bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiological aspects of influenza in man and other animals
Authors: Hobson Derek
Published: December 2008

The recurrent problem in human influenza is the pandemic increase in mortality and social dislocation which occurs every 10–15 years whenever a new subtype of type A virus emerges, with antigens which cannot be neutralized by antibodies induced in the population by infection or vaccination with any of the foregoing epidemic strains.

There is an urgent need to interpret these past antigenic shifts so that the constitution of the next pandemic strain can be predicted, allowing effective specific vaccines to be made in advance.

The pandemic viruses are unlikely to be direct mutants from one to another. Epidemiological evidence of their cyclic recurrence in mankind at 70 year intervals suggests the role of animal reservoirs of influenza viruses. Man may be infected directly, or after genetic recombination between an animal virus with novel antigens and a human strain with the necessary virulence for man.
Clinical aspects of ‘Q’ fever
Authors: Brown G Laing
Published: December 2008

‘Q’ fever is an acute febrile illness seen mainly among members of the farming community. The infection is contracted from sheep and cows mainly by inhalation of infected dust, but can be spread by raw milk.

The symptoms bear a marked resemblance to influenza and in the majority of cases the illness clears up spontaneously. A firm diagnosis can best be made by demonstrating a rise in complement fixing antibodies. Patchy consolidation of the lungs is seen on X-ray in about one-third of the cases and occasionally the infection becomes implanted on previously damaged heart valves and gives rise to subacute bacterial endocarditis. Treatment with tetracycline or trimethoprim sulphamethoxazole is indicated.
The vaccination of man and other animals against rabies
Authors: Crick Joan
Published: December 2008

Rabies vaccines and their use in man and other animals are described. Safe and reliable vaccines are available for veterinary use, but many of the problems associated with the vaccination of humans remain unsolved.
Antimalarial drugs and their actions
Authors: Peters W
Published: December 2008

New antimalarial drugs are required, partly because of the emergence of drug resistant strains of malaria parasites and partly because better compounds are needed to cure relapsing tertian malaria. In reviewing the diverse modes of action of currently used antimalarials, against a background of the pathogenesis of malaria, attention is drawn to deficiencies in our knowledge. Even less do we understand how the malaria parasite becomes resistant to certain drugs, in particular chloroquine. New approaches to the problem include the application of combinations of existing antimalarials, and the search for new drugs on an unprecedentedly vast scale. Out of over a quarter million compounds that have recently been screened, a handful are now in clinical trial and are showing great promise for the treatment of multiple resistant falciparum malaria. The paper concludes by summarizing current recommendations for the prophylaxis and therapy of malaria due to drug resistant parasites.
Toxicity of co-trimoxazole in nutritional haematinic deficiency
Authors: Hill A V L , Kerr D N S
Published: December 2008

A woman of 47 habituated to analgesics and living on an inadequate diet was deficient in iron, folate and vitamin B12. Treatment of pyelonephritis with co-trimoxazole precipitated pancytopenia with a megaloblastic bone marrow. She recovered following withdrawal of the drug and administration of iron, folate and vitamin B12.
The value of percutaneous cholangiography
Authors: Evison Gordon , McNulty Myles , Thomson Colin
Published: December 2008

Percutaneous cholangiograms performed on fifty patients in a district general hospital have been reviewed, and the advantages and limitations of the examination are described. The investigation is considered to have sufficient diagnostic value to warrant its inclusion in the diagnostic armamentarium of every general radiological department.
Intravascular haemolysis complicating treated non-ketotic hyperglycaemic diabetic coma
Authors: Blackwell S W , Burns-Cox C J
Published: December 2008

A patient with non-ketotic hyperglycaemic diabetic coma is reported with the complications of cerebral oedema, oliguric renal failure, transient cataracts, possible acute pancreatitis and intravascular haemolysis. The last association has not been reported before, and it may have been due to rapid infusion of hypotonic saline producing haemolysis locally at the infusion site.
Liposarcoma of the kidney
Authors: Lien W M
Published: December 2008

Two cases of liposarcoma of the kidneys were described, these being the thirty-sixth and thirty-seventh cases documented in the world literature. The association between renal liposarcoma and tuberous sclerosis was discussed. The presenting symptoms and signs of this condition were noted. A search of the recent world literature has been carried out.
The treatment of carcinoma of the lung by radiotherapy
Authors: Deeley Thomas J
Published: December 2008

Where the diagnosis of cancer of the lung is made by bronchoscopy the preferred treatment is surgery for squamous lesions and radiotherapy for anaplastic and oat-cell lesions. In inoperable tumours 8% of patients survive for more than 3 years after a radical course of radiotherapy; some clinical trials aimed at improving this survival rate are described. This lecture deals with the established disease, earlier diagnosis, before spread, would make radical treatment with a possibility of cure possible in more patients but this disease can be prevented to a large degree and this is the obvious method of attack.
Chemotherapy for carcinoma of the bronchus—a brief review
Authors: Bleehen Norman M
Published: December 2008

A brief theoretical approach to the chemotherapy of carcinoma of the bronchus is considered. Some of the currently available data and prospects for the future are reviewed.
The terminal care of patients with lung cancer
Authors: Twycross R G
Published: December 2008

