bluuebunny/crossref_metadata_2025 huggingface dataset:
Psoriasis and gout
Authors: Fordham J N , Storey G O
Published: December 2008

Ten cases of gouty arthritis are described in association with psoriasis. Eight were receiving intensive inpatient treatment for their skin condition. Diagnosis was based on clinical grounds or, in 3 cases, by compensated polarizing microscopy (CPM) of synovial fluid. All patients were male and 5 of them had conditions other than psoriasis known to predispose to hyperuricaemia. The patients appeared to fit into three groups: five had typical lower limb gout occurring in conjunction with long-standing extensive psoriasis; 3 patients had preceding features of inflammatory synovitis, one of whom subsequently developed typical distal interphalangeal involvement of peripheral psoriatic arthritis; two patients appeared to have coincident gout and psoriasis.

We believe that an association of gout with extensive long-standing psoriasis may exist particularly in male patients with an additional cause for hyperuricaemia. Long-term studies of a large population of psoriatics are required. Previous reports may have underestimated the incidence of gout because of failure to examine synovial fluid for crystals particularly from those patients with a subacute large joint arthropathy.
Intravenous urography and childhood trauma
Authors: Okorie N M , MacKinnon A E
Published: December 2008

Results of intravenous urography (IVU) in 33 patients suspected of suffering from renal trauma were reviewed. It was concluded that when haematuria is only detected microscopically and clears within 24 hr then an IVU is not necessary, in the absence of other evidence of significant urinary tract injury.
Assessment of analgesic drugs in soft tissue injuries presenting to an accident and emergency department—a comparison of antrafenine, paracetamol and placebo
Authors: de Gara C , Taylor M , Hedges A
Published: December 2008

In a preliminary dose-finding study in patients following abdominal hysterectomy, antrafenine was found to be an effective analgesic in single oral doses of 300-600 mg.

A double-blind controlled between-patient study was carried out to compare antrafenine (up to 1200 mg daily), paracetamol (up to 4 g daily) and placebo as analgesic in the control of pain produced by ligamentous knee or ankle injuries, low back pain or rib injuries. The only significant difference (P<0·05) noted between drug treatments was a longer duration of analgesic activity following antrafenine.

The implications of these results for the study of potential analgesic drugs in soft tissue injuries are discussed.
Spinal opiate analgesia and facial pruritus: a neural theory
Authors: Scott Peter V , Fischer H B J
Published: December 2008

Facial pruritus associated with spinal opiate analgesia in man is thought to result either from release of histamine or from imbalance of sensory modulation secondary to spread of opiate to the medulla or fourth ventricle. There is another possibility: the sensory imbalance may be secondary to rostral spread of opiate effect by nervous transmission. Evidence is adduced in support of possible anatomical pathways, and in support of a medullary ‘itching centre’ in man.
Herniae: benign or malignant?
Authors: Haywood I R
Published: December 2008

Three cases of cancer presenting at inguinal hernia repair are described. The importance of the awareness of this possibility is emphasized, and one finger routine mini-laparotomy exploration is recommended. In suspicious cases further access via epigastric vessel division is also recommended as is the value of histological examination of the hernial sac.
Hypothyroidism masquerading as polymyositis
Authors: Cabili Shaltiel , Kaplinsky Naomi , Pines Amos , Frankl Otto
Published: December 2008

A group of patients is described who presented with proximal muscle weakness and elevated muscle enzymes. They were initially believed to have polymyositis and one of them was even treated as such over a long period of time. The patients were subsequently found to have hypothyroidism and responded well to thyroid hormone replacement.

Hypothyroidism should always be considered in the differential diagnosis of polymyositis. A polymyositis-like picture has to be regarded as a symptom and not as a disease since it occurs in several metabolic, infectious, malignant and drug-induced diseases.
Sugar chromatography of urine and faeces in acute gastroenteritis
Authors: McCormack J G , Steel A E
Published: December 2008

Sugar chromatography was performed on urine and faecal specimens obtained at admission from 482 children under the age of five years admitted to hospital because of acute gastroenteritis. The sensitivity of the chromatography was such that 2 μg of the various sugars could be detected, which is equivalent to 5 mg per g of stool, and this level was considered a positive result. Fifty-nine (12·2%) children without any clinically apparent milk intolerance had sugar chromatographic abnormalities, in 32 of whom a disaccharide was found in the urine and/or faeces. Twenty-one children, all under the age of nine months, developed a relapse of their diarrhoea when full strength milk was reintroduced. In only one of these cases, a two-month-old boy with sucrose in his urine, was a disaccharide found on chromatography.

It is concluded that testing for disaccharides in urine or faeces by chromatography in children with acute gastroenteritis is of no value in predicting who is likely to suffer from clinical relapse when milk feeding is subsequently recommenced.
Internal mammary lymph node biopsy guided by computed tomography
Authors: Irving Henry C , Hardy Graham J
Published: December 2008

Internal mammary lymph node enlargement may be demonstrated using computed tomography (CT), and a confirmatory tissue diagnosis of metastatic involvement may be obtained using fine needle aspiration biopsy with needle tip placement guided by the CT scanner. A case history is described to illustrate how a patient presented 9 years after mastectomy with an internal mammary lymph node metastasis and how cytopathological diagnosis of this metastasis was achieved by CT guided biopsy.
Oat cell carcinoma of bronchus presenting as an acute psychiatric illness in young women
Authors: Ralston S H , Fogelman I , Lowe G D O
Published: December 2008

