bluuebunny/crossref_metadata_2025 huggingface dataset:
Muscular (hypertrophic) subaortic stenosis (hypertrophic obstructive cardiomyopathy): the evidence for true obstruction to left ventricular outflow
Authors: Wigle E D , Henderson M , Rakowski H , Wilansky S
Published: December 2008

The clinical and haemodynamic significance of the subaortic pressure gradient in patients with muscular (hypertrophic) subaortic stenosis (hypertrophic obstructive cardiomyopathy) has long been debated. In this report we summarize the evidence which indicates that true obstruction to left ventricular outflow exists in these patients.

Rapid left ventricular ejection, through an outflow tract narrowed by ventricular septal hypertrophy, results in Venturi forces causing systolic anterior motion of the anterior (or posterior) mitral leaflets. Mitral leaflet-septal contact results in obstruction to outflow and the accompanying mitral regurgitation. The time of onset of mitral leaflet-septal contact determines the magnitude of the pressure gradient and the severity of the mitral regurgitation, as well as the degree of prolongation of left ventricular ejection time and the percentage of left ventricular stroke volume that is ejected in the presence of an obstructive pressure gradient. Early and prolonged mitral leaflet-septal contact results in a large pressure gradient, significant mitral regurgitation, as well as dramatic prolongation of the ejection time and a large percentage of left ventricular stroke volume being obstructed. Late and short mitral leaflet-septal contact results in little haemodynamic perturbation. Hypertrophic cardiomyopathy patients with obstructive pressure gradients are significantly more symptomatic than those without. Thus the obstructive pressure gradients in hypertrophic cardiomyopathy are of clinical as well as haemodynamic significance. To deny the existence of obstruction to outflow in patients with muscular subaortic stenosis is to deny these patients appropriate medical and surgical therapy.
Phonoechocardiography and intracardiac phonocardiography in hypertrophic cardiomyopathy
Authors: Shaver J A , Alvares R F , Reddy P S , Salerni R
Published: December 2008

The salient phonoechocardiographic features of patients having hypertrophic cardiomyopathy (HCM) with or without left ventricular outflow tract (LVOT) gradients are reviewed. Intracardiac sound and pressure recordings from high fidelity catheter-tipped micromanometers have documented that the precordial murmur is the summation of both the systolic ejection murmur (SEM) arising from the LVOT, as well as the mitral regurgitant murmur recorded from the left atrium. The intensity of the precordial murmur varies directly with the LVOT gradient, which in turn is determined primarily by the contractility and loading conditions of the left ventricle.

Reversed splitting of the second heart sound (S2) with paradoxical respiratory movement is a common finding in HCM, and when present, almost always denotes a significant LVOT gradient. It is due to marked lengthening of the left ventricular ejection time secondary to prolongation of the contraction and relaxation phases of left ventricular systole. The presence of a fourth heart sound (S4) is the rule in HCM when normal sinus rhythm is present, and is a reflection of a forceful left atrial contraction into a hypertrophied noncompliant left ventricle. A third heart sound (S3) is also common in HCM, and often the initial vibrations occur before the 0 point of the apexcardiogram (ACG) and continue giving the auscultatory impression of a diastolic rumble. When associated with a loud S1, which is frequently present, the clinical presentation may mimic mitral stenosis. This is particularly true when the patient has chronic atrial fibrillation. Careful attention to evidence of marked left ventricular hypertrophy as well as the typical echocardiographic findings of HCM preclude this diagnosis.

In conclusion, phonoechocardiography is a simple non-invasive technique which almost always makes the definitive diagnosis of HCM.
Surgical treatment of hypertrophic cardiomyopathy (Düsseldorf experience)
Authors: Bircks W
Published: December 2008

Surgical treatment appears to be the therapy of choice in hypertrophic, obstructive cardiomyopathy, at least in patients who are in the advanced stage of the disease and refractory to medical treatment. In addition, strong evidence has been obtained that surgical treatment improved the prognosis at least in patients who required only a myectomy via a transaortic approach.
Serial cardiac function tests in myocarditis
Authors: Miklozek C L , Kingsley E M , Crumpaker C S , Modlin J F , Royal H D , Come P C , Mark R , Abelmann W H
Published: December 2008

Sixteen patients (mean age 27 years, range 16 to 39 years) with the diagnosis of myopericarditis established by strict clinical criteria were evaluated following recovery 0.7 to 4.0 years (mean 2.7 years) later. Evidence of an acute viral infection was present in 44%. During the acute illness, the major clinical manifestations consisted of pericarditis in 10 patients, acute myocardial infarction in 5, right ventricular dysfunction in 5, bundle branch or hemiblock in 4, ventricular arrhythmias in 3, congestive heart failure in 3 and cardiogenic shock and inappropriate sinus tachycardia in one patient each. Holter monitoring, echophonocardiography and radionuclide ventriculography results were abnormal in 57, 67 and 64% of patients respectively. At follow-up, these tests were abnormal in 67, 7 and 73%. Focal wall motion abnormalities were present in five. Seventy-five percent of patients had one or more abnormal tests at last follow-up. Although 8 patients had improved by a scoring system, 5 patients had an increase in the number of abnormal tests, including one who died. These findings indicate that persistent abnormalities following recovery from myopericarditis are not rare and support the hypothesis that the syndrome of dilated cardiomyopathy may be a sequel of myopericarditis.
Glomus tumour of the hallux: diagnosis by Doppler-shift ultrasound and digital subtraction angiography
Authors: Kreel L , Thornton A , Pardy B J
Published: December 2008