Lung cancer is the commonest form of malignant disease seen at St Christopher's Hospice. More than 35% of the male and about 8% of the female cancer patients are admitted with this diagnosis. This means that each year approximately 100 patients with lung cancer are amitted and cared for at the hospice. The more common symptoms experienced by 185 consecutive terminal lung cancer patients admitted to St Christopher's Hospice are listed in Table 1.
Collaborative studies of acute respiratory disease in patients seen in general practice and in children admitted to hospital. Aims, field methods and morbidity rates
Authors: Miller D L
Published: December 2008

Two collaborative studies of acute respiratory disease were organized, one in patients seen in general practice and the other in children admitted to hospital. The main aims were to study the epidemiology and clinical presentation of these diseases and of the viruses associated with them. The field methods used are described and analyses of the consultation rates in general practice and of hospital admissions in children are presented. Both consultations and admissions were most frequent by far in very young children, especially those under the age of 1 year, but the pattern of incidence for the various clinical categories differed with age. Lower respiratory illnesses were relatively much more frequent in infants and in adults over 65 than in intermediate age groups. Seasonal variations were slight for most upper respiratory tract conditions but pronounced for lower respiratory illnesses, especially bronchiolitis of infants which was epidemic each winter, and for influenza. Changes in the initial diagnosis in patients seen in general practice did not greatly influence the total morbidity pattern but the final diagnoses showed a substantial proportional increase in the number of cases of lower respiratory illness. The shortcomings of the field methods and clinical records available for use in the study and the reliability of the results are discussed.
Viral and epidemiological findings in MRC/PHLS surveys of respiratory disease in hospital and general practice
Authors: Poole Pauline M , Tobin J O'H
Published: December 2008

The results found and the laboratory methods used for the isolation of viruses and β haemolytic streptococci in two MRC/PHLS surveys of respiratory disease in patients in hospital and general practice are described. 717 viruses and 82 β haemolytic streptococci were isolated from 2418 children in hospital and 835 viruses and 435 strains of β haemolytic streptococci from patients seen in general practice. Virus isolation rates in the two surveys were 28·9% and 21·0% respectively. Rates by age, sex, time and by clinical categories are given and discussed in relation to isolations from control subjects, the cause of deaths in twenty-two of the children tested, and the incidence of convulsions and meningism found in those examined in these surveys.
Adenovirus infections
Authors: Pereira Marguerite S
Published: December 2008

Ninety-three adenoviruses were found in the MRC/PHLS survey of patients in general practice and eighty-eight in those admitted to hospital, types 1, 2, 3, 5 and 7 being the most frequent ones isolated. The adenoviruses accounted for 11% and 12% of all viruses and were present in 2% and 4% of patients examined in these surveys. These agents were present at all times with slightly increased frequency in the first part of each year. Fever, pharyngitis and tonsillitis were the most frequent symptoms encountered.
Psychosurgery and the limbic system
Authors: Kelly Desmond
Published: December 2008

The limbic system can be considered to consist of a central ‘core’ from which three well-defined circuits emerge. These are the Papez or medial circuit, the basolateral circuit and the defence reaction circuit. The functions of the primitive limbic brain are modulated by a higher order control—the frontal lobe. Emotional responses and physiological changes have been obtained by stimulation of fronto-limbic pathways and limbic circuits and these have been used for location of target sites in psychosurgery. For the relief of intractable depression and anxiety, lesions are generally made in the lower medial quadrant or posteroorbital part of the frontal lobe, where there is a concentration of fronto-limbic connections. In primary obsessional neurosis lesions at this site produce less satisfactory results, but these illnesses may be helped by lesions in the cingulate gyrus, which is part of the Papez circuit. Patients with epilepsy and aggressive outbursts may respond to temporal lobotomy, or to operations, such as amygdalotomy, where lesions are placed in the defence reaction circuit.
Custom psychosurgery
Authors: Turner Eric
Published: December 2008

It seems fundamentally improbable that different mental symptoms and personality disorders should be relieved by one single form of operation on the brain. The present paper describes five operations which can be performed with benefit to different types of psychiatric abnormality; namely, unilateral temporal lobectomy, unilateral or bilateral temporal lobotomy, inferior quadrant pre-frontal leucotomy, paramedian frontal leucotomy and posterior cingulectomy.

The symptoms that represent an indication for these various operations and the results of the operations on the symptom complexes are described. The proposition is put forward that only operations suitable for the precise psychiatric diagnosis should be used. A new form of analysis of sphenoidal lead examinations is described which is of primary importance in conjunction with psychiatric examination in deciding which operation a particular patient would or would not benefit from. A concept of diencephalic instability is introduced in connection with this EEG analysis to supplement the usual concept of centrencephalic epilepsy. Diencephalic instability as defined here seems to respond specifically to paramedian lobotomy, provided of course the clinical condition justifies such a step.
Amygdalotomy
Authors: Hitchcock Edward , Cairns Valerie
Published: December 2008

The results of a multi-disciplinary research project into the management and assessment of patients with epilepsy and behaviour disturbances are reported in eighteen patients who have undergone amygdalotomy over the past 5 years. The psychological and neuro-surgical assessments are detailed and the effects of stimulation and coagulation of the amygdala nucleus are described in six patients.

