bluuebunny/crossref_metadata_2025 huggingface dataset:
The significance of hyponatraemia in liver failure
Authors: Ring-Larsen H
Published: December 2008

It is possible by means of peritoneal dialysis to correct hyponatraemia occurring in liver failure. The normalization is not, however, attended by any apparent improvement in liver function, hepatic encephalopathy or renal function. Likewise correction of the serum ammonia level did not improve the clinical picture.

A correction of the extracellular ion concentration and a possible more normal intracellular composition achieved by peritoneal dialysis may thus eliminate one life-threatening factor in severe liver failure. However, this does not seem to improve the chances of survival of the patients.
Discussion
Authors: de Wardener H E
Published: December 2008

Dr V. Arroyo (Barcelona): We did a study on the incidence and possible mechanism of hyponatraemia in fifty-five cirrhotic patients with ascites. Thirty-one patients had a normal plasma sodium concentration (> 130 mEq/1) and were considered a control group. The twenty-four patients with hyponatraemia could be divided into two separate groups. One group had a very low renal capacity to excrete free water with values for free water clearance less than 1 ml/min and in these patients the hyponatraemia could be explained on the basis of over hydration. However, the other group with hyponatraemia had a similar capacity to excrete free water as the control group. In this group there must be another mechanism, e.g. a shift of sodium from extra-cellular to intracellular spaces.
A rational approach to the treatment of ascites
Authors: Arroyo V , Rodés J
Published: December 2008

A rational approach to the diuretic therapy of ascites is proposed. Fifty-five patients were classified according to their ability to excrete sodium and free water. Patients with a high urinary sodium excretion can be treated by low sodium intake alone. In most patients with a low sodium excretion but high free water clearance, distal diuretics (spironolactone or triamterene) with a low sodium diet will relieve ascites. Patients with low values for sodium excretion and free water clearance also have poor glomerular filtration rate and only a few of these will respond to diuretic therapy.
Discussion
Authors: Sherlock Sheila
Published: December 2008

Chairman: Ought we to investigate renal function in every patient with ascites in the way you describe?
Discussion
Authors: Sherlock Sheila
Published: December 2008

Chairman: I am most surprised at your results on the changes in portal pressure you describe, Dr Arroyo. How did you measure the pressure?
Obituary Ian Gilliland 16 February 1913-10 July 1975
Authors: Krikler D M
Published: December 2008

When Dr A. A. G. Lewis relinquished the editorship of the Postgraduate Medical Journal in February 1973, the choice of a successor was obviously crucial. The journal had taken a deliberate step to involve itself more deeply in the reporting and analysis of medical advances, and the availability of Ian Gilliland was warmly welcomed. His intense involvement in medical education had made him an obvious choice, and this was supported by his close contacts with the British Postgraduate Medical Federation and the Royal Postgraduate Medical School. Unfortunately illness struck within a short while, but he was able to carry on and guide the journal for a total period of some 2 years before he relapsed. During this brief time, he showed great intellectual vigour and considerable promise, and his loss will thus be all the more keenly felt.
Evaluation of baclofen (Lioresal) for spasticity in multiple sclerosis
Authors: Hedley D W , Maroun J A , Espir Michael L E
Published: December 2008

The effect of baclofen on spasticity and muscle spasms was assessed in thirty-five patients with multiple sclerosis. Benefit from reduction of spasticity was obtained in sixteen patients. A higher proportion of patients confined to a wheelchair was helped than ambulant patients, but overall functional improvement was limited. Twenty-one of the thirty-five patients had troublesome spasms and thirteen of them had significant relief on baclofen. Substituting identical dummy tablets confirmed that benefit was attributable to the pharmacological effects of baclofen in ten of the sixteen patients whose spasticity was reduced and in eight of the thirteen whose muscle spasms were relieved. In two of the remainder, benefit appeared to be due to placebo effect, and the others maintained their improvement after stopping the drug.

The drug had to be withdrawn in nine patients because of increased weakness and in ten other patients who had intolerable side effects. The optimum dose of baclofen tolerated ranged from 15 mg to 80 mg daily. The importance of adjusting the dose regime to the requirement of each individual and starting with small doses in multiple sclerosis is emphasized.
Severe Guillain-Barré syndrome following urethritis with cardiovascular and ophthalmic involvement
Authors: Marshall A J , Rogerson F Elizabeth
Published: December 2008

A patient with a severe form of the Guillain-Barré syndrome is described and the case illustrates the rare cardiovascular and ophthalmic complications which can occur. Urethritis, probably due to gonorrhoea, preceded neurological symptoms and this association has not been previously reported.
Hypertrophic osteoarthropathy associated with Fallot’s tetralogy—a case report
Authors: George B Olu , Mabayoje J Olu
Published: December 2008

A case of Fallot’s tetralogy associated with hypertrophic osteoarthropathy in a young Nigerian female is described. The clinical spectrum of hypertrophic osteoarthropathy is reviewed. The rarity of this syndrome is stressed. Some other aspects of the clinical manifestation of cyanotic congenital heart disease which may mimic the skeletal syndrome are mentioned.
Cryptococcal meningitis in steroid-treated systemic lupus erythematosus
Authors: Khan M Anees , Sbar Sidney
Published: December 2008

A case of cryptococcal meningitis complicating steroid-treated systemic lupus erythematosus (SLE) which was successfully treated with amphotericin B is described.