A case is presented of a glomangioma with typical history and clinical findings, proven by operation and histology. Unique radiographic features are demonstrated including visualization of the tumour on a soft tissue radiograph and associated hyperaemic bone changes, continuous wave Doppler results indicating hyperaemia and an arterio-venous malformation, and the clear demonstration of the tumour in both frontal and lateral views was possible by intra-arterial digital subtraction angiography (DSA) under local anaesthesia. Fibrous dysplasia of a femur was an incidental finding.
Cushing's syndrome—transitory immune deficiency state?
Authors: Würzburger M I , Prelević G M , Brkić S D , Vucković S , Pendić B
Published: December 2008

A 28 year old female patient with Cushing's syndrome due to an adrenal adenoma also suffered from recurrent urinary infections (proteus), tonsillitis (streptococcus), permanent candidiasis and perimandibular abscess (Staphylococcus pyogenes). Suppression of cellular and humoral immunity was confirmed by in vitro tests. After successful right adrenalectomy the clinical signs of Cushing's syndrome disappeared and no evidence of either bacterial or fungal infection were noted one year postoperatively. Immunological tests showed the restitution of both cellular and humoral immunity.

The course of the disease in the patient supports the idea that Cushing's syndrome might be considered as a transitory immune deficiency state.
Insulin oedema
Authors: Evans D J , Pritchard-Jones K , Trotman-Dickenson B
Published: December 2008

A 35 year old markedly underweight woman presented with uncontrolled diabetes. Following insulin therapy she developed gross fluid retention with extensive peripheral oedema, bilateral pleural effusions and weight gain of 18.8 kg in 22 days, accompanied by a fall in plasma albumin. She responded well to treatment with diuretics and salt-poor albumin, losing 10.3 kg in 6 days without recurrence of oedema. Severe insulin oedema is an uncommon complication of insulin therapy and may be due to effects of insulin on both vascular permeability and the renal tubule.
How does stress exert its effects—smoking, diet and obesity, physical activity?
Authors: Kornitzer M , Kittel F
Published: December 2008

Using a job stress questionnaire a negative correlation was found between job stress and physical fitness and a positive one with Type A behaviour. No correlation was found between job stress and obesity, nutritional patterns or physical activity. Subjects with angina had higher scores on the job stress questionnaire than normal controls. The job stress score was not predictive of future coronary heart disease.
Stress mechanisms in hypertension
Authors: Steptoe A
Published: December 2008

Recent studies of stress mechanisms in hypertension have focussed on the cardiovascular and neuroendocrine reactions to challenging or threatening psychosocial stimuli. Fixed hypertension may develop in some animal models following chronic exposure to psychosocial conflict. Acute experiments in humans show that marked sympathetically-mediated cardiovascular reactions accompany the performance of challenging tasks. Responses are more accentuated in hypertensives and in people at high risk for developing the disorder. The working hypothesis to emerge is that the haemodynamic responses that accompany attempts to cope with challenging environments may promote the spiral towards sustained hypertension in susceptible individuals.
Successful control of Cushing's disease in the elderly with long term metyrapone
Authors: Donckier J , Burrin J M , Ramsay I D , Joplin G F
Published: December 2008

A 77-year old woman with pituitary-driven Cushing's disease is described. The condition was completely controlled on long-term treatment with metyrapone.
DIDMOAD syndrome with megacystis and megaureter
Authors: Chu P , Staff W G , Morris J A , Polak J M
Published: December 2008

A case of DIDMOAD syndrome (diabetes insipidus, diabetes mellitus, optic atrophy and nerve deafness) is described. There was unusually severe urinary tract dilatation which led to an ileal conduit diversion. Immunohistological study of the bladder wall and ureter revealed a marked diminution in nerve fibres, which may have been primary or secondary to the muscle hypertrophy. The possible pathogenesis of the urinary tract dilatation is discussed in relation to this finding.
Transient lupus anticoagulant and fansidar therapy
Authors: Jeffrey R F
Published: December 2008

A case of the Stevens-Johnson syndrome following Fansidar therapy is reported in which a marked feature was the presence of a circulating anticoagulant of the lupus inhibitor type. Treatment with steroids resulted in complete recovery and disappearance of the anticoagulant.
Surgery for the acute abdomen in adults with leukaemia
Authors: Martell R W , Jacobs P
Published: December 2008

In a retrospective analysis five of 104 patients with acute leukaemia undergoing cytotoxic chemotherapy developed abdominal signs requiring emergency surgical exploration. Two common features in these patients were the inclusion of cytosine arabinoside in their treatment regimen and a necrotizing lesion involving the terminal ileum, appendix, and right colon. Appendicectomy was performed in two and hemicolectomy in three. Of the patients receiving high-dose cytosine arabinoside one died in the immediate post-operative period and two after recovery from surgery but before marrow regeneration; the remaining two patients received conventional dose cytosine arabinoside, and both recovered. The inclusion of this agent is standard in modern treatment programmes, resulting in significant improvement in long-term disease-free survival, so that a greater awareness of this complication is necessary. Early surgery, utilizing modern support techniques, is recommended as feasible and appears to offer the only realistic chance of survival.
Recurrent sterile meningitis caused by a pituitary abscess
Authors: Ford J , Torres L F , Cox T , Hayward R
Published: December 2008