It is concluded that certain cases benefit by amygdalotomy, but that changes are not limited to a decrease in abnormal aggressive behaviour but also lead to a decrease in other areas of maladaptive behaviour. The aim of the operation is to enable the patient to respond more appropriately in a range of situations which in turn would lead to an increase in general effectiveness.
The influence of antihypertensive treatment over the incidence of cerebral vascular disease
Authors: Beevers D G , Hamilton M , Fairman M J , Harpur J E
Published: December 2008

The incidence of stroke in a group of 499 treated hypertensive patients was closely related to the adequacy of control of hypertension. This trend was independent of the level of diastolic blood pressure at presentation, and differed markedly from the incidence of myocardial infarction and angina pectoris which did not vary with adequacy of control.
Treatment of severe hypertension and hypertensive emergencies with intravenous clonidine hydrochloride
Authors: Niarchos Andreas P , Baksi Arun K
Published: December 2008

Eleven severely hypertensive patients, median age 54 years, were treated with intravenous (i.v.) clonidine hydrochloride (Catapres). In nine there were life-threatening complications: severe left ventricular failure (LVF), hypertensive encephalopathy, cerebral haemorrhage, dissecting aortic aneurysm, renal failure, and severe epistaxis. In two patients there was pronounced, but uncomplicated, elevation of blood pressure. 0·15 mg or 0·3 mg clonidine was given every 40 min with electrocardiographic (ECG) monitoring. The mean systolic and diastolic blood pressures in the eleven patients were respectively 266 and 165 mmHg before treatment falling to 165 and 109 mmHg after treatment (P < 0·001). The mean decrease in heart rate was 26 beats/min (P < 0·001). Doses of clonidine required for control ranged from 0·15 mg (one ampoule) to 0·9 mg (mean 0·56 mg), although one patient received a total of 0·9 mg without an adequate response. The presenting condition caused the eventual death of two patients. There were no serious side effects, except for one transient episode of sino-atrial heart block. It is concluded that clonidine is effective and safe in the treatment of hypertensive emergencies.
Anomalous responses to stimulation and suppression tests in Cushing's syndrome due to a calcified adrenal adenoma
Authors: Epstein S , McLaren E H , Goldin A R
Published: December 2008

A case of Cushing's syndrome, due to an adrenal adenoma, which responded to dexamethasone with a rise in plasma urinary steroids is described. Further unusual features were radiologically visible calcification and a response to ACTH stimulation.
Oesophago-cardiac fistula complicating achalasia
Authors: Strong R W
Published: December 2008

A case is reported of a patient with carcinoma of the oesophagus, secondary to a longstanding achalasia and subsequent development of a fistulous communication between the oesophagus and the heart. The literature is reviewed.
Lipomatous pseudohypertrophy of the pancreas associated with chronic pulmonary suppuration in an adult
Authors: Siegler D I M
Published: December 2008

This report describes a man who died at the age of 43 of overwhelming pulmonary suppuration in association with pancreatic steatorrhoea. Autopsy revealed lipomatous pseudohypertrophy of the pancreas. The patient is the longest documented survivor with pulmonary complications of lipomatous pseudohypertrophy of the pancreas. The literature on this rare condition is reviewed.
Anti-rheumatic drugs
Authors: Currey H L F
Published: December 2008

Prescription of anti-rheumatic drugs should be by approved name because in most cases differences in absorption can be compensated by titration of dosage against effectiveness and toxicity. There are a few instances, for example phenylbutazone, where known differences of bio-availability justify the use of a particular brand.
Anti-diabetic drugs
Authors: Galton D J
Published: December 2008

The duel nomenclature for drugs is confusing from the medical practitioner’s point of view. Multiple medications containing the same active drugs are available for prescription. Standardization of these preparations is urgently required.
Substitution: right or wrong?
Authors: Barfield J C
Published: December 2008

Drug economy has always been and will continue to be important for hospitals. Substitution, as an aid to economy, requires reappraisal in the light of our developing knowledge of formulation and resultant bio-availability. The continued unqualified use of generic names in teaching and prescribing requires re-examination as a part of the problem and this highlights the need for better communication between medicine and pharmacy.
The hospital pharmacist
Authors: Baker J A
Published: December 2008

In hospitals, the use of approved names for prescribing and labelling is an essential requirement for precision and safety in giving medicines. Substitution is an unavoidable consequence of using approved names which brings benefits, but creates problems that demand more widespread recognition and urgent attention. In particular, dangerous variations in response following brand changes can occur in patients stabilized on certain products. The Licensing Authority and the Pharmaceutical Industry have a responsibility to eliminate brand bio-availability differences. But there is an immediate need; firstly, to identify the small number of products where brand changes in patients stabilized on them can result in potentially dangerous variations in response; and secondly, to safeguard patients being treated with these products, by avoiding substitution and preventing inadvertent brand changes by including brand or manufacturer’s names on labels and in all communications between hospital doctors and general practitioners. The complete elimination of substitution is not feasible and the indiscriminate use of brand names in hospitals causes confusion and increases risks of error in giving medicines.
Trial of a single low dose of heparin in the prevention of post-operative deep-vein thrombosis monitored by doppler ultrasound
Authors: Bates T
Published: December 2008

A consecutive, randomly allocated, controlled, double-blind clinical trial of the prophylactic effect of a single pre-operative low dose of heparin on the incidence o-post-operative deep-vein thrombosis showed no reducf tion in the number of thromboses detected.