Two young women are described who presented with an acute psychiatric illness, due to the metabolic effects of inappropriate anti-diuretic hormone (ADH) secretion. In both patients symptoms were promptly abolished by correction of the biochemical disturbance and subsequent investigations revealed hitherto occult oat cell carcinoma of bronchus. These patients demonstrate the value of routine laboratory investigations in all patients with an acute psychiatric illness and illustrate that bronchial carcinoma must be considered in patients of all age groups presenting with the syndrome of inappropriate ADH secretion.
Gastro-intestinal haemorrhage—an unusual presentation of carcinoid tumours
Authors: Watkins R M
Published: December 2008

A case of small bowel carcinoid tumours causing gastro-intestinal haemorrhage is presented. The difficulties associated with pre-operative diagnosis and operative localization are discussed.
Is maternal gastrin important in congenital hypertrophic pyloric stenosis?
Authors: Lucey Michael R , McCann Shaun , Weir Donald G
Published: December 2008

The birth of a normal infant to a woman with Zollinger-Ellison syndrome is described. The cord blood serum gastrin was very elevated. This suggests that maternal gastrin can cross the placenta, a fact previously in doubt in man. The infant did not develop congenital hypertrophic pyloric stenosis. This is further evidence that raised blood gastrin in utero is not an important causative factor in the development of congenital hypertrophic pyloric stenosis in man.
Persistent gastrointestinal bleeding successfully treated with aminocaproic acid
Authors: Graham D R , Walker R J
Published: December 2008

An elderly female presented with persistent upper gastrointestinal bleeding from a mucosal lesion in the second part of the duodenum. This failed to respond to surgery, but was successfully treated with aminocaproic acid.
Failure of naloxone to reverse the cardiotoxocity of Distalgesic overdose
Authors: Barraclough C J , Lowe R A
Published: December 2008

A case of severe poisoning with dextropropoxyphene and paracetamol (Distalgesic) in which the cardiotoxic effects of dextropropoxyphene were not reversed by naloxone is reported. A probable reason for this failure is suggested with reference to the differing pharmacological actions of dextropropoxyphene on cardiac conducting tissue and the central nervous system.
Atopic disease in the Hong Kong Chinese
Authors: Fung Y M , Mayberry J F , Rhodes J , Newcombe R G
Published: December 2008

One hundred and sixty Chinese men and 96 women resident in Hong Kong completed a questionnaire about atopic disease and their responses were compared with replies from 500 Britons. Asthma and hayfever were less common in the Chinese and this could not be attributed to medical awareness as the results were similar in Chinese surgical patients and Chinese medical students. The role of heredity and environment may be assessed by studying Chinese people who have moved to Britain.
Thyroid disease in diabetics
Authors: Sugrue D D , McEvoy M , Drury M I
Published: December 2008

Among a diabetic clinic population of 5,000 there were 113 patients (1.1%) with concurrent clinical thyroid dysfunction (56 hyperthyroid, 57 hypothyroid). Seventy-one (62.8%) of these patients were insulin-dependent and diabetes preceded thyroid disease in 85 (75.2%). Twenty patients were given carbimazole for two or more years and of these 15 (75%) relapsed, a percentage not significantly different from that seen in non-diabetic patients. The value of screening diabetic patients for evidence of thyroid dysfunction is discussed.
Neurosyphilis in the Leicester area
Authors: Alani S , Millac P
Published: December 2008

Twenty patients with neurosyphilis are reviewed. They were gathered over a 15-year period during which the overall incidence was 0.18 per 100,000, though fewer cases appeared in the latter half of the study. The commonest presentation was with mental symptoms and classical forms of neurosyphilis were rarely seen. No patient presented with epilepsy. There is a case for the more selective use of serological testing.
Subcutaneous nodular synovitis following medial arthrotomy in a case of myxoid liposarcoma of the thigh
Authors: McClure J , Iyer Prema , Bauze R J , Mukherjee T
Published: December 2008

A lesion of pigmented synovitis appeared as a nodule in the scar one year after arthrotomy and was removed one year later. It was clearly distinguished from a concurrent myxoid liposarcoma on clinical and morphological grounds (light and electron microscopy).
Metastatic duodenojejunal carcinoma from ovarian primary
Authors: Clayden G S , Reynolds G
Published: December 2008

A 55-year-old woman presented with symptoms of progressive sub-acute high gastrointestinal obstruction. Barium studies, upper gastrointestinal endoscopy, ultrasound and ERCP were normal. Diagnosis was therefore delayed. At laparotomy, malignant tumours were found at the duodenojejunal flexure and left ovary, which were histologically identical and consistent with an ovarian primary. Endoscopic techniques for visualization of the third and fourth parts of the duodenum should be employed after barium studies, including careful screening in this area, have failed to reveal pathology.
Lymphoma-like syndrome following para-aminosalicylic acid
Authors: Nagaratnam N , Bhuvanendran N , Jiffry A J , Ramachandra V
Published: December 2008

This report describes a patient who developed a Hodgkin’s disease-like picture both clinically and pathologically, following the administration of para-aminosalicylic acid, with complete regression on cessation of therapy.
Effect of ingestion of paraquat on a 20-week gestation fetus
Authors: Musson F A , Porter C A
Published: December 2008

A woman ingested a small amount of paraquat when 20 weeks pregnant. There appeared to be no effects on the fetus.
Necrotizing fasciitis: an alternative approach
Authors: Percival R , Hargreaves A W
Published: December 2008