The case of a 21 year old woman who presented with recurrent sterile meningitis and bitemporal hemianopia is described. Computed tomographic scan showed a large low density ring enhancing lesion above and within the pituitary fossa which at operation and on histological examination was found to be compatible with an abscess. The visual field defect recovered completely and the scan appearances returned to normal postoperatively.
Previously unreported abnormalities of dermal basement membranes and collagen fibrils in a patient with X-linked spondyloepiphyseal dysplasia tarda
Authors: Borsey D Q , Hopwood D , Montgomery A J , Walsh D B , Jung R T
Published: December 2008

Electron microscopic findings of the skin biopsy of a boy with spondyloepiphyseal dysplasia tarda showed several novel features. The basement membrane of the epidermis showed focal irregular thickening and reduplication. The collagen fibres showed foci of fibrous long spacing collagen and marked variation in fibre diameter. Taken together these abnormalities have not been reported in any other condition.
Use of computerized tomography of the abdominal wall in the diagnosis of partial post-operative wound dehiscence
Authors: Smith-Behn J , Arnold M , Might J
Published: December 2008

A patient had occult post-operative partial wound dehiscence which was accurately diagnosed by performing a CT scan of the abdomen. It is suggested that CT scan of the abdominal wall is useful for early diagnosis of occult abdominal wound dehiscence.
Serum uric acid, serum glucose and diabetes: relationships in a population study
Authors: Cook D G , Shaper A G , Thelle D S , Whitehead T P
Published: December 2008

The relationships between serum uric acid, serum glucose and diabetes have been examined in a survey of 7735 middle-aged men drawn at random from general practices in 24 British towns. There was a positive relationship between serum glucose and serum uric acid concentrations up to about 8.0 mmol/l; at higher levels of glucose, serum uric acid decreased. Uric acid levels were significantly reduced in insulin-dependent diabetics and in those on oral hypoglycaemics and also in ‘non-diabetics’ with casual glucose levels > 10 mmol/l.

Both uric acid and glucose concentrations were positively related to body mass index; only uric acid was positively related to alcohol intake. Men on antihypertensive treatment had raised levels of uric acid (significant) and glucose (non-significant). The positive relationship between serum uric acid and serum glucose could not be explained by associations with body mass index, alcohol intake, age, social class, gout or treatment for hypertension. It probably reflects the biochemical interaction between serum glucose and purine metabolism, with increased excretion of uric acid during hyperglycaemia and glycosuria.
Lumbar puncture and subarachnoid haemorrhage
Authors: Patel M K , Clarke M A
Published: December 2008

Medical notes of 123 patients with subarachnoid haemorrhage were examined. No patient deteriorated at the time of lumbar puncture. All but 2 patients with associated intracerebral haematomas had markedly impaired consciousness or focal signs.

Two of 30 patients with meningitis were initially diagnosed as subarachnoid haemorrhage, and one died without lumbar puncture. If consciousness is not markedly impaired and focal signs are absent, lumbar puncture is safe in patients with subarachnoid haemorrhage.
Myocardial hypertrophy, fibrosis and infarction following exposure of the heart to radiation for Hodgkin's disease
Authors: O'Donnell L , O'Neill T , Toner M , O'Briain S , Graham I
Published: December 2008

A 35 year old man was treated for stage IIA Hodgkin's disease by radiation to the upper thorax, axillae and neck. Three years later he presented with intractable and ultimately fatal congestive heart failure.

Autopsy revealed massive biventricular hypertrophy with widespread subendocardial fibrosis and myocardial infarction, but with little coronary artery disease. Such a complex of features has not previously been described after radiation therapy and cannot be adequately explained by other known causes of heart muscle disease. Ventricular hypertrophy with extensive subendocardial fibrosis may be part of the spectrum of radiation heart disease.
Blood eosinophilia and ulcerative colitis—influence of ethnic origin
Authors: Benfield G F A , Asquith P
Published: December 2008

Blood eosinophilia is an alleged manifestation of ulcerative colitis. To investigate this association and to determine the effect of race, the occurrence of eosinophilia in all 44 Asians presenting between 1968–84 was compared to that in an age- and sex-matched group of indigenous white Caucasian patients presenting over the same period. Nineteen (43%) of the Asians presented with an eosinophilia compared to only 3 Caucasians (P < 0.0001); similar numbers (14 and 13) in both groups demonstrating transient eosinophilia on occasions during maintenance treatment although not related to clinical relapse. A control group of Asians with other disorders not known to be associated with eosinophilia did not manifest this abnormality on presentation although 3 patients did so transiently during out-patient observation.

Eosinophilia is a feature of ulcerative colitis in many Asians possibly due either to an unusual racial response to ulcerative colitis or as a reflection of the underlying pathogenesis of their disease. We have not confirmed earlier suggestions of such a feature in white Caucasians. Eosinophilia occurring during maintenance treatment in both groups may be drug-related.
Acute myeloblastic leukaemia associated with solitary plasmacytoma of the ilium
Authors: Maharaj D , Dolan G
Published: December 2008

A 72 year old man developed acute myeloblastic leukaemia two years after he had been treated with local curative therapy and chemotherapy for a solitary plasma cytoma of the ilium.
Primary hepatocellular carcinoma presenting as fulminant hepatic failure in a young woman
Authors: Levy L J , Swinburne L M , Boulton R P , Losowsky M S
Published: December 2008

A 29 year old Caucasian female, with no history of chronic liver disease, presented with fulminant hepatic failure, the cause of which was not established until post-mortem when it was found that she had a rare form of hepatocellular carcinoma. To our knowledge, this is the only detailed report of hepatocellular carcinoma presenting in this manner.
Anorexia nervosa and pancreatic ascites
Authors: Isaacs P , Saunders A J , Rosen B K , Sladen G E
Published: December 2008

Acute alcoholic pancreatitis was undiagnosed in a patient with anorexia nervosa who subsequently developed pancreatic ascites and oedema, wrongly attributed to protein malnutrition alone. She became hyperphagic in an attempt to reverse the malnutrition and hence the abdominal swelling, indicating that the goal of attaining a thin shape was the major determinant of the eating disorder in this patient.

