bluuebunny/crossref_metadata_2025 huggingface dataset:
Controlled trial of terfenadine and chlorpheniramine maleate in perennial rhinitis
Authors: Brostoff Jonathan , Lockhart J D F
Published: December 2008

A double-blind clinical trial in 60 patients with perennial rhinitis was conducted to compare the efficacy and side effects of two antihistamines, terfenadine and chlorpheniramine maleate, and placebo. There was no statistically significant difference in response between active treatments and placebo. Although side effects were more frequent with chlorpheniramine this also was not statistically significant.
Intestinal vasculitis and lithium carbonate-associated diarrhoea
Authors: Cannon S R
Published: December 2008

A 57-year-old male manic depressive patient is described who presented as an ‘acute abdomen’ whilst receiving treatment with lithium carbonate. Small bowel resection was performed, the histopathology of which revealed local vasculitic changes with thrombosis and subsequent infarction of the ileal wall. The possible aetiological role of lithium in this vasculitis is discussed.
Echocardiography in the diagnosis of right ventricular endomyocardial fibrosis
Authors: George B O , Gaba F E , Talabi A I , Adeniyi D S
Published: December 2008

Twenty-one patients with endomyocardial fibrosis (EMF) and right ventricular involvement were studied by M-mode echocardiography. All 21 patients showed echocardiographic findings consisting of (i) increased right ventricular dimension, (ii) paradoxical septal motion, (iii) increased right ventricular outflow dimension (iv) thickening of the right ventricular anterior wall with increased right ventricular anterior wall motion, and (v) easily recordable tricuspid valve. In addition, some of the patients had posterior pericardial effusion, and fine fluttering of the tricuspid valve. EMF was diagnosed clinically in all the patients, haemodynamically and angiographically in 15 and confirmed at autopsy in one.

None of these echo findings was present in two patients with constrictive pericarditis, and two patients with massive ascites due to portal hypertension.
The management of large congenital liver cysts
Authors: Rashed A , May R E , Williamson R C N
Published: December 2008

Congenital solitary cysts of the liver seldom exceed 10 cm in diameter. Four such cases were seen over a 5-year period in a city with a catchment population of about 800,000. One of these cysts was asymptomatic, but the others were complicated by intracystic haemorrhage, probable perforation and cyst-enteric fistula. Pre-operative liver scans and findings at laparotomy indicated a different treatment in each case—observation, aspiration, enucleation and drainage.
Wernicke’s encephalopathy in hyperemesis gravidarum
Authors: Nightingale S , Heath P D , Bates D , Barron S L
Published: December 2008

A 20-year-old woman developed severe persistent vomiting early in pregnancy. In three months she lost 18 kg of body weight and showed the biochemical features of mild hepatic failure. Four days after starting intravenous dextrose and insulin, she developed short-term memory loss, confusion, ataxia, dysarthria, mild left upper motor neurone facial weakness and upbeat nystagmus. Thiamine was given and no further deterioration occurred. The vomiting persisted until intra-uterine fetal death. Thereafter, her medical, neurological and psychological problems gradually improved. The association of hyperemesis gravidarum, intravenous calorie load and Wernicke’s encephalopathy is discussed.
Post-biopsy renal arteriovenous fistula: successfully embolized with a Gianturco Mini Coil
Authors: Cassidy M J D , Harries-Jones E P , Van Zyl-Smit R
Published: December 2008

A case is reported of a renal arteriovenous fistula following percutaneous needle biopsy resulting in heavy haematuria that was successfully occluded by transcatheter embolization with a Gianturco Mini Coil.
Sclerotherapy in the treatment of a recurrent lymphocele
Authors: Pope A J , Ormiston M C , Bogod D G
Published: December 2008

The management of postoperative lymphoceles is often lengthy and unsatisfactory. We describe the successful treatment of a recurrent lymphocele by the repeated injection of sodium tetradecylsulphate (STD) after percutaneous aspiration. This method of treatment has not to our knowledge been previously described.
Klinefelter’s syndrome associated with systemic sclerosis
Authors: O’Donoghue D J
Published: December 2008

A case of systemic sclerosis is reported in a 41-year-old male with Klinefelter’s syndrome. The significance of this association to the aetiology and pathogenesis of systemic sclerosis is discussed.
The Zollinger-Ellison syndrome and ectopic gastric mucosa
Authors: Galland R B , Fletcher D R , Evans D J , Shlugman D , Polak J M , Baron J H , Welbourn R B
Published: December 2008

