bluuebunny/crossref_metadata_2025 huggingface dataset:
Metaphyseal chondrodysplasia
Authors: Spranger J W
Published: December 2008

Any review of the metaphyseal chondrodysplasias is complicated by their variety and mainly unknown pathogenesis. The more familiar types display considerable clinical and radiological diversity: even more so the rarer disorders which still require complete definition, but differences in their mode of inheritance make diagnostic precision mandatory. These dysplasias present in infancy or in childhood, when the patient, usually dwarfed, may be proportionate, so that some forms may be confused with rickets or other lesions. Mental retardation is unusual, but the skin, hair, nails and facies provide valuable diagnostic features. Radiological abnormalities mainly affect the metaphyses of the shortened limb bones, less often the skull, vertebrae, pelvis, ribs and extremities, and sometimes their distribution may indicate the specific type of dysplasia. In a further complex group multiple systems are involved, notably the pancreas, intestine and lympho-reticular, causing malabsorption and haematological or immunological disorders.
Echocardiographic diagnosis and evaluation of cardiomyopathies: idiopathic hypertrophic subaortic stenosis, Chagas' heart disease and endomyocardial fibrosis
Authors: Hernández-Pieretti O
Published: December 2008

Echocardiographic investigations on patients with hypertrophic cardiomyopathy with obstruction have been detailed and compared with the changes found in sixty patients with chronic Chagas' 'cardiomyopathy'. These changes are similar to those encountered in congestive cardiomyopathy. Endomyocardial fibrosis is rare in Venezuela, but six patients have been found in that country and the echocardiographic changes in one of these patients has been included in this study.
Reversible lactic acidosis associated with repeated intravenous infusions of sorbitol and ethanol
Authors: Batstone G F , Alberti K G , Dewar A K
Published: December 2008

Infusions of fructose or sorbitol are used commonly in parenteral nutrition and may cause lactic acidosis. A case is reported in whom blood lactate concentration was monitored frequently over a 5-day period during intravenous feeding with a sorbitol-ethanol-amino acid mixture. During the first five infusions blood lactate rose only moderately, but with the final infusion lactate rose to 11-1 mmol/l and the patient had a severe metabolic acidosis. In retrospect the patient had shown deterioration in renal and hepatic function tests during the preceding 24 hr. On terminating the infusions the blood lactate concentration fell rapidly. It is suggested that great care should be exercised when using such infusions in ill patients and acid base status and renal and hepatic function should be monitored frequently.
Granular cell myoblastoma of the biliary tree
Authors: Savage A , Devitt P
Published: December 2008

A granular cell myoblastoma of the common bile duct is described which caused episodes of jaundice in a young woman. Histological examination demonstrated a close association of the tumour with nerve fibres, tending to support the theory of origin from Schwann cells. The lesion is benign and after excision carries an excellent prognosis.
Chlamydial, gonococcal, and herpes virus infections in neonates
Authors: Csonka G W , Coufalik E D
Published: December 2008

The incidence, type of lesions, portal of entry and treatment of chlamydial, gonococcal, and herpetic infections of neonates are briefly discussed. Herpes neonatorum is potentially the most serious of these conditions and major efforts in its prophylaxis are called for.
Neonatal streptococcal infections
Authors: Parker M T
Published: December 2008

Most serious neonatal streptococcal infections are caused by group-B streptococci. The pattern of serious group-B neonatal disease in Britain resembles that described in other countries; both "early-onset" and "late-onset" forms are seen, but reliable incidence rates have not yet been determined. Serological-type III strains predominate in neonatal meningitis in Britain, but not so markedly as in some parts of the U.S.A. A deficiency of group-II strains in meningitis is, however, apparent in both countries. Present information about the carriage of group-B streptococci suggests that antibiotic prophylaxis administered to mothers or infants is unlikely to reduce greatly the frequency of "early-onset" disease. The continuous presence of a suitable chemical disinfectant in the vagina during labour might be more effective. Insufficient is known about the epidemiology of "late-onset" neonatal disease for rational preventive measures to be designed. More information is required about the postnatal acquisition of group-B streptococci by neonates and its sources, and about passive transfer of type-specific antibody from the mother to her child.
Neonatal meningitis
Authors: Goldacre M J
Published: December 2008

Some of the main features of neonatal meningitis, studied in a defined population of infants, are reviewed. The incidence rate was twenty-six cases per 100 000 live-births. The case fatality rate was 43%. Gram-negative intestinal bacilli were the commonest infecting organisms. Streptococci accounted for an important minority of cases. It is stressed that neonatal meningitis usually presents as a non-specific illness, without the clinical signs of meningitis which are familiar in older patients. Twenty-three of the seventy-six infants in this study (30%) weighed 2500 g or less at birth. Another eight infants were born to mothers whose membranes had been ruptured for 24 hr or more.
The outcome of hepatitis B virus infection in pregnancy
Authors: Cossart Y E
Published: December 2008

The literature concerning hepatitis B in pregnancy is reviewed and problems of management of both the acute and chronic infections are discussed.
The biochemistry of the basal ganglia and Parkinson's disease
Authors: Curzon G
Published: December 2008