Three cases of necrotizing fasciitis are presented. The initial management of necrotizing fasciitis remains undisputed. However, following a limited success with a conventional treatment policy, a more radical approach with immediate skin grafting following debridement is suggested.
Endralazine in patients with severe hypertension and renal insufficiency
Authors: Higgs E R , Banks R A , Harrison P R , Kingswood J C , Mackenzie J C
Published: December 2008

Endralazine, a new peripheral vasodilator, was given in conjunction with a beta-blocker to 21 patients with hypertension and chronic renal failure. All subjects were either poorly controlled on their previous antihypertensive regime or were experiencing unacceptable adverse effects from drugs. After 4 weeks blood pressure was reduced in all patients and symptomatic side effects were few. Two patients became anti-nuclear factor (ANF) positive in weak titre but without evidence of the lupus syndrome.
Hodgkin’s disease with pulmonary cavitation
Authors: Friedland Michael L , Wittels Edward G , Deutsch Allan
Published: December 2008

A case of Hodgkin’s disease presenting with pulmonary cavitation is reported. The relevant literature is reviewed.
Coeliac disease in monozygotic twins
Authors: Shale Dennis J , Hall Reginald , Johnston Desmond G , Roberts D F
Published: December 2008

A case of concordance for coeliac disease in monozygous twins is reported. One presented with failure to enter puberty and responded to the exclusion of gluten from her diet. The other twin was asymptomatic. They represent a well documented example of monozygous twins with concordance for coeliac disease.
Gross hepatomegaly due to ‘minimal change’ liver disease in a young female alcoholic
Authors: Majumdar Sisir K , Shaw G K , Aps E J , Thomson Allan D , O’Gorman P , Bugler J
Published: December 2008

The case of a grossly enlarged liver due to alcohol excess in a woman of 21 is reported. This case further demonstrates that a chronic alcoholic can have gross hepatomegaly with normal histology and normal liver function tests. The possible pathogenetic basis of ethanol-induced hepatomegaly (‘minimal change’ liver disease) is discussed.
The aetiology of oligomenorrhoea and/or hirsuties: a study of 467 patients
Authors: Ferriman D , Purdie A W
Published: December 2008

An analysis of 467 patients with oligomenorrhoea and/or hirsuties in respect to duration of the menstrual cycle, body hair growth, ovarian size and the presence of psychological factors has revealed some useful pointers to diagnosis in this syndrome. Some 70% probably suffered from polycystic ovarian disease. Hirsuties and post-pill amenorrhoea are strong pointers to such a diagnosis. Some 10% of the cases may have been psychogenic in origin and are notably found among non-hirsute patients with normal sized ovaries. Another 10% may have been physiological in nature. All other disorders accounted for no more than 10% of the cases. Anorexia nervosa and ovarian dysgenesis are particularly to be found among amenorrhoeic, non-hirsute patients with normal sized (or small) ovaries accounting for no less than 37% of this group in our series.
Aspergillus epidural abscess in a patient with obstructive airway disease
Authors: Chee Y C , Poh S C
Published: December 2008

A 54-year-old Chinese man with episodic bronchial asthma since 25 years of age was treated for pulmonary tuberculosis in 1976 because of left upper lobe lesions on chest radiograph. In 1981 he presented with an extradural mass compressing the thoracic spinal cord, thought to be tuberculosis but which on biopsy was found to be aspergillosis. Sputum culture, type on skin-prick reactivity and serum precipitating antibodies were positive for Aspergillus. Amphotericin B intravenously, then ketoconazole orally did not substantially improve his clinical course. He died about four months post-laminectomy.
Monodermal cystic ovarian teratoma composed of respiratory epithelium
Authors: Prasad S B , Sinha M R
Published: December 2008

An atypical presentation of a mature cystic teratoma of the ovary is presented.
Recurrent glomerulonephritis
Authors: Coles G A
Published: December 2008

A patient with seven attacks of acute glomerulonephritis is described. Following each attack renal function returned to normal. Investigations strongly suggested immune complex disease as the cause of the nephritis but extensive tests failed to define the antigen. The possibility of an exogenous self-administered antigen is considered.
Multiple joint tuberculosis presenting as HLA-B27 disease
Authors: Hopkins G O
Published: December 2008

A case of multifocal osteoarticular tuberculosis in a young Caucasian male is presented. The diagnostic difficulty, compounded by slow progression of the disorder and the presence of the tissue antigen HLA-B27, is discussed.
Diabetes insipidus as a complication of acute myelomonocytic leukaemia
Authors: Philippakos D , Kakouros S , Dervenoulas J , Pontidas E
Published: December 2008

A female patient, aged 44, with diabetes insipidus as a complication of acute myelomonocytic leukaemia (AMML) is described. She presented with bleeding, anaemia, polyuria and polydypsia. She was treated with intranasal vasopressin for diabetes insipidus and responded well to treatment. Chemotherapy was administered for the leukaemia and a full remission was achieved. The patient relapsed a few days before final admission to hospital and died of septicaemia 7 months after initial diagnosis. A short review of the literature related to this subject is also presented.
Two-dimensional echocardiography in endomyocardial disease
Authors: Acquatella Harry
Published: December 2008

To assess the usefulness of two-dimensional echocardiography in the diagnosis of endomyocardial disease, 7 subjects with this disorder, proved by angiography or necropsy, were studied. Typical echographic findings included apical obliteration of either one or both ventricles by an echogenic mass with preserved systolic inwards motion. Some subjects showed increased specullar echo reflectance at the endocardial border of the obliteration. The combination of apical obliteration, posterior fibrotic thickening of mitral or tricuspid valves, hyperdynamic contraction of noninvolved ventricular walls and large atria constitutes an echographic pattern suggestive of this syndrome.
Endomyocardial disease in South America—report on 23 cases in Venezuela
Authors: Puigbo J J , Combellas I , Acquatella H , Marsiglia I , Tortoledo F , Casal H , Suarez J A
Published: December 2008

Twenty-three cases of endomyocardial disease (ED) are presented, studied in Venezuela, a tropical country in northern South America.