Ectopic gastric mucosa in an intramesenteric ileal diverticulum caused fatal bleeding after total gastrectomy in a patient with the Zollinger-Ellison syndrome (ZES).
An unusual presentation of a mesenteric cyst of the sigmoid colon
Authors: Simpson D A , Horsburgh A G
Published: December 2008

A case of sigmoid mesenteric cyst presenting as an acute abdominal emergency is reported. The variable presentation and uncommon occurrence of these cysts are the main difficulties in pre-operative diagnosis.
An unusual case of gustatory sweating
Authors: Hayes P C , Tulloch J A
Published: December 2008

A non-insulin-dependent diabetic who developed gustatory sweating is reported. Generalized auto-immune disease and anosmia were also present.
Glandular fever-like illness associated with sulphasalazine
Authors: Carr-Locke David L , Ali Muntaz
Published: December 2008

A patient with ulcerative colitis is described in whom a glandular fever-like illness was associated with the use of sulphasalazine which recurred in part on re-exposure to the drug. This complication has been previously described three times from the United States but not from the United Kingdom.
The effects of amiodarone on thyroid function
Authors: Jaggarao N S , Sheldon J , Grundy E N , Vincent R , Chamberlain D A
Published: December 2008

The effects of amiodarone on thyroid function tests in 100 patients treated for 6 weeks to 8 years are reported. One patient became thyrotoxic and 10 developed latent or overt hypothyroidism. Twenty-five patients remained clinically euthyroid throughout, but had free thyroxine indices above the normal range. In these patients with apparently anomalous results, total tri-iodothyronine was normal in 19 cases and low in 1; conversely, free thyroxine was high in all 17 cases in which it was measured. Thyrotrophin releasing hormone (TRH) tests were abnormal in 4 of the 13 patients who had the test. Reverse tri-iodothyronine was significantly raised after 2 weeks amiodarone in 5 healthy subjects, but an equivalent amount of iodine in 9 healthy individuals did not significantly affect any of these tests. We believe that these changes are due in part to inhibition of peripheral conversion of thyroxine to tri-iodothyronine with diversion to reversed tri-iodothyronine. Thyroid function tests should be checked once or twice a year in all patients on maintenance amiodarone. Tests indicating hypothyroidism are likely to be clinically relevant, whereas levels of thyroxine suggesting thyrotoxicosis may be misleading and do not usually imply the need to discontinue treatment with the drug.
The symptomatic and objective effects of nifedipine in combination with beta-blocker therapy in severe angina pectoris
Authors: Jenkins R M , Nagle R E
Published: December 2008

Nine patients with severe coronary artery disease and disabling angina receiving either regular metoprolol or oxprenolol, together with glyceryl trinitrate tablets as required for chest pain, were studied. Nifedipine 10 mg three times per day was compared to placebo in a double blind randomized control trial, using patient diary cards and exercise tests. The number of recorded episodes of angina during the placebo period of 15.0 +/- 2.1 (mean +/- s.e.m.) per patient per week was significantly reduced to 11.2 +/- 2.5 during the nifedipine period (P less than 0.05). Similarly, the recorded number of glyceryl trinitrate tablets consumed during the placebo period of 12.6 +/- 2.1 was significantly reduced to 9.1 +/- 2.0 tablets per patient per week during the nifedipine period (P less than 0.05). There was a statistically significant increase in both the duration of exercise to onset of chest pain (from 241 +/- 16.3 seconds on placebo to 306 +/- 38.4 seconds on nifedipine (P less than 0.05)) and the total work performed to the onset of chest pain during the nifedipine period compared to the control and placebo periods (P less than 0.05). There was a significant increase (P less than 0.05) in exercise time before the onset of appreciable ST depression (greater than 1 mm) on exercise testing during the nifedipine period (66.2 +/- 4.2 sec) compared to the control period (51.2 +/- 3.0 sec) and placebo periods (58.7 +/- 3.5 sec). Although nifedipine was generally well tolerated, one patient experienced a severe episode of angina whilst taking the drug, which required admission to hospital.
Squamous cell carcinoma arising in a pilonidal sinus presenting with the formation of an abscess
Authors: Jamieson N V , Goode T B
Published: December 2008

