bluuebunny/crossref_metadata_2025 huggingface dataset:
Proximal motor neuropathy, IgA paraproteinaemia and anti-myelin-associated glycoprotein reactivity
Authors: Hemachudha T , Phanuphak P , Phanthumchinda K , Kasempimolporn S
Published: December 2008

We report a case with proximal motor neuropathy associated with benign IgA lambda paraproteinaemia. Immunoblot demonstrated reactivity to myelin-associated glycoprotein and not to P2 protein of peripheral nerve. Dramatic improvement of the polyneuropathy was observed with steroid treatment alone within 4 weeks.
Bacterial calcification in infective endocarditis
Authors: Poller D N , Curry A , Ganguli L A , Routledge R C
Published: December 2008

The present report is the first description to our knowledge of a clinical case of bacterial calcification in human infective endocarditic vegetations. Partial calcification of bacteria within vegetations may be a further mechanism of bacterial protection from host defences and antibiotics. Similar calcification has recently been reported in vegetations formed on porcine valvular prostheses implanted experimentally in sheep.
Pneumococcal Waterhouse-Friderichsen syndrome despite a normal spleen
Authors: Bramley P N , Shah P , Williams D J , Losowsky M S
Published: December 2008

A previously fit 56 year old female presented with a rapidly progressive and fatal pneumococcal septicaemia with disseminated intravascular coagulation. Post-mortem studies confirmed a Waterhouse-Friderichsen syndrome and revealed an anatomically normal spleen; intracellular diplococci were seen within splenic macrophages providing evidence of normal splenic function. This appears to be only the second case of Waterhouse-Friderichsen syndrome due to pneumococcal septicaemia in a patient with a normal spleen.
Axillary artery occlusion as a presenting feature of Crohn’s disease
Authors: Sheehan-Dare R A , Goodfield M J D , Wilson P D , Rowell N R
Published: December 2008

A 20 year old Caucasian woman with Crohn’s disease is described in whom axillary artery occlusion due to arteritis dominated the clinical picture. This case demonstrates that isolated large vessel arteritis can be an unusual feature of Crohn’s disease. Crohn’s disease should be considered in any patient presenting with a large vessel arteritis.
Central hypoventilation in a seven year old child following pertussis treated with negative pressure ventilation
Authors: Russell-Jones D L , Treacher D F , Lenicker H M , Tashanov M , Spencer G T
Published: December 2008

We report the case of a 7 year old girl who developed central hypoventilation following pertussis and who was treated by negative pressure ventilation using a new portable tank respirator. We believe this is the first reported case of central hypoventilation following pertussis successfully treated by intermittent negative pressure ventilation.
Cardiac tamponade complicating leukaemia: immediate chemotherapy or pericardiocentesis?
Authors: Leung W H , Tai Y T , Lau C P , Wong C K , Cheng C H , Chan T K
Published: December 2008

Although leukaemic infiltration of the pericardium is frequently observed at post-mortem, clinically evident cardiac tamponade is rare. Two cases of cardiac tamponade complicating leukaemia are presented. One patient had cardiac tamponade as the initial presentation of acute lymphoblastic leukaemia and experienced complete resolution of the pericardial effusion within 6 days after chemotherapy without therapeutic pericardiocentesis. The other patient with chronic myeloid leukaemia developed cardiac tamponade requiring pericardiocentesis as the first sign of acute blastic transformation. The roles of early chemotherapy and pericardiocentesis in managing this complication are discussed.
Dyskinesia in the elderly presenting as respiratory disorder
Authors: Godlee F N , Brooks D J , Impallomeni M
Published: December 2008

Two elderly women suffering from dyskinesia affecting the respiratory muscles are described. The diagnosis was initially missed in both cases, and thought to be anxiety syndrome in one patient, and chronic obstructive airways disease in the other. Drug therapy further increased the severity of the dyskinetic movements which greatly improved when it was discontinued. Dyskinesia should be considered as the cause of respiratory disorder in old age, especially when this develops slowly in patients with movement disorders and a history of taking antidopaminergic drugs.
Acute organic brain syndrome due to drug-induced eosinophilia
Authors: Ng S C , Lee M K , Teh A
Published: December 2008

A 72 year old man developed acute organic brain syndrome associated with marked eosinophilia following self medication with a variety of drugs. Investigations revealed no other known causes of eosinophilia. Withdrawal of drugs resulted in dramatic drop in eosinophil count paralleled by clinical resolution of neurological problems. To our knowledge drug-induced eosinophilia has not previously been associated with acute organic brain syndrome.
Conn’s syndrome due to an ectopic adrenal adenoma
Authors: Arnold J , Mitchell A
Published: December 2008

A 31 year old woman presented with resistant hypertension. Investigations revealed that she had Conn’s syndrome. Computed tomography showed both adrenals to be normal but an ectopic adenoma was identified posterior to the stomach. Surgical excision of the tumor confirmed benign aldosteronoma and cured her hypertension. We believe this to be the first report of Conn’s syndrome caused by an ectopic adrenal adenoma.
The metabolic effects of fatal cyanide poisoning
Authors: Singh B M , Coles N , Lewis P , Braithwaite R A , Nattrass M , FitzGerald M G
Published: December 2008