Although apparently rare, this mycotic infection has been reported from six patients with SLE in the medical literature over the past 10 years. Four of the six had been treated with steroids for periods ranging from 10 weeks to 6 years. In only one of these was the fungal infection diagnosed and effectively treated. Because effective therapy is available it is imperative that cryptococcal meningitis be not confused with progressive central nervous system involvement of SLE.
Familial dwarfism: case report
Authors: Nader S , Fisher J A , Doyle F H , Mashiter K , Joplin G F
Published: December 2008

Three sisters are described, of consanguinous parents, with multiple trophic hormone deficiencies presenting as short stature. In two of them the size of the sella turcica is large in relation to the skeletal age and height. All three show an acute metabolic response to an administered preparation of human growth hormone.
Agreement and disagreement between pathologists in histological diagnosis
Authors: Sissons H A
Published: December 2008

Studies on differences of observation and interpretation between pathologists in connection with histological diagnosis are rare. The present paper gives a general account of such a study, by members of the Cancer Research Campaign’s Bone Tumour Panel, of certain histological features of ‘malignant round-cell tumours’ of bone. Significant differences were found, not only between the different cases studied, but between the observations of the different pathologists, and between the repeated observations of individual pathologists.
The influence of nutritional factors on lead absorption
Authors: Barltrop D , Khoo H E
Published: December 2008

The nutritional factors which affect lead absorption have been studied. Synthetic diets of known composition were compounded to contain 0·075% Pb as PbCl2 labelled with 203Pb. Rats were exposed to lead for periods of 48 hr. The dietary intake was then measured and the absorption of lead determined by means of a whole-body counter. Lead absorption was increased by high fat, low mineral, low protein and high protein diets but was decreased by high mineral diet. Low fat, low fibre, high fibre, low vitamin and high vitamin diets had no effects on lead absorption.
Food hygiene and travel at sea
Authors: Hobbs Betty C , Colbourne M J , Mayner P E
Published: December 2008

The incidence of gastroenteritis on a passenger ship is reviewed and discussed in relation to the agents of infection from stool specimens, the bacteriological condition of food samples, and the practice of galley hygiene.
Testicular tumour presenting as haematemesis
Authors: Lock M R
Published: December 2008

The case is presented of a malignant testicular tumour which presented with a haematemesis due to multiple tumour deposits in both stomach and jejunum. No similar case has been previously recorded. The pathology and aetiology of testicular tumours are discussed.
Transient psychological syndrome following diazepam therapy for tetanus
Authors: Malatinský J , Procházka M , Kadlic T
Published: December 2008

Two cases of transitory reversible pathopsychological changes associated with diazepam therapy in tetanus are described. The psychopathology developed owing to an abrupt discontinuance of diazepam or to a sudden reduction of its dosage. The reinstitution of diazepam in low doses and the administration of regulators of cerebral metabolism resulted in a progressive normalization of the psychological state.

It is suggested that the described syndrome was caused by two aetiological factors; the toxinfectious factor giving rise to the primary cerebral dysfunction, and the prolonged action of high doses of diazepam with a sudden withdrawal, playing a role as precipitating factor.

EEG findings showed widespread abnormality which corresponded with the clinical diagnosis. Even the normalization in EEG correlated well with the disappearance of psychiatric symptomatology.

To avoid such undesirable psychic side effects, a gradual discontinuance of the drug is recommended.
VP 16-213 in acute myelogenous leukaemia
Authors: Smith I E , Clink H MacD , Gerken M E , McElwain T J
Published: December 2008

The use of the epipodophyllotoxin VP 16-213 is described in twenty patients with acute myelogenous leukaemia resistant to other chemotherapy. The drug was usually given in 5-day courses of 50 mg/m2 daily and occasionally in 24-hr infusions of 250 mg/m2, on the basis of its phase-activity.

Complete remission was achieved in only two patients: in one of these, remission was maintained with VP 16-213 for 8 months, and in the other for 10 weeks. A partial response was achieved in one other patient. Seventeen patients showed no response. No responses or remissions were achieved when the drug was used in a 24-hr infusion. Side effects were minimal, and the degree of marrow depression much less than for most other agents known to be active in acute myelogenous leukaemia. It was of interest that remission was achieved in one patient without the customary period of marrow hypoplasia. It is suggested that, although VP 16-213 appears to have minimal activity in the dosage used here, improvement might be sought by increasing the dosage, by scheduling the drug in a different way, or by using it in a combination chemotherapy regime.
Inhibition of platelet release reaction by acetylsalicylic acid
Authors: Rowan R M , Renton R L , McDonald G A , Corne S J , Brown D F
Published: December 2008

The inhibitory potency and duration of action of single doses of aspirin B.P., claradin (a low sodium effervescent preparation of acetylsalicylic acid) and aloxiprin (an aluminium co-polymer of acetylsalicylic acid) on platelet release reaction induced by adenosine diphosphate (ADP) were studied in seventeen volunteers. Aspirin B.P. and claradin at 300 mg and 150 mg inhibited release reaction in all subjects within 24 hr; 75 mg was effective only in some subjects. Aloxiprin gave less marked response and a dose of 300 mg was required to inhibit the effect in all volunteers. Where occurring, inhibition of release reaction persisted for three days after treatment with all preparations and restoration to normal occurred in most subjects by the sixth day.