A case of squamous cell carcinoma arising in a pilonidal sinus and presenting with abscess formation is described and the treatment is discussed.
The role of the routine pre-operative chest X-ray in the elderly general surgical patient
Authors: Seymour David Gwyn , Pringle Robert , Shaw James William
Published: December 2008

In an unselected group of 233 patients aged 65 years and over undergoing non-cardiopulmonary surgery, 57·5% had some abnormality on routine pre-operative chest X-ray and 40·3% had an abnormality which was regarded as clinically significant. Of all patients, 32·2% subsequently required a postoperative chest film for diagnostic purposes, and in these cases the pre-operative X-ray was invaluable as a baseline. During the study period there were ten occasions where the discovery of an abnormality on a routine pre-operative chest film directly affected the treatment plan. Pre-operative chest radiology proved ineffective as a method of predicting postoperative respiratory complications and was of only limited effectiveness in predicting postoperative cardiac morbidity.

It is concluded that a routine pre-operative chest X-ray should be available in all elderly surgical patients (a) as a baseline measurement and (b) to exclude unsuspected disease. The prediction of postoperative cardiac and respiratory morbidity, however, is best achieved by non-radiological means.
Mucormycosis in a diabetic
Authors: Batra V K , Gaiha M , Gupta P S
Published: December 2008

A case of juvenile diabetes mellitus with rhino-orbital mucormycosis treated successfully with amphotericin B is described.
Fatal renal haemorrhage following haemodialysis in a patient with obstructive uropathy
Authors: Palaniswamy R , Singhal P C , Rao M S , Laimayum D S , Raghu K , Chary K S
Published: December 2008

A 22-year-old male with obstructive uropathy and renal failure was given pre-operative haemodialysis. He collapsed five hours later. Autopsy revealed massive intrarenal haemorrhage and rupture of a dilated superior calyx intraperitoneally. Anticoagulation employed during haemodialysis was probably responsible for this spontaneous renal haemorrhage and subsequent calyceal rupture.
Hepatic granulomata associated with adenocarcinoma
Authors: Rebello R , Warnes T W
Published: December 2008

A case is described in which extensive investigations failed to reveal the cause of hepatic granulomata, except that at post-mortem an adenocarcinoma of the lung was found; an association between the two is therefore suggested.
Appendix vermiformis duplex
Authors: Khanna A K
Published: December 2008

Duplication of the appendix is rare, and fewer than 100 cases have been reported. A case of double appendix with one caecum is reported with inflammation of both appendices.
Primary hyperparathyroidism unmasked by donor nephrectomy
Authors: Hollands M J , Williams Gordon
Published: December 2008

A patient who was normocalcaemic before donation of a kidney to her son developed hypercalcaemia in the immediate postoperative period, which was subsequently found to be due to a parathyroid adenoma. It is assumed that the hypercalcaemia was unmasked by the reduction in glomerular filtration rate following the nephrectomy.
Amniotic fluid embolism and disseminated intravascular coagulation complicating hypertonic saline-induced abortion
Authors: Ballas S , Lessing J B , Michowitz M
Published: December 2008

Amniotic fluid embolism (AFE) associated with disseminated intravascular clotting (DIC) is usually fatal. Such a combination generally occurs at the term of pregnancy or in the immediate postpartum period. A case of AFE with DIC following a hypertonic-saline-induced abortion, is reported. The patient was in the midtrimester with a live fetus. Prompt recognition and treatment of her condition ensured her complete recovery. Such a case has not, to our knowledge, been previously reported.
Epidemiology aspects of endomyocardial fibrosis
Authors: Hutt M S R
Published: December 2008

Endomyocardial fibrosis (EMF) is a specific clinicopathological entity. It occurs sporadically throughout the world but is endemic in parts of Africa, India and South America. In sporadic cases, blood eosinophilia is a common feature; this is a variable finding in endemic cases. The curious geographical distribution of EMF in the tropics remains unexplained.
Endomyocardial disease—clinical features
Authors: Goodwin J F
Published: December 2008