The metabolic pathways for five transmitters in the basal ganglia are briefly described; the results of determinations of their concentrations, of their rate-limiting enzymes and of their degradation products are summarized. The changes found in Parkinson's disease are described. While dopamine synthesis in the basal ganglia is defective in this condition, abnormalities of other transmitters occur, and their possible significance is discussed.
The treatment of Parkinson's disease
Authors: Godwin-Austen R B
Published: December 2008

The treatment of Parkinson's disease is discussed. Levodopa is the most effective drug in this therapy. The place of other agents is discussed.
Quadriceps myositis: an appraisal of the diagnostic criteria of quadriceps myopathy
Authors: Mohr P D , Knowlson T G
Published: December 2008

A patient with the clinical picture of quadriceps myopathy was shown to have an underlying myositis. Review of the literature showed myositis to be a rare cause of the 'quadriceps syndrome' but it is important to identify this group because they are potentially treatable with corticosteroids.
Clinical and electroencephalographic data indicative of brain tumours in a seizure population
Authors: Vignaendra V , Ng K K , Lim C L , Loh T G
Published: December 2008

One hundred and two patients suffering from seizures, with focal EEG signs (101 cases) and focal seizures but generalized EEG abnormalities (one case) were divided into tumour (twenty-one cases) and non-tumour (eighty-one cases) groups on the basis of contrast radiological studies. Retrospective analysis of various clinical data and EEG abnormalities, determined before the contrast radiological examinations, showed that the following were statistically significantly different between the two groups in favour of a tumoral aetiology for the seizures: age at onset of fits (>20 years), presence of focal neurological signs and increased intracranial pressure, presence of focal unilateral delta waves without accompanying epileptic discharges, beta asymmetry between the cerebral hemispheres and hyperventilation-induced electrical seizures. A brain scan was a very useful screening test for the detection of a tumoral aetiology for seizures.
Assessment of casual blood pressure variations
Authors: Thulin Thomas , Bengtsson Bo , Scherstén Bengt
Published: December 2008

All residents in a suburban community in southern Sweden, 8 years of age and older, were invited to an ophthalmological examination. The examination included a blood pressure determination.

Of the 1917 persons invited 85·5% took part in the study. 3·5% of these were excluded because they were taking antihypertensive drugs. The investigations were conducted during 14 consecutive months and at different times of the day.

The systolic and diastolic blood pressure distribution curves exhibited a positive skewing. The blood pressures rose to a plateau with essentially unchanged pressures in the age groups 28–32 years up to 38–42 years. In these ages, the systolic blood pressure was significantly higher among the males than among the females. The relation was reversed in the age groups above 48 years. The diastolic blood pressure showed no significant sex differences in the various age groups.

A multiple linear regression analysis was used to determine whether there were diurnal and seasonal effects on the blood pressure independent of the age and sex. The systolic blood pressure during the winter months was 4·1 and 5·0 mmHg higher in the male and female subjects respectively, while the diastolic blood pressure during the winter months was 1·7 and 1·9 mmHg higher in the male and female subjects respectively. The time of day had no effect on the systolic blood pressure while the diastolic blood pressure increased by 0·24 and 0·27 mmHg/hr from 8 a.m. to 9 p.m. in the male and female subjects respectively.

It is concluded that the small genuine effects of the time of measurement of casual blood pressure lack practical importance in screening of hypertension.
The outcome of pregnancy in women suffering from migraine
Authors: Wainscott G , Sullivan F M , Volans G N , Wilkinson M
Published: December 2008

The reproductive histories of 777 women suffering from migraine were compared with 182 non-migrainous women. The incidence of miscarriage, stillbirth and toxaemia of pregnancy was very similar in both groups and there was no increase in the number of congenital malformations in the children born to women who suffered from migraine compared with the control group or with the national average. It was concluded that women suffering from migraine did not have an increased risk of giving birth to children with deformity and it was unlikely that drugs most commonly used in the treatment of migraine were teratogenic.
Perspectives in coronary prevention
Authors: Turner R W D
Published: December 2008

The seeds of premature coronary heart disease are often sown in childhood and it is the developing arteries of children which are the most susceptible. Paediatricians and all who work with them have the earliest and most promising opportunities for prevention.

Coronary protection can be added to the potential advantages of breast feeding and to ensure appropriate fatty acid balance throughout weaning.

It is reasonable to accept the strong consensus of opinion on diet reflected in the reports of the eighteen national committees. They are: to reduce total fat intake to 30–35% of the energy, to restrict consumption of saturated fat, cholesterol, sugar, and salt, to increase unrefined carbohydrate and polyunsaturated fat, and to maintain a P/S balance of 1.0–1.5:1.

Food is the fundamental coronary risk factor, but others may add insult to injury. Smoking, hypertension, obesity, lack of exercise, and stress, each of which is related to behaviour, may start in childhood. Smoking doubles the overall risk CHD and increases it ten times in males under 45 years old. Good habits, including food preferences and eating patterns learned early, are those most likely to be continued.

School meals require and should match revised nutritional education.

The co-operation of the food industry is essential and can be anticipated, but it requires a clear lead by paediatricians.

The nutritional advice should come from the medical profession.