Metabolic and toxicological data were obtained during the first 24 hours following severe and eventually fatal cyanide poisoning. Initial blood cyanide concentrations were 804 mumol/l but fell rapidly over 24 hours following cobalt edetate therapy to 15 mumol/l. However, plasma thiocyanate concentrations rose over 24 hours (147-267 mumol/l) suggesting continued tissue detoxification. The major metabolic abnormality was lactic acidosis (initial pH 7.21, blood lactate 17.5 mmol/l) which corrected over 12 hours. Despite high circulating insulin concentrations the responses of blood glucose, plasma non-esterified fatty acid, blood glycerol and 3-hydroxybutyrate suggested marked insulin resistance.
Malignant fibrous histiocytoma of the mediastinum
Authors: Aggarwal P , Sharma S K , Dey A B , Chattopadhyay T K , Mathur M
Published: December 2008

A case of malignant fibrous histiocytoma of the mediastinum presenting with unusual features of fever and leucocytosis is reported. This is the youngest patient reported in the literature who had this tumour in the mediastinum.
Amitriptyline overdose complicated by intestinal pseudo-obstruction and caecal perforation
Authors: McMahon A J
Published: December 2008

I report a case of intestinal pseudo-obstruction, spontaneous caecal perforation and faecal peritonitis caused by an overdose of amitriptyline. This rare but serious complication should be borne in mind in patients who remain constipated while convalescing after self-poisoning with tricyclic antidepressants.
Acetonitrile ingestion: delayed onset of cyanide poisoning due to concurrent ingestion of acetone
Authors: Boggild M D , Peck R W , Tomson C R V
Published: December 2008

A fatal case of acetonitrile ingestion is reported. The patient presented having apparently taken an overdose but was well until around 24 hours after the supposed ingestion, when cardiovascular collapse and profound metabolic acidosis developed. Later investigation revealed that the patient had taken acetone and acetonitrile. Acetone is known to slow the metabolism of acetonitrile to cyanide, thereby delaying the appearance of toxicity.
Vagal nerve schwannoma—a new diagnostic sign
Authors: Morrissey M S C , Sellars S L
Published: December 2008

A case of vagal nerve schwannoma with a new physical sign is presented. The tumour was largely cystic and aspiration, performed twice, immediately elicited a cough reflex from the patient.

Treatment was by total excision and the patient made a good recovery. Complete cystic degeneration of a vagal nerve schwannoma is uncommon. A search of the literature has failed to find any previous reports of fine needle aspiration causing a cough reflex in these tumours.
Acute renal failure associated with a labetalol overdose
Authors: Korzets A , Danby P , Edmunds M E , Feehally J , Walls J
Published: December 2008

A case of acute renal failure in association with a deliberate labetalol overdose is described. The possible pathogenetic mechanisms behind the deterioration in renal function are discussed. Treatment of beta-blockade overdose, with special emphasis on the place of glucagon in such poisoning, is reviewed.
Long term treatment of myasthenia gravis with azathioprine
Authors: Fonseca V , Havard C W H
Published: December 2008

Twenty-seven patients with myasthenia gravis have been treated with azathioprine in conjunction with pyridostigmine and prednisolone for a total of 138 patient years. Side effects necessitated discontinuation of treatment in only four patients. Treatment with azathioprine was associated with marked clinical improvement in all the remaining 23 patients, resulting in reduction in the dose of pyridostigmine and prednisolone. The number of hospital admissions as well as the number of episodes of respiratory failure were markedly reduced.
Adverse effects of captopril in hospital outpatients with hypertension
Authors: Walley T , Winstanley P , Roberts D , Grimmer M , Orme M , Breckenridge A
Published: December 2008

Hypertensive patients prescribed captopril while attending a hospital hypertension clinic were studied, to identify the benefits of the drug, its adverse effects and factors predisposing to them. One hundred and eighty two patients were followed for a mean of 18 months; 24 received captopril alone, and 158 combinations of captopril and other antihypertensive drugs, especially loop diuretics (91/158), or thiazide diuretics (57/158), or other vasodilators (57/158). The mean final dose of captopril was 67 mg/day.

Blood pressure (BP) was effectively controlled in 73% of patients (mean fall in systolic BP 29 mmHg, CI 24 to 34, P ≤ 0.001; mean fall in diastolic BP 18 mmHg, CI 16 to 20, P ≤ 0.001). Blood urea and creatinine rose slightly in all patients (urea by 0.9 mmol/l [13%], CI 0.5–1.3, P ≤ 0.001 and creatinine by 9 mumols/l [8%], CI 4–13, P ≤ 0.001). Twenty six patients were withdrawn from captopril therapy: 6 because of poor control of their blood pressure, two because it was no longer necessary and 12 (7.7%) because of extrarenal adverse effects—10 for rashes, one each for gastric upset and impotence. Captopril was withdrawn in a further 6 patients, because of deteriorating renal function. Factors discriminating those at risk of renal dysfunction were high doses of captopril, concomitant high dose diuretic therapy and undiagnosed renovascular disease.
Solitary cerebral metastasis from a papillary carcinoma of the thyroid
Authors: Goolden A W G , Mclaughlin J E , Valentine A R , Pease C
Published: December 2008

A woman aged 52 was treated with radioactive iodine for a papillary carcinoma of the thyroid. Four years later she developed signs and symptoms of an intracranial space occupying lesion. A computed tomographic scan showed a mass in the right posterior frontal region. Although she was suspected of having metastatic disease a definite diagnosis was not established until she died 6 months later when post-mortem examination confirmed that she had a cerebral metastasis from a papillary carcinoma of the thyroid. There was no evidence of metastatic disease elsewhere in the body.