The clinical features of tropical and temperate zone endomyocardial fibrosis (EMF) are the same, allowing for certain regional, environmental and possibly genetic variations. For example, the seasonal incidence in rainy humid areas probably reflects the large and repeated parasitic infestations in tropical EMF, while the absence of tissue eosinophilia in organs other than the heart in tropical EMF may reflect racial and environmental differences between tropical and western geographical areas that have still to be elucidated. That EMF occurs in Europeans who have lived in the tropics is undoubted, but the absence of right ventricular involvement in Europeans in the tropics, but not in temperate climes, is unexplained; perhaps it is a chance finding. It is also apparent that the extreme degrees of right ventricular EMF that are commonly seen in the tropics, with almost complete obliteration of the ventricular cavity are not usually seen in eosinophilic EMF in temperate areas. Involvement of both ventricles and of both atrioventricular valves is, however, common both in the tropics and in temperate climate EMF.
A case of insulinoma with peripheral neuropathy
Authors: Jayasinghe K S A , Nimalasuriya A , Dharmadasa K
Published: December 2008

A 25-year-old woman with chronic neuropsychiatric symptoms, peripheral neuropathy and hypoglycaemia was found to have an islet cell adenoma in the pancreas. Her neuropsychiatric symptoms disappeared following its removal and she partially recovered from her peripheral neuropathy.
The lymphomas—current management
Authors: Lister T A , Malpas J S
Published: December 2008

The malignant lymphomas are an heterogeneous group of diseases, manifest most frequently by the development of painless lymphadenopathy with or without splenomegaly and sometimes associated with constitutional symptoms. The natural history of these conditions is one of progressive increase in lymphadenopathy, both in terms of size and the number of sites, with death occurring from intercurrent infection or as a consequence of compression of a vital organ by lymph nodes. Spontaneous regression, although it has been reported, is very rare. The rate of progression, and the specific sites most frequently involved, vary with the specific subtype of lymphoma in question. Happily, the natural history is rarely observed nowadays since treatment is available which may cure a significant proportion of patients and be of very considerable palliative benefit to others. Their importance to the physician lies in the fact that, as a group, they are the seventh commonest malignancy in the United Kingdom, they afflict a relatively young population and have become potentially curable.
Efficacy and side effects of mianserin, a tetracyclic antidepressant
Authors: Wakeling A
Published: December 2008

Antidepressant drugs have been in extensive use for over 20 years. Initially 2 groups of compounds, the monoamine oxidase inhibitors (MAOI) and tricyclic compounds based on the imipramine configuration were widely used. In the early 1960’s after a few years of wide use, interest in the MAOI group fell following the recognition of a serious adverse effect. Blackwell (1963) described the occurrence of hypertensive crisis with occasional fatalities when these compounds were taken with certain foodstuffs. It is of interest, however, that in recent years there has been some resurgence of interest in these compounds and the suggestion that their dangers may have been exaggerated (Tyrer, 1979) or might be ameliorated by combination with tricyclics (Pare et al., 1982). Interest in the tricyclic group however has continued unabated and over the years at least 20 antidepressants based on the original imipramine configuration have been produced. There is now a widespread and extensive accumulated experience of these compounds and although they remain the most widely prescribed antidepressant, it is now clear that they have a number of serious disadvantages. The most important of these are cardiotoxicity, potential fatality in overdose, marked peripheral anticholinergic activity and reduction in seizure threshold (Blackwell, 1981a). As these disadvantages exist to some extent with all the tricyclics produced so far, there have, not surprisingly, been active attempts to produce different and safer antidepressant compounds.
Cryosurgery in the treatment of rectal carcinoma
Authors: Lambrianides A L , Ghilchik M W
Published: December 2008

Four patients with adenocarcinoma of the rectum were treated by cryosurgery. In all cases there was considerable improvement in local symptomatology following treatment, although in 2 patients troublesome complications were encountered following application of the cryoprobe. All 4 patients are alive at 2 years.
Hypertrophic osteoarthropathy: two unusual causes
Authors: Barber P V , Lechler R
Published: December 2008

Two patients with hypertrophic osteoarthropathy of unusual aetiology are described. The first patient developed the condition in association with oesophageal carcinoma and the second as a complication of active pulmonary tuberculosis. In the second case, substantial resorption of new bone was seen following treatment.
Kaposi’s sarcoma associated with hairy cell leukaemia
Authors: De Cock K M , Lucas S B , Gichuyia N R , Kasili E G , Radia K , Wankya B M
Published: December 2008