A daily dose of 50 mg claradin for 12-15 days in five volunteers produced complete inhibition of release reaction for most of the treatment period. Inhibition of release reaction took up to 3 days to occur. Normal aggregation returned within 3 days of discontinuing treatment in all subjects. A daily dose of 25 mg claradin gave inconsistent results.

It is suggested that if a trial of acetylsalicylic acid be undertaken for the prevention of arterial thrombosis based on its ability to inhibit platelet release reaction then a daily dose of 50 mg would be sufficient.
The effect of desmethylimipramine on the absorption of alcohol and paracetamol
Authors: Hall R C , Carter R , Brown Deirdre , Kendall M J
Published: December 2008

Many drugs can delay gastric emptying and may thereby impair the absorption of other drugs. Desmethylimipramine (DMI) is an antidepressant with anticholinergic properties which might be expected to delay the rate of gastric emptying. In five out of six subjects, DMI significantly delayed both the absorption of alcohol (assessed by a breathalyser) and of paracetamol, and there was a correlation between the two. The breathalyser can therefore be used to predict the extent to which one may impair the absorption of another drug by its effect on gastrointestinal motility.
Effects of β-adrenergic blockade and stimulation on airways in normal subjects
Authors: Bradley G W , Henderson A K , Mills R J
Published: December 2008

The effects of propranolol and salbutamol on conventional pulmonary function tests and closing volume have been studied in ten normal subjects. Propranolol and salbutamol had minor effects on measurements of airways resistance but had no effect on closing volume which is particularly sensitive to changes in peripheral airways. It was concluded that propranolol had negligible overall effect on central and peripheral airways properties in normal subjects, and it would appear that β-adrenergic activity has little measurable influence on peripheral airways in normal man at rest.
5-Hydroxytryptamine (5-HT) in the whole-blood of patients with depressive illness
Authors: Coppen A , Rowsell A R , Turner P , Padgham Cheryl
Published: December 2008

Whole-blood 5-HT was examined in thirty-five depressive patients not on antidepressants, and in comparable control subjects. The concentration of whole-blood 5-HT was significantly lower during depression, but returned to normal after clinical recovery.
GM1-generalized gangliosidosis variant with cardiomegaly
Authors: Benson P F , Brown S P , Babarik A , Mann T P
Published: December 2008

A female infant with generalized GM1-gangliosidosis differing in several aspects from previously reported cases is described. Clinically she is the first case to have cardiomegaly, unilateral congenitial dislocation of the hip and normal facial appearance. She had a higher residual leucocyte β-galactosidase activity towards two synthetic substrates, namely p-nitrophenyl-β-D-galactoside (PNP-β-gal) and 4-methylumbelliferyl-β-D-galactoside (MU-β-gal) than in previously reported cases. Total β-hexosaminidase activity was raised in cultured fibroblasts, leucocytes, brain, kidneys and liver of the patient, and in fibroblasts from the parents. The parents' leucocytes had normal β-galactosidase activity towards PNP-β-gal but slightly reduced activity towards MU-β-gal. The parents' cultured fibroblast enzyme, however, had moderately low activities towards both substrates.

It is suggested that she may represent a genetic variant of generalized GM1-gangliosidosis and that assay of leucocyte β-galactosidase activity should be added to the list of investigations for infantile cardiomegaly of unknown origin.
The role of humoral immunity in host defence against influenza A infection in mice
Authors: Virelizier J L , Oxford J S , Schild G C
Published: December 2008

The respective roles of cell-mediated immunity and humoral immunity in host defence were investigated in mice infected with influenza A/PR8 virus. Transferred immune spleen cells were shown to provide full protection only when they were actually secreting antibody. Serum antibody transferred in ‘physiological’ amounts was found to be protective in immunologically intact or in immunosuppressed animals. The specificity of the transferred antibody was shown to be critical, since antibody to internal components of the virus was inefficient while antibody to haemagglutinin, especially that to the strain-specific determinants of the haemagglutinin molecule, was highly efficient.
Assessment of vaccine efficacy by challenge studies in man
Authors: Tyrrell D A J
Published: December 2008

The only final test of the potency of a vaccine is its ability to protect against exposure in an epidemic. Laboratory tests for control purposes attempt to predict this capacity. It is suggested that challenging small groups of volunteers with attenuated influenza virus is a good index of immunity which could be used to check and refine present tests and to evaluate new ones.
Planning for influenza epidemics
Authors: Beare A S
Published: December 2008

In the present circumstances, influenza vaccination cannot produce a significant reduction in the incidence of the disease without preliminary preparation and planning. The epidemiological situation is constantly changing, and vaccines should be chosen for their suitability for prevailing conditions. When viral antigens undergo appreciable change, and immunity in the population is low, people are especially susceptible to infection with live vaccines made from the new variants. Because of their potential high yield, it is therefore possible at this time to consider the use of these vaccines on a large scale. In interpandemic years, killed vaccines should be used selectively for the protection of individuals, but may also be considered for more general use in closed communities. Vaccines should as far as possible contain the same antigens as the epidemic virus. Reassessment of the influenza situation should be made annually, taking into account the types of viruses in circulation, the immune state of the population and any other factors likely to affect influenza outbreaks. Regular attempts to do this would ultimately improve the standard of forecasting.