Cerebral metastases from papillary carcinoma of the thyroid are uncommon but may occur in patients who have metastases in bones or lungs. A search of the literature has revealed only two patients with solitary cerebral metastases.
Post-partum thyroiditis can be painful
Authors: Othman S , Parkes A B , Richards C J , Hall R , Lazarus J H
Published: December 2008

A patient with post-partum thyroiditis is described. She was a 22 year old with a negative family history of autoimmune thyroid disease who was noted to have a high titre of antithyroid microsomal antibody during pregnancy. She developed mild hyperthyroidism 8 weeks post-partum but at 12 weeks she had a mildly painful enlarged thyroid gland. At 20 weeks post-partum she had severe thyroidal pain with dysphagia. The thyroid was exquisitely tender to palpation. She was treated with L-thyroxine and the pain resolved within 4 weeks. This is the first report documenting pain in the thyroid as a feature of post-partum thyroiditis.
First degree atrioventricular block associated with right atrial myxoma
Authors: Roberts D H , Ramsdale D R
Published: December 2008

First degree atrioventricular block occurred in a 68 year old man with a large right atrial myxoma. This conduction abnormality resolved within three months of successful surgical removal of the tumour. It is suggested that mechanical compression by the myxoma on either the underlying conduction tissue or the interventricular septum is likely to have caused this phenomenon.
Community defibrillation in the Scottish Highlands
Authors: Jones M C , Kerr F , Eckersley A P R
Published: December 2008

Prompt defibrillation after cardiac arrest is necessary to save life. Inexpensive systems providing defibrillation facilities in the community of the Highlands have been devised, one for Inverness town practices, and one for rural practices. Both systems work by ‘blind’ defibrillation, once the clinical diagnosis of cardiac arrest is confirmed. Acute anti-arrhythmic drugs and intravenous infusions were not available. The systems functioned satisfactorily with general acceptance by the general practices concerned.
The natural history of euthyroid multinodular goitre
Authors: Elte J W F , Bussemaker J K , Haak A
Published: December 2008

In this communication data on the natural history of euthyroid multinodular goitres are presented. From a total group of 140 patients (mean age 54.6 years, 14 men and 126 women; 88 with autonomous, 52 with non-autonomous function), follow-up data were available for 90 patients (mean age 54.0 years, 11 men and 79 women; 64 with autonomous, 26 with non-autonomous function). During follow-up (means: 5.0 years, maximum 12.2 years) transitions in function were seen 15 times; 8 autonomous patients became hyperthyroid after < 1–7 years. There were 6 transitions from non-autonomy to autonomy and 1 from autonomy to non-autonomy. One patient who demonstrated the whole cycle from non-autonomy through autonomy up to hyperthyrodism is described in more detail. In one patient operated upon because of hyperparathyroidism a follicular carcinoma was found by chance. Mechanical problems were the reason for surgery in 6 patients only, 16 patients were operated upon because of cosmetic reasons (mostly in the early years of the study). Finally, results from 19 TRH tests in 16 autonomous patients suggest that TRH tests in patients with autonomously functioning euthyroid multinodular goitres are not yet redundant.
Does preoperative computed tomography scanning aid assessment of oesophageal carcinoma?
Authors: Kirk S J , Moorehead R J , McIlrath E , Gibbons J P , Spence R A J
Published: December 2008

In this study 50 patients (36 male, 14 female) with oesophageal carcinoma have been examined preoperatively by computed tomography. Three parameters were assessed, nodal involvement, invasion of adjacent organs, and metastatic disease. For all patients the computed tomography findings were correlated with the subsequent surgical and pathological findings. Sensitivity for both invasion and node involvement is low (36% to 67%). Specificity however, is high (85% to 95%). Computed tomography is therefore relatively reliable when it predicts a ‘negative result’ for either invasion or node involvement. However, its predictive value for a positive result is not as reliable.
Opportunistic Listeria pericardial effusion
Authors: Crellin A M , Shareef D S , Maher E J
Published: December 2008

A case is described of pericardial effusion due to Listeria monocytogenes infection in a woman with advanced carcinoma of the cervix, rheumatoid arthritis and on corticosteroid therapy. Focal infection with listeria in immunocompromised adults has a high mortality unless promptly diagnosed. The correct diagnosis may have been made if an unexplained pericardial effusion had been tapped.
Left handedness in an identical twin discordant to his co-twin for handedness and schizophrenia, with neurological and psychometric evidence of left hemisphere damage
Authors: Weller M P I
Published: December 2008

A left handed, monozygotic, male twin developed schizophrenia, whilst his right handed brother was free of psychopathology. There was no family history of mental illness or left handedness. The affected twin had left side motor weakness and an EEG showed scattered irregularities, particularly on the left. Psychometry indicated left sided tempero-parietal dysfunction. The relationship between left temporal lobe damage and schizophrenia is considered.
Repeated echocardiography: essential in the management of Staphylococcus aureus endocarditis
Authors: O'Sullivan J J , Aherne T , Erwin J
Published: December 2008

Staphylococcus aureus endocarditis in a previously healthy 25 year old man is described. Repeated echocardiography recorded rapid progression of aortic root and interventricular septal involvement and, even though the patient was clinically stable, early surgery was advised with a satisfactory outcome. This case report clearly demonstrates the vital role of repeated cross-sectional echocardiography in the management of such cases.
Fatal myocarditis with acute polymyositis in a young adult
Authors: Bhan A , Baithun S I , Kopelman P , Swash M
Published: December 2008