Fifty-five patients were given 5000 units of heparin subcutaneously 1-1½ hr pre-operatively and fifty-seven patients were given a placebo. The incidence of thrombosis detected by the doppler ultrasound was 14·5% in the heparin group and 12·3% in the control group.

It is suggested that a further trial monitored by ultrasound is indicated in which low-dose heparin is given for various periods post-operatively in addition to a pre-operative dose.
Oxymetholone in aplastic anaemia
Authors: Mir M A , Delamore I W
Published: December 2008

Thirty-one patients with aplastic anaemia were treated with oxymetholone. Twenty-eight patients lived beyond 2 months and of these eleven patients showed clinical and haematological improvement. Ten of these had some active erythropoietic areas as shown by bone marrow biopsies and by the presence of an elevated reticulocyte count in the peripheral blood. Two patients who responded in spite of a markedly hypoplastic marrow and reticulocytopenia became oxymetholone dependent and relapsed when the drug was withdrawn. They failed to respond a second time when oxymetholone was re-introduced. Side effects were frequent. These were mostly tolerable and reversible on reduction of the dose but three patients died of acute myeloblastic leukaemia and in three others the drug had to be withdrawn.
The use of dicobalt edetate (Kelocyanor) in cyanide poisoning
Authors: Hillman B , Bardhan K D , Bain J T B
Published: December 2008

A case of accidental poisoning with sodium cyanide is reported. The patient was treated with a new antidote, dicobalt edetate (Kelocyanor). Blood levels of cyanide were shown to fall markedly.
Gastro-oesophageal reflux and hiatus hernia—endoscopy
Authors: Roesch W
Published: December 2008

The endoscopic diagnosis of hiatal hernia (sliding type) relies on direct and indirect criteria during the oesophagoscopic or gastroscopic approach. A wide separation between the anatomic and mucosal oesophago-gastric junction, the presence of a so-called Schatzki-ring, a wandering junction with sliding gastric mucosal folds during inspiration and two ring-like structures are important. Whereas radiology seems to be superior to endoscopy in the diagnosis of asymptomatic hiatus hernia, oesophagoscopy may reveal sequelae of reflux like oesophagitis, erosions, ulcers and strictures. Peptic oesophagitis is found in about 10% to cause upper gastrointestinal haemorrhage.
Surgical treatment of carcinoma of the oesophagus
Authors: Cleland W P
Published: December 2008

There is a place for a radical surgical approach to the problem of carcinoma of the oesophagus and it should be our first aim to determine whether such an approach is justified. If radical treatment can not be carried out then the surgeon’s only concern is with the preservation of the function of swallowing.
Acute barbiturate poisoning in young epileptics
Authors: Hancock B W
Published: December 2008

Two young epileptic patients presenting in coma with focal neurological signs were found to be suffering from unsuspected acute barbiturate overdose. There had been strenuous denial of any possibility of psychiatric disturbance or of self-poisoning in the history obtained from their parents at the time of admission. The importance of excluding deliberate drug overdose in any young epileptic patient presenting with prolonged or atypical coma is re-emphasized.
Blood pressure control during maintenance haemodialysis with isonatric (high sodium) dialysate
Authors: Stewart William K , Fleming Laura W
Published: December 2008

Isonatric (high sodium) dialysis has several advantages, including relative freedom from cramps. The diastolic blood pressures and body weights of nine originally hypertensive patients on maintenance haemodialysis have been recorded for 15 months throughout alternating periods on isonatric (145 mEq/l) and low (132·5 mEq/l) dialysate sodium concentration. Isonatric dialysis resulted in a temporary 1-2 kg increase in mean pre-dialysis weight, requiring increased ultrafiltration. This coincided with a slight increase in mean pre-dialysis diastolic blood pressure which was corrected when post-dialysis body weights were lowered to compensate for the increased weight gain between dialyses. Once the ‘ideal’ individual post-dialysis body weight for each patient was established, pre-dialysis diastolic pressures less than 90 mmHg were achieved routinely. Ten subsequent patients who have never received low sodium dialysis also have well controlled pressures. These findings are contrary to the orthodox view that low sodium dialysis is mandatory to avoid hypertension.
Giant cell arteritis
Authors: Turner R G , Henry J , Friedmann A I , James D Geraint
Published: December 2008

Giant cell (senile, temporal or cranial) arteritis occurs three times more frequently in women and the majority of patients are over 70 years of age. This series of forty-seven patients presented with visual symptoms and most also had a constitutional upset. The ocular signs were of ischaemic papillopathy (in 80%), which was unilateral in 61% and bilateral in 17%; or central retinal artery occlusion (13%). The ESR was always elevated above 40 mm, and in 28% it was above 100 mm. The main ophthalmic differential diagnosis was to determine whether it was arteritic or atherosclerotic ischaemic papillopathy in this age group, and principal differences are outlined (Table 6). Following corticosteroid therapy, vision improved in 23%, remained unchanged in 64% and deteriorated in 13% of patients. Visual deterioration predominated in elderly women who received steroids late in the course of the disorder. Early steroid therapy is recommended in elderly patients with visual symptoms and significantly raised ESRs.
The effect of Verapamil on the cardiac conduction system in man
Authors: Roy P R , Spurrell R A J , Sowton E
Published: December 2008

Using His bundle electrograms the effect of Verapamil on the specialized conduction system in eleven patients was studied during routine cardiac catheterization.