Random immunization, as is practised for other virus diseases, is unprofitable in influenza.
Glucose intolerance, diabetes mellitus and atherosclerosis; prospects for prevention
Authors: Keen Harry
Published: December 2008

Increased prevalence and incidence of arterial disease has become the major cause of disability and death in diabetics in Western cultures—but is much less common among Japanese and African diabetics. In the West, the presence of lesser, ‘subdiabetic’ degrees of glucose intolerance are probably independent ‘risk factors’ for accelerated atherosclerosis. Although many explanations for the link have been advanced—among them direct effects of glucose and insulin on the arterial wall, less direct effects of circulating lipoproteins, abnormalities of blood clotting and fibrinolysis and elevated blood pressure, even the influence of antidiabetic treatment itself—none has been clearly established. Nevertheless there is scope and hope that appropriate measures may reduce the raised arterial disease risk in the diabetic.
Evidence of regression of atherosclerosis in primates and man
Authors: Armstrong Mark L
Published: December 2008

Atherosclerotic lesions induced in non-human primates regress after the stimulus is removed. That some human lesions also regress is strongly suggested by several types of evidence. The general course of human atherosclerosis is progressive, and the impact of current regimens on the rate of progression is uncertain.
Exertional hypotension due to postganglionic sympathetic blocking drugs
Authors: Talbot S , Gill G W
Published: December 2008

Debrisoquine, guanethidine and bethanidine may produce troublesome hypotensive symtoms related to exertion. Thirteen patients with such symptoms were exercised on a treadmill and the response of blood pressure and heart rate was compared to that of thirty patients without these symptoms, who were exercised to the same extent. There was a slight drop of systolic and diastolic pressures on standing in both groups, but after exertion there was a significantly greater drop of systolic pressure in the group with symptoms than in the asymptomatic group. The diastolic pressure after exertion was significantly lower in the group with symptoms. It was impossible to predict from the standing blood pressure levels at rest which patients would develop hypotensive symptoms after exertion. All three drugs had a similar negative chronotropic effect at rest and on exercise. It is suggested that patients are exercised during control of hypertension in order to identify those prone to exertional hypotension. Patients with such hypotension should be exercised on each attendance before the blood pressure is measured. Treatment other than postganglionic sympathetic blocking drugs should be employed whenever possible in patients with milder hypertension.
Betahistine hydrochloride in Méniére's disease
Authors: Frew I J C , Menon G N
Published: December 2008

A double-blind, placebo-controlled, cross-over clinical trial was performed to assess the effect of betahistine hydrochloride (Serc) in Ménière's disease. The diagnosis was based on paroxysmal attacks of rotational vertigo, with tinnitus, and a fluctuating sensori-neural deafness, together with the results of auditory and vestigular tests. Twenty-eight patients were admitted to the trial over 3 years. Twenty-two patients completed the trial. In total, they received betahistine 32 mg daily, for a period of 16 weeks, and placebo also for the same length of time, preceded in every case by a 4-week pre-treatment period. Daily symptom score cards were kept. There was a statistically significant improvement in favour of the drug with regard to vertigo, tinnitus and deafness. Vertigo was the most responsive symptom. No adverse reactions were observed.
Levamisole treatment of a child with severe aphthous stomatitis and neutropenia
Authors: Verhaegen H , De Crée J , De Cock W , Brugmans J
Published: December 2008

The treatment of a 12-year-old girl with a lifelone history of recurrent infections and aphthous stomatitis is reported. A profound neutropenis, first noted at the age of 2 years, occurring at least every month was observed together with multiple mouth ulcers a sore throat and swelling of the jugular glands. Levamisole, originally described as an anthelmintic, has a beneficial effect on the symptoms of recurrent aphthous stomatitis. After levamisole treatment aphthous stomatitis was milder and in the 1-year follow-up period the patient was asymptomatic several times during a phase of obvious neutrophil depression. The child no longer complained of a sore throat with swelling of the jugular glands and the recurrent staphylococcal infections of the skin disappeared. After therapy a marked increase in monocytes at the moment of neutropenia was observed.
Isolation for high-risk patients
Authors: Emond Ronald T D
Published: December 2008

Standard isolation accommodation provides adequate protection against the infectious diseases prevalent in the U.K. but higher standards are necessary for more dangerous infections imported from overseas. These may be provided reasonably cheaply by modifying existing wards but staff are still exposed to risk. By physically separating the patient from the attendants, the Trexler plastic isolator affords a greater degree of protection and is of particular value when dealing with a dangerous infection against which there is no form of immunization.
Chemoprophylaxis of respiratory infections
Authors: Batten John
Published: December 2008

