bluuebunny/crossref_metadata_2025 huggingface dataset:
Ipratropium bromide in patients with nocturnal asthma
Authors: Cox I. D. , Hughes D. T. D. , McDonnell K. A.
Published: December 2008

Fourteen patients with nocturnal asthma were recruited to a two period crossover trial which compared a run-in period on nightly salbutamol (200 micrograms) with a period on nightly ipratropium bromide (160 micrograms) and a period on nightly salbutamol plus ipratropium at night.

Morning dipping, as assessed by the fall in peak flow overnight, was significantly reduced in the periods when ipratropium bromide was taken. Peak flow in the morning and also at night was improved when taking ipratropium bromide. Ipratropium bromide in adequate dosage appears to be effective in reducing morning dipping in asthma.
Comparison of nifedipine (retard formulation) and mefruside in the treatment of mild to moderate hypertension—a prospective randomized double-blind crossover study in general practice
Authors: Douglas-Jones A. P. , Mitchell A. D.
Published: December 2008

Twenty-two patients under general practice care, suffering mild to moderate hypertension and receiving no active treatment had three baseline blood pressure measurements taken during a single blind 4-week placebo run-in period. One patient was secondarily excluded at this stage because of a placebo response and one patient dropped out for personal reasons. The remaining 20 patients were randomized to receive either nifedipine 20 mg twice a day or mefruside 25 mg once a day in a classical two-period crossover design with 8-week treatment periods separated by a 4-week single-blind placebo washout. During 8 weeks nifedipine therapy the mean supine blood pressure was reduced from 173 (s.d. = 15.4)/107(s.d. = 6.4) mmHg to 150(s.d. = 16.7)/93(s.d. = 10.8) mmHg whereas the corresponding reduction for mefruside was from 174(s.d. = 15.9)/107(s.d. = 9.4) mmHg to 153(s.d. = 19.1)/94(s.d. = 9.7) mmHg. Neither drug affected postural changes in blood pressure. Standing blood pressure measurements under 8 weeks nifedipine therapy fell from 172(s.d. = 12.3)/103(s.d. = 5.6) mmHg to 150(s.d. = 17.9)/94(s.d. = 10.0) mmHg with corresponding changes for mefruside being 174(s.d. = 14.7)/106(s.d. = 9.0) mmHg to 150(s.d. = 20.2)/95(s.d. = 9.4) mmHg. Since blood pressures returned to within 4% of baseline values by the end of the placebo washout period it can be inferred that each therapy was a significant (P less than 0.05 for all blood pressure variables) antihypertensive treatment in its own right.
A case of recurrent salmonella septicaemia in an infant
Authors: Mitchell-Jones P. J. , Sankey R. J.
Published: December 2008

A 6-month-old girl was admitted with a febrile illness. Salmonella eastbourne was isolated from the stool and blood cultures. Septicaemia was treated with antibiotics but recurred twice on cessation of therapy. The only focus of infection found was the gut itself. Septicaemia did not recur following loss of the pathogen from the gut.
A hole in a primigravid uterus—an unusual finding at elective caesarean section
Authors: Olobo-Lalobo J. H.
Published: December 2008

The spontaneous rupture of the primigravid uterus before the onset of labour is an obstetric rarity. Invariably there is a history of antecedent scarring. A case of uterine rupture, an unusual finding at Caesarean section, is reported. The only antecedent history was partial salpingectomy and oophorectomy. The probable mechanism of rupture is discussed. Admission at 32 weeks and Caesarean section at 36 weeks is recommended in the next pregnancy.
Ischaemic colitis associated with psychotropic drugs
Authors: Gollock John M. , Thomson James P. S.
Published: December 2008

Two cases of patients with ischaemic colitis requiring operative treatment are presented. Both had received a commonly used psychotropic drug in large dosage before the acute episode. Evidence is produced which may link the drugs used with the condition of ischaemic colitis.
Measurement of plasma group I pepsinogens
Authors: Levine D. F. , Beer M.
Published: December 2008

Plasma group I pepsinogen (PG I) concentration is now a readily available non-invasive marker of gastric secretory function, with several potentially useful applications.

Ninety-eight percent of control subjects had a plasma PG I below 115 ng/ml while values above this level were seen in 43% of duodenal ulcer patients. Plasma PG I levels below the observed normal lower limit of 30 ng/ml were seen consistently in patients with documented achlorhydria or pernicious anaemia.

In 48 patients with a variety of upper gastrointestinal disorders there was a significant correlation between PG I pepsinogens and pentagastrin-stimulated maximal acid output.

Changes in plasma PG I promise to be useful in evaluating both operations on the vagus and newer anticholinergic drugs, whilst in epidemiological and family studies these measurements seem well suited to explore duodenal ulcer heterogeneity.
Comparative study of four antacids
Authors: Jacyna M. R. , Boyd E. J. S. , Wormsley K. G.
Published: December 2008

Four antacid preparations have been studied in a stratified, randomized, double-blind trial to evaluate criteria which determine patients' acceptance of this type of therapy. There was a considerable range of judgements about palatability, but preference was determined not only by factors such as the smell, taste, texture and after-taste of the preparation, but also by the order in which the antacids were tested and by the age and sex of the patient. The preparations also differed considerably in acid-neutralizing capacity and ability to bind bile salts, as well as cost. We conclude that individuals requiring antacid therapy should be allowed to chose from among a range of preparations, in order to maximize compliance.
Relapse of lymphoma in the heart after a 10-year remission
Authors: Bell A. J. , Mufti G. J. , Hamblin T. J.
Published: December 2008

A 71-year-old woman presented with intractable cardiac failure 10 years after receiving treatment for lymphoma.