The diagnosis was confirmed in 18 cases by means of pathological studies, and in 5 cases by angiocardiography which showed the characteristic obliterative ventricular lesions. Eosinophilia was present in 35% of the patients. The most frequent clinical feature was heart failure associated with mitral regurgitation. Systemic embolism was the first clinical feature in 5 cases. In 2 cases, ED was associated with autoimmune haemolytic anaemia or vasculitis.

Necropsy revealed a predominance of the left-sided (9/16 cases) and biventricular (6/16 cases) types. The pathological lesions were characterised by fibrous thickening of the endocardium at the apex and the ventricular inflow tracts extending to the myocardium and involving the atrioventricular valves.

ED is frequently misdiagnosed as rheumatic valvular cardiopathy.

The two-dimensional echocardiogram is a very useful procedure for determining the spatial anatomy of ED. The echo findings were closely correlated with ventriculographic and necropsy findings. Even though ED is widely spread around the world, it is most frequently found in tropical and subtropical countries in Africa, Asia and America, such as Venezuela and Brazil. This suggests that there are aetiological factors in these latitudes, about which little is known.
Cyclic adenine nucleotide levels in lymphocytes from patients with systemic sclerosis: efficiency of prostaglandin infusions
Authors: Kovacs Iren B , Dowd Pauline M , Kirby J D T , Turner Paul
Published: December 2008

Basal intracellular cAMP levels of lymphocytes from patients with systemic sclerosis, all suffering from Raynaud’s phenomenon, were significantly lower than those obtained from normal controls. Moreover, the cAMP response to isoprenaline of these patients’ lymphocytes was inhibited. Intravenous infusion of prostaglandins (E1 and I2) restored the basal levels and greatly improved the responsiveness of the cells to isoprenaline stimulation.
Aneurysm of the mitral valve complicating Streptococcus milleri endocarditis
Authors: Akinjide-Obonyo Akindele P , Moussalli Henri , Bray Colin L , Beton David C , Stanbridge T Nigel
Published: December 2008

A case of Streptococcus milleri endocarditis which caused an aneurysm of the anterior leaflet of the mitral valve is reported. There is only one previous report of a mitral valve aneurysm secondary to infective endocarditis demonstrated by angiography. Streptococcus milleri normally causes endocarditis in an older age group than the patient we describe. Some salient features of this increasingly recognized human pathogen are emphasized.
Toxic shock syndrome complicated by laryngeal oedema
Authors: Gatling W , Mufti G J , McDonald S J
Published: December 2008

A 50-year-old woman was admitted as an acute medical emergency and was diagnosed as having toxic shock syndrome. Thirty-six hours after admission she went into hepato-renal failure and had disseminated intravascular coagulation. She developed severe laryngeal oedema, a complication which has not been reported previously, and was intubated with great difficulty. She recovered from this, but died 5 weeks after the presentation of a pulmonary embolus.
The need for prophylactic treatment to the central nervous system in patients with aggressive non-Hodgkin’s lymphoma
Authors: Hawkey C J , Toghill P J
Published: December 2008

During 2 years, 6 out of 34 patients presenting with newly diagnosed non-Hodgkin’s lymphoma developed central nervous system (CNS) complications. All were male and had diffuse, undifferentiated lymphomas. In all 6 patients, CNS disease developed during, or shortly after, treatment. We suggest that a group at high risk from these complications can be identified and should be considered for a trial of prophylaxis.
A unique apudoma producing the glucagonoma and gastrinoma syndromes
Authors: Dawson J , Bloom S R , Cockel R
Published: December 2008

A patient is described who presented with a 10 year history of intermittent peptic ulcer symptoms and a 3 year history of an undiagnosed skin rash. Investigations indicated raised plasma levels of gastrin, glucagon and pancreatic polypeptide. A single tumour was localised to the pancreas and resected. The tumour had the typical histology of an apudoma, and contained cells which stained for gastrin, glucagon, pancreatic polypeptide and neurotensin.
Hypocalcaemia, a possible manifestation of thyrotoxicosis
Authors: Beigel Y , Arie R , Wysenbeek A J , Halabe E , Blum I
Published: December 2008

A severely thyrotoxic patient was found to have hypocalcaemia and tetany, which cleared when she became euthyroid.

Cessation of treatment with propranolol and propylthiouracil resulted in a recurrence of the thyrotoxicosis and the reappearance of hypocalcaemia. Reinstitution of treatment resulted in a second remission of the thyrotoxicosis and correction of the hypocalcaemia.