Chemoprophylaxis of certain respiratory infections has been described. The benefit and cost of chemoprophylaxis of tuberculosis have been compared and indications outlined. While some protection against influenzal infection by drugs of the adamantane group has been demonstrated, chemoprophylaxis against respiratory virus infections is as yet unavailable or impractical. In diseases associated with impaired bronchial clearance the influence of long term chemoprophylaxis on the natural history of the disorders becomes less certain. Morbidity in chronic bronchitis and bronchiectasis may be reduced. In cystic fibrosis, however, although the prognosis has been undoubtedly improved by chemoprophylaxis, the effects of long term treatment of infection in the later stages are uncertain.
Phaeochromocytoma and hypercalcaemia
Authors: Ghose R R , Winsey H S , Jemmett J , Woodhead J S
Published: December 2008

An example of possible pseudohyperparathyroidism associated with a non-endocrine benign tumour is reported. Some of the pertinent factors contributing to hypercalcaemia under these circumstances are reviewed, with particular reference to ectopic hyperparathyroidism and catecholamine-induced endogenous hyperparathyroidism.
Stricture of the descending colon due to schistosomiasis
Authors: Wright S G , Renton Peter , Swarbrick E T
Published: December 2008

An example of a localized non-fibrous stricture of the colon due to Schistosoma mansoni infection is reported. The radiological and colonoscopic features are described. After treatment of the infection with niridazole, the stricture resolved completely. The pathogenesis of bowel lesions in schistosomiasis is briefly discussed.
The validity and significance of hormone levels in gynaecology
Authors: Sommerville Ian F
Published: December 2008

The development of radioimmunoassay of steroid hormones in peripheral venous blood has led to a more direct index of gonadal production and concurrent monitoring of glandular function. While serial analyses of total urinary oestrogens can be correlated with luteinizing hormone (LH) excretion in treating amenorrhoea, radioimmunoassay of plasma oestrogens measures acute changes in ovarian responsiveness. For studies of androgens radioimmunoassay of plasma testosterone is the method of choice, but fractionation of urinary 17-oxosteroids may be useful and can be extended to include the pregnane series and corticoids. Urinary pregnanediol, however, may not reflect the endogenous secretion of progesterone and should be reserved for assessing induction of ovulation. Luteal function can be evaluated rapidly and specifically by radioimmunoassay of plasma progesterone. Although radioimmunoassay offers a new approach to ovarian physiology, its systematic application to disease is still in the future.
Steroids in the assessment of prenatal development
Authors: Chamberlain Geoffrey , Kitchin Yvonne
Published: December 2008

Methods for identifying the fetus at risk and monitoring fetal well-being as pregnancy progresses are now an established part of prenatal care in the Western World. In this short review the use of steroids in the assessment of prenatal development is discussed. The metabolism of oestrogens, progestogens, corticosteroids and androgens during pregnancy is outlined and the relative merits, in terms of usefulness and practicability, of urinary and plasma steroid assays are discussed.
Steroids and the eye—indications and complications
Authors: Dinning W J
Published: December 2008

Corticosteroid therapy is of great value in many types of eye disease. The indications are briefly discussed, together with the choice of agent and mode of administration. The dangers of steroids are now widely recognized, and the complications are discussed, particularly cataract and glaucoma. Reference is also made to optic neuritis and thyroid ophthalmopathy, where the role of steroids is uncertain. Particular stress is laid on the need to keep steroid dosage as low as possible, so as to avoid systemic side effects. There are unfortunately many situations where treatment of doubtful efficacy has produced severe side effects. Despite the overall benefit of steroids in ophthalmology, there is a pressing need to find alternative treatment for a variety of blinding disorders.
The possibility of dietary protective factors in duodenal ulcer. II. An investigation into the effect of pre-feeding with different diets and of instillation of foodstuffs into the stomach on the incidence of ulcers in pylorus-ligated rats
Authors: Jayaraj A Paul , Tovey Frank I , Clark C G
Published: December 2008

Rats pre-fed on a South Indian diet show a much higher incidence of ulceration of the stomach after pyloric ligation than those on a North Indian diet. Removing vegetables and pulses from the North Indian diet deprives it of its protective effect. Staple foodstuffs with a high buffer content (unmilled rice, unrefined wheat and a millet [ragi]) placed in the stomach after pyloric ligation are also protective, but those with a low buffer content (milled rice, tapioca, sorghum and maize) are not protective. Refined wheat, however, gives protection despite its low buffer content. The significance of these findings in relationship to the distribution of duodenal ulcer in India and Africa is discussed.
The interrelationship between hypocomplementaemia, partial lipodystrophy and mesangiocapillary glomerulonephritis
Authors: Wakefield Marion A
Published: December 2008

A further case of mesangiocapillary glomth reduced serum C3 levels is reported. The father of the patient was also found to have C3 deficiency. This lends support to the hypothesis that C3 deficiency may be the primary disorder relating these conditions and there is evidence in this case that the deficiency may be genetically determined. It is suggested that the complement state of close relatives, particularly younger siblings, of patients with these disorders should be investigated and, if abnormalities are found, they should be followed-up in order to elucidate the role of hypocomplementaemia in these uncommon disorders.
Systemic mastocytosis—central nervous system features and lymphographic demonstration of lymph node involvement
Authors: Hancock B W , Dandona P , Cumberland D C , Jarratt J A
Published: December 2008