Extensive investigations failed to demonstrate a recurrence of her disease, but resolution of her cardiac failure following a trial of chemotherapy and subsequently a cross-sectional echocardiogram suggested intracardiac relapse. This was later confirmed at autopsy. Cardiac metastases should be suspected in patients with malignant disease who develop signs or symptoms related to the heart.
An unusual presentation of sarcoidosis—spontaneous haemopneumothorax
Authors: Gomm Stephanie A.
Published: December 2008

Pneumothorax is a very rare complication of early stage sarcoidosis. A young man is reported with a left sided spontaneous haemopneumothorax and a right apical pneumothorax in association with early sarcoidosis.
Renal amyloidosis and non-specific aorto-arteritis—a hitherto undescribed association
Authors: Dash S. C. , Sharma R. K. , Malhotra K. K. , Bhuyan U. N.
Published: December 2008

Two patients presented with the nephrotic syndrome complicating non-specific aorto-arteritis (Takayasu’s arteritis). Histologically both had renal amyloidosis. On investigation there was no evidence of chronic infection or any immuno-inflammatory disease known to be associated with amyloidosis. These cases raise the possibility of a significant association between aorto-arteritis of the Takayasu type and systemic amyloidosis.
Disulfiram-induced hepatitis—report of a case and review of the literature
Authors: Nässberger Lennart
Published: December 2008

Disulfiram has been used as an adjunct to the treatment of chronic alcoholism since 1948. We report a young woman who developed clinical, biochemical and histopathological signs of a liver hypersensitivity reaction. A review of the literature is also presented.
Breast problems in 1,000 consecutive referrals to surgical out-patients
Authors: Ellis Harold , Cox Peter J.
Published: December 2008

One-thousand consecutive referrals of breast complaints to surgical out-patients are presented with breakdown according to the pathological groups of final diagnoses. The relationship of these groups to parity, breast feeding and age are discussed as also is the clinical management of these cases.
Exocrine pancreatic insufficiency and idiopathic haemochromatosis
Authors: Jansen P. L. M. , Thien T. , Lamers C. B. , Yap S. H. , Reekers P. , Strijk S.
Published: December 2008

The case history of a 34-year-old patient with precirrhotic idiopathic haemochromatosis and severe chronic steatorrhoea is presented. The pancreas had a normal appearance on ultrasonography and endoscopic retrograde pancreaticography. However, pancreatic function tests revealed significant abnormalities. The pancreatic output of trypsin, amylase, lipase and bicarbonate was deficient and basal and stimulated serum pancreatic polypeptide levels were subnormal. In contrast, the oral glucose tolerance test was unimpaired. The pancreatic insufficiency had started suddenly during a summer vacation and may have had a viral aetiology. The hypothesis is advanced that in haemochromatosis the iron-laden pancreatic acinar and PP-producing cells are more susceptible to damage by viruses than normal pancreatic cells.
Crohn’s disease and pericarditis
Authors: Manomohan V. , Subbuswamy S. G. , Willoughby C. P.
Published: December 2008

A patient is described who developed acute pericarditis during a severe first attack of Crohn’s disease. The opportunity was taken to measure levels of circulating immune complexes, both during the acute phase of the illness and during convalescence; no significant change in these levels from normal values was found. The Crohn’s disease and the associated pericarditis responded to systemic corticosteroid therapy, and no relapse has occurred during 14 months of follow-up.
Formic acid poisoning with suicidal intent: a report of 53 cases
Authors: Rajan N , Rahim R , Krishna Kumar S
Published: December 2008

A report of 53 cases of formic acid ingestion with suicidal intention is presented. The patients were seen in one hospital in Kerala State over a 3 year period. Fifteen patients died and 38 patients survived. The pattern of clinical features seen is presented.
Thyrotoxicosis, myasthenia gravis and periodic paralysis in a Chinese man
Authors: Lee K O , Guan R , Ee B , Cheah J S
Published: December 2008

The association of myasthenia gravis and periodic paralysis in thyrotoxicosis has not been reported before. We describe a Chinese man with thyrotoxicosis and myasthenia gravis, who subsequently developed periodic paralysis. The possible aetiological links are discussed.
Listeria monocytogenes endocarditis
Authors: Sheinman B D , Evans T , Sage R
Published: December 2008

A fatal case of endocarditis due to Listeria monocytogenes is reported. Case reports of endocarditis due to this organism are rare but indicate a higher mortality than with many other causes of bacterial endocarditis. The size of the problem may be underestimated because the organism has a ‘diphtheroid’ appearance and may be incorrectly dismissed as a contaminant.
Patterns of drug taking in patients with chronic airflow obstruction
Authors: James P N E , Anderson J B , Prior J G , White J P , Henry J A , Cochrane G M
Published: December 2008