A 21 year old woman presented with acute polymyositis associated with fatal myocarditis. The significance of cardiac involvement in polymyositis is discussed in relation to this unusually fulminant case.
Precipitation of hypercalcaemia in sarcoidosis by foreign sun holidays: report of four cases
Authors: Cronin C C , Dinneen S F , O'Mahony M S , Bredin C P , O'Sullivan D J
Published: December 2008

Hypercalcaemia after foreign sun holidays in four patients is described. Although only one was a known case, all had sarcoidosis. The pathogenic mechanisms are discussed and the implications of excessive sun exposure for the mode of presentation and the management of sarcoidosis are highlighted.
The effective use of cardiac enzymes and electrocardiograms in the diagnosis of acute myocardial infarction in the elderly
Authors: Gama R , Swain D G , Nightingale P G , Buckley B M
Published: December 2008

The diagnosis of acute myocardial infarction (AMI) in the elderly is difficult and often depends on the results of investigations. In a 3-month prospective study, 270 patients admitted to an acute geriatric unit were studied to determine the most effective diagnostic strategy for the diagnosis of AMI, and to assess the value of screening acute geriatric admissions for AMI.

Patients were assessed clinically and investigated with serial electrocardiograms and measurements of serum creatine kinase (CK), aspartate aminotransferase (AST), and lactate dehydrogenase activities on three consecutive days after admission.

Measurement of serum activity of CK and AST had a diagnostic sensitivity of 100% and specificity of 86.8% for AMI. This was the optimum combination of cardiac enzymes in the diagnosis of AMI. Although electrocardiograms on the first two days of admission had a low diagnostic sensitivity (33.3%) their usefulness was their high positive predictive value (100%) when characteristic of an AMI. AMI was considered in the differential diagnosis of 79 patients (29%). All 25 patients (9%) who had an AMI were in this group, and therefore screening all geriatric admissions for AMI is not clinically justified.
Severe haemolytic anaemia due to cold anti-‘i’ antibodies associated with cytomegalovirus infection
Authors: Aguado J M , Castrillo J M , Sanz J , Serrano J
Published: December 2008

A 66 year old patient with multiple myeloma and monoclonal cryoglobulinaemia who developed a severe haemolytic anaemia following a cytomegalovirus infection is reported. The presence of a high titre of anti-‘i’ cold antibody of IgM subclass is demonstrated. Anti-‘i’ antibody disappeared when complement-fixation antibody titres against cytomegalovirus decreased. Various pathogenetic mechanisms involved in the development of haemolytic anaemia associated with cytomegalovirus infection are discussed. To our knowledge, this is the first case described in the English language publications associating severe haemolytic anaemia with an anti-‘i’ antibody after a cytomegalovirus infection in an immunocompromised patient.
Immunoblastic lymphoma presenting with syncope due to sinoatrial node disease
Authors: Dolan G , Jones A P , Reilly J T
Published: December 2008

A 68 year old man presented with syncope associated with episodes of sinus arrest. He responded to insertion of a demand pacemaker. During investigation he was noted to have generalized lymphadenopathy and biopsy revealed that he had an immunoblastic lymphoma. Before further assessment could be made, he developed rapid atrial fibrillation, resistant to several anti-arrhythmic agents and died several days after admission. At autopsy a nodular plaque of lymphoma was found to overly the sinoatrial node which was markedly fibrosed with evidence of lymphomatous infiltration of the surrounding microvasculature.
Pancreatic carcinoma presenting as bleeding from segmental gastric varices: pitfalls in diagnosis
Authors: Mullan F J , McKelvey S T D
Published: December 2008

Splenic vein occlusion leading to gastric variceal haemorrhage should be considered in cases of obscure upper gastrointestinal bleeding. We report an unusual case in which the underlying pathology was a resectable carcinoma of the pancreatic tail.
Efficacy of enalapril in essential hypertension and its comparison with atenolol
Authors: el Mangoush M , Singh N K , Kumar S , Basha A , Gupta B S , Bolya Y K , Gamati A
Published: December 2008

The effect of enalapril was evaluated in 67 patients with essential hypertension, and its therapeutic efficacy was compared with atenolol in a placebo run-in, single-blind, cross-over trial. Enalapril significantly reduced blood pressure in all grades of essential hypertension. As monotherapy it ‘normalized’ blood pressure in 88%, 50% and 25% of patients with mild, moderate and severe hypertension respectively. Optimal dose for most of the patients was 20 to 40 mg/day. Comparison with atenolol revealed almost parallel efficacy of the two drugs, although enalapril produced a significantly greater reduction in systolic blood pressure in patients with mild and moderate hypertension (P < 0.01 in each group). No serious side effects were encountered with either drug. Enalapril, therefore, has a potent and slightly superior antihypertensive effect to that of atenolol, and may be used as a ‘first-step’ drug in the treatment of hypertensive patients.
A gastrectomy population: 25–30 years on
Authors: Tovey F I , Godfrey J E , Lewin M R
Published: December 2008

Prior to 1960 a Polya gastrectomy was the most frequent operation for duodenal ulcer. The majority of these patients now have reached the age of sixty or older. A prospective longitudinal study of a cohort of patients who underwent gastrectomy between 1955 and 1960 was undertaken. Twenty five to thirty years later the study has revealed the extent of the nutritional problems that may arise with the passage of time and shows that these numerically far outweigh the mechanical post-gastrectomy syndromes and weight loss which tended to dominate the earlier post-gastrectomy scene.