Every contact with children and their parents provides an opportunity for enquiry and giving advice.
Influence of nutrition in childhood on the origins of coronary heart disease
Authors: Wolff Otto , Brook C G D
Published: December 2008

Both the quality and the quantity of food ingested are relevant to the genesis of risk factors for coronary heart disease and the two are inseparable. Nevertheless they have a major common pathway through hypertension, which may well be the most important consequence of a high-protein, high-carbohydrate, high-fat, high-energy and high-sodium diet.

Because body fatness is a strongly genetically determined characteristic and because it evolves over the whole period of childhood a vigorous and sustained programme of health education is required at all levels. The aim of such a programme is to effect a small shift in the fatness of the whole population; such a shift would dramatically and disproportionately reduce the incidence of obesity. Since the morbidity and mortality which is found in obese subjects arises primarily from cardiovascular disease in general, and coronary heart disease in particular, nutritional influences have obvious relevance to the prevention of coronary heart disease.
Arterial changes in infants of smoking mothers
Authors: Asmussen I
Published: December 2008

Examination of umbilical arteries and veins, and vessels in placental villi was carried out by electronmicroscopy in smoking and non-smoking mothers. Severe vascular changes were found in the smoking group. These findings suggest that similar changes may be present in the vessels of the newborn child. Stopping pregnant women from smoking may help to prevent CHD in their children in later life.
The paediatrician's responsibility for the prevention of coronary heart disease
Authors: Wolfe O H
Published: December 2008

A strong case exists in favour of encouraging children not to smoke, to be reasonably physically active and to eat in moderation to avoid obesity. The principal role of the paediatrician is in the education of health personnel who are in a position to influence children and their families to adopt these measures. Paediatricians will also be involved with children at special risk of ischaemic heart disease. They have a responsibility to promote reasearch to determine the efficacy of these measures in the prevention of coronary heart disease.
Upper gastro-intestinal endoscopy and radiology in the elderly
Authors: Stanley T V , Cocking J B
Published: December 2008

The results of oesophago-gastro-duodenoscopy (OGD) and radiology in one hundred consecutive elderly patients were reviewed to assess the efficacy, safety and acceptability of endoscopy in this age group. False positive radiological features occurred in two of nine patients with normal endoscopic examinations. The remaining ninety-one patients had 138 lesions, sixty-four of which were diagnosed by both techniques. Endoscopy missed fourteen lesions partly because of unsuccessful intubation (one patient) or incomplete examinations due to obstructive lesions (eight patients). Radiology misdiagnosed or did not demonstrate sixty-one lesions. OGD proved to be safe and relatively well tolerated; it was invaluable at confirming or refuting the diagnosis of malignancy, at detecting multiple pathology and identifying bleeding lesions, but it gave inferior results with hiatus herniae. Thus it can usefully be undertaken in the elderly as a complementary examination to radiology.
Splenic cysts: a report of six cases and a brief review
Authors: Shousha S
Published: December 2008

Six cases of splenic cysts, removed surgically in the Royal Free Hospital during the last 10 years, are presented. These include a hydatid cyst, two primary, epithelium lined, and three secondary, non-epithelium lined cysts.

The histology, aetiology, symptomatology, diagnosis, treatment and complications of splenic cysts are discussed.
Partial lipodystrophy with nephrotic syndrome
Authors: Hunter A M , Lawson A A H , Thomson D
Published: December 2008

A patient with nephrotic syndrome in association with partial lipodystrophy is reported. The features of partial lipodystrophy are well recognized and the renal lesion is a mesangiocapillary glomerulo-nephritis of a dense deposit type with an associated depression of C3. This type of kidney involvement is becoming increasingly recognized as common in the syndrome of partial lipodystrophy.
The assessment of glomerular function: creatinine clearance or plasma creatinine?
Authors: Morgan D B , Dillon S , Payne R B
Published: December 2008

Plasma creatinine concentration is superior to creatinine clearance for the detection of abnormal glomerular function, of changes of glomerular function in patients with chronic renal disease. Creatinine clearance should be abandoned as the routine assessment of glomerular function.
Plasma renin activity following renal transplantation
Authors: Snow M H , Jachuck S J , Robson V , Wilkinson R
Published: December 2008

Plasma renin activity (PRA) was studied serially for up to 21 days following transplantation in thirteen patients receiving renal allografts. PRA was measured during fasting and recumvency and its relationship to renal function, diuretic administration, plasma sodium, allograft rejection and blood pressure was examined.