A questionnaire on the pattern of drug taking was completed by 185 patients with chronic airflow obstruction. Of these, 49% admitted to taking their prescribed therapy regularly and 33% could be regarded as being fully compliant. The use of increasing numbers of drugs was not accompanied by a fall in compliance. Regular drug taking was better in patients (particularly females) with asthma than in patients with chronic bronchitis and emphysema. During acute exacerbations of airflow obstruction, excessive use of bronchodilators beyond the recommended increase in medication was rare; indeed, underuse of therapy in this situation was commoner. These conclusions must be regarded as tentative since the questionnaire was not validated by repeat interviewing or measurement of drug usage.
Spontaneous rupture of the uterus associated with pyometra
Authors: Parkinson D J , Alderman B
Published: December 2008

A case is reported in which an elderly patient was admitted with signs and symptoms of an acute abdomen. A laparotomy revealed uterine rupture with free pus in the peritoneal cavity and subsequent histology of the uterus showed no evidence of malignancy.
Use of amiodarone during pregnancy
Authors: Robson D J , Jeeva Raj M V , Storey G C A , Holt D W
Published: December 2008

Two cases are reported in which amiodarone was administered during pregnancy for longer periods than has been reported previously. Limited placental transfer of amiodarone and its desethyl metabolite was observed in both cases. A normal child resulted from each pregnancy despite, in one case, amiodarone therapy throughout the entire pregnancy. However, caution is urged in the use of amiodarone during pregnancy in view of the limited data available.
A case of herpes zoster associated encephalitis with rapid response to acyclovir
Authors: Cheesbrough J S , Finch R G , Ward M J
Published: December 2008

A case of herpes zoster encephalitis which responded very rapidly to acyclovir is presented. The differential serum: cerebrospinal fluid antibody response was followed and its value in making the diagnosis is discussed. The penetration of acyclovir into the cerebrospinal fluid was measured, and found to be in agreement with predicted values.
Raynaud's syndrome and carpal tunnel syndrome
Authors: Waller D G , Dathan J R
Published: December 2008

We report three cases of Raynaud's syndrome with digital ischaemic ulceration, in association with carpal tunnel syndrome. In all cases, the aetiology of the Raynaud's syndrome was probably unrelated to the nerve compression. However, symptoms were worse on the side of the median nerve lesion in two patients and worse on the side with the most severe nerve dysfunction in the third; symptoms were relieved by carpal tunnel decompression in two patients. We suggest that carpal tunnel syndrome may exacerbate Raynaud's syndrome and should be considered particularly in patients with asymmetrical digital lesions.
Torsion of a wandering spleen
Authors: Witz M , Witz L , Reina A , Shenkman L , Dinbar A
Published: December 2008

We present an unusual case of torsion of a wandering spleen in a 14 year old boy. Wandering spleen is an entity which has rarely been reported in infants and children. Although patients may be asymptomatic, some may present as an acute surgical emergency if trauma or torsion of the vascular pedicle occurs, as in our case. The treatment of this condition is splenectomy.
Biliary sequelae of endoscopic sphincterotomy
Authors: Greenfield C , Cleland P , Dick R , Masters S , Summerfield J A , Sherlock S
Published: December 2008

Twenty five patients were reviewed a mean of 36 months after successful endoscopic sphincterotomy for the removal of bile duct stones. All the patients had improved symptomatically but 20% had episodes of mild abdominal pain and a similar number had elevated serum gamma glutamyltranspeptidase activities (up to 3 times normal). In 12 patients (50%) biliary gas was demonstrated indicating reflux of duodenal contents. Clinical cholangitis did not occur. Aspiration liver biopsy revealed mild portal tract fibrosis and inflammation in patients with biliary reflux. Biliary reflux was significantly associated with mild upper abdominal pain (P < 0.05). This study has shown that mild abnormalities of biliary function persist after endoscopic sphincterotomy. The long term consequence of these changes is unclear.
Six year remission of ACTH-dependent Cushing's syndrome using bromocriptine
Authors: Atkinson A B , Kennedy A L , Sheridan B
Published: December 2008

A patient with ACTH-dependent Cushing's syndrome remained in clinical and biochemical remission six years after pituitary irradiation and while on bromocriptine therapy. When bromocriptine was discontinued urinary free cortisol values became elevated, and were not suppressed by dexamethasone. After reintroduction of the drug, remission was again obtained. It is concluded that bromocriptine is responsible for continuing longterm remission in this case. The possible use of bromocriptine as an adjunctive therapy in ACTH-dependent Cushing's syndrome is discussed.
Delayed encephalopathy following cardiac arrest
Authors: Barnes M P , Newman P K
Published: December 2008

A 46 year old woman suffered a post-operative cardiac arrest associated with prolonged depression of oxygenation and respiration. She made a good initial recovery but one year later insidiously developed symptoms of widespread central nervous system damage compatible with a delayed post-hypoxic encephalopathy. This case is unusual in the length of time between the hypoxic insult and the later deterioration and also illustrates other atypical features of a delayed post-hypoxic syndrome.
Relationships between radiological and biochemical evidence of rickets in Asian schoolchildren
Authors: Abdul-Motaal A , Gettinby G , McIntosh W B , Sutherland G R , Dunnigan M G
Published: December 2008