Systemic mastocytosis is uncommon. A patient is reported with many of the characteristic lesions of this disorder but with two features not before described—the occurrence of mixed pyramidal and neuromyopathic neurological signs and the demonstration of lymph nodes with abnormal architecture by lymphography.
The results of 100 small tissue biopsies of testis in male infertile patients
Authors: Scott R , Sinclair J , Rourke A , Chowdhury S , Yates A , Shaba J
Published: December 2008

The value of testicular biopsy in male infertility has recently been emphasized by Meinhard, McRae and Chisholm (1973), and the present authors agree with them that a biopsy is essential for the following reasons: (1) to establish a firm diagnosis; (2) to rationalize therapy on the basis of histological findings; (3) new developments in drug therapy and electronmicroscopic techniques will help to clarify many areas of doubt and uncertainty in this difficult field; (4) the diagnosis of 'sloughing' by itself may mask changes in germinal cell development which may be amenable to hormone therapy.
Penetration of digoxin into cerebrospinal fluid
Authors: Schott G D , Holt D W , Hayler A M
Published: December 2008

The concentration of digoxin in the cerebrospinal fluid (CSF) of ten patients receiving conventional oral doses of this cardiac glycoside has been measured by a radioimmunoassay technique. Digoxin was undetected in eight patients and barely detectable in two, suggesting the presence of a significant blood-CSF barrier for digoxin. The implication of these findings is discussed.
Obstructive cholecystitis due to metastatic melanoma
Authors: Ostick D G , Haqqani M T
Published: December 2008

A patient with isolated metastases from cutaneous melanoma to the gall-bladder is reported. The patient presented clinically with obstructive cholecystitis. The course of melanoma is unpredictable and the possibility that an apparently unassociated condition is due to metastases should always be considered. Isolated metastases may respond well to radical surgery and reward the surgeon's efforts.
Technical possibilities for coronary artery bypass surgery and the outlook for graft patency
Authors: Yacoub M H
Published: December 2008

In an attempt to analyse the results of saphenous bypass grafting 213 patients were re-investigated by repeat coronary, graft and left ventricular angiography. In this series, the presence of diffuse arterial disease was not considered as a contra-indication to operation. Instead, additional endarterectomy was performed.

The overall patency rate was 88% and was not significantly altered by the passage of time, although the patency rate during the first 6 months was 94%. The patency rate did not appear to be influenced by the age of the patient, the severity of the lesion pre-operatively, the artery grafted nor additional endarterectomy. The run-off was judged to be good in 82% of grafts investigated before 6 months, compared to 70% of those investigated later. Progress of the disease in the native vessels appeared to be slightly accelerated in the segment proximal to the graft.
Phaeochromocytoma with unilateral renal artery stenosis
Authors: Thomas C , Kolhatkar R K , Sharma N L , Deodhare S G
Published: December 2008

A patient with renal artery stenosis due to compression by a phaeochromocytoma is described. He underwent nephrectomy and tumour removal successfully.
Correlation between anti-DNA antibody titre and psychiatric manifestations in systemic lupus erythematosus
Authors: Levo Y , Kalaci J , Pick A I , Golomb M
Published: December 2008

A patient with systemic lupus erythematosus with predominant psychiatric involvement was followed during two psychotic exacerbations of her disease. A high correlation was found between disease activity and the titre of anti-DNA antibodies. Disease activity was preceded and accompanied by a high titre, while remission was associated with low titre. The significance of this correlation for the pathogenesis, diagnosis and managment of the psychiatric symptoms of systemic lupus erythematosus are discussed.
Corrugation of the skull in Paget's disease of bone
Authors: Chakravorty N K , Das S K , Kataria M S
Published: December 2008

Paget's disease of bone has been known for about 100 years and the usual deformities of bone, e.g. bowed tibia, large head, are well described in medical text books. However, there does not appear to have been a description of corrugation of the skull as a recognized deformity in Paget's disease. Three cases are now described to illustrate this deformity as an unusual but valuable sign in this disease.
The simultaneous presentation of Hodgkin's disease of myeloma
Authors: Ibbotson R M , Revell P A , Molland E A , Minton M J
Published: December 2008

The simultaneous presentation of Hodgkin's disease and multiple myeloma is described. This is rare as only one previous case appears to have been documented. Speculations as to the aetiology are discussed as well as the significance of the presentation.
Survival and death from subdural haematoma on medical wards
Authors: Dronfield M W , Mead G M , Langman M J
Published: December 2008

All patients with subdural haematoma presenting to medical wards in Nottingham over a 5-year period have been reviewed. Of twenty-one such patients eight were first diagnosed at post-mortem, whilst all of the remaining thirteen patients in whom the diagnosis was made in life survived following neurosurgical evacuation of the haematoma. Diagnostic failure was caused mainly by failure to consider the possibility of subdural haematoma or misinterpretation of negative investigations. An attempt has been made to characterize the clinical patterns that may suggest the presence of a subdural haematoma, and recommendations are made on the investigation of such patients.
Pathological validation of auscultation of the elderly heart
Authors: Denham M J , Pomerance A , Hodkinson H M
Published: December 2008