Measurement of ascitic fluid amylase concentration should be carried out in all patients with unexplained ascites.
Failure of conventional chemotherapy in aggressive lymphomas
Authors: Cunningham D , Hepplestone A , Gilchrist N L , Dagg J H , Evans I L , Soukop M
Published: December 2008

Between 1975 and 1982 in 2 centres in Glasgow, 53 previously untreated patients with aggressive non-Hodgkin’s lymphomas received chemotherapy consisting of one of the following regimens-CVP, MOPP, CHOP or BACOP. Twenty nine patients (55%) entered complete remission (CR), 20 (38%) had partial remission (PR) and 4 (7%) had progressive disease (PD). Of the 29 patients in CR, 9 have relapsed and died, 5 died of infection, 4 died of non-malignant causes, and 11 (21%) remain alive and disease free. The median survival for the CR group is 40 months. All of the patients in the PR and PD group are dead, median survival 11 months.

These chemotherapy regimens will cure only the minority of patients with aggressive lymphomas and the use of more intensive regimens is indicated.
Post-traumatic diabetes insipidus combined with primary polydipsia
Authors: Labib M , McPhate G , Marks V
Published: December 2008

We describe a case of diabetes insipidus after head injury in which thirst persisted despite treatment with DDAVP and normal plasma osmolality. Symptoms were only completely relieved when plasma osmolality was below 270 mosmol/kg. We believe that this might have been due to hypothalamic injury causing resetting of the thirst osmostat. To our knowledge, this type of primary polydipsia has not been described before in association with diabetes insipidus following head injury.
Hereditary spherocytosis in sisters unmasked by parvovirus infection
Authors: McLellan N J , Rutter N
Published: December 2008

Teenage sisters were found to have hereditary spherocytosis when they presented in aplastic crisis associated with otherwise asymptomatic parvovirus infection. Such patients may present a source of cross-infection to others at risk.
Blood lactate changes during exercise at high altitude
Authors: Binns N , Wright A D , Singh B M , Coote J H , Bradwell A R
Published: December 2008

Blood lactate concentrations were measured in 18 normal subjects at the end of an exercise test designed to maintain heart rate at 85% of maximum for 15 minutes. Blood lactate concentrations were reduced at high altitude (4846 m) and correlated positively with basal pH and negatively with basal Pa,O2 levels. Blood lactate concentrations tended to be lower in those subjects on acetazolamide but were not correlated with the severity of acute mountain sickness or with the workload of the exercise test. We conclude that the pH changes are probably the most significant factor in reducing lactate concentrations.
Macrocytic anaemia due to copper deficiency in a patient with late onset hypogammaglobulinaemia
Authors: Oppenheimer S M , Hoffbrand B I , Dormandy T L , Parker N , Wickens D G
Published: December 2008

Very few cases of acquired severe copper deficiency have been described. The principal effects are haematological, but the precise abnormalities are uncertain due to the possible association of other deficiencies. A case of isolated severe copper deficiency associated with late onset hypogammaglobulinaemia is reported in which the chief findings were macrocytic anaemia, neutropenia and a decrease in mean platelet volume. All these abnormalities resolved when copper therapy was instituted and recurred when the medication was stopped.
Acute post-streptococcal glomerulonephritis followed shortly by acute rheumatic fever
Authors: Kwong Y L , Chan K W , Chan M K
Published: December 2008

A 16 year old girl with post-streptococcal glomerulonephritis developed acute rheumatic fever 19 days afterwards. Previous publications on concurrent post-streptococcal glomerulonephritis and acute rheumatic fever are reviewed.
‘Neutropenia’ in black west Indians
Authors: Zezulka A V , Gill J S , Beevers D G
Published: December 2008

A prospective case control study routine haematological parameters was conducted in 294 healthy Black and White age/sex-matched subjects. The most important finding relevant to clinical practice was a reduction of total white cell count in Blacks due mainly to reduced neutrophil numbers. Twenty-one percent of sickle negative Blacks had white cell counts below the lowest value seen in Whites. The haemoglobin concentration, erythrocyte mean cell volume and monocyte count were also significantly lower amongst Blacks though lymphocyte counts were higher. The racial differences in haemoglobin and white count were not accounted for by differences in smoking and drinking habits. They were also found when Blacks with sickle cell trait were compared to age/sex-matched Whites and in others taking the oral contraceptive pill. Awareness of racial group should aid interpretation of routine tests and avoid unnecessary investigation of normal ‘neutropenic’ Blacks.
Primary pulmonary artery sarcoma: intra-operative similarity to pulmonary embolus
Authors: Berg G A , Hamid B N A , Kenyon W E , Drakeley M J
Published: December 2008