By the end of the first decade, iron deficiency was the commonest nutritional problem. Vitamin B12 deficiency assumed more importance in the second decade. During the third decade both reached equal prevalence, being found in some 90% of the female and 70% of the male residual population. Vitamin D deficiency and early osteomalacia was a lesser problem, reaching its climax in the second decade. Evidence suggested a high incidence of osteoporosis and this requires further investigation. Overall, women fared worse than men with a higher and earlier incidence of iron deficiency, particularly in the pre-menopausal group.

This study emphasizes the increasing need for regular screening of post-gastrectomy patients to detect early iron, vitamin B12 and vitamin D deficiencies as patients grow older.
The Employment Medical Advisory Service
Authors: Henderson R T S , Carter J T
Published: December 2008

The historical development of the Employment Medical Advisory Service is described, and the Service's present organization is related to its range of activities, including its role as a source of information and advice on occupational health. The Employment Medical Advisory Service's influence on the development of occupational health practice, the collection of new knowledge and its adaptability in changing social and employment conditions is described, and examples of its work are given.
Non A, non B hepatitis in the aged
Authors: Sonnenblick M , Oren R , Tur-Kaspa R
Published: December 2008

In order to study the clinical picture of non A, non B hepatitis in the elderly, a retrospective study was carried out in the two main hospitals in Jerusalem. Thirty-six patients with acute viral hepatitis, older than 65, have been hospitalized between the years 1982–1988. Seventy-two percent were diagnosed as non A, non B hepatitis. All patients were symptomatic and the main symptoms were abdominal pain, fever and jaundice. Thirty percent of the patients had marked cholestasis, while the disease was uneventful in 96% of the cases. Non A, non B hepatitis is the main type of viral hepatitis in the aged and should be suspected in patients with abdominal pain, fever and cholestasis.
Dipyridamole echocardiography: the bedside stress test for coronary artery disease
Authors: Buchalter M B , Bourke J P , Heads A , Hawkins T
Published: December 2008

Identification of dipyridamole-induced regional wall motion abnormalities by echocardiography has recently been proposed as an alternative diagnostic stress test for coronary artery disease. This study evaluates this new technique by comparing the results obtained (overall, regionally and by abnormality type) with those of thallium-201 myocardial imaging after dipyridamole stress in 25 patients.

Acceptable echocardiograms were obtained in 20 patients (80%). Concordance of echocardiographic abnormalities for both overall and regional thallium abnormalities was 85%. Sensitivity, specificity and predictive value of dipyridamole echocardiography for overall and regional thallium defects were 92%, 71% and 85%, and 91%, 81% and 85% respectively. However, concordance between the two for abnormality type (i.e. ischaemia versus infarction) was only 66% and the sensitivity, specificity and predictive value of dipyridamole echocardiography for identifying ischaemia as opposed to infarction were only 43%, 82% and 63%, respectively.

There was substantial agreement between thallium and echocardiographic imaging after dipyridamole infusion in the diagnosis of coronary artery disease. Echocardiography appears less well able to distinguish infarction from active ischaemia. Dipyridamole echocardiography provides a highly versatile, noninvasive bedside stress test for the detection and localization of coronary artery disease.
Cerebellar syndrome with hydrocephalus due toMycoplasma pneumoniaeinfection
Authors: Coleman R J , Brown J S , Butler P , Swash M
Published: December 2008

A 27 year old woman developed a cerebellar syndrome with serological evidence of recent Mycoplasma pneumoniae infection. The cranial computed tomographic scan showed effacement of the fourth ventricle, enhancement of the basal meninges and hydrocephalus affecting the lateral and third ventricles. Clinical and radiological recovery occurred over 5 weeks. We propose that this was a manifestation of immune-mediated encephalomyelitis induced by the infection rather than direct invasion of the central nervous system.
Mefenamic acid-induced neutropenia and renal failure in elderly females with hypothyroidism
Authors: Handa S I , Freestone S
Published: December 2008

We report mefenamic acid-induced non-oliguric renal failure and severe neutropenia occurring simultaneously in two elderly females. The neutropenia was due to maturation arrest of the myeloid series in one patient. Both patients were also hypothyroid, but it is not clear whether this was a predisposing factor to the development of these adverse reactions. However, it would seem prudent not to use mefenamic acid in hypothyroid patients until the hypothyroidism has been corrected.
Electrical shock sustained in pregnancy followed by placental abruption
Authors: Yoong A F E
Published: December 2008

The case of a pregnant woman suffering a large placental abruption following electric shock at 32 weeks' gestation is reported. No other such cases have been published in the literature.
Economic evaluation of gastric ulcer prophylaxis in patients with arthritis receiving non-steroidal anti-inflammatory drugs
Authors: Knill-Jones R , Drummond M , Kohli H , Davies L
Published: December 2008

This study assesses the economic benefits of misoprostol in the prophylaxis of gastric ulcers larger than 0.3 cm in patients with osteoarthritis receiving non-steroidal anti-inflammatory drugs. Independent epidemiological data were obtained for patients in Scotland and the West Midlands. Co-diagnosis of arthritis with gastric ulcer recorded in the routine data was substantially less (4% Scotland, 10% West Midlands) than the 21% found at case review. These data were combined with cost and patient management data in a decision analysis model to explore whether prophylactic use of misoprostol altered substantially the average cost of managing gastric ulcer. Using conservative assumptions and a daily dose of 400 micrograms, cost savings per patient to the National Health Service of £5–£8 pounds over a 3-month period are expected in the groups of patients studied, while at the 800 micrograms dose there would be a net cost of £23–£25 pounds. Sensitivity analysis showed that under many assumptions misoprostol is expected to be cost saving or cost neutral.
Early diagnosis of Graves' optic neuropathy using visual evoked responses
Authors: Batch J A , Lepre F
Published: December 2008