Systolic murmurs present in 129 geriatric patients followed to post-mortem were assessed as mitral or aortic in origin by simple clinical assessment alone. Post-mortem examination contradicted clinical findings in only 2% of cases. Mitral valve pathology, mostly post-inflammatory scarring or mucoid degeneration, was present in 50% of the cases with murmurs. There was a significant correlation between the presence of murmurs, particularly mitral murmurs, and congestive cardiac failure, and there was also a significant correlation with age. A tendency for aortic systolic murmurs to be associated with a higher mean systolic blood pressure was not significant and there was no significant association between systolic murmurs and ischaemic heart disease.
Chlorpropamide-induced thrombocytopenia
Authors: Cunliffe D J , Gorst D W , Palmer H M
Published: December 2008

Thrombocytopenia is a rare complication of chlorpropamide therapy. An immunological mechanism is generally held responsible, but has never previously been proved. In the present case the existence of such a mechanism has been established.
Polyarteritis nodosa of the liver: a report of two cases
Authors: Cowan R E , Mallinson C N , Thomas G E , Thomson A D
Published: December 2008

Two patients with liver disease due to polyarteritis nodosa are described. They presented in a similar manner, with a swinging fever, a polymorphonuclear leucocytosis and high alkaline phosphatase levels, but the natural history of the illness was different, with revocery in one and death in the other.
The different effects of sodium bicarbonate and aluminium hydroxide on the absorption of indomethacin in man
Authors: Garnham J C , Kaspi T , Kaye C M , Oh V M
Published: December 2008

The influence of oral sodium bicarbonate and aluminium hydroxide on the absorption of indomethacin has been studied in normal volunteers. While sodium bicarbonate appeared to increase indomethacin absorption, aluminium hydroxide markedly reduced both the rate and extent of absorption. The buccal absorption of indomethacin over the pH range 5-9 was also studied in normal volunteers, and showed that the percentage absorption increased markedly as the pH was reduced. The clinical importance both of pH-partition and of adsorption are discussed in the context of antacid interactions. It is concluded that caution must be exercised when prescribing an antacid with other orally-administered drugs.
Coeliac disease with mild mucosal abnormalities: a report of four patients
Authors: Scott B B , Losowsky M S
Published: December 2008

In a routine adult gastroenterological practice, seventeen (15%) of 123 patients had small-intestinal biopsies which were neither normal nor were completely flat as found in classical coeliac disease. Some of these had a possible cause for the mild mucosal abnormality, but in six there was no other apparent cause and all four of these who were treated with a gluten-free diet responded morphologically and symptomatically. It is concluded that at least these four patients have coeliac disease in a mild form and that the classical flat biopsy is not a prerequisite for the diagnosis of coeliac disease.
Management of prolonged hypoglycaemia in Beckwith's syndrome
Authors: Moncrieff M W , Lacey K A , Malleson P N
Published: December 2008

A new-born baby with Beckwith's syndrome had severe hypoglycaemia, and was treated with glucagon and prednisone. Treatment was stopped at 1 month of age and his blood glucose levels were satisfactory for the ensuing 6 weeks. However, at 10 weeks of age, he had a hypoglycaemic convulsion and required large doses of diazoxide and prednisone for the next 2 months to maintain the blood glucose above 40 mg/100 ml. Insulin excretion was raised until he was 4 months old. Cases of Beckwith's syndrome which develop hypoglycaemia, should be treated with diazoxide and corticosteroids until insulin excretion is normal.
Pulmonary alveolar microlithiasis
Authors: Onadeko B O , Abioye A A , Beetlestone C A , Adetuyibi A , Cooke A R , Sofowora E O
Published: December 2008

A case of pulmonary avleolar microlithiasis is reported. This is of especial interest as it is the first case to be reported from Africa South of the Sahara. The clinical presentation of the patient follows a similar pattern as that of cases already described by other workers. The diagnosis in this case was made in life by a combination of radiological examination and a lung biopsy. The clinical presentat on and aetiology of the condition are briefly discussed.
A new look at erythromycin
Authors: Lacey R W
Published: December 2008

This article reviews the current place of erythromycin in antibiotic therapy. Overall, erythromycin is thought to be underused because: (1) the fear of resistance has been exaggerated; (2) significant toxicity has been associated with only one derivative (the estolate); (3) newer antibiotics have very rarely been demonstrated to be superior to erythromycin. Erythromycin has an important place in treating acute upper and lower respiratory tract infections, acute otitis media, sinusitis, skin and soft tissue, osteomyelitis, prostatitis, infections due to Mycoplasma spp. and Chlamydia organisms, and infections due to anaerobes.
Streptococcus agalactiae in urinary tract infections
Authors: Mhalu F S
Published: December 2008

Streptococcus agalactiae was found to be the cause of approximately 1% of urinary tract infections in a London teaching hospital in the 2 years studied. Of the forty-eight patients with this infection, forty-three were female. In nine patients the infection followed renal transplantation while in nine others it occurred in the presence of chronic renal failure. The rest, who included seven females who developed the infection following hysterectomies, had other clinical conditions which could have predisposed to such infections. The rarity of urinary tract infection by S. agalactiae is in contrast to the high frequency with which the organism colonizes the normal urethra. Serotypes III and II were the predominant isolates in these patients with urinary tract infections; this corresponds to the distribution of the different serotypes in the genito-urinary tract of normal individuals.
Perforation of the right ventricle and cardiac tamponade caused by a venous catheter
Authors: Iglesias A , Rufilanchas J J , Maronas J M , Figuera D
Published: December 2008