An infarcted right lower lobe, thought to be due to a thrombotic pulmonary embolus, was resected in a 48 year old man. Subsequent examination of the lobe unexpectedly showed the infarction to be secondary to a primary sarcoma of the pulmonary artery.
Eosinophilic colitis as a complication of the hypereosinophilic syndrome
Authors: Shah A M , Joglekar M
Published: December 2008

A patient with the hypereosinophilic syndrome complicated by a severe eosinophilic colitis is reported. The association has not previously been recorded.
Liver abscess in the tropics: experience in the University Hospital, Kuala Lumpur
Authors: Goh K L , Wong N W , Paramsothy M , Nojeg M , Somasundaram K
Published: December 2008

We reviewed 204 cases of liver abscess seen between 1970 and 1985. Ninety were found to be amoebic, 24 pyogenic and one tuberculous. The cause of the abscesses in the remaining 89 patients was not established. The patients were predominantly male, Indians, and in the 30-60 age group. The majority of patients presented with fever and right hypochondrial pain. The most common laboratory findings were leucocytosis, hypoalbuminaemia and an elevated serum alkaline phosphatase. Amoebic abscesses were mainly solitary while pyogenic abscesses were mainly multiple. Complications were few in our patients and included rupture into the pleural and peritoneal cavities and septicaemic shock. An overall mortality of 2.9% was recorded.

The difficulty in diagnosing the abscess type is highlighted. The single most important test in helping us diagnose amoebic abscess, presumably the most common type of abscess in the tropics, is the Entamoeba histolytica antibody assay. This test should be used more frequently in the tropics.
Benylin dependence, metabolic acidosis and hyperglycaemia
Authors: MacRury S , Neilson R , Goodwin K
Published: December 2008

We describe a patient who had consumed large quantities of a proprietary cough mixture containing diphenhydramine, ammonium chloride and sodium citrate (Benylin expectorant) daily for several months and subsequently presented with confusion, marked metabolic acidosis and non-ketotic hyperglycaemia.
Ulcerative colitis in Asian immigrants
Authors: Benfield G F A , Montgomery R D , Asquith P
Published: December 2008

Forty-four Asian immigrants in Birmingham and 44 age- and sex-matched white Caucasians with ulcerative colitis were compared to investigate the existence of any ethnic differences in the pattern of disease. Asian immigrants demonstrated a male preponderance of 2:1, and compared to the matched Caucasians there was a higher incidence of presenting eosinophilia and a milder course of disease, with more patients experiencing only a single initial attack. In spite of this clinical difference, total or subtotal colitis was the commonest pathological type in both white Caucasians and Indians, whereas in Pakistanis localized distal disease predominated. All ethnic groups suffered the same overall complication rate (55%) which is at variance with the experience of low complication rates in India. The age of onset of ulcerative colitis was related to age at immigration with a mean interval of 11 years.

Although in some respects Asian immigrants share the disease pattern of the indigenous population, the observed significant differences could be of importance with regard to pathogenesis.
Hypomagnesaemia causing myopathy and hypocalcaemia in an alcoholic
Authors: Pall H S , Williams A C , Heath D A , Sheppard M , Wilson R
Published: December 2008

A well-nourished alcoholic patient developed a subacute myopathy which responded rapidly to correction of severe hypomagnesaemia. The finding of profound hypocalcaemia prompted the measurement of serum magnesium. Magnesium deficiency should be looked for in any alcoholic patient with a myopathy as the prognosis seems better than in many other forms of alcoholic myopathy. Correction of the magnesium deficiency corrects the hypocalcaemia without the need for calcium supplementation.
Recurrent ureteric obstruction in association with Henoch-Schönlein purpura
Authors: Powell J M , Ware H , Williams G
Published: December 2008

The most common urological manifestation of Henoch-Schönlein purpura is focal proliferative glomerulonephritis. Ureteric obstruction as a consequence of the disease has been reported in children but is rare. We report an adult male patient with Henoch-Schönlein purpura causing unilateral, bi-focal, recurrent ureteric obstruction.

We speculate that ureteric involvement in Henoch-Schönlein purpura may be more common than hitherto suspected and that even with a demonstrable obstructive episode, consideration must be given for an initial conservative approach.
Raised parathyroid hormone levels in the milk alkali syndrome: an appropriate response?
Authors: Bullimore D W , Miloszewski K J
Published: December 2008

A case of the ‘milk alkali syndrome’ associated with grossly elevated levels of amino terminal parathyroid hormone is described. The hypercalcaemia (calcium 4.09 mmol/l) and hyperparathyroidism settled on conservative measures. Factors in the milk alkali syndrome which might stimulate the release of parathyroid hormone include parathyroid gland hyperplasia secondary to suppression of ionized calcium, alteration in sensitivity of calcium receptors on the cells of the parathyroid glands, the stimulation of an intermittent alkaline tide in the blood and the high intake of phosphate and bicarbonate. We suggest that high levels of parathyroid hormone in the milk alkali syndrome may be appropriate rather than paradoxical.
Lung cancer, immune thrombocytopenia and the lupus inhibitor
Authors: Kozlowski C L , Johnson M J , Gorst D W , Willey R F
Published: December 2008

This case report describes the simultaneous occurrence of autoimmune thrombocytopenia and the lupus anticoagulant in a patient with primary adenocarcinoma of the bronchus. Treatment with corticosteroids and plasmapheresis resulted in a return to normal of the partial thromboplastin time and the disappearance of the platelet antibodies. The carcinoma was inoperable.
Haemolytic-uraemic syndrome presenting as an acute abdomen
Authors: Lamont P M , Davidson A I G
Published: December 2008