In five patients, the absolute and relative refractory periods of the A-V node, and retrograde conduction through the A-V node was studied using programmed electrical stimulation techniques.

Verapamil caused prolongation of anterograde and retrograde A-V nodal conduction times. The effect on anterograde conduction was only partly reversible with Atropine. No significant effect on the remainder of the conduction system was observed.

It is concluded that Verapamil has a direct effect on A-V nodal conduction independent of any vagotonic effect.
Acquisition of hepatitis B antigen in the newborn period
Authors: Cossart Yvonne E
Published: December 2008

This paper describes six mother and infant pairs where the mother developed serum hepatitis during pregnancy. These findings are compared with those in three Australian antigen carrier mothers and their babies. The literature is also reviewed and it is concluded that neonatal hepatitis seldom occurs in infants whose mothers have hepatitis early in pregnancy or are chronic carriers of Australia antigen. In contrast the risk of infection of infants born to mothers who develop serum hepatitis later in pregnancy or in the puerperium approaches 50%.
Psychological characteristics of patients with the irritable bowel syndrome
Authors: Palmer R L , Crisp A H , Stonehill E , Waller Sheila L , Misiewicz J J
Published: December 2008

The Eysenck Personality Inventory, the Middlesex Hospital questionnaire, and forearm blood-flow were used to measure aspects of psychological status in forty-one patients with the irritable bowel syndrome, who were compared in this respect with twenty-five matched psychoneurotic subjects and with a general population. The results show a positive association between psychoneurotic disorder and the irritable bowel syndrome.
The incidence of the shock syndrome in a general hospital
Authors: Ledingham I McA , McArdle C S , Fisher W D , Maddern M
Published: December 2008

During a 1-year period (May 1971-May 1972), patients developing the shock syndrome in a large general hospital were referred to a multi-disciplinary shock team. Sepsis, haemorrhage and severe hypoxaemia were the principal precipitating factors. Mortality exceeded 70% in the septic and cardiogenic shock series and was lowest in shock attributable to fluid depletion and drug overdose. Whereas improvement in mortality in the haemorrhagic shock group is likely to result from more rapid and aggressive primary surgery, septic shock, particularly arising from intestinal complications, will require a more complex solution. A shock team seems an important addition to the services of a modern general hospital.
The effects of intravenous protein—calorie supplementation on the tissue composition of postoperative body weight loss
Authors: Elebute E A
Published: December 2008

The components of postoperative body weight loss were analysed in eleven adult male patients who had uncomplicated abdominal surgery of moderate severity namely vagotomy and a drainage procedure for chronic duodenal ulceration. Four patients (Group I) had the routine postoperative regimen which consisted of intravenous isotonic dextrose and dextrose-saline solutions. Another group of four patients (Group IIa) had supplementation of this regimen with 50% dextrose and an amino-acid/sorbitol preparation whilst a group of three (Group IIb) patients had supplementation with only amino-acid/sorbitol preparation.

Group I patients exhibited the expected losses of lean tissue and body fat, but these were partially obscured by retention of extracellular water. Group IIa exhibited excessive loss of extracellular water which was parallel to an increased urine flow and this loss completely overshadowed the reduction in lean tissue and body fat losses produced by the protein and calorie supplementation. Group IIb patients exhibited the smallest amount of weight loss because they had a reduction in lean tissue and body fat losses whilst they still exhibited a mild antidiuretic response. It is suggested that the amino-acid/sorbitol preparation provides the safest form of supplementation, particularly in the face of increased extra-renal losses of water such as may be dictated by a warm tropical environment.
Eosinophilic leukaemia terminating with an encephalopathy
Authors: Yuill G M , Lascelles R G , Scholtz C
Published: December 2008

A 52-year-old man developed an illness which lasted for 2 years until its fatal termination. It comprised in chronological order: mild asthma, skin irritation, mature eosinophilia in the peripheral blood, and finally an encephalopathy. The diagnostic problem of distinguishing between eosinophilic leukaemia and an eosinophilic leukaemoid reaction is discussed. The cause of the encephalopathy was discovered at autopsy to be a widespread intravascular thrombotic process. The question of future possible therapy is discussed.
Amoxycillin: pharmacokinetic studies in normal subjects, patients with pernicious anaemia and those with renal failure
Authors: Lawson D H , Henderson A K , McGeachy R R
Published: December 2008