PRA fell steadily as renal function improved and plasma sodium rose following transplantation and when rejection episodes were excluded an inverse relationship between PRA and renal function could be seen. It is not possible to say whether the changes in PRA and function are causally related or whether changes in plasma sodium alone account for the observed changes in PRA. Some rejection episodes were accompanied by an increase in PRA, but this was not sufficiently consistent to be of value in the diagnosis of rejection. PRA also increased in relation to frusemide-induced fluid loss. There was no relationship in these patients between PRA and blood pressure.
The problems of massive small bowel resection and difficulties encountered in management
Authors: Barros D'Sa A A B , Parks T G , Roy A D
Published: December 2008

Massive small bowel resection is imperative in the management of several pathological conditions and is accompanied by high operative mortality. In those that survive, serious nutritional disturbances are inevitable. Intestinal adaptation is said to occur but cannot be relied upon. Long-term parenteral nutrition is problematical and often unsuccessful. Many surgical procedures have been adopted in an effort to improve prognosis and have been found wanting. Controlled experimental studies in the use of reversed segments and a limited number of reported clinical cases using the method after massive resection suggest that this technique may improve the function of the residual intestine to such an extent that other supportive measures are unnecessary.
The insidious presentation of the juvenile form of metachromatic leucodystrophy
Authors: Gordon N
Published: December 2008

Certain progressive cerebral diseases can present with emotional and behavioural disorders. The juvenile form of metachromatic leucodystrophy is one of these. The histories of two children with this condition are given to demonstrate the insidious form of onset.
Juvenile hepatic fibropolycystic disease and other abnormalities
Authors: Carty J E , Jones C T
Published: December 2008

Two cases are described of hepatic fibropolycystic disease (Brunt, 1973). Both had neonatal pyloric stenosis, one craniostenosis and the other acromegaly and neuro-fibromatosis.
Study by vaginal cytology of ovarian function in pre-menopausal womenPaper presented at the VIth International Congress of Cytology, Tokyo, Japan, May 2–5, 1977.
Authors: Mehta P V
Published: December 2008

In the pre-menopausal years, the ovarian secretion waxes and wanes until its cessation. In this study of women in the pre-menopausal period neither did the menstrual pattern prove to be a reliable criterion by which to judge the extent of oestrogen effect or deficiency nor was there correlation between serial colpocytology and endometrial histology, Hyperplasia of the endometrium was seen with different degrees of oestrogen status and in the menopause. Maximum cases of hyperplasia were seen in the irregularly menstruating group of women. It is therefore emphasized that before beginning oestrogen therapy, both colpocytology and endometrial histology should concur to establish oestrogen deficiency. A close watch should be kept on cases showing an endometrial hyperplasia.
Avascular necrosis of the femoral head in patients receiving intermittent cytotoxic and corticosteroid therapy for Hodgkin's disease
Authors: Hancock B W , Huck P , Ross B
Published: December 2008

Two patients with stage IIIB Hodgkin's disease are reported, in whom treatment with cytotoxic and corticosteroid therapy was followed by avascular necrosis of the femoral head.
Immunoglobulin profiles of the chronic antibody response: discussion in relation to brucellosis infections
Authors: White R G
Published: December 2008

The use of a sensitive and quantitative radioimmunoassay has enabled much finer dissection of the immunoglobulin-antibody profiles for an individual immune response. The kinetics of the response are considered in relation to the switch from IgM to IgG antibody production. In the domestic fowl, the kinetics of this switch varied with different antigens: whereas the response to a thymus-dependent antigen proceeded through a brief 19S response to a declining 7S response, the response to a thymus-independent antigen failed to switch from 19S to 7S for several weeks and consisted of repeated excursions of 19S antibodies. When injected intravenously and simultaneously, Salmonella adelaide O (killed) organisms (thymus-independent) and sheep red cells (thymus-dependent) interact so that the response to the latter fails to switch from 19S to 7S and consists of repeated excursions of 19S antibody. The changed character of the sheep red cell response is interpreted as being due to lack of 7S antibody. Passive antibody to either sheep red cells or to S. adelaide produced an inhibition of the sheep red rell response so that only one excursion of 19S antibody was observed.

The use of the radio-immunoassay enables an independent measurement of all IgM, IgG and IgA antibody to the surface antigen of Brucella obortus. The test, when applied to forty-six sera from individuals with various types of brucellosis, successfully detected antibody in many instances in which conventional serological tests were negative, and such antibody (if IgM) was associated with acute or (if IgG or IgA) with chronic cases of brucellosis. The radioassay test should prove highly valuable effectively to eliminate, in individual patients, the diagnosis of brucellosis based on the inability of conventional tests to detect significant antibody levels.
Bacteraemia after manipulation of the urinary tract. The importance of pre-existing urinary tract disease and compromised host defences
Authors: Quintiliani R , Klimek J , Cunha B A , Maderazo E G
Published: December 2008

The factors related to the occurrence of bacteraemia following urinary tract manipulation were studied in a large community hospital. During a 3-year period, forty-six of 326 episodes of hospital-acquired bacteraemia were associated with urinary tract manipulation. All thirty of forty-six cases felt to be definitely related to urinary tract manipulation (other obvious sources of bacteraemia being absent) had pre-existing urinary tract disease, especially of an obstructive type; only one in this group died from sepsis. The remaining sixteen patients had other possible sources of bacteraemia besides urinary tract manipulation and had disorders associated with defects in host defences; twelve (75%) in this group died from overwhelming sepsis. Thus, if bacteraemia occurs in a patient having had urinary tract manipulation but without any underlying urinary tract abnormality or impairment in host defences, its source should be searched for in other areas of the body.
Familial Hodgkin's disease
Authors: Hull P J , Delamore I W
Published: December 2008