Haemolytic-uraemic syndrome (HUS) may present with symptoms and signs suggestive of an acute surgical condition of the abdomen. The patient described was admitted with clinical features sufficient to warrant operation but later proved to have HUS.
Pregnancy and alpha-1 antitrypsin deficiency
Authors: Atkinson A R
Published: December 2008

A 29 year old patient with alpha-1 antitrypsin deficiency and bullous emphysema became pregnant against the advice of her physicians. Despite a mid-trimester pneumothorax requiring the insertion of a chest tube, she went on to deliver a healthy child under epidural anaesthesia using a midforceps technique. Vaginal delivery is not necessarily contra-indicated in multiparous patients with bullous emphysema.
The effective evaluation of thyroid status in patients on phenytoin, carbamazepine or sodium valproate attending an epilepsy clinic
Authors: Connacher A A , Borsey D Q , Browning M C K , Davidson D L W , Jung R T
Published: December 2008

To assess the most efficient means of monitoring thyroid status in an epilepsy clinic, total thyroxine (T4), free thyroxine stimulating hormone (TSH) were measured in 71 adult patients treated long-term with either phenytoin (DPH), carbamazepine (CBZ) or sodium valproate (VAL). Twenty-seven patients with one or more abnormal thyroid hormone results were further investigated by a thyrotrophin releasing hormone (TRH) test and clinical assessment. T4 was found to be normal in 85% on VAL, 40% on CBZ and 39% on DPH. FT4 was normal in more patients, namely 95% on VAL, 70% on CBZ and 65% on DPH. The TRH tests indicated that FT4 was the most efficient screening test for hypothyroidism in this epileptic population. We estimate that the use of FT4 alone as a screening test would have reduced by 60% the number of TRH tests required.
Management and outcome of infective prepatellar bursitis
Authors: Wilson-MacDonald J
Published: December 2008

Forty seven cases of prepatellar bursitis are reported. Twenty one patients had sustained a recent injury with a break in the skin which had caused the infection and seventeen patients were employed in jobs which involved kneeling. Oral antibiotics proved to be inadequate treatment in many cases. Splintage and intravenous antibiotics with or without aspiration of the bursa were usually successful in treating the condition, although nine patients required surgical drainage of the bursa. Twelve patients continued to have symptoms months or years after the infection, particularly those with preexisting chronic bursitis, or those who kneeled at work. There was little difference in the results between the different treatment groups.
Cretinism and lingual thyroid presenting in an adult
Authors: Yeung V T F , Loong E P L , Cockram C S
Published: December 2008

A 29 year old woman presented with menorrhagia secondary to hypothyroidism. Subsequent investigation confirmed the presence of a lingual thyroid. Features of cretinism were present despite the late presentation. This unusual case is discussed with reference to previous publications.
Common iliac artery aneurysm presenting as acute sciatic nerve compression
Authors: Mohan S R , Grimley R P
Published: December 2008

Aneurysms of the iliac arteries usually remain silent, but when they rupture the consequences can be dramatic. They produce few clinical signs suggestive of their presence. However, such aneurysms have been found to be the cause of non-vascular clinical situations. Often they present with features of compression on adjacent viscera. We present a case in which a large common iliac artery aneurysm was found to be causing symptoms of acute sciatic nerve compression.
Coagulation abnormalities in patients with eosinophilia
Authors: Vázquez J J , Fernández Pavón A , Arnalich F , Gil A , López Pastor A , García Muñoz M S , Peña J M , Barbado F J
Published: December 2008

Haematological variables in patients with eosinophilia and in healthy control subjects were studied in order to determine whether there were abnormalities in the coagulation system in patients. We found significantly elevated levels of fibrinogen, fibrin degradation products, platelet number and beta-thromboglobulin in patients. The abnormalities were not related to the causes of eosinophilia nor to its severity. This lack of correlation could be due to the heterogeneity of human peripheral blood eosinophils.
Is serodiagnosis of herpes simplex encephalitis safe?
Authors: Coghlan J G , Monaghan C , Carney P A , Moran J H
Published: December 2008

We present a case of probable tuberculous meningitis in which serological changes ‘diagnostic’ of herpes simplex encephalitis were found. Evidence is provided that the serological changes in this case represent a true false positive, and that reliance on clinical plus serological criteria to diagnose herpes simplex encephalitis could result in failure to diagnose and treat tuberculous meningitis.
Hot-bath epilepsy
Authors: Pall H S , Williams A C
Published: December 2008

Immersion in hot baths is an infrequently recognized cause of reflex epilepsy. Two such cases are described. Increased awareness of unusual forms of reflex epilepsy is necessary as this may have important prognostic and therapeutic implications.
Clostridium difficile colitis following treatment with metronidazole and vancomycin
Authors: Bingley P J , Harding G M
Published: December 2008

A 25 year old woman developed Clostridium difficile colitis following a course of vancomycin and metronidazole prescribed for pelvic inflammatory disease. The condition resolved after treatment with vancomycin given alone. Colitis following this combination of antibiotics has not been described previously.
Spontaneous intraperitoneal rupture of a neurogenic bladder; the importance of ascitic fluid urea and electrolytes in diagnosis
Authors: Ramcharan K , Poon-King T M W , Indar R
Published: December 2008