The case is described of a patient with hairy cell leukaemia who later developed Kaposi’s sarcoma. This association has not been reported before and the coexistence of hairy cell leukaemia with another tumour is very rare. The implications of this unusual association are briefly discussed.
Cryptogenic cirrhosis in relapsing polychondritis
Authors: Islam N , Ahmed Z , Alam M N
Published: December 2008

A case of relapsing polychondritis with histologically proven cirrhosis is reported. This association has not been described before.
Reversible diminished insulin requirement during acute renal failure
Authors: Naschitz Johanan E , Barak Carmella , Yeshurun Daniel
Published: December 2008

Very little is known concerning insulin requirements in diabetic patients who develop acute renal failure, although decrease in daily insulin requirement in patients with chronic renal failure is recognized.

A 46-year-old diabetic patient is described, whose daily insulin requirement decreased from 56 to 8 units per day during an episode of acute post-streptococcal glomerulonephritis causing acute reversible renal failure. The insulin requirement returned to its previous level after the patient recovered.
Spontaneous abortion and diabetes mellitus
Authors: Wright Alexander D , Nicholson Hamish O , Pollock Andrew , Taylor Kenneth G , Betts Susan
Published: December 2008

In 58 consecutive pregnancies in insulin-dependent diabetic women, glycosylated haemoglobin levels were abnormally high in 78% at the time of booking for antenatal care.

Spontaneous abortion was the outcome in 15 pregnancies, 10 occurring before the 15th week of gestation. Glycosylated haemoglobin levels were significantly higher in those women who aborted spontaneously than in women who delivered successfully (12.8 +/- 1.8% v. 11.2 +/- 2.3%, mean +/- s.d.). These results emphasise the inadequacy of diabetic control in the first trimester and lend further support to the importance of good control at this critical time in insulin-dependent diabetes.
Streptococcus milleri liver abscesses associated with leiomyosarcoma of the ileum
Authors: Gleeson D C , Fielding J , Heath D A
Published: December 2008

We report a case of multiple Strepococcus milleri liver abscesses manifesting dramatically on serial CT scanning in a patient subsequently shown to have a leiomyosarcoma of the ileum.
Florid granulomatous reaction in a seminoma
Authors: Pickard W Russell , Clark Alistair H , Abel B J
Published: December 2008

A case of seminoma of the testis complicated by an extensive granulomatous reaction is reported. This reaction was so florid that a benign condition was initially considered until further material for histology was examined and the correct diagnosis made.
Haemoperitoneum from benign ileal leiomyoma
Authors: Tasker D Gordon
Published: December 2008

Intraluminal gastrointestinal haemorrhage is a common feature of benign leiomyoma of the small bowel. A case is reported of an ileal leiomyoma which caused free intraperitoneal haemorrhage. It is believed that such an occurrence has not been reported previously.
Reno-vascular disease in polycythaemia rubra vera
Authors: Biggs Beverley , Anderton J L
Published: December 2008

Hypertension and polycythaemia rubra vera commonly occur in the same patient. This is regarded as coincidence and the hypertension does not respond to correction of polycythaemia. We report a case of renal artery stenosis occurring simultaneously with polycythaemia rubra vera and suggest that renovascular occlusive disease should be excluded in such patients with refractory hypertension.
Vaginal vein thrombosis in pregnancy
Authors: Gitstein S , Ballas S , Peyser M R
Published: December 2008

Vaginal vein thrombosis in a pregnant woman is reported. This entity should be differentiated from vaginal arteriovenous fistula which may cause severe antepartum, intrapartum and post-partum haemorrhage.

The humoral and mechanical factors which favour the occurrence of varicosities and thrombosis are briefly described. Surgical management is suggested as being both simple and effective.
An unusual late sequel to hysterectomy
Authors: Hertzanu Yancu , Hurwitz Julius
Published: December 2008

A case is reported of a large infected foreign body granuloma associated with a retained non-opaque swab presenting 9 years after hysterectomy. An abdominal radiography and whole body computed tomography (CT) scanning demonstrated gas collections in a large abdominal mass. The case underlines the necessity for using radioopaque swabs in all surgical operations.
Trigeminal neuralgia—earlier referral for surgery
Authors: Garvan Neil J , Siegfried Jean
Published: December 2008

Patients with trigeminal neuralgia may be treated in many ways before referral for definitive surgery. This aspect has been looked at in a group of 140 consecutive patients. Patients on prolonged medication have been