It is suggested that in this patient, the thyrotoxicosis was the cause of hypocalcaemia. The various pathogenetic mechanisms are discussed.
The use of pleurodesis for intractable pleural effusion due to congestive heart failure
Authors: Davidoff D , Naparstek Y , Eliakim M
Published: December 2008

Two patients in whom pleurodesis was used for intractable pleural effusion due to congestive heart failure are described. This procedure eliminated the pleural effusion but resulted in accumulation of fluid in other body compartments. Pleurodesis has a limited role in the treatment of intractable pleural transudates in congestive heart failure.
Adverse ocular reactions to drugs
Authors: Spiteri M A , James D Geraint
Published: December 2008

Drugs acting on various parts of the body may also affect the eye insidiously. Increased awareness of such drug toxicity by the prescribing doctor should encourage him to consider effects on the cornea, lens, retina, optic nerve and elsewhere when checking the patient’s progress. The following review concerns adverse ocular effects of systemic drug administration.
Gold-induced lung disease
Authors: Heyd Judith , Simmeran Ari
Published: December 2008

A 70-year-old female with seronegative rheumatoid arthritis developed interstitial pneumonitis while on chrysotherapy. The reversibility of lung disease and favourable response to steroid treatment support the diagnosis of gold-induced lung disease and distinguish this entity from other forms of interstitial lung disease associated with rheumatoid arthritis. The relevant literature related to gold-induced lung disease is briefly reviewed.
Ectopic ACTH-producing lung cancer presenting with prostatic metastasis
Authors: Smedley H M , Brown C , Turner A
Published: December 2008

The case is described of a patient presenting with prostatic symptoms and a biopsy proven neoplasm in the prostate gland. Radical radiotherapy initially given to the pelvis produced satisfactory symptomatic improvement with tumour regression, but the patient subsequently developed endocrine complications which led to the site of the primary carcinoma being reconsidered. The case illustrates the ubiquitous nature of aggressive metastatic cancer.
Suppression of prolonged fever during treatment of pulmonary tuberculosis: importance of using twice versus single daily dose of prednisolone
Authors: Chung K F , Snashall P D
Published: December 2008

We describe the clinical course of a patient with extensive pulmonary tuberculosis, in whom fever persisted despite adequate anti-tuberculous and broad-spectrum antibiotic treatment. A once daily morning dose of prednisolone failed to suppress the fever, but a twice daily regime was successful.
Superior mesenteric artery syndrome
Authors: Jones Peter A , Wastell C
Published: December 2008

Superior mesenteric artery syndrome (SMAS) was diagnosed in a 16-year-old boy who presented with a short history of repeated vomiting associated with weight loss to the point of collapse. After resuscitation and investigation, he was treated surgically and subsequently recovered well. The diagnostic difficulties and possible pathogenesis of SMAS are discussed and the literature reviewed.
Endobronchial involvement in Wegener’s granulomatosis
Authors: Amin Rajni
Published: December 2008

Right middle lobe collapse as a result of endobronchial involvement with Wegener’s granulomatosis is reported in a 60-year-old woman. A review of the literature has revealed 6 cases of lobar collapse, only 2 of which had endobronchial disease.
An audit of a medical anticoagulant clinic in a District General Hospital
Authors: Shafi M , Mayberry J , Calcraft B
Published: December 2008

The working and costs of the anticoagulant clinic at the Royal Gwent Hospital was reviewed over the period July 1980-June 1981. The hospital notes of the patients were reviewed and a questionnaire distributed to each patient. The majority of patients have cardiac valve problems or deep vein thrombosis, the latter sometimes being associated with pulmonary emboli. No major complications were reported during the year, but 9.7% reported rectal bleeding or haematuria. The annual cost of running the clinic is approximately 20,000 pounds and, if this is representative of Britain as a whole, about 3.75 million pounds is spent annually on anti-coagulation clinics.

Several recommendations are made for improving the anticoagulant clinic service, which includes making sure that the doctor at the clinic and the patient are made aware of the reason for anticoagulation, its duration, and possible side effects and interactions with other drugs.
Altered glycosylation and sialylation of serum proteins and lipid bound sialic acids in chronic renal failure
Authors: Kishore B K , Gejyo F , Arakawa M
Published: December 2008

Abnormalities in the metabolism of carbohydrates, lipids and proteins are well documented in chronic renal failure (CRF). We have studied the extent of glycosylation and sialylation of serum proteins and also the levels of lipid-bound sialic acids in nondiabetic patients with CRF maintained on haemodialysis. The total neutral sugar content (TNS) and the non-enzymatic glycosylation (NEG) of serum proteins, the protein-bound sialic acids (PSA) and the lipid-bound sialic acids (LSA) were found to be significantly elevated in the patients as compared to a group of healthy controls. A single dialysis therapy produced some alterations in these measurements. The TNS correlated significantly with the NEG and also with the PSA. No correlation existed between total lipids. None of these measurements, however, correlated with the serum creatinine values. The established as well as putative pathophysiological consequences of these findings are discussed.
The natural history of painful diabetic neuropathy—a 4-year study
Authors: Boulton A J M , Armstrong W D , Scarpello J H B , Ward J D
Published: December 2008

Thirty-nine patients with painful diabetic peripheral neuropathy were selected for a follow-up study to determine the natural history of this condition. Symptoms, motor conduction velocities (MCV) and ankle pressure indices were recorded at the initial assessment and after a mean study period of 4.7 years. Thirty-six patients completed the study and showed no significant changes in symptoms, but there was a significant fall in median nerve MCV. It is concluded that symptoms of established diabetic neuropathy persist for several years, and the changes in MCV may reflect continuing deterioration in nerve function.
Incomplete suppression of parathyroid hormone activity in sarcoidosis presenting with hypercalcaemia
Authors: Ghose R R , Woodhead J S , Brown R C
Published: December 2008

An adult patient presenting in summertime with sarcoidosis and demonstrating raised levels of serum calcium and 1,25-dihydroxycholecalciferol was observed to have a serum immuno-reactive parathyroid hormone concentration in the mid-normal range. Renal function was normal. Corticosteroid administration quickly depressed serum calcium and 1,25-dihydroxycholecalciferol into the normal range; serum parathyroid hormone also fell to low levels.