Spontaneous intraperitoneal bladder rupture in a 38 year old man with a spastic paraparesis since infancy is described. Delayed diagnosis resulted in peritoneal autodialysis so providing an opportunity for documentation of biochemical abnormalities. Surgery resulted in a successful outcome. The literature on this rare condition is outlined and difficulties in diagnosis are discussed. The diagnostic value of urea and electrolyte levels in ascitic fluid is emphasized.
Ventricular fibrillation and reinfarction in pregnancy
Authors: O’Donnell M , Meecham J , Tosson S R , Ward S
Published: December 2008

This is the first reported case of a woman suffering a potentially fatal dysrhythmia and reinfarction during the same pregnancy and surviving to produce a healthy, live infant.
Cricopharyngeal Crohn’s disease
Authors: Rowe P H , Taylor P R , Sladen G E , Owen W J
Published: December 2008

We report a case of Crohn’s disease of the cricopharyngeal oesophagus which presented with complete dysphagia and was successfully treated by balloon dilatation. We can find no previous reports of such a case.
Routine practice in the diagnosis of adenocarcinoma of the stomach: a survey of tumours diagnosed in the Portsmouth and Oxford Health Districts 1979–1980.
Authors: Deakin M , Colin-Jones D G , Vessey M P
Published: December 2008

If the poor prognosis for patients with adenocarcinoma of the stomach is to be improved, it is important to make the diagnosis at an early stage. In order to evaluate our routine diagnostic practice, we have performed a retrospective study of patients in the Portsmouth and Oxford Health Districts who were diagnosed as having adenocarcinoma of the stomach during 1979 and 1980. Three hundred and forty-two patients were identified; the great majority had advanced disease at the first presentation. Only 9 patients (2.6%) were identified as having early gastric carcinoma and a total of 46 patients (13.4%) had either Stage 1 or 2 disease. Despite the provision of an endoscopy service, gastric carcinoma is still being diagnosed at an advanced stage. Initial false negative investigations caused a delay in diagnosis in 18.4% of patients. During the year preceding diagnosis (when tumour was likely to have been present), the false negative rate for barium meal examination was 25.5% and for endoscopy 13.5%. Negative results should not deter us from pursuing the diagnosis of tumour in those patients with persisting symptoms.
Acquired common variable hypogammaglobulinaemia and lymphoedema
Authors: Lozewicz S , Morris G , Garbett N , Browse N , Slavin B , Cole P
Published: December 2008

Two patients with lymphoedema of the legs developed recurrent respiratory infections and were found to have panhypogammaglobulinaemia. The early recognition and treatment of this form of immunity deficiency in patients with lymphoedema is important in order to prevent recurrent infections which could cause pulmonary damage and further lymphatic stasis.
Covert inhalation of tablet causing fatal pneumonia
Authors: Hill S N , Main A N H , Fuggle W J
Published: December 2008

Inhalation of foreign bodies is usually associated with acute respiratory symptoms. We report a case of an elderly woman who died from pneumonia due to covert tablet inhalation. Clinicians caring for the elderly should consider this as a possible cause for pneumonia which fails to respond to usual therapy.
Non-Hodgkin’s lymphoma of bone causing avascular necrosis of the femoral head
Authors: Renowden S , Fitzgerald E J , Kemp A M
Published: December 2008

A 14 year old boy presented with a painful hip, initially attributed to Perthes’ disease although it is uncommon in teenagers. Subsequent investigation showed that the underlying pathology was non-Hodgkin’s lymphoma.
Iron deficiency in pernicious anaemia: a neglected diagnosis
Authors: Atrah H I , Davidson R J L
Published: December 2008

In 114 patients (52 males and 62 females) with long-standing pernicious anaemia, hypoferritinaemia was found in 27 (23.7%) and hypochromic microcytic anaemia in 19 (16.6%). Our findings indicate that iron deficiency is a common yet neglected complication of long-standing pernicious anaemia and warrants greater diagnostic and therapeutic attention.
Prolongation of the QT interval by ketanserin
Authors: Cameron H A , Waller P C , Ramsay L E
Published: December 2008

In hypertensive patients single doses of ketanserin 40 mg prolonged the corrected QT interval (QTc) for at least 8 hours, with a maximal increase of 35 ms (P less than 0.001, n = 6) after 2 hours. During chronic dosing (20 and 40 mg b.d.) the QTc was further prolonged, by 46 and 45 ms respectively. QTc prolongation after treatment with a mean dose of 73 mg/day for 7 weeks (n = 26) was significantly related to body weight (r = -0.58, P less than 0.01), and to the dose of ketanserin corrected for body weight (r = 0.63, P less than 0.01), but not to plasma concentrations of ketanserin, ketanserinol, potassium or calcium. High doses of ketanserin (mean dose 167 mg/day, n = 9) increased the QTc by 40 ms (P less than 0.001), with prolongation of up to 80 ms in individual patients. Treatment with ketanserin at doses proposed for clinical use (40-80 mg/day) may carry a risk of ventricular arrhythmias.
Hepatic epithelioid haemangioendothelioma: difficult name, difficult diagnosis?
Authors: Cobden I , Johri S , Terry G , Robinson K B , Bennett M K , Lendrum R
Published: December 2008