A family with Hodgkin's disease is described. Each affected member of the family had mediastinal involvement and in each case the histology was that of nodular sclerosing Hodgkin's disease. The significance of these findings with reference to the aetiology of the disease is discussed.
An outbreak of encephalomyelitis in the Royal Free Hospital Group, London, in 1955
Authors: Compston Nigel Dean
Published: December 2008

This paper is a précis of the report given by the staff of the Royal Free Hospital (Medical Staff of the Royal Free Hospital, 1957) of an epidemic amongst the staff of the Royal Free Hospital in 1955.
‘Epidemic neuromyasthenia’ at the Hospital for Sick Children, Great Ormond Street, London
Authors: Dillon M J
Published: December 2008

An outbreak of an illness with features in common with ‘epidemic neuromyasthenia’ affected the staff of the Hospital for Sick Children in London between August 1970 and January 1971. At least 145 cases were observed and the majority of these were nurses. Symptomatology was protean, clinical findings minimal and relapses frequent. Care was taken to minimize anxiety and fear in a vulnerable population, and laboratory investigations were purposefully limited in number for this reason. In general, laboratory findings, including virological investigations were negative. A high incidence of anti-complementary activity and the presence of ill defined aggregates in some acute sera on electron microscopy were interesting and possibly significant findings suggesting the presence of immune complexes. These findings, plus the ability of lymphocytes from some patients to proliferate in vitro, were thought to represent possible evidence of an infective process. Although no children were affected during the 1970 outbreak, it is interesting that seven children have recently been referred to the hospital with features compatible with ‘epidemic neuromyasthenia’.
‘Epidemic neuromyasthenia’ in Southwest Ireland
Authors: Corridan J P
Published: December 2008

During the course of an obscure illness in a teenage girl it was eventually realized that the diagnosis was ‘epidemic neuromyasthenia’. The illness which occurred between February and September 1976 was characterized by fatigue, pallor, headache, nuchal pain, alterations in mentation, dizziness, nausea and vomiting, paraesthesiae, weakness and heaviness of limbs, and a prolonged relapsing course. Investigation brought to light fourteen patients with similar symptoms—twelve female and two male. In view of the shortcomings of retrospective enquiries, especially those involving the assessment of notes made by other people, and the problem of trying to define a nonfatal illness with protean symptoms, many of a nonspecific nature, with few physical findings and negative laboratory studies, caution is necessary. Under these circumstances it is claimed on clinical epidemiological evidence that a diagnosis of ‘epidemic neuromyasthenia’ could be sustained confidently in three patients and probably in a fourth. Six patients were considered possible cases and four were rejected.
Ill defined neurological diseases of possible viral origin
Authors: Sutton R N P
Published: December 2008

Any approach towards elucidating the aetiology of an ill defined disease such as ‘epidemic neuromyasthenia’ has to be a comprehensive and wide-ranging one. Although viruses must be strong candidates, by reason of their ubiquity, this need not necessarily be the case and we have recently seen the onset of Legionnaires' disease as a new entity caused by a bacterium. We do not always recognize that a particular virus may affect the entire community and that the patient seen in hospital may represent only the tip of the submerged iceberg and that, in closed communities more of the iceberg will be seen. Silent viral epidemics are probably frequent and may only be recognized in retorspect. As an example the recent epidemic with adenovirus type 7 will be alluded to. Possible variations in virus and, to a lesser extent, in the host which could modify the course of an individual infection are discussed.
Effect of prolonged therapy with neuroleptics on hepatic microsomal enzyme activity in schizophrenic patients
Authors: Majumdar Sisir K , Kakad Pravin P
Published: December 2008

Gamma-glutamyl transpeptidase (GGT) is one of the hepatic microsomal enzymes and is now considered to be a reliable biochemical marker of enzyme induction.

Serum levels of this hepatic microsomal enzyme were estimated in twenty-eight schizophrenic patients treated with neuroleptics (fluphenazine, flupenthixol and chlorpromazine) for a prolonged period. No biochemical evidence of induction of the hepatic microsomal enzymes was noticed. It is suggested that these drugs may not cause hepatic microsomal enzyme induction in humans and that interference of rates of metabolism via enzyme induction in other drugs used concurrently need not be anticipated.
Postpartum thyroiditis
Authors: Hoffbrand B I , Webb S C
Published: December 2008

Three women presented 4–6 months after delivery with a goitre and spontaneously changing thyroid function believed to be due to autoimmune thyroiditis. All three patients had transient hypothyroidism and one initially had evidence of thyrotoxicosis. Hypothyroidism in autoimmune thyroiditis is generally regarded as permanent. However, evidence is now accumulating, and is reviewed here, to suggest that relapses or onset with transient thyrotoxicosis and hypothyroidism followed by spontaneous, more or less complete, remission occur in one or more varieties of thyroiditis in the postpartum period.
Fetal drug syndromes
Authors: Gordon Neil
Published: December 2008

Certain drugs which affect fetal development are considered. Phenytoin taken during pregnancy may result in infants who remain mentally and physically retarded, with abnormal craniofacial appearance and limb defects. A boy with such a syndrome is reported. Trimethadione is another drug which has been said to be teratogenic, and to cause a typical phenotype which is described. The fetal alcohol syndrome is now well recognized and has similar features to those related to anti-epileptic drugs taken during pregnancy. A high level of suspicion of possible associations between congenital defects and drugs must be maintained.
Total body potassium depletion and renal tubular dysfunction following carbenoxolone therapy
Authors: Dickinson R J , Swaminathan R
Published: December 2008