A 27 year old woman with Graves' disease developed progressive ophthalmopathy and was noted to have abnormal visual evoked responses (VER). She was treated with high dose prednisone with clinical improvement and return of the visual evoked responses to normal. On withdrawal of steroids symptoms recurred and VER again were abnormal. Orbital irradiation was given with improvement in the ophthalmopathy and VER again normalized. To our knowledge this report represents the first demonstration of improvement in VER with treatment in Graves' optic neuropathy.
Diagnostic aspiration of an iatrogenic hydrothorax following subclavian catheterization
Authors: Steiger M J , Morgan A G
Published: December 2008

Central venous catheterization is not without hazard. Inadvertent placement in the pleural space can occur without the development of a pneumothorax and pressure measurements may appear misleadingly normal. This case report illustrates an effective method of diagnosing and draining an iatrogenic hydrothorax which resulted in this way.
Spontaneous rheumatoid fistula of the elbow joint
Authors: Huston G , Newman R J
Published: December 2008

A case of rheumatoid arthritis, whose presenting problem was a non-infective fistula of the elbow joint, is described. Penicillamine therapy was ineffective, but synovectomy led to healing.
Subcutaneous sarcoidosis mimicking carcinoma of the breast
Authors: Gallimore A P , George C D , Lampert I A
Published: December 2008

A 65 year old woman presented with bilateral breast lumps. Clinical examination suggested a diagnosis of mammary carcinoma, but a histological diagnosis of sarcoidosis was made. Subsequent investigations revealed evidence of pulmonary sarcoidosis.
An unusual omental hernia
Authors: Rayter Z , Chinegwundoh F
Published: December 2008

A unique case of a type of omental hernia is presented, which caused small bowel obstruction. The hernia is described and possible aetiological factors discussed.
Do non-steroidal anti-inflammatory drugs or smoking predispose to Helicobacter pylori infection?
Authors: Maxton D G , Srivastava E D , Whorwell P J , Jones D M
Published: December 2008

Susceptibility to Helicobacter pylori infection is a poorly understood phenomenon. This study was undertaken to establish whether either smoking or chronic non-steroidal anti-inflammatory drug (NSAID) consumption might in some way predispose to H. pylori infection and hence lead to peptic ulceration. Serological evidence of H. pylori infection was assessed in 100 consecutive subjects receiving NSAIDs without any evidence of gastrointestinal upset and 100 matched controls. All subjects had a full assessment of their smoking habits. Sixty-three per cent of patients taking NSAIDs compared to 51% of controls had evidence of H. pylori infection (NS). Smoking habit also had no effect on H. pylori colonization. The ulcerogenic potential of NSAIDs and smoking does not appear to be mediated via a prediposition to H. pylori infection.
Whipple's disease with cerebral involvement
Authors: Robson D K , Faraj B B , Hamal P B , Ironside J W
Published: December 2008

A case of Whipple's disease, initially presenting with abdominal symptoms and later with neurological manifestations, is reported. The diagnosis was not made in life, but on post-mortem examination of the brain. This case emphasizes the importance of early diagnosis and treatment of this uncommon disorder.
Erosive arthritis in relapsing polychondritis
Authors: Jawad A S M , Burrel M , Lim K L , Scott D G I
Published: December 2008

We report the case history of a 57 year old man who has suffered from typical deforming, relapsing polychondritis for 13 years. He has also developed erosive destructive seronegative polyarthritis involving some of his distal interphalangeal, proximal interphalangeal, metacarpophalangeal, intercarpal, wrist, intertarsal and metatarsophalangeal joints. The distribution of joint involvement in the small joints of the hands and feet is asymmetrical. Both hips and knee joints have also been involved necessitating bilateral total hip and right total knee replacement. The articular associations with relapsing polychondritis are discussed.
Immunotactoid glomerulopathy associated with mycosis fungoides
Authors: Torrelo A , Rivera M T , Mampaso F , España A , Marcèn R , Ortuño J , Ledo A
Published: December 2008

A patient with mycosis fungoides developed a nephrotic syndrome. Renal biopsy revealed deposits of a highly organized fibrillar material which did not stain with the typical amyloid stains; this picture was consistent with the diagnosis of non-amyloidotic fibrillary glomerulopathy or immunotactoid glomerulopathy. We believe this is the first case reported of immunotactoid glomerulopathy associated with mycosis fungoides. Possible pathogenetic implications are discussed with reference to previous publications.
Cutaneous myiasis in an elderly debilitated patient
Authors: Roche S , Cross S , Burgess I , Pines C , Cayley A C D
Published: December 2008

A 77 year old woman, with chronic immobility, developed bed sores which became infested with maggots. This progressed to cutaneous myiasis which is an uncommon complication of this particular phenomenon.
Emotionalism following brain damage: a complex phenomenon
Authors: Allman P , Hope R A , Fairburn C G
Published: December 2008