Two patients with epithelioid haemangioendotheliomata of the liver are described. Both presented with abdominal pain and malaise, with hepatomegaly and a variable degree of hepatocellular dysfunction. Diagnosis was delayed in both cases, each patient undergoing a protracted series of investigations including repeated liver biopsies. The major obstacles to early diagnosis were a lack of clinical awareness of the condition and difficulties in interpretation of the liver histology: the widespread sclerosis in the tumour tissue is easily mistaken for a post-necrotic or cirrhotic process. The key to the diagnosis is the demonstration of cells containing Factor-VIII-related antigen confirming the endothelial origin of the tumour. One patient died within three months of presentation and the other after 18 months. The tumour may, therefore, be more aggressive than earlier reports seem to suggest. It seems likely that the tumour is being under-diagnosed and although no specific therapy has been shown to be of value, a greater awareness of the condition, resulting in a more prompt diagnosis, should save patients from undergoing unnecessary investigation.
Melioidosis with brain abscess
Authors: Pit S , Chea F K C , Jamal F
Published: December 2008

Central nervous system involvement in melioidosis is rare. We describe a 48 year old woman who developed septicaemia and a brain abscess due to Pseudomonas pseudomallei. Since there is a continuing practical problem in bacteriological confirmation of the aetiological agent, diagnosis of melioidosis has to be made on clinical suspicion.
Ectopic release of GHRH and ACTH from an adenoid cystic carcinoma resulting in acromegaly and complicated by pituitary infarction
Authors: Southgate H J , Archbold G P R , El-Sayed M E , Wright J , Marks V
Published: December 2008

A 23 year old man presented with a tumour mass in the lung. Subsequent investigation showed ectopic secretion of adrenocorticotrophic hormone (ACTH) and growth hormone releasing hormone (GHRH) from an adenoid cystic carcinoma. The patient progressed to show the clinical effects of long term exposure to high blood levels of both growth hormone and cortisol. The case was complicated by pituitary infarction. The very high blood levels of ACTH, growth hormone (GH) and GHRH proved resistant to treatment with the somatostatin analogue, SMS 201-995, and a possible side effect of the drug is reported. To our knowledge this is the first reported case of ectopic hormone secretion by an adenoid cystic carcinoma.
Multiple smooth muscle tumours in neurofibromatosis presenting with chronic gastrointestinal bleeding
Authors: Cox J G C , Royston C M S , Sutton D R
Published: December 2008

Gastrointestinal involvement in neurofibromatosis is well recognised. We present an unusual manifestation of gastro-intestinal neurofibromatosis--chronic gastrointestinal bleeding from extensive smooth muscle tumours.
Heatstroke and rhabdomyolysis presenting as fulminant hepatic failure
Authors: Fidler Sarah , Fagan Elizabeth , Williams Roger , Dewhurst I , Cory C E
Published: December 2008

Heatstroke following vigorous exercise is reported in a young male. Severe hepatic and renal failure resulted but the patient completely recovered following treatment by active measures to reduce his core temperature.
Leptospirosis — can it be a sexually transmitted disease?
Authors: Harrison N A , Fitzgerald W R
Published: December 2008

Person to person spread of leptospirosis has not been previously reported. We describe two cases occurring in a man and wife which tantalisingly raise this possibility.
Neurological complications of human immunodeficiency virus infection
Authors: Kennedy P G E
Published: December 2008

The protean neurological manifestations of human immunodeficiency virus (HIV) infection are reviewed. Both the central nervous system and peripheral nervous system may be affected and many of the complications may occur in individuals with acquired immunodeficiency syndrome (AIDS)-related complex, or who are seropositive for HIV alone as well as those with the established AIDS syndrome. Specific therapy is available for certain of these neurological conditions, but the clinical course in others is untreatable and progressive. Although it seems likely that the pathogenesis of some of these syndromes such as the AIDS-dementia complex are due to the direct effect of HIV on the nervous system, in others the neurological injury probably occurs as a consequence of the immunosuppression which HIV induces, or immune-mediated mechanisms.
Graves’ disease presenting as pyrexia of unknown origin
Authors: Shaked Y , Samra Y , Zwas S T
Published: December 2008

Fever is a common clinical manifestation of inflammatory processes of the thyroid and thyroid crisis. On the other hand, fever alone as a presenting symptom of thyrotoxicosis, without other manifestations, is extremely rare. A female patient is described in whom fever persisted for two months prior to hospitalization, but without clinical symptoms or signs to lead to suspicion of thyroid disease. After exhaustive investigation it was found that the patient was suffering from hyperthyroidism. Fever disappeared gradually on antithyroid therapy, recurred when the drugs were withdrawn for a rechallenge trial, and cleared up again after renewal. Four other cases of persistent fever as a presenting symptom of hyperthyroidism were found on a review of previous publications. Thyrotoxicosis should, therefore, be included in the differential diagnosis of pyrexia of unknown origin.
Neurological manifestation of carbon monoxide poisoning
Authors: Hart I K , Kennedy P G E , Adams J H , Cunningham N E
Published: December 2008

The clinical signs and post-mortem findings in a case of carbon monoxide poisoning are described, and correlated with the computer tomographic (CT) scan appearances. The value of serial CT scanning as a diagnostic tool is highlighted.
Lactic acidosis due to metformin therapy in a low risk patient
Authors: Tymms D J , Leatherdale B A
Published: December 2008

A 55 year old diabetic women treated with chlorpropamide and metformin for three years presented with acute oliguric renal failure and lactic acidosis from which she died. The plasma metformin level was very high suggesting that the lactic acidosis was caused by the drug. There were no contraindications to metformin therapy and renal function was normal three months previously. This case demonstrates that lactic acidosis can occur as a result of metformin therapy in the absence of pre-existing risk factors.