It was concluded that corticosteroid suppression, when incorporating measurements of serum calcium and 1,25-dihydroxycholecalciferol concentrations, can distinguish between sarcoidosis-related hypercalcaemia and primary hyperparathyroidism. The significance of the changes in parathyroid hormone concentration is obscure.
Sarcoidosis and lymphoma in the same patient
Authors: Brennan Neil J , Fennelly James J , Towers Robert P , FitzGerald Muiris X
Published: December 2008

A case of lymphocytic lymphoma in a patient with coincidental sarcoidosis is described, and the possible relationship of the two conditions is discussed. A revised set of diagnostic criteria is proposed to overcome previous difficulties encountered in validating such dual pathology.
Transient hemiparesis—a rare complication of phenytoin toxicity
Authors: Sandyk R
Published: December 2008

A 31-year-old man on phenytoin for post-traumatic epilepsy developed transient hemiparesis contralateral to the injury. This appeared to have been precipitated by phenytoin intoxication. A possible mechanism for focal neurological deficit occurring in brain-damaged patients on phenytoin is discussed.
Enflurane for controlled hypotension
Authors: Firn Shirley
Published: December 2008

Enflurane was substituted for halothane in an established technique of controlled hypotension, involving beta-blockade and sympathetic ganglion blockade, for 2 groups of patients. One group was undergoing major plastic surgery and/or major maxillo-facial surgery and these patients breathed spontaneously. The other group was undergoing major neurosurgery and received intermittent positive pressure ventilation (IPPV). All patients were carefully monitored during anaesthesia and for 24 hours postoperatively. Good operation conditions were produced and no ill effects of controlled hypotension were detected in any of the patients.
Thirteen anaesthetics for facial reconstruction in a child
Authors: Ince C S , Howard E C
Published: December 2008

At the age of 4, a 13-year-old sucked caustic soda pellets resulting in severe circumoral scarring. Many previous attempts at correction had failed.
Ethnic differences in the distribution of normally formed singleton stillbirths
Authors: Terry P B , Condie R G
Published: December 2008

The normally formed singleton stillbirth deliveries occurring in Dudley Road Hospital in 1979, 1980 and 1981 were classified according to the primary aetiology. There was a higher than normal stillbirth rate in the Indian group which was almost entirely accounted for by the increased number of stillbirths falling into the ‘intrauterine death before labour’ group.
Breast cancer in blacks, Asians and whites in Birmingham
Authors: Potter J F , Dawkins D M , Terry P , Beevers D G
Published: December 2008

A retrospective study was mounted into the frequency of breast cancer in blacks, whites and Asians attending Dudley Road Hospital in the years 1970-1981 inclusive. This figure was compared with the ethnic distribution of the surrounding population and of admissions for all causes. Breast cancer was uncommon in both ethnic minorities compared with whites, but was commoner in blacks than in Asians. These trends are similar to the World Health Organization figures for Britain, Jamaica and India. Differences in parity and breast feeding do not explain the variability of breast cancer in this study.
Indican excretion in the elderly
Authors: Kirkland J L , Vargas E , Lye Michael
Published: December 2008

It has been suggested that up to a half of elderly hospitalized patients excrete an abnormally high concentration of indican compared with young individuals. Thus, the commonly used colorimetric qualitative test for urinary indican excess may be invalid in the aged. However, of 21 young control subjects, 18 healthy elderly subjects, and 23 disabled, elderly, long-stay patients, no individual had levels of indican detectable by the standard colorimetric qualitative test. The use of a quantitative assay demonstrated that urinary indican concentration is similar in young and elderly individuals. A diurnal variation in urinary indican concentration was discovered which may affect the interpretation of the qualitative test.
Persistent vocal cord paralysis in subacute thyroiditis
Authors: Langevitz P , Cabili S
Published: December 2008

We report a patient with subacute thyroiditis complicated by vocal cord paralysis; the paralysis has persisted after recovery from thyroiditis.
Tracheal obstruction presenting as asthma
Authors: Parrish R W , Banks J , Fennerty A G
Published: December 2008

A case is reported in which a tracheal tumour presented with symptoms suggestive of bronchial asthma. In the assessment and management of airways obstruction and wheeze, it is important to bear in mind that disease other than asthma and chronic bronchitis may present in this way.
Strangulated umbilical hernia in a child
Authors: Vyas I D , MacKinnon A E
Published: December 2008

We describe a case of strangulated umbilical hernia in a girl aged 5 years. She presented with an acute inflammatory lesion at the umbilicus which was initially thought to be due to cellulitis with possible abscess formation. Exploration revealed an umbilical hernia containing necrotic greater omentum.
Retrograde ileo-ileal intussusception
Authors: Mitra A. , Roth R. N.
Published: December 2008