One hundred Asian schoolchildren provided evidence of the relationships between radiological and biochemical evidence of rickets in a vitamin D-deficient population. In a retrospective study of the X-rays of 56 children the variables serum alkaline phosphatase, inorganic phosphorus and age provided a discriminant function which correctly classified 10 of 11 children with radiological evidence of rickets and 44 of 45 children with negative or marginally abnormal X-rays. When the discriminant function was applied to a prospective study of 44 children, three children with radiological evidence of rickets were correctly classified together with 38 of the remaining 41 children with negative or marginally abnormal X-rays. Serum alkaline phosphatase was the most important variable in the discriminant analysis, followed by serum inorganic phosphorus and age. Low levels of serum 25-hydroxy vitamin D (25-OHD) are of little value in predicting the severity of radiological evidence of rachitic bone disease in a vitamin D-deficient population.
Requests for hypnotic drugs and placebo response in elderly hospital in-patients
Authors: Bayer A J , Pathy M S J
Published: December 2008

Requests for night sedation and the use of placebo as first line drug management were studied prospectively in 1174 consecutive elderly hospital in-patients. Of the 390 (33.2%) patients requesting sleeping pills in hospital, 37 were subsequently satisfied without the prescription of additional medication. A further 216 patients were entirely satisfied with a placebo capsule during all of their hospital stay. An ‘active’ hypnotic drug was required by only 137 patients, many of whom were noisy and disturbing other patients in the ward. Most of the active hypnotic drugs prescribed to elderly hospital patients are unnecessary and a majority of those requesting hypnotics consistently respond to placebo. There remains a need for greater education of patients, nurses and doctors in the non-pharmacological management of sleep disorders.
Atrial myxoma presenting with cerebral haemorrhage
Authors: Macaulay V M , Crawford P J , McKeran R O
Published: December 2008

Emboli from left atrial myxomas are a recognized cause of cerebral ischaemia. The myxomatous embolus may infiltrate the cerebral arterial wall, resulting in aneurysmal dilatation with a risk of rupture. Myxoma-associated cerebral haemorrhage has been described in patients with progressive neurological dysfunction. We report a new presentation. Our patient, a previously healthy 20 year old girl, developed acute intracerebral haemorrhage for which craniotomy was performed. Histology of evacuated haematoma revealed an intravascular fragment of myxoma. Echocardiography demonstrated a left atrial myxoma which later was uneventfully excised. Early diagnosis of embolic cardiac myxoma requires awareness of the diversity of clinical manifestations, and careful histological analysis of surgical specimens.
Severe oesophageal injury caused by Steradent
Authors: Barclay G R , Finlayson N D C
Published: December 2008

An elderly woman swallowed 2 tablets of a denture-cleansing agent (Steradent) believing them to be her sleeping tablets. This caused severe burning pain in the throat and resulted in a tight postcricoid oesophageal stricture. Treatment by repeated dilatation of the stricture has been only partially successful. Characteristic containers for non-medicinal tablets might help those with poor vision, and medicinal and non-medicinal tablets should never be stored in the same place.
Oncogenic osteomalacia: strange tumours in strange places
Authors: Weiss D , Bar R S , Weidner N , Wener M , Lee F
Published: December 2008

Two patients presented with hypophosphataemic osteomalacia and were subsequently found to have small tumours unusual histopathology and location causing the osteomalacia. Each tumour was found after an intensive search for occult masses. Studies of vitamin D metabolism and renal tubular function before and after surgery yielded further insight into the pathophysiology of oncogenic osteomalacia. These cases demonstrate that microscopic quantities of tumour are capable of causing the syndrome and further illustrate the high index of suspicion often necessary to locate causative tumours in patients with hypophosphataemic osteomalacia.
Echo-free renal masses on ultrasound: the stethoscope as an adjunct to their diagnosis
Authors: Suarez R , Lynn A H
Published: December 2008

A patient with an intrarenal arteriovenous malformation is described. Ultrasound suggested this to be a renal cyst but auscultation revealed a loud bruit and, on the basis of this, arteriography rather than cyst puncture was carried out.
Increased plasma triglycerides, cholesterol and apolipoprotein E during prolonged fasting in normal subjects
Authors: Markel A , Brook J G , Aviram M
Published: December 2008

Plasma lipid and high density lipoprotein (HDL) levels were studied in 20 normal, healthy, non-obese males while fasting (150 kcal/d with free intake of water) for 6 d in a hunger strike. Plasma triglyceride and cholesterol levels were increased by 18% after 6 d of fasting. HDL-cholesterol concentration was not significantly changed for 4 d, but decreased by 22% after 6 d. Platelet aggregation induced by adenosine diphosphate (ADP) or collagen after 6 d of fasting was in the normal range. In 3 subjects fasted for 9 d, a complete plasma lipoprotein analysis was done. Very low and low density lipoprotein (VLDL and LDL) levels were elevated, whereas HDL was reduced after 9 d of fasting. On isoelectric focusing analysis, a marked reduction in apolipoprotein (apo) E concentration in both VLDL and HDL was noted. Liver function tests showed a reduction in hepatic enzyme activity; and since apo E is of hepatic origin also, we suggest that long fasting inhibits liver function in normal subjects.
Chronic dyspepsia pain in general practice—its causes and diagnosis
Authors: Lance P , Gibson-Glubb S , Gazzard J A , Gazzard B G
Published: December 2008

One hundred consecutive patients who had consulted their general practitioner because of upper abdominal pain related to eating, were investigated after initial interviews by the general practitioner, a medical registrar and the same consultant physician. Thirty seven had active upper gastrointestinal or biliary tract diseases, including 29 with peptic ulcers. The general practitioner and consultant correctly distinguished between organic and non-organic dyspepsia (NOD) in 51 and 65 cases respectively. Although the sensitivity of the general practitioner diagnosis of organic disease was high (95%), the specificity (23%) and predictive value (42%) were low.