This paper presents data on the absorption and disappearance of a new semisynthetic antibiotic—amoxycillin—in patients with pernicious anaemia and those with renal failure. Absorption of this drug is unimpaired in these patients. Adequate serum and urine levels are obtained even in patients with creatinine clearance levels below 10 ml/min. The half-life of this drug is markedly prolonged in patients undergoing regular dialysis therapy, and a single 250 mg dose will provide adequate serum levels for 24 hr, if this is given after dialysis is complete.
Pulmonary circulation and ventilation
Authors: Leigh Julian M
Published: December 2008

The pulmonary circuit receives the whole of the cardiac output, and the flow through it is governed by events in the systemic circulation. Its function is gaseous exchange, and the low resistance and high capacitance of the circuit is subservient to this function. Local flow is affected by intra-alveolar oxygen tension, and regional flow by passive hydrostatic effects due to gravity. The distribution of ventilation is also affected by gravity owing to the effect of the latter on regional compliance. When the cardiac output falls, as it does in most methods of induced hypotension, there is an accompanying increase in physiological dead space owing to an increase in the alveolar component.
The high fibre diet in the treatment of diverticular disease of the colon
Authors: Painter N S
Published: December 2008

Diverticular disease of the colon causes symptoms even in the absence of inflammatory diverticulitis. These symptoms vary from vague dyspepsia to severe colic which may lead to resection of the sigmoid for ‘diverticulitis’. This paper discusses the use of a high fibre diet, including miller’s bran, in the treatment of uncomplicated diverticulosis. In the majority of cases this diet relieves symptoms and lessens the need for surgery in diverticular disease.
Familial spontaneous pneumothorax
Authors: Delaney J C , Gale A , Walker B A
Published: December 2008

Familial spontaneous pneumothorax is a rare condition. Two families with this condition are described: identical twin sisters of one family and three brothers of another family. The suggestion is made that at least some cases of spontaneous pneumothorax are genetically determined.
Villous papilloma of the appendix associated with mucocoele and intussusception
Authors: Darby A J , Doctor A
Published: December 2008

A case of villous papilloma of the appendix, associated with mucocoele formation and intussusception, is described. The literature is reviewed and it appears that there is no previous report of this association. It is suggested that so-called malignant mucocoeles of the appendix arise from pre-existing villous papillomas.
Radiological changes in left lobe amoebic liver abscesses
Authors: Ramachandran S
Published: December 2008

Elevation of the left dome of the diaphragm occurred in 43% of cases with left lobe amoebic liver abscesses. It was rarely seen in patients with an abscess in the right hepatic lobe. Elevation of the right dome of the diaphragm, which occurred in 36% of cases, is also compatible with a diagnosis of left lobe abscess. This radiological sign was present in 75% of cases with right lobe abscesses. Pleuro-pulmonary changes in the left chest, when associated with an elevation of the left dome of the diaphragm, favours the diagnosis of an amoebic abscess of the left lobe of the liver. Radiological changes in barium studies are usually confined to patients with large hepatic abscesses. In clinical practice the information obtained from simple radiology can provide adequate diagnostic confirmation of the presence of a left lobe liver abscess.
Some clinical pharmacological studies with indoramin, with observations on its therapeutic usefulness
Authors: de B. White C , Royds R B , Turner P
Published: December 2008

In the treatment of fifteen patients with essential hypertension, in open trial indoramin caused a mean blood pressure fall from 180/115 mmHg to 159/98 mmHg. No reversal of antihypertensive effect was seen in four patients after additions of the tricyclic antidepressant drug desipramine. Blood pressure did not begin to rise in these four patients for at least 5 weeks after stopping indoramin. The implications of these findings are discussed.
An evaluation of sotalol, a β-blocking agent, in patients with angina pectoris
Authors: Gooding P G , Berman E
Published: December 2008

In a multi-centre study, sotalol was compared with placebo in 146 patients with angina pectoris using a double-blind crossover design. Sotalol had a significant effect in reducing the number of anginal attacks and the number of nitroglycerin tablets used. The medication was safe and produced minimal side effects.
Purpura fulminans with haemolytic anaemia
Authors: Nagi N A , Al-Hasso A R A
Published: December 2008

A 10-month-old female infant with purpura fulminans is reported. The patient had clotting abnormality compatible with consumption coagulopathy. Histopathological examination revealed the presence of microthrombi. Heparin was effective in correcting the clotting defects. The infant also suffered from microangiopathic haemolytic anaemia. She died 17 days after the onset of the illness from infection in spite of antibiotic therapy.
Lumbar plexitis and rhabdomyolysis following abuse of heroin
Authors: Greenwood R J
Published: December 2008

A young man was admitted following abuse of impure (‘Chinese’) heroin. He showed a number of the less common complications of heroin abuse. These are now more likely to be seen in England in view of the increasing incidence of heroin addiction.
Effects of anticonvulsants and inactivity on bone disease in epileptics
Authors: Murchison Lilian E , Bewsher P D , Chesters Marion , Gilbert J , Catto G , Law Elizabeth , McKay E , Ross H S
Published: December 2008