A case is reported in which a venous catheter perforated the right ventricle and caused cardiac tamponade. Methods recommended to avoid such complications include limiting the length of the radio-opaque catheter, and modifications to the catheter tip.
Acute appendicitis in association with non-obstructive carcinoma of the caecum
Authors: Waller D G , Glasgow M
Published: December 2008

A case of carcinoma of the caecum is reported, which presented as acute appendicitis, although the carcinoma did not obstruct either the lumen of the appendix or the colon. The prognosis for caecal or proximal colonic neoplasm presenting as appendicitis is poor. This is in part due to the association being missed at the initial laparotomy. It is suggested that a more aggessive attitude should be taken in the pre- and post-operative management of any patient over 50 years of age who presents with appendicitis. The difficulties of identifying a small tumour at laparotomy even if the mucosa can be palpated are emphasized.
Epistaxis and hypertension
Authors: Charles R , Corrigan E
Published: December 2008

The status of nose bleeding as a symptom of high blood pressure has been studied in patients admitted because of epistaxis. Twenty-six patients with a factor predisposing to nasal bleeding had age- and sex-adjusted systolic and diastolic scores similar to those of the general population. One hundred and sixty-eight patients with no such factor formed a different population with significantly higher age- and sex-adjusted systolic and diastolic scores. It is concluded that epistaxis is a true symptom of hypertension.
Fatal digoxin overdose
Authors: Nicholls D P
Published: December 2008

Overdosage with cardiac glycosides is well documented, but not usually fatal. A case is described in which cardiac arrest in asystole was associated with a serum digoxin level of 50-4 microgram/1, the highest concentration yet reported after oral administration.
Leiomyosarcomatosis of probable uterine origin with long survival—a case report
Authors: Young R A
Published: December 2008

A case of leiomyosarcomatosis is presented. Over a period of 15 years the patient underwent seven operations to remove eleven tumours, the largest as big as a football, before dying of widespread metastases: between operations the patient was remarkably well. The disease was almost certainly of uterine origin from apparently benign fibroids, and photomicrographs are provided as supportive evidence. The various modes of presentation of abdominal leiomyosarcoma—mass, pain, obstruction, fistula, anaemia—are illustrated in the case report. The value of repeated palliative surgery in such cases is emphasized.
Antibacterial therapy in general medical wards
Authors: Lawson D H , MacDonald S
Published: December 2008

Information from a comprehensive drug surveillance programme is analysed to provide details of antibacterial drug use in medical wards. Some 28% of patients received antibacterial therapy, usually for the treatment of respiratory or urinary tract infections. The agents most frequently prescribed were ampicillin, co-trimoxazole and tetracyclines. Overall, 11% of recipients experienced one or more adverse effect of therapy. No significant bacterial growth was obtained from some 40% of specimens of sputum sent from patients. A plea is made for more rational use both of sputum culture in the investigation of patients with respiratory infection and of antibiotics in their treatment.
Haematological abnormalities in acute pancreatitis. A prospective study
Authors: Murphy D , Imrie C W , Davidson J F
Published: December 2008

Twenty-five patients with acute pancreatitis were studied prospectively in the first week of their admission using haematological and coagulation tests. Platelet counts initially fell and later returned to admission levels. Rising levels of plasma fibrinogen were recorded. The kaolin cephalin clotting time was shorter than its control in twenty-one patients. Eighteen patients had elevated fibrinogen degradation products and fourteen had a positive ethanol gelation test. It is suggested that by taking into account the results in series of individual patients a degree of intravascular coagulation may be a common feature of acute pancreatitis. In one patient (presented in detail) strong evidence for disseminated intravascular coagulation was found
A case of myasthenia gravis treated with steroids: some suggestions for the mechanisms underlying their effect
Authors: Dandona P , Corkan E J , Sladen G E
Published: December 2008

This report deals with a patient with long standing myasthenia gravis treated with a small dose of corticosteroids. The response to treatment was prompt and the post-therapeutic deterioration in function was minimal and cholinergic in nature. It is suggested that the dose of anticholinesterases be reduced concomitantly with the institution of steroid treatment.
Pseudomembranous enterocolitis complicating ampicillin therapy
Authors: Read L , Cove-Smith J R
Published: December 2008

A case of fatal pseudomembranous enterocolitis associated with ampicillin therapy is described and possible mechanisms for its production discussed.
Active treatment of ganglia in children
Authors: MacKinnon A E , Azmy A
Published: December 2008

One hundred and twenty-eight children, admitted for active treatment of ganglia around the wrist, hand, ankle or foot are reviewed. The methods of treatment are discussed. The most satisfactory results were obtained by excision (7-2% recurrence) and incision with a tenotome (11% recurrence). The overall recurrence rate was 19%. The ganglia around the wrist had the highest rate of recurrence.