There were fewer organic diagnoses amongst the patients under the age of 30 (P < 0.05) and those with symptoms for less than 3 months (P < 0.01). No patient under 30 with symptoms for less than 3 months had organic dyspepsia. We suggest that if dyspeptic patients over the age of 30 and those under 30 with symptoms for longer than 3 months are investigated, about one-third will be found to have organic diseases.
Placental chorioangiomatosis—a high risk pregnancy
Authors: Jaffe R , Siegal A , Rat L , Bernheim J , Gruber A , Fejgin M
Published: December 2008

A case of diffuse chorioangiomatosis leading to fetal hydrops, disseminated intravascular coagulopathy with massive umbilical vein thrombosis and fetal death is described. Although rare, this benign mesenchymatous malformation of the placenta should be kept in mind as a possible cause of neonatal morbidity. Prenatal diagnosis could prevent fetal death.
Reversible renal failure due to psychogenic urinary retention
Authors: Korzets Z , Garb R , Lewis S , Bernheim J L
Published: December 2008

A case of advanced, reversible renal failure due to psychogenic urinary retention occurring in a 17 year old female, is reported. The diagnosis of psychogenic urinary retention was made on the basis of existent florid psychopathology and the concomitant exclusion of an organic cause. Family psychodynamics are discussed. Psychosocial intervention led to a resumption of normal micturition, the disappearance of the urinary retention with resultant improvement of renal function.
Improved cardiac function after renal transplantation
Authors: Fleming S J , Caplin J L , Banim S O , Baker L R I
Published: December 2008

There are few reports of the outcome of renal transplantation in patients with severe left ventricular (LV) impairment. We describe three men with chronic disabling heart failure associated with LV dysfunction in whom a remarkable improvement in cardiac function followed renal transplantation. Transplantation may offer the prospect of successful rehabilitation in these circumstances. Undue pessimism as to the prognosis in such patients is unwarranted.
Massive ascites due to omental endometriosis
Authors: Naraynsingh V , Raju G C , Ratan P , Wong J
Published: December 2008

Endometriosis associated with massive ascites is an unusual combination. Only 12 cases have been reported since its first description by Brews in 1954. The authors report the first case where radical surgery was avoided because of successful hormonal therapy.
Nonspecific small bowel ulceration
Authors: Thomas W E G , Williamson R C N
Published: December 2008

Six patients (4 male, 2 female) developed nonspecific small bowel ulceration between the ages of 4 months and 76 y. Five had gastrointestinal haemorrhage, usually chronic and resulting in iron deficiency anaemia. Four had features of subacute intestinal obstruction; there were no perforations. A small bowel enema was the most useful single investigation for delineating the lesions, and surgical excision was curative in all but one case. No aetiological causes could be implicated, other than in one patient taking a daily tablet of Navidrex-K.
Avulsion of the anterior superior iliac spine complicating bone biopsy
Authors: Stellon A , Davies A , Williams R
Published: December 2008

We present a case report of avulsion of the anterior superior spine following a transiliac crest biopsy, a previously unreported occurrence.
Post partum presentation of hypercalcaemic sarcoidosis
Authors: Wilson-Holt N
Published: December 2008

A number of corticosteroid responsive diseases have been shown to undergo exacerbation in the puerperium. The presentation of a woman 8 weeks after delivery with severe hypercalcaemia, a highly steroid sensitive feature of sarcoidosis, adds to the evidence that sarcoidosis can also be numbered amongst such diseases with relapse in the puerperium.
Acute pancreatitis in association with small cell lung carcinoma: potential pitfall in diagnosis and management
Authors: Allan S G , Bundred N , Eremin O , Leonard R C F
Published: December 2008

Tumour metastases to the pancreas are a rare but recognized cause of acute pancreatitis, there is a 24–40% incidence of pancreatic involvement from small cell lung cancer in autopsy series but only a very few cases of tumour-induced acute pancreatitis have been described. Chemotherapy has been advocated as the primary therapy in patients with known oat cell carcinoma who develop acute pancreatitis. We describe 2 patients with acute haemorrhagic pancreatitis in association with disseminated small cell carcinoma but without evidence of tumour invasion in the gland and with gall stones present in the gall bladder. Chemotherapy would have been inappropriate therapy for these patients.
Pyoderma gangrenosum in myelodysplasia and acute leukaemia
Authors: Jacobs P , Palmer S , Gordon-Smith E C
Published: December 2008

Pyoderma gangrenosum is a rare occurrence in patients with haematological malignancy. This characteristic but nonspecific inflammatory process with skin destruction occurred in 4 patients with myelodysplasia, in one with acute leukaemic transformation of myelofibrosis, and in de novo acute myeloblastic leukaemia in another. Clinically, the cutaneous lesion in these patients differed from that associated with inflammatory bowel disease, arthritis, or the idiopathic type of pyoderma gangrenosum by having the vesiculo-bullous borders. Histopathological differences were also evident since more superficial layers of the skin were involved in the ulceration than typically encountered in patients with non-malignant systemic disease.