A case of retrograde ileo-ileal intussusception in a boy of 16 years is reported. There was no apparent predisposing cause. The patient was treated by resection-anastomosis of the ileum and recovered uneventfully.
The role of echocardiography in the investigation of focal cerebral ischaemia
Authors: Burnett Peter J. , Milne John R. , Greenwood Richard , Giles Martin R. , Camm John
Published: December 2008

One-hundred and ten patients referred for echocardiography to exclude a cardiac source of cerebral emboli were prospectively studied. Four patients with known cardiac abnormalities, for which they were receiving inadequate anticoagulation, were excluded from the study, and 18 patients were subsequently found to have a non-embolic cause for their cerebral pathology. Twenty-eight patients with a normal clinical examination, chest X-ray and electrocardiogram, and 27 patients with hypertension alone had echocardiograms which did not reveal a cardiac source of embolus. Of the remaining group of 33 patients, six were found to have a probable cardiac source of embolus and nine had abnormalities which may be associated with cerebral emboli. Echocardiography may not be indicated in patients with a normal clinical examination, chest X-ray and electrocardiogram, and in patients with hypertension alone. However, if these patients are excluded echocardiography gives a high yield of positive findings which may be of practical importance in the management of the patient.
A comparison of isocaloric high carbohydrate and high fat test meals in diabetics
Authors: Jones D. B. , Patel P. , Slaughter P. , Carter R. D. , Mann J. I. , Hockaday T. D.
Published: December 2008

Ten diabetic patients were given test meals at breakfast and lunch on successive days to compare the acute glycaemic responses to meals either high (65%) (HC) or extremely low (12%) in carbohydrate; the latter was very high (71%) in fat (HF). The meals were isocaloric and fibre content, though higher in HC, was within the range of the average British intake for both diets.

The mean fasting blood glucose levels were similar on the 2 days (9.8 mmol/l; 9.6 mmol/l) but mean peak post-prandial levels were significantly greater after the HC meals (17.7 mmol/l after breakfast and 14.1 mmol/l after lunch) than after the HF meals (11.7 mmol/litre after breakfast; P less than 0.02; 8.1 mmol/l after lunch; P less than 0.02). Mean blood glucose value for the 6-hr study period was significantly higher after the HC meals (14.0 mmol/l) than after the HF meals (9.2 mmol/l; P less than 0.001). There was no significant difference in mean fasting, peak or total mean triglyceride level.

In the short term, therefore, meals very low in carbohydrate and high in fat are followed by a lower glycaemic response than meals high in carbohydrate but with only a usual (22 g/day) fibre content. Delayed gastric emptying after HF meals may well contribute to the results but long-term use of such HF meals is not advised in view of the extremely high fat content.
Horner’s syndrome with ipsilateral vocal cord and phrenic nerve palsies
Authors: Amin Rajni
Published: December 2008

Two further cases of a recently described syndrome (Rowland Payne, 1981) constituting a triad of sympathetic ophthalmoplegia, phrenic nerve palsy and ipsilateral vagus or recurrent laryngeal nerve paralysis are described. This is a syndrome of signs, but hoarseness, dysphagia, dysaesthesia and pain in the ipsilateral shoulder may be associated symptoms. Development of this syndrome in patients with malignant disease does not necessarily signify a very grave prognosis.
Fatal ventricular tachycardia in association with propafenone, a new class IC antiarrhythmic agent
Authors: Nathan A. W. , Bexton R. S. , Hellestrand K. J. , Camm A. J.
Published: December 2008

A man with a past history of malignant ventricular arrhythmias occurring late after myocardial infarction was admitted for assessment. Monitoring revealed frequent ventricular premature beats and occasional non-sustained runs of ventricular tachycardia. Other drugs having failed, he was started on oral propafenone which is a new Vaughan Williams class IC antiarrhythmic agent. Several hours after starting this drug he had incessant ventricular tachycardia and subsequently died. Other class IC agents have been shown to have a high incidence of proarrhythmic effects, and particular care should be taken with these potent new drugs.
Does health education prevent childhood accidents?
Authors: Minchom P. E. , Sibert J. R. , Newcombe R. G. , Bowley M. A.
Published: December 2008

In an attempt to test the assumption that health education directed at parents and children can reduce childhood accidents, a controlled study was carried out in Ely , one area of Cardiff. Using conventional health education techniques, the campaign was carried out in June and July 1981 and monitored by the numbers of injured children attending the local Accident and Emergency Department.

Comparison of accident numbers in Ely between 1980 and 1981 and between Ely and the whole of Cardiff in 1981 showed no significant change. A slight increase in trivial injuries suggested an increased willingness to attend hospital. There was no change in the age distribution of victims.