Emotionalism is a common and distressing consequence of many forms of brain damage. There is uncertainty about its classification, aetiology and treatment. A commonly used typology is difficult to apply in practice as illustrated by three clinical examples. We describe the various components of emotionalism and highlight their range and variability. In future research each component should be examined in detail using a standardized form of assessment.
Multiple sclerosis associated with trismus
Authors: D'Costa D F , Vania A K , Millac P A
Published: December 2008

This report describes the case history of a middle-aged lady who presented with symptoms and signs over one year leading to a diagnosis of multiple sclerosis. During one of her relapses, she developed trismus—an association that has not been described before in multiple sclerosis.
Anticoagulation instability with life-threatening complication after dietary modification
Authors: Chow W H , Chow T C , Tse T M , Tai Y T , Lee W T
Published: December 2008

Anticoagulation instability due to a change in intake of vitamin K after dietary modification was observed in 2 patients on long-term oral anticoagulants. One patient developed diffuse bruises treated conservatively with fresh frozen plasma transfusion and the other had a thrombosed aortic prosthesis which required emergency operation. To prevent such complications, dietary modification especially with food rich in vitamin K should be undertaken with care in patients on long-term oral anticoagulants.
Anaphylactic reactions to topical antibiotic combinations
Authors: Eedy D J , McMillan J C , Bingham E A
Published: December 2008

We describe two patients who developed anaphylaxis type reactions following the application of the topical antibiotic Polyfax (polymixin B and bacitracin). We draw attention to this potentially serious complication of topical antibiotic preparations and emphasize the need for careful history taking before prescribing such preparations.
Bleeding oesophageal varices associated with anabolic steroid use in an athlete
Authors: Winwood P J , Robertson D A F , Wright R
Published: December 2008

A 30 year old bodybuilder who had been taking anabolic steroids for 18 months presented with bleeding oesophageal varices. Serious liver disease secondary to anabolic steroids including peliosis hepatis, nodular hyperplasia and malignant change is well recognized. We report what is, to our knowledge, the first case of bleeding oesophageal varices associated with the use of anabolic steroids.
Primary renal ganglioneuroblastoma in an adult
Authors: Jalleh R P , Newman P L , Jenkins M T , Sturdy D E
Published: December 2008

A rare case of primary renal ganglioneuroblastoma in a 68 year old female is presented. The authors believe this to be the first case report of this tumour arising in the kidney of an adult patient.
Spontaneous rupture of the spleen in Legionnaires' disease
Authors: Holmes A H , Ng V W , Fogarty P
Published: December 2008

A case of Legionnaires' disease is described in a 63 year old man who presented with pneumonia and confusion. Eleven days after admission he became acutely hypotensive and attempts at resuscitation failed. Post-mortem examination revealed spontaneous splenic rupture and massive hepatocellular necrosis—an outcome that has not previously been associated with Legionnaires' disease.
Coarctation of the aorta associated with a sinus venosus atrial septal defect presenting with endocarditis in middle age
Authors: D'Costa D F , Davidson A R
Published: December 2008

We report the case of a 44 year old man who presented with an infective endocarditis and was found to have a coarctation of the aorta associated with a sinus venosus atrial septal defect and a small ventricular septal defect. The association of coarctation with a sinus venous atrial septal defect presenting with endocarditis in an adult is extremely rare.
Testicular teratoma and peripheral neurofibromatosis
Authors: Hilton D A , Muller S , Macpherson D S
Published: December 2008

Peripheral neurofibromatosis (Von Recklinghausen's disease) has been previously reported in association with a number of tumours and recently with aqueductal stenosis. We report a case which had both aqueductal stenosis and a testicular teratoma, which has not previously been reported in this condition.
Acute gastroenteritis: the need to remember alternative diagnoses
Authors: Felton J M , Harries A D , Beeching N J , Rogerson S J , Nye F J
Published: December 2008

Five hundred and ninety-four patients were consecutively admitted to an infectious disease unit over a 2-year period with a referral diagnosis of acute gastroenteritis or food poisoning. In 175 (29%) patients, gastrointestinal symptoms were associated with a condition other than gastrointestinal infection. Non-infective gastrointestinal disease was present in 90 patients, systemic infection in 50 and systemic disease in 35. Four illustrative case histories are presented to emphasize the need for a high index of suspicion if diseases such as malaria, septicaemia or appendicitis are not to be missed.
Ipratropium bromide: are patients treated with optimal therapy?
Authors: Millar A B , Bush A , Al-Hillawi H , Goldman J , Denison D M
Published: December 2008

A double-blind crossover placebo controlled study was performed on 20 patients with stable chronic asthma, in order to obtain dose response data to ipratropium bromide (40, 80, 200 micrograms) given by metered dose inhaler. The use of the 200 micrograms dose gave a significantly greater peak effect and duration of action than the recommended standard therapeutic dose of 40 micrograms. There were marked individual variations in response to higher doses. Maximum response detected by spirometry occurred within 24 hours of inhalation, thus patients likely to gain clinical benefit are readily identified. The higher dose was well tolerated by most patients and may have clinical application in the treatment of patients who do not respond to the standard dose regime.
High peripheral and axial bone densities in a postmenopausal woman with untreated hypoparathyroidism
Authors: Orr-Walker B , Harris R , Holdaway I M , Foote G , Reid I R
Published: December 2008