No significant biochemical or radiological features of vitamin D deficiency were found in groups of juvenile and adult epileptics and control groups of non-epileptic patients in hospitals for the mentally retarded. There was evidence of hepatic enzyme induction in patients on anticonvulsants, in that urinary D-glucaric acid concentration and excretion were raised. No effect was found of prolonged anticonvulsant therapy on bone densitometry, but in children immobility was closely associated with decreased bone density. The evidence suggests that disuse osteoporosis is the major bone disease in these mentally retarded children.
Vick vapour rub intoxication
Authors: Duckham J M , Lee H A
Published: December 2008

So far as we are aware there has been no previous report of Vick vapour rub intoxication presenting as iron deficiency anaemia with minimal liver functional impairment. We present this case for its interest and to illustrate the rewards of a routine and detailed drug-taking history.
An unusual self-inflicted injury of the breast
Authors: Sampson D
Published: December 2008

A self-inflicted injury of the breast can present difficult diagnostic problems as is illustrated by the case report. A young woman had excoriated her left nipple causing profuse haemorrhage. Following excision of the nipple and a breast biopsy, the patient presented 1 month later with an abscess caused by the introduction of stones and gravel into the biopsy wound.
Prostaglandins in reproductive physiology
Authors: Craig Gillian M
Published: December 2008

The role of prostaglandins in reproductive physiology is reviewed with particular emphasis on their possible importance in ovulation in humans. A possible interaction between gonadal steroids, biogenic amines and prostaglandins at hypothalamic-pituitary level, in relation to the release of luteinizing hormone releasing factor, and LH, is discussed. Anomalies regarding the role of oestrogens in LH release are noted, and it is suggested that high oestrogen levels may release prostaglandins from the uterus and/or centrally in humans, in connection with the mid-cycle LH surge and ovulation. A hypothetical role for prostaglandins in sexual behaviour and premenstrual changes is discussed.

The hypotheses open up new areas for clinical research to establish the role of prostaglandins in human endocrinology. The need for measurement of prostaglandin metabolites in blood and urine is emphasized.
Muscle fatigue
Authors: Edwards R H T
Published: December 2008

Muscle fatigue is a common symptom but there are no universally accepted methods for quantitating the function of voluntary muscle. This paper describes three main methods of assessment: simple clinical tests of muscle function; thermal probe measurements of metabolic heat production during muscular contraction; needle biopsy studies of muscle structure and chemistry. These methods, though at a relatively early stage of development, have given promising results which suggest that they could be useful in assessing possible new forms of treatment in patients with neuromuscular disorders.
Precipitating antibody in the sputum in chronic respiratory disease
Authors: Clarke C W
Published: December 2008

Precipitating antibody against bacterial antigens obtained from known pathogens has been looked for in sputum of patients with chronic respiratory disease. Preliminary results suggest that detection of precipitating antibody to a cell wall extract of the organism may be important in determining its pathogenicity in a particular patient. Local antibody production appears to be important in these conditions. It is proposed that this locally produced precipitating antibody may be contributing to the underlying lung pathology.
Clindamycin for acute osteomyelitis in children
Authors: Wharton M R , Beddow F H
Published: December 2008

A series of thirty-five children with acute haematogenous osteomyelitis who received clindamycin as the antibiotic of choice is described. Successful primary healing was achieved in thirty-three patients. The advantages of operation when indicated are discussed in relation to bacteriological identification.
Diurnal patterns of oral glucose tolerance in diabetics
Authors: Walsh C H , Wright A D
Published: December 2008

Oral glucose tolerance tests were performed in the morning and afternoon in twenty newly diagnosed untreated diabetic patients. Fasting blood glucose levels were significantly higher in the morning than in the afternoon. Blood glucose values after glucose ingestion also tended to be higher in the morning than in the afternoon. This pattern, however, was most marked for the patients with the greatest degrees of hyperglycaemia. It was also more evident in females than males. Serum insulin values did not differ significantly in the morning and afternoon.
Forced alkaline diuresis for lithium intoxication
Authors: Forrest John A H
Published: December 2008

A case of lithium intoxication treated with forced alkaline diuresis is described. Although clearance of lithium from the plasma by this method is less efficient than by haemodialysis it is as effective as peritoneal dialysis, is easier for nursing and medical staff to undertake and carries less risk of complications. In the absence of facilities for haemodialysis forced alkaline diuresis is the treatment of choice for lithium intoxication.
Recent advances in the treatment of male sub-fertility
Authors: Bye Patrick
Published: December 2008

Recent advances in our understanding of the physiology of reproduction in the male are reviewed. An hypothesis concerning the role of androgens in spermatogenesis is discussed.
Hirsutism
Authors: London D R
Published: December 2008

Hirsutism is usually caused either by an increase in androgen production by the ovary or adrenal or it may be due to increased sensitivity of the hair follicle to normal amounts of circulating androgens. The diagnostic possibilities can be resolved on clinical grounds by laparoscopy and by hormone measurements. The commonest causes of this symptom are ‘idiopathic hirsutism’ and the polycystic ovary syndrome. Treatment is of the underlying condition or, when that is not possible, by local removal of hair or by the administration of oral contraceptives or glucocorticoids.
A case of sarcoidosis in a Chinese woman
Authors: Ong Y Y , Chew C H , Chiang S C
Published: December 2008