Despite the less penetrating nature of this variant, treatment of the pyoderma gangrenosum is unsatisfactory and in the absence of effective therapy for the underlying disease, healing occurred only in the patient with acute leukaemia who achieved complete remission in response to chemotherapy.
Reversibility of acute renal failure in elderly patients with the nephrotic syndrome
Authors: Searle M , Cooper C , Elliman J , Dathan R , Maciver A
Published: December 2008

Acute renal failure may occur in the nephrotic syndrome due to minor glomerular changes, especially in the elderly. We describe five cases and review the literature. Previous renal damage due to ischaemia and drugs may be important in pathogenesis. We stress the importance of active management of these cases, as the renal lesions are reversible and recovery can be expected.
Myocarditis and fulminant hepatic failure from coxsackievirus B infection
Authors: Read R B , Ede R J , Morgan-Capner P , Moscoso G , Portmann B , Williams R
Published: December 2008

A case of fulminant hepatic failure in association with myocarditis is reported. Presentation suggested an acute hepatitis which was complicated by cardiac failure. Evidence of severe myocarditis was found at autopsy.
A comparison of diltiazem and atenolol in angina
Authors: Wheatley D
Published: December 2008

Diltiazem was compared to atenolol in a double-blind trial involving 78 patients suffering from coronary heart disease. Following a 2 week control period, patients were randomly allocated to 6 weeks treatment with one or the other drug.

The patients themselves made daily records of anginal attacks, trinitrate requirements, well-being and exercise tolerance. With both drugs there were highly significant reductions in the anginal attack rate and trinitrate requirements, and significant improvement on the other measures. However, there were no significant between drug differences.

The incidence of side effects with diltiazem was very low and no patient had to omit treatment for this reason, although three patients did so on atenolol.
A case of ocular toxicity to ethambutol—an idiosyncratic reaction?
Authors: Karnik A M , Al-Shamali M A , Fenech F F
Published: December 2008

Optic neuritis, a well known adverse effect of ethambutol, is related to the dose and duration of the therapy. The patient described here developed rapidly progressive deterioration of vision after only 3 days of treatment with ethambutol. Such a case has not been reported before and it is suspected that this was an idiosyncratic reaction.
Small bowel obstruction due to an enterolith originating in a jejunal diverticulum
Authors: Clarke P J , Kettlewell M G W
Published: December 2008

A case of small bowel obstruction caused by an enterolith from a jejunal diverticulum is reported. As such diverticula are usually asymptomatic, the diagnosis was not entertained pre-operatively.
Breast disease in young West Indian women: an analysis of 1051 consecutive cases
Authors: Raju G C , Jankey N , Naraynsingh V
Published: December 2008

Our analysis of 1051 breast biopsies in West Indian women under the age of 30 y revealed that 99% of the breast lumps were benign. Fibroadenoma was the commonest (67%) lesion and there was a steady increase in the frequency of fibrocystic disease with age. Carcinoma in this group is therefore rare. Thus most patients can be reassured with certainty of their benign disease and have biopsy at a convenient time.
The value of 5-aminosalicylic acid in inflammatory bowel disease for patients intolerant or allergic to sulphasalazine
Authors: Donald I P , Wilkinson S P
Published: December 2008

The use of sulphasalazine in inflammatory bowel disease is often limited by intolerance or allergy. In previous studies 5-aminosalicylic acid (5ASA), the active ingredient of sulphasalazine, coated with an acrylic resin, has been shown to be as effective as sulphasalazine in maintaining remission. In this study coated 5ASA was given to 37 patients intolerant or allergic to sulphasalazine. Thirty-three patients have tolerated 5ASA satisfactorily, and most experienced improved control of their disease. Four patients reported similar side effects with sulphasalazine and 5ASA.
Audit of nebuliser use
Authors: Williams P E , Renowden S A , Ward M J
Published: December 2008

The use of nebulisers was assessed in four hospitals. Nebulisers were checked in use and medical and nursing staff were interviewed. All but one nebuliser was driven by 100% oxygen and only 3 of 111 interviewees preferred air for patients with hypercapnia. In 5 of 44 nebulisers in use, water was used as the dilutant. The calculated times for complete nebulisation of the solutions ranged from 3.5 to 117 min. The results of this survey illustrate a need for better education concerning the use of nebulisers in hospitals.
Immunoglobulin deficiency responding to vitamin B12 in two elderly patients with megaloblastic anaemia
Authors: Kafetz K
Published: December 2008

Two elderly patients with vitamin B12 deficiency were found to have low immunoglobulin levels. These returned to normal on treatment with vitamin B12.
Primary meningococcal pericarditis with tamponade
Authors: Ramsdale D R , Kaul T K , Coulshed N
Published: December 2008

A case of primary purulent meningococcal pericarditis presenting with chest pain, hypotension and cardiac tamponade followed by oliguric renal failure is reported. Treatment with antibiotics and surgical drainage was successful.
Pregnancy in a woman with premature ovarian failure
Authors: Finer N , Fogelman I , Bottazzo G
Published: December 2008

We report the case of a 32 year old woman with premature ovarian failure associated with ovarian autoantibodies, autoimmune Addison's disease and primary hypothyroidism who became pregnant following the treatment of her thyroid and adrenal deficiencies.
Metastatic carcinoma of the breast in the anal canal
Authors: Dawson P M , Hershman M J , Wood C B
Published: December 2008