A patient with hypokalaemia-associated renal tubular damage following carbenoxolone therapy is described. The hypokalaemia was reflected by a low level for total body potassium (TBK) and investigations confirmed renal tubular dysfunction. Hypokalaemic nephropathy may be secondary to intracellular potassium depletion rather than the hypokalaemia itself.
Unusual extra-intestinal manifestations in inflammatory bowel disease (IBD)
Authors: Alroy G G , Kursbaum A
Published: December 2008

The extra-intestinal complications of inflammatory bowel disease (IBD) usually appear in patients with long standing active intestinal disease. A patient with Crohn's colitis is described, in whom extra-intestinal symptoms, some of which were unusual, preceded the definitive diagnosis by 9 years.
Amiodarone in the treatment of refractory supraventricular and ventricular arrhythmias
Authors: Wheeler P J , Ingram D V , Puritz R , Chamberlain D A
Published: December 2008

Amiodarone is an antiarrhythmic agent unrelated to other drugs in current use. It has been little used in Britain, and no formal clinical trials have been possible because the drug has not been licensed by the Committee on Safety of Medicines. Nevertheless it has unique properties which can be valuable in the treatment of a wide spectrum of arrhythmias, particularly supraventricular tachycardias. Amiodarone has a slow onset of action and is cumulative. A sustained action is therefore achieved without the need for frequent maintenance dosage. Fifty patients have been treated with amiodarone in maintenance doses ranging from 200 mg on alternate days to 200 mg twice daily either alone, or in combination with conventional therapy. All were resistant to conventional therapy alone or could not be treated with usual agents because of unwanted drug effects. Of 27 patients with supraventricular arrhythmias, 18 were completely controlled and the other 9 were markedly improved. Six of 8 patients with recurrent life-threatening ventricular arrhythmias were well controlled symptomatically. Results were predictably less satisfactory in 15 high risk post-infarction patients with malignant arrhythmias and severe myocardial damage, but 6 were probably improved as a result of amiodarone. All patients on maintenance therapy for 3 months or more developed corneal microdeposits. None has any visual symptoms or other ocular defect, and treatment has not been curtailed as a result of this well recognized effect which is believed to be reversible and benign. Amiodarone can control patients with otherwise refractory arrhythmias including some which are life-threatening. Formal clinical trials are needed to define accurately its future role in the prevention and treatment of serious rhythm disorders of the heart.
The cause of the raised plasma urea of acute heart failure
Authors: Thomas R D , Newill A , Morgan D B
Published: December 2008

The concentrations of urea, urate, phosphate and creatinine were measured in the plasma of 30 consecutive patients admitted acutely with heart failure. On admission, 20 had a raised plasma urea, 21 had a raised plasma urate, but only 6 had a raised plasma phosphate and only 6 had a raised plasma creatinine. A further 9 of the patients developed a raised plasma urea after admission. The increase in plasma urea present on admission was greater than expected for the fall in GFR (as indicated by the increase in plasma creatinine). The results for plasma and urine taken together suggest that a major cause of the raised plasma urea was an increased urea production rather than a reduced glomerular filtration rate. There was no obvious relationship between plasma urea and clinical features, or diuretic therapy.
Extra-cranial aneurysm of the internal carotid artery treated by proximal ligation
Authors: Haywood I R , Ellis H
Published: December 2008

A case of aneurysm of the extra-cranial section of the internal carotid artery extending to the base of the skull is described. Treatment comprised proximal vessel ligation, the tolerance of the patient's cerebral circulation to this procedure first being assessed by measuring the back pressure across the circle of Willis after temporary carotid artery occlusion. The value of this technique is discussed.
Subendocardial infarction and thrombocytopenia
Authors: Fireman Z , Yust I , Zahavi J , Kahn Y , Abramov L A
Published: December 2008

Two female patients who suffered from drug-induced thrombocytopenic purpura and subendocardial myocardial infarction are presented. One of them died from cerebral haemorrhage and diffuse subendocardial punctate haemorrhages were found at post-mortem. The abnormal haemostasis which is associated with thrombocytopenia might induce diffuse damage of the myocardium and might impair heart performance. This finding may be more frequent than hitherto appreciated and calls for serial electrographic tracings in thrombocytopenic patients.
Volvulus of the transverse colon
Authors: Mortensen N J McC , Hoffman G
Published: December 2008

Volvulus of the transverse colon is a rare condition requiring early diagnosis and treatment. In the absence of ischaemic changes within the redundant bowel, success can be anticipated with conservative fixation procedures. A case is reported which was treated by reduction, decompression and parallel colopexy. Although this disease has been infrequently reported in the past there may well be an increasing incidence with the introduction of high fibre diets and the use of the colonoscope.
The pathogenesis of respiratory viral infection
Authors: Heath R B
Published: December 2008