A case of sarcoidosis in a Chinese woman presenting with hilar lymphadenopathy is described. In addition, there were neurological features, a depressed tuberculin test and a positive Kveim test. The condition is rare in the Chinese.
Transvenous endomyocardial biopsy—application of a method for diagnosing heart disease
Authors: Caves Philip , Coltart John , Billingham Margaret , Rider Alan , Stinson Edward
Published: December 2008

Introduction

Although biopsy of the kidney, liver, and many other organs is routine in clinical medicine, biopsy of the heart is infrequently performed. In consequence, little is known of the serial histological changes which occur in non-fatal myocardial disease. Published techniques for obtaining myocardial biopsies have included percutaneous needle biopsy of the left ventricle, catheter needle biopsy of the interventricular septum, and open thoracotomy. The associated morbidity and mortality with these methods have precluded their widespread acceptance (Shirey et al., 1972).
Secondary syphilis presenting with jaundice
Authors: Bhowmick B K , Simpson B , Way S P B
Published: December 2008

A patient with secondary syphilis presenting with jaundice is reported. Hepatic histology showed evidence of non-specific granuloma and active hepatitis but no cholestasis. This has been treated successfully with antisyphilitic therapy. The possibility of syphilitic pancreatitis and diabetes mellitus is discussed. The importance of serological tests for syphilis in jaundice of obscure origin is emphasized.
Diabetes mellitus and primary hyperparathyroidism
Authors: Walsh C H , Soler N G , Malins J M
Published: December 2008

Eight patients suffering from primary hyperparathyroidism and diabetes mellitus are reported. All of the patients are female. The clinical problems resulting from the co-existence of these two endocrine disorders and the similarity of their symptoms are discussed. The experience from a large diabetic clinic population suggests that the association of hyperparathyroidism with diabetes merits further investigation.
Neurosurgery in the older patient
Authors: Stewart Ian , Millac Paul , Shephard R H
Published: December 2008

The outcome of brain and spinal surgery has been assessed in 141 patients who were over the age of 65 at the time of operation. Patients tolerated investigation and surgery remarkably well and good results were obtained for benign lesions. Survival times and the contribution of surgery to reducing disability in malignant disease were disappointing.
Poikiloderma atrophicans vasculare as a pointer to reticulosis of the skin
Authors: Chapman Robert S , Paul C Jose
Published: December 2008

A case of reticulosis of the skin (mycosis fungoides) terminating in reticulum cell sarcoma is described where the features of poikiloderma atrophicans vasculare had been present for 40 years. The likelihood of reticulosis eventually developing after such a change in the skin is believed to be around 50%.
Hypothalamic-pituitary abscess
Authors: Mohr P D
Published: December 2008

A case of hypothalamic-pituitary abscess is described, and previous case reports discussed. The clinical picture is one of hypopituitarism, a fluctuating clinical course with attacks of meningism, and a background of sphenoid sinusitis.
A brainstem syndrome associatedxb with Mycoplasma pneumoniae infection—A report of two cases
Authors: Jachuck S J , Gardner-Thorpe C , Clark F , Foster J B
Published: December 2008

Two patients with a serologically-proved infection with Mycoplasma pneumoniae (MP) developed cranial nerve pareses which cleared spontaneously within 1 month of the onset. The sixth and seventh cranial nerves were the most severely affected. It is suggested that the signs were due to a mild brainstem encephalitis associated with the MP infection. The benign course of the syndrome is emphasized. The neurological complications of MP infection may be commoner than has been generally supposed.
Pathogenesis of renal failure in cirrhosis and fulminant hepatic failure
Authors: Wilkinson S P , Hurst D , Portmann B , Williams Roger
Published: December 2008

Acute renal failure in cirrhosis and fulminant hepatic failure represents a spectrum with ‘functional renal failure’ at one end and acute tubular necrosis at the other. In fulminant hepatic failure the development of renal failure is not necessarily a measure of the severity of liver damage.

Functional renal failure is due to active renal vasoconstriction which may, at least in fulminant hepatic failure, be initiated by systemic endotoxaemia.
Discussion
Authors: Black Douglas
Published: December 2008

Chairman: Dr Wilkinson showed in his patients with fulminant hepatic failure that when the effective renal plasma flow was less than approximately 150 ml/min, the Limulus test was positive. Do you have any information about the responsiveness of these patients to any form of plasma expansion?
Discussion
Authors: Williams Roger
Published: December 2008

Dr Martini (Marburg): In your experience Mr Dawson, does renal failure occur after other abdominal operations or infections not confined to the biliary tree, e.g. appendicitis?
Factors relating to sodium excretion in experimental ascites
Authors: Blendis L M
Published: December 2008

Although there is some disagreement about the role of the proximal convoluted tubule in the sodium retention of caval dogs, most authors agree that the major site of increased sodium resorption is the ascending loop of Henle. Furthermore, although the majority of experimental evidence suggests that the increase in sodium resorption is caused by alteration in physical factors, presumably in the vasa recti, there is some evidence that circulating substances may also be involved.