic neuropathy in an additional six (20%). None of the controls showed any abnormality. Within the alcoholic group, those with autonomic neuropathy were older, were more likely to be female and to have established alcoholic liver disease. Symptoms were a poor guide to the presence or absence of autonomic neuropathy.
Acyclovir treatment of herpes simplex encephalitis: experience in a district hospital
Authors: Gulliford M C , Chandrasekera C P , Cooper R A , Murphy R P
Published: December 2008

Herpes simplex encephalitis may be underdiagnosed in Britain. We report eight patients treated at one hospital over three years. Fever, impaired consciousness or focal neurological signs were seen in all patients at presentation but herpes simplex encephalitis was rarely considered as the initial diagnosis. The electroencephalogram was the only initial investigation that was abnormal in each case and was the most useful test in establishing a clinical diagnosis. The diagnosis was confirmed by laboratory methods in each case. Following acyclovir treatment five patients were able to resume normal activities, one patient has moderate disability and two patients died. Three patients showed clinical evidence of relapse but two improved after further treatment with acyclovir. Herpes simplex encephalitis is a treatable condition and should be considered in all patients presenting with fever and neurological signs. The electroencephalogram is usually abnormal and the changes may be characteristic of the condition.
Congenital hypothyroidism from complete iodide transport defect: long-term evolution with iodide treatment
Authors: Albero R , Cerdan A , Sanchez Franco F
Published: December 2008

Hypothyroidism from iodide transport deficiency is a rare disease, especially when found in two affected siblings. Treatment with high doses of iodide has been recommended, but no long term results have been reported. Two siblings with congenital hypothyroidism due to total failure to transport iodide have been followed up during twelve and a half years of treatment with oral potassium iodide. Iodine doses varied between 10.3 and 22 mg/day, and serum total iodine concentrations between 100 and 210 micrograms/dl. Total triiodothyronine (T3), thyroxine (T4) and free T4 were in the normal range during the time of study. Basal thyroid stimulating hormones (TSH) and maximum TSH response to thyrotrophin releasing hormone (TRH) were also in the range of normal values. These data along with clinical findings confirmed the potential usefulness of iodine in hypothyroidism due to complete iodide transport defect.
Sheehan’s syndrome presenting with type III hyperlipoproteinaemia
Authors: Carr D , Thornes H M , Rutter A C , Finney R D , Turner P R
Published: December 2008

A patient is described in whom the presenting feature of hypopituitarism was the development of palmar xanthomata associated with type III hyperlipoproteinaemia. Treatment of her secondary hypothyroidism with thyroxine caused resolution of the xanthomata and hyperlipidaemia, but the underlying compositional abnormality of the lipoproteins could still be observed.
Chest pain--a common feature of ankylosing spondylitis
Authors: Dawes P T , Sheeran T P , Hothersall T E
Published: December 2008

We compared the incidence, nature and frequency of chest pain in a group of 45 ankylosing spondylitis patients with an age and sex matched group of normals. Twenty-five ankylosing spondylitis patients had experienced recurrent chest pain compared to three normals, and had a significantly reduced chest expansion. The presence of chest pain in ankylosing spondylitis can be an early presenting feature of the disease (eight patients had chest pain before spinal symptoms), and is associated with more severe disease.
Treatment of portal hypertension by subtotal splenectomy and central splenorenal shunt
Authors: Petroianu A
Published: December 2008

A method is proposed to reduce portal hypertension utilizing subtotal splenectomy and a central splenorenal shunt. The advantages of this method are: diversion of the splenic component of the portal circulation, creation of a shunt for the portal blood into the systemic circulation, preservation of the splenic function and correction of the manifestations of the hypersplenism. Two cases are presented who remain well four years after surgery.
Disseminated intravascular coagulation with Fusobacterium necrophorum septicaemia
Authors: Potter M N , Drysdale H C , Price P A , Buck A C
Published: December 2008

A 23 year old woman died within six hours of admission from acute disseminated intravascular coagulation. Fusobacterium necrophorum, a Gram negative anaerobic organism, was isolated as a single pathogen from the blood cultures. This association has not previously been reported.
Calcified thoracic disc with herniation of the nucleus pulposus in a child
Authors: Schapira D , Goldsher D , Nahir M , Scharf Y
Published: December 2008

A twelve year old boy presented with acute cervical and interscapular pain, torticollis and low grade fever. The neurological examination was normal. Roentgenograms showed calcification of the T3-T4 disc and posterior herniation of the nucleus pulposus was demonstrated by computed tomography. A rapid and dramatic amelioration of the symptoms was produced by treatment with a non-steroidal anti-inflammatory drug.

Intervertebral disc calcification in childhood is an uncommon and usually benign condition. Its clinical and radiological features are discussed in the light of the relevant literature.
Hypersensitivity reaction with intravenous GnRH after pulsatile subcutaneous GnRH treatment in male hypogonadotrophic hypogonadism
Authors: Popović V , Milošević Z , Djukanović R , Micić D , Nesović M , Manojlović D , Djordjević P , Mićić J
Published: December 2008

Chronic pulsatile subcutaneous administration of low doses of gonadotrophin releasing hormone (GnRH) is an effective therapy for men with hypogonadotrophic hypogonadism. Hypersensitivity reactions to GnRH are rare.