We present a case of metastatic carcinoma of the breast in the anal canal. Recurrence in this site has not been previously reported.
Coxsackie viral myocarditis
Authors: O'Connell John B , Robinson John A
Published: December 2008

Coxsackie viral myocarditis is a common disease, yet idiopathic dilated cardiomyopathy is a less common consequence. Insights gained from studying the Coxsackie virus B-3 murine model of myocarditis has led to the hypothesis that an acute Coxsackie viral myocarditis can result in persistent, non-viral mediated cellular responses that result in a chronic inflammatory state leading to progressive myocyte loss and ultimate development of dilated cardiomyopathy. Although the evidence linking myocarditis to dilated cardiomyopathy is circumstantial in man, the identification of defects in immunoregulation may provide the impetus to further research into the pathogenesis and ultimately the development of more rational therapies directed at modulating immune responses to alter the natural history of clinical dilated cardiomyopathy.
Thyrotrophin augmentation after commencing thyroxine replacement in primary hypothyroidism
Authors: Ghose R R , Upadhyay H P
Published: December 2008

Prospective measurements of serum thyrotrophin and thyroxine concentrations were made in six patients with primary hypothyroidism treated consecutively with an incremental regimen of oral thyroxine. A fall in thyrotrophin occurred over several months, accompanied by a concurrent slow rise in serum thyroxine. Those patients with the highest initial values for thyrotrophin showed the typical curvilinear decline in thyrotrophin, whereas the remaining patients disclosed a transient rise in thyrotrophin for the first 3 months. This paradoxical rise was not associated with depression of cardiac output or glomerular filtration rate.

The significance of thyrotrophin augmentation is uncertain, but it may be more common than generally appreciated. It did not occur in those patients with the most severe degrees of thyroid deficiency. Thyroxine exerts a dual action, and augmentation of thyrotrophin may reflect a dominant effect of increased protein synthesis, in contrast to negative feedback inhibition which suppresses thyrotrophin. These opposing actions are in competition at different dose levels of thyroxine, and may contribute not only to augmentation or suppression of thyrotrophin, but also to the curvi-linear pattern of fall. Such variations impair the utility of thyrotrophin as an index of euthyroidism.
Twice daily tripotassium dicitrato bismuthate in the treatment of duodenal ulceration
Authors: Hollanders D
Published: December 2008

Fifty three patients with endoscopically proven duodenal ulceration have cooperated in a clinical trial to compare the ulcer healing effect of tripotassium dicitrato bismuthate (TDB) at standard dosage administered either twice or four times daily. No statistically significant difference has been found to exist between ulcer healing in the two groups at 4 weeks (72% and 67%, P = 0.944) or at 8 weeks (92% and 81%, P = 0.504) and it is concluded that twice daily TDB maintains the effectiveness of the drug and has advantages for patient compliance.
Colorectal lymphoma simulating inflammatory colitis and diagnosed by immunohistochemistry
Authors: Sagar S , Selby P , Sloane J , McElwain T J
Published: December 2008

Lymphomatous colitis is probably an uncommon syndrome but its recognition may be of importance to patients under the care of gastroenterologists or oncologists. The case of an elderly man with lymphocytic lymphoma who developed lymphomatous colitis 6 years after initial presentation is reported.
T-cell lymphoblastic lymphoma of the uterus complicated by Chlamydia trachomatis pneumonia
Authors: Cunningham D , Gilchrist N L , Lee F D , Haxton M , Heppleston A , Forrest G J , Soukop M
Published: December 2008

This is the first documented case of a T-cell lymphoblastic lymphoma arising in the uterus. At presentation, the patient also had a life-threatening pneumonia due to Chlamydia trachomatis which responded to erythromycin and tetracycline. Cytotoxic therapy produced partial tumour regression, but the patient died 14 weeks after diagnosis, probably as a result of intercurrent infection.
Pteridines and mono-amines: relevance to neurological damage
Authors: Smith I , Howells D W , Hyland K
Published: December 2008

Patients with phenylalanine hydroxylase deficiency show increased concentrations of biopterins and neopterins, and reduced concentrations of serotonin and catecholamines, when phenylalanine concentrations are raised. The pterin rise reflects increased synthesis of dihydroneopterin and tetrahydrobiopterin, and the amine fall a reduction in amine synthesis due to inhibition by phenylalanine of tyrosine and tryptophan transport into neurones. The pterin and amine changes appear to be independent of each other and are present in the central nervous system as well as the periphery; they disappear when phenylalanine concentrations are reduced to normal. Patients with arginase deficiency show a similar amine disturbance but have normal pterin levels. The amine changes probably contribute neurological symptoms but pterin disturbance is not known to affect brain function.