It has been reported that bone density is increased in patients with treated hypoparathyroidism, though it is unclear whether this increase is attributable to the condition itself or to its treatment. We have recently investigated a 70 year old woman with untreated hypoparathyroidism from the time of thyroid surgery at the age of 29 years. Bone mineral content of the non-dominant distal forearm was 3.7 standard deviations above the mean normal value found in 23 healthy volunteers of comparable menopausal age, and was also above the mean normal value found in premenopausal women. The vertebral mineral density of her lumbar spine (measured by quantitative computed tomography) was 3.0 standard deviations above the mean normal value. These findings suggest that high bone density is a feature of hypoparathyroidism per se and that postmenopausal bone loss may be significantly attenuated in this condition.
Systemic sclerosis and chronic lymphocytic leukaemia
Authors: Sidi Y , Fadilah R , Pinkhas J , Prokocimer M
Published: December 2008

The association between the CREST (calcinosis, Raynaud phenomena, oesophageal hypomotility, sclerodactyly and telangiectasia, variant of systemic sclerosis and chronic lymphocytic leukaemia is described in three patients. The present description raises the possibility that the association of chronic lymphocytic leukaemia and systemic sclerosis is non-random.
Sickle cell trait and stroke in the young adult
Authors: Radhakrishnan K , Thacker A K , Maloo J C , El-Mangoush M A
Published: December 2008

Two young patients with sickle cell trait (AS haemaglobinopathy) and ischaemic stroke are reported. The stroke involved the internal carotid artery territory in one and the brainstem in the other. A review of the literature is presented to suggest that the association of sickle cell trait and cerebral infarction is more than coincidental. Haemoglobin electrophoresis should be undertaken routinely in young subjects with ischaemic stroke.
Horizontal transmission of hepatitis B virus amongst British 2nd World War soldiers in South-East Asia
Authors: Gill G V , Bell D R , Vandervelde E M
Published: December 2008

Infection with hepatitis B virus (HBV) is much more common in tropical than in temperate countries. Visitors to the tropics are thus at risk from HBV, though the degree of risk, and the routes of infection involved are uncertain. We report serological markers of HBV in two groups of 2nd World War soldiers, who served in the Thai/Burma jungles. The groups comprised 100 ex-prisoners of the Japanese (POW), and 100 Burma Campaign Veterans (BCV). Surface antigen to HBV (HbsAg) was positive in 0% of POW and 2% of BCV (P = not significant). Surface antibody (anti-HBs) and core antibody (anti-HBc) were both positive in 40% POW and 13% BCV (P < 0.001). Quoted UK prevalence rates for these markers are 0.1% for HBsAg, 1.5% for anti-HBs and 0.7% for anti-HBc. Both groups thus show very high rates of past HBV infection. For the POW there were many possible reasons, including contaminated surgical instruments and needles, blood transfusions, and multiple beatings with common weapons. None of these factors operated significantly for BCV. Malarial transmission was, however, intense in both groups, though more so in POW. The data thus again raise the possibility of horizontal transmission of HBV by biting insects in tropical countries.
Simultaneous occurrence of transient resolving thyrotoxicosis due to painless thyroiditis, hypopituitarism and diabetes insipidus following pituitary apoplexy
Authors: Sasaki Haruka , Ohnishi Osamu , Okudera Toshio , Okumura Makoto
Published: December 2008

A rare case of concomitant association of transient thyrotoxicosis due to painless thyroiditis, hypopituitarism and central diabetes insipidus following spontaneous pituitary apoplexy is presented.
Cyclic oscillations of leucocyte counts in chronic myeloid leukaemia
Authors: Malhotra O P , Salam S R
Published: December 2008

A patient with chronic myeloid leukaemia, having two unusual features, is described. He had absence of splenomegaly and marked periodic fluctuations of leucocyte counts, occurring spontaneously, in the initial phase of the disease. The latter finding suggests that, at least in some patients with chronic myeloid leukaemia, negative feed back control mechanism(s), possibly exerted by colony stimulating factor, may be retained which may have therapeutic implications.
Asymptomatic cerebral calcification—a previously unrecognized feature
Authors: Arnold M M , Kreel L
Published: December 2008

While investigating the radiological appearances of globus pallidus calcification in an autopsy case, cortical-pia mater calcification was detected. There was no documentation of its existence in the literature of radiology, neurology and neuropathology. To establish its incidence and clinical significance, 20 consecutive autopsy brains (15 males, 5 females, age 32–73 years, mean age 56.7) were studied with high resolution radiography and histology. Clinical records, autopsy findings, in-life plain skull films and computed tomography of the brain (if available) were reviewed. Radiologically, the calcifications appeared as 1–2 mm irregular spots or tiny pin-point opacities in the pia mater and subcortical regions, either unilaterally or bilaterally in the frontal (15 cases), temporal (15), parietal (3) and occipital lobes (1). Similar calcification was detected in 1 of the 3 in-life computed tomographic scans available. Histologically, these cortical-pia mater calcifications were extracellular amorphous calcified masses of various sizes in necrotic neural tissue, frequently associated with microscopic haemorrhage and hypoxic neuronal changes in the adjacent brain tissue. Blood vessels in the region were not hyalinized or calcified. The occurrence was not related to age. Hospital stay was < 7 days in 14 and < 30 days in 2; 50% of patients died within 48 hours after admission. None of the patients had records of long term cytotoxic chemotherapy, radiotherapy or central nervous system infection. Two had stroke, one had cerebellar atrophy and one mild hypercalcaemia. The high incidence of calcifications in the temporal lobes, while asymptomatic, suggests that cortical calcification may be a pointer to the aetiology of idiopathic epilepsies in the elderly.