We wish to report hypersensitivity reactions with intravenous GnRH after low dose subcutaneous pulsatile GnRH treatment in two men with hypogonadotrophic hypogonadism due to suprasellar disease.
Intra-vascular leiomyoma of the popliteal vein
Authors: Grimer R J , Armstrong G R
Published: December 2008

A large mass in the popliteal fossa was found to be a leiomyoma of the popliteal vein with portions of tumour both inside and outside the vein. This is only the second recorded case of a benign smooth muscle tumour of a peripheral vein.
Abdominal epilepsy misdiagnosed as psychogenic pain
Authors: Singhi P D , Kaur S
Published: December 2008

The authors present the case report of a child with abdominal epilepsy who had suffered from abdominal pain for several months under the label of psychogenic pain. The important historical clues were pallor and cold sweating during the paroxysm, followed by lethargy and prolonged sleep. An abnormal electroencephalogram and a remarkable response to anticovulsants confirmed the diagnosis. This condition must be considered in a child with undiagnosed recurrent abdominal pain.
Irritant contact facial dermatitis due to nebulizer therapy
Authors: Eedy D J , Barton K , Stanford C F
Published: December 2008

A case is reported of a patient with long-standing, severe airflow obstruction requiring long-term nebulizer therapy developing a facial dermatitis in the area bounded by the nebulizer mask. The facial dermatitis seems to be the result of the combined irritancy of the nebulizer solutions and moisture, and prophylactic measures are suggested for patients requiring long-term nebulizer therapy.
Accuracy in the clinical diagnosis of parkinsonian syndromes
Authors: Gibb W R G
Published: December 2008

This review of Parkinson’s disease and related disorders emphasizes the difficulties of distinguishing between variants of the parkinsonian syndrome. Characteristic clinical features may remain absent for many months, but accuracy of diagnosis may be improved by considering certain presenting symptoms and signs. The main characteristics of various parkinsonian syndromes are reviewed and their major distinguishing features are emphasized. Future improvement in the precision of clinical diagnosis, especially early in the course of parkinsonian syndromes, will depend on selecting out patients with Parkinson’s disease using positive diagnostic criteria.
Pharmacokinetics of flupirtine in elderly volunteers and in patients with moderate renal impairment
Authors: Abrams S M L , Baker L R I , Crome P , White A S T , Johnston A , Ankier S I , Warrington S J , Turner P , Niebch G
Published: December 2008

The pharmacokinetics of flupirtine after a single oral dose of 100mg have been studied in patients with moderate renal impairment and in healthy elderly subjects aged 66-83 years. Mean elimination half-life of flupirtine was higher in elderly patients than in younger normal subjects, and this was associated with an increased maximum serum concentration and reduced clearance. The mean half-life in patients with renal impairment was higher than in normal subjects. There was no correlation between observed elimination half-life and degree of renal impairment, but the creatinine clearance of most patients fell in a narrow range between 43 and 60 ml/min. In the light of these results and until further information is available, it would be prudent to start treatment of patients who are elderly or have evidence of renal impairment with half the dose of flupirtine recommended for younger patients with normal renal function.
Glomerulonephritis preceding late relapse of Hodgkin’s disease
Authors: Lynn W A , Marcus R E
Published: December 2008

We report a case of focal sclerosing glomerulonephritis which developed 11 years after successful treatment of nodular sclerosing Hodgkin’s disease. Hodgkin’s disease relapsed 7 months later and responded completely to combination chemotherapy with simultaneous improvement in renal function. This case shows that relapse of Hodgkin’s disease may occur after a 10 year interval and furthermore it may preceded by nephrotic syndrome. Renal disease in such cases may not recover until the underlying Hodgkin’s disease is treated.
Biliary colic after micro dieting
Authors: Green N J , Fowlis G A , Chadwick S J D
Published: December 2008

A 33 year old man presented with biliary colic and transient obstructive jaundice. In the 4 weeks preceding admission he had been taking a very low calorie diet (the Cambridge Diet) and celebrated achieving his target weight with a fatty meal on the morning of admission. An ultrasound of the gallbladder suggested biliary sludge. We suggest that he developed the biliary sludge as a consequence of calorie restriction and that, following the fatty meal, the gall bladder contracted causing biliary colic and transient obstructive jaundice.
Rifampicin-induced adrenal insufficiency in the acquired immunodeficiency syndrome: difficulties in diagnosis and treatment
Authors: Ediger S K , Isley W L
Published: December 2008

Rifampicin, an antituberculous drug, causes increased hepatic metabolism of steroid hormones. We report the case of a patient with the acquired immunodeficiency syndrome treated with rifampicin who had a ‘normal’ screening test for adrenal insufficiency, yet had clinical evidence of adrenal failure. Diagnostic testing could not be completed due to lack of clinical response to dexamethasone. Both of these findings are due to the unique effects of rifampicin on steroid metabolism.