Patients with defective biopterin metabolism exhibit severely impaired amine synthesis due to tetrahydrobiopterin deficiency. Pterin concentrations vary with the site of the defect. Symptoms include profound hypokinesis and other features of basal ganglia disease. Neither symptoms nor amine changes are relieved by controlling phenylalanine concentrations. Patients with dihydropteridine reductase (DHPR) deficiency accumulate dihydrobiopterins and develop secondary folate deficiency which resembles that occurring in patients with defective 5,10-methylene tetrahydrofolate reductase activity. The latter disorder is also associated with Parkinsonism and defective amine and pterin turnover in the central nervous system, and a demyelinating illness occurs in both disorders. In DHPR deficiency cerebral calcification may develop in a similar distribution to that seen in congenital folate malabsorption and methotrexate toxicity. Symptoms are ameliorated by therapy with 5-formyltetrahydrofolate but exacerbated by folic acid.
Plasma electrolytes in elderly patients taking fixed combination diuretics
Authors: Bayer A J , Farag R , Browne S , Pathy M S J
Published: December 2008

Plasma potassium and sodium concentrations were measured in a group of elderly patients taking maintenance thiazide diuretic therapy alone, with a potassium supplement or in combination with a potassium sparing diuretic. Fixed dose combinations of a thiazide and potassium sparing diuretic did not significantly reduce the prevalence of hypokalaemia and the combination of amiloride-hydrochlorothiazide was associated with a disproportionate number of cases of hyponatraemia. The desirability of the current widespread use of fixed dose combination diuretics over less expensive single agents is questioned.
Record linkage study of hypokalaemia in hospitalized patients
Authors: Paice B J , Paterson K R , Onyanga-Omara F , Donnelly T , Gray J M B , Lawson D H
Published: December 2008

Retrospective analysis of biochemical data from 58,167 hospital inpatients revealed that 21% developed hypokalaemia during hospitalization-in 5.2% the serum potassium was < 3.0 mmol/l. Subsequent evaluation showed a positive correlation between hypokalaemia and both female sex and hospital mortality. Patients with leukaemia and lymphoid tumours, especially when receiving antibiotic or cytotoxic therapy, and patients with gastro-intestinal malignancy were amongst those most frequently experiencing hypokalaemia. There was no significant association with cardiovascular disease. Drug and intravenous fluid administration accounted for the hypokalaemia in 56% of patients. While drug-related hypokalaemia was most commonly seen with diuretics, it was also apparent following use of steroids, insulin and haematinics.
Bilateral salmonella salpingo-oophoritis
Authors: Ghose A R , Vella E J , Begg H B
Published: December 2008

A previously healthy nulliparous caucasian female presented with lower abdominal pain and a history of diarrhoea and vomiting for 2 weeks. Repeated stool examinations and blood culture were negative. A lump in the lower abdomen became more apparent over the next 2 weeks and a subsequent laparotomy revealed bilateral tubo-ovarian abscess formation. One ovary which was endometriotic and both the tubes were excised and the pus yielded a heavy growth of Salmonella stanley.
Immobilization hypercalcaemia due to low bone formation and responding to intravenous sodium sulphate
Authors: Evans R A , Lawrence P J , Thanakrishnan G , Hills E , Wong S Y , Dunstan C R
Published: December 2008

A young man developed acute renal failure and hypercalcaemia following severe burns. The hypercalcaemia was initially controlled by haemodialysis, but it persisted after return of renal function. Plasma PTH was inappropriately elevated, but the nephrogenous cyclic adenosine monophosphate level was low; thus the PTH was probably not biologically active, and may have been artefactually elevated by the moderate renal impairment. Bone histology, showed a normal resorbing surface, but a zero forming surface, implying that the bone dissolution leading to hypercalcaemia resulted from a failure of bone formation. Because of widespread infection and impaired renal function, the hypercalcaemia could not be treated by corticosteroid drugs, mithramycin or phosphate, and there was no response to salmon calcitonin. He was therefore treated with intravenous sodium sulphate, which increased urinary calcium excretion and reduced the plasma calcium. Sodium sulphate still has a role in the treatment of patients with hypercalcaemia.
Acute pancreatitis in hepatitis A infection
Authors: Lopez Morante A , Rodriguez de Lope C , San Miguel G , Pons Romero F
Published: December 2008

Hepatitis viruses are an uncommon cause of acute pancreatitis. We present the case of a boy with acute pancreatitis complicating viral hepatitis with satisfactory recovery. The finding of IgM-anti HAV antibodies implicates hepatitis A virus as the cause.
Fatal xylenol self-poisoning
Authors: Watson I D , McBride D , Paterson K R
Published: December 2008

A case of fatal xylenol ingestion by a long-stay mental hospital patient is described. The clinical course was similar to that observed in other phenolic poisonings with active bowel sounds, nausea and vomiting, severe metabolic acidosis, hypotension and cardiac and renal failure.

The formulation of xylenol ingested contains alcohol which would facilitate absorption; due to the dangers of such poisonings care must be exercised as to access and exposure to xylenol sterilising agents.
Significance of the measurement of uric acid fractional clearance in diuretic induced hyponatraemia
Authors: Sonnenblick M , Rosin A J
Published: December 2008

The biochemical features of severe hyponatraemia due to thiazide administration in 7 non-oedematous patients were compared with those in hyponatraemia due to frusemide. Hypouricaemia has been shown to occur in hyponatraemia due to the syndrome of inappropriate antidiuretic hormone activity and this was measured along with fractional uric acid clearances in all the patients. Five of the patients had been on thiazides (or hydrochlorothiazide with amiloride) for only a few days to a few weeks. Fractional uric acid clearance was elevated and serum uric acid levels were low in five of them and returned to the normal range on restoration of serum sodium to normal. By contrast, the patients on frusemide did not show any abnormality in fractional uric acid clearance at any stage.

These results are consistent with excess ADH activity as having caused hyponatraemia induced by thiazides in 5 of the 7 cases, whereas frusemide caused a sodium depletion syndrome. Treatment in the former cases is by water restriction, and in frusemide-induced salt depletion by saline supplementation.