Sendai virus is used as a model to study the histological response and the mechanism of recovery of mice from infection. Although mice infected intranasally do not appear ill, the ciliated columnar cells of the bronchial epithelium undergoes rapid necrosis followed later by repair. Interferon is produced at an early stage of infection and antibody formation follows later. Cyclophosphamide given to mice infected with Sendai virus abolishes the humoral antibody response but not interferon production; the mice develop pneumonic lesions. They cannot eliminate virus and they die. On the other hand, deprivation of ‘T’ lymphocytes by thymectomy, irradiation and bone marrow reconstitution renders mice more susceptible to Sendai virus but they do not die. The humoral response is thus apparently helped by ‘T’ lymphocytes and interferon production is not vital for recovery.
The human enteric coronaviruses
Authors: Clarke S K R , Caul E O , Egglestone S I
Published: December 2008

A coronarirus was seen in the faeces from 15 (4·2%) of 355 adults with diarrhoea and from 5 (5·2%) of 96 adults without diarrhoea. Similar particles were seen in the faeces from 5 (2·2%) of 227 children aged 1–14 years with gastroenteritis, but in none of those from 230 infants under one year of age with gastroenteritis.

There was no evidence that the coronavirus was responsible for any of 34 outbreaks of gastroenteritis, although it possibly caused diarrhoea in patients admitted to a psycho-geriatric unit. Excretion of the virus often continued for many months.

One strain was propagated in human embryo kidney monolayers and human embryo intestinal organ cultures, although serial passage could not be accomplished.
Slow viruses and chronic disease of the central nervous system
Authors: Sutton R N P
Published: December 2008

Although recognized since the 1930s, slow infections have only recently received considerable attention. There are three types, group A (related to the type C RNA viruses), group B (bizarre agents such as scrapie and kuru) and group C (viruses such as measles which normally produce acute infections but which are behaving here in an unusual fashion). These viruses are only united in that they produce disease with excessively long incubation periods. Many slow infections result in neurological diseases and these will be discussed, together with some possible explanations of their action.
Antigenic memory to influenza A viruses in man determined by monovalent vaccines
Authors: Marine W M , Thomas J E
Published: December 2008

This study was conducted to test the limits of the doctrine of ‘original antigenic sin’ in influenza A. The design included use of zonal purified 1000 CCA (chick cell agglutinating) units monovalent vaccines consisting of H0N1, H1N1, H2N2 and H3N2. Age cohorts with different primary influenza A infections were established for the 687 volunteers. The vaccines administered to each age cohort were selected to test the responsiveness of original antigenic sin antibody to homologous and heterologous challenge. Anamnestic responses were demonstrated with Hsw1N1,H0N1, and H1N1 and with H2N2 and H3N2 but not between the groups. The synthesis of these findings is that there are 2 original antigenic sins - 2 families of influenza A viruses.
Chlormethiazole—no hangover effect but not an ideal hypnotic for the young
Authors: Castleden C M , George C F , Sedgwick E M
Published: December 2008

The hangover effects of 768 mg chlormethiazole, an hypnotic with a half-life of approximately 4 hr, were compared with those of placebo in a double-blind cross-over study in 8 young subjects. Ten hours after dosing there were no differences between the preparations in the subjects' psychomotor performance, EEG sleep scores, or visual analogue ratings. Thus, an hypnotic which is rapidly removed from the body may confer considerable advantages. However, all 8 subjects had unpleasant nasal symptoms following chlormethiazole, and it is therefore not an ideal hypnotic for this age group.
Progressive systemic sclerosis in the elderly
Authors: Dalziel J A , Wilcock G K
Published: December 2008

There is evidence to suggest that the incidence of progressive systemic sclerosis in the elderly is more common than in younger age groups. As in younger patients, late onset cases may have minimal skin changes and this can cause difficulty in diagnosis. The case histories of 2 patients are presented to illustrate these points.
Sarcoma obstructing right ventricular cavity: clinical, echocardiographic, haemodynamic and angiographic features
Authors: Malcolm A D , Shiu M F , Jenkins B S
Published: December 2008

Right atrial hypertension and pericardial effusion developed 2 years after mastectomy for fibrosarcoma. Clinical and echocardiographic features suggested right ventricular tumour. At catheterization the right ventricular cavity was almost obliterated, with an infundibular gradient of 13 mmHg, and biopsy of the mass was attempted. Post-mortem revealed extensive infiltrating and intracavitary right ventricular fibrosarcoma without extracardiac tumour.
Isolated perforation of the gall bladder following blunt abdominal trauma
Authors: Laffey D A , Hay D J
Published: December 2008

Isolated perforation of the gall bladder as a consequence of blunt abdominal injury is rare. A single case is described which illustrates several features which may characterize this lesion.
The effect of darkness on vitamin D in adults
Authors: Fairney A , Fry J , Lipscomb A
Published: December 2008

Circulating 25-hydroxy vitamin D measurements were made on Caucasians in the Antarctic. Following a period of 3 months' complete darkness there was a significant fall in 25-hydroxy vitamin D values. These results emphasize the importance of u.v. light on skin synthesis of cholecalciferol and support the view that the geriatric and immigrant population should be adequately exposed to sunlight to prevent vitamin D deficiency.
Nutrition in pregnancy
Authors: Hytten F E
Published: December 2008

Epidemiological evidence shows that women living in affluent circumstances have bigger babies with a lower mortality than underpriviliged women. How much of that effect is due to nutrition alone is not known but supplementary feeding in pregnancy of chronically ill nourished women does appear to increase mean birth weight, and famine conditions in a basically well nourished community reduce the birth weight; in both cases the birth weight difference is relatively small and could be accounted for by no more than fetal adipose tissue.