The benefits of health education and alternative methods of accident prevention are discussed and the need for further research is emphasized.
Laryngocoele causing airflow obstruction—a case report and summary of clinical manifestations in five other patients
Authors: Banks J. , Davis B. R. , Monie R. D. H.
Published: December 2008

We present six patients with laryngocoeles , one of whom presented as an emergency to a Chest Unit. A swelling in the neck was present in five, two patients had hoarseness progressing to stridor and three complained of dysphagia. No underlying cause was found in any of the patients. Surgical management was necessary in five with good results.
Impaired nitrazepam metabolism in hypothyroidism
Authors: Kenny Rose Anne , Kafetz Kalman , Cox Maria , Timmers Josepha , Impallomeni Mario
Published: December 2008

Delayed metabolism of a number of drugs has been described in hypothyroid patients. We report an elderly hypothyroid female who had prolonged delay in the metabolism of a commonly-used sedative, nitrazepam, and discuss the importance of delayed drug metabolism in hypothyroidism.
Effect of the H2-receptor antagonist ranitidine on depression and anxiety in duodenal ulcer patients
Authors: Robins Ashley H. , Lucke Wendy , McFadyen M. Lynn , Wright John P.
Published: December 2008

Depression and anxiety were measured during the course of a double-blind, placebo-controlled trial of the histamine H2-receptor antagonist, ranitidine (150 mg twice daily), in patients suffering from duodenal ulcer but free of systemic disease. There were 25 patients in the ranitidine group (mean age: 33.2 years) and 28 in the placebo group (mean age: 37.2 years). In both groups there was a highly significant and progressive decrease in depression and anxiety scores over the 4 weeks of treatment. There were no instances of mental confusion. In our group of otherwise physically healthy patients, ranitidine appeared to be free of neuropsychiatric complications.
Hypertensive encephalopathy complicating transplant renal artery stenosis
Authors: McGonigle R. J. S. , Bewick M. , Trafford J. A. , Parsons V.
Published: December 2008

A 26-year-old female diabetic patient developed hypertensive encephalopathy with gross neurological abnormalities complicating renal artery stenosis of her transplant kidney. The elevated blood pressure was unresponsive to medical treatment. Surgical correction of the stenoses in the renal artery cured the hypertension and renal failure and led to the patient’s complete recovery.
Recurrence of asthma following removal of a noradrenaline-secreting phaeochromocytoma
Authors: Harvey J. N. , Dean H. G. , Lee M. R.
Published: December 2008

A patient with asthma and a phaeochromocytoma is described. At about the time she was first noted to be hypertensive her asthma resolved spontaneously but bronchospasm returned with some severity when the tumour was removed. The phaeochromocytoma was of the noradrenaline secreting variety. Possible mechanisms through which this catecholamine might have produced the observed alleviation of asthma are considered.
Phaeochromocytoma in a coeliac ganglion in pregnancy
Authors: Parsons J. , Clunie R. W. D. , Letchworth A. T.
Published: December 2008

A case of a phaeochromocytoma is reported which presented as collapse in the postpartum period. The site of the tumour was in the coeliac ganglion.
Serum phosphorus levels in pulmonary tuberculosis
Authors: Kardjito T. , Ediyanto S. P. , Grange J. M.
Published: December 2008

The mean level of phosphorus was significantly higher in a group of 96 Indonesian patients with pulmonary tuberculosis than in 100 control subjects. The levels in disease showed a moderate correlation with those of the globulin proteins, but not the gamma-globulins. There was an association between levels of phosphorus and those of transferrin but not with those of seven other acute-phase associated proteins.

There was a tendency for phosphorus levels to be higher in those with elevated polymorphonuclear leucocyte counts and, although not significantly so, in those with more extensive active disease, suggesting an association with tissue destruction. It appears therefore more relevant to study the behaviour of this element than that of calcium in tuberculosis.
Immobilization hypercalcaemia with severe bone mineral loss and hypogonadism
Authors: Need Allan G. , Morris Howard A. , Horowitz Michael , Nordin B. E. Christopher
Published: December 2008

Moderate hypercalcaemia occurred in a 17-year-old male who was immobilized with abdominal and right hip sepsis for 9 months after a motor vehicle accident.

The hypercalcaemia was due to bone resorption, with a urine hydroxyproline:creatinine ratio of 0.203 (normal less than 0.017) and a urine calcium loss of 22.9 mmol/24 hr, associated with impaired renal function. There was radiological evidence of severe bone demineralization in the pelvis over 42 weeks.

Radiocalcium absorption, using 47Ca, was decreased (0.17, normal range 0.35–1.30), renal tubular maximum for calcium reabsorption was decreased (1.61 mmol/1 glomerular filtrate, normal range 1.8-2.2), the serum parathyroid hormone concentration was in the low normal range (3.2, 3.6 u/l, normal range 2-6) and the plasma 1,25-dihydroxy-vitamin D concentration was decreased despite a normal 25-hydroxy-vitamin D concentration, indicating suppression of the parathyroid, 1,25-dihydroxy-vitamin D axis. The patient was found to be hypogonadal at 41 weeks after admission and testosterone therapy was begun, with associated improvement in mobilization and a reduction of the hypercalcaemia.
Cerebral arterial occlusion and intracranial venous thrombosis in a woman taking oral contraceptives
Authors: Montón F. , Rebollo M. , Quintana F. , Berciano J.
Published: December 2008

Occlusion of the middle cerebral artery and thrombosis of the superior sagittal sinus are reported in a 30-year-old woman taking oral contraceptives (OC). The coexistence of arterial and venous cerebral pathology as a complication of OC use has only been previously reported in one case. The pathogenesis of this rare association is briefly discussed.
Cardiac tamponade in rheumatoid arthritis
Authors: Sanchez-García Pedro , Cordero-Sánchez Miguel , Pavón-Osuna Pedro , Arribas-Jiménez Antonio , del Pino-Montes Javier , de Portugal-Alvarez José
Published: December 2008

A 56-year-old woman with definite rheumatoid arthritis developed cardiac tamponade while her disease was both clinically and serologically inactive. To our knowledge such a complication has been reported only once previously.