The fetus may be much less vulnerable to vagaries of maternal diet than has been thought because of protective physiological mechanisms associated with pregnancy. Firstly the mother's energy balance changes, so that if she has access to extra food in the first half of pregnancy she will store large amounts of depot fat as an energy buffer against possible privation later. Secondly, there are widespread changes in nutrient metabolism one of which is to lower plasma levels of most nutrients, and that may tip the balance of advantage away from maternal tissue towards the placenta. Finally, the placenta itself has developed elaborate mechanisms to acquire nutrients from the maternal circulation. A notable exception to that rule is glucose for which no active transport mechanism has evolved and which might therefore be regarded as a low priority nutrient; it may be that the generous supply of glucose for the fetus which would be provided by a well fed woman does little more than allow the fetus to build up its fat stores.
Blood clotting and fibrinolysis in pregnancy
Authors: Howie P W
Published: December 2008

During normal pregnancy, the concentrations of many of the clotting factors rise, thereby increasing the potential to generate fibrin. There is also evidence of increased thrombin activity during normal pregnancy which sharply increases during placental separation. Antithrombin III, the main inhibitor of thrombin and activated factor X, shows no compensatory rise during pregnancy but increases during the puerperium.

Plasminogen and antiplasmin concentrations rise during pregnancy but systemic fibrinolytic activity, as measured by the euglobulin lysis time, is markedly depressed during pregnancy; the reduced fibrinolytic activity returns to non-pregnant values very soon after delivery. The loss of fibrinolytic activity is presumed to be loss of plasminogen activator, because when this is added in excess in the urokinase sensitivity test, the fibrinolytic response is normal. The capacity for localized fibrinolytic activity is not lost, however, because fibrinolytic degradation products are slightly raised during pregnancy.

The overall pattern is one of increased coagulant and reduced fibrinolytic capacity during pregnancy which may protect the pregnant woman against the haemostatic challenge of placental separation.
Diabetes insipidus, diabetes mellitus, optic atrophy and deafness. A clinical and genetic study
Authors: Nagi N A
Published: December 2008

Two Iraqi sisters and a female cousin developed diabetes insipidus (DI), diabetes mellitus (DM), optic atrophy (OA), and deafness (D), (the ‘DIDMOAD’ syndrome) before the age of 12 years. One girl exhibited all the features of this disease complex only 3 months after an unusually late onset of recognizable symptoms at 11 years 9 months. Another girl died suddenly and unexpectedly. This family study illustrates the recessive inheritance pattern of the syndrome.
Weight and skeletal maturation - a study of radiological and chronological age in an anorexia nervosa population
Authors: Lacey J H , Crisp A H , Hart G , Kirkwood B A
Published: December 2008

The carpal bones of 18 anorexia nervosa patients were radiographed and the X-ray age assessed by 2 different standard methods.

The study demonstrates that skeletal development in anorexia nervosa patients is delayed such that there is no association between radiological assessment of age and chronological age. It is strongly suggested that bony development actually ceases when body weight falls sufficiently to stop menstruation. There was a highly significant (P = 0.001) linear relationship between radiological age and the sum of the age of onset of the illness plus any period(s) of re-feeding. Weight gain seems to re-kindle the bone maturing mechanisms: the role of weight thresholds and associated hormone activity being discussed.

The findings of this study strongly support the existing evidence that the anorexia nervosa patient is biologically and psychologically immature.
Cimetidine in the prevention of gastric ulcer relapse
Authors: Machell R J , Ciclitira P J , Farthing M J G , Dick A P , Hunter J O
Published: December 2008

Twenty-five patients with healed gastric ulcers completed an 11-month double-blind controlled trial comparing cimetidine 1 g daily with placebo in the prevention of ulcer relapse. Ulcers recurred in 14 patients, 12 on placebo, 2 on cimetidine. In 11 patients, 9 on cimetidine, 2 on placebo, the ulcers remained healed at the end of the trial (P < 0.002).

Cimetidine 1 g daily significantly reduces the relapse rate in gastric ulceration.
The anal cushions—a fresh concept in diagnosis
Authors: Thomson H
Published: December 2008

The anal canal is lined by cushions of specialized submucosal tissue which assist the continence mechanism. Starting with that premise, its various afflictions are examined and found to be more logically related, and much more readily understood.
Paradoxical embolism associated with oral contraceptives: an underdiagnosed lesion?
Authors: de Swiet J
Published: December 2008

A case of cerebral embolism is described in which paradoxical features have been proved clinically, and which may explain some hitherto unaccountable reported cases, and suggests the value of prospective studies. A successful outcome of such a proved case, associated with oral contraceptives, does not appear to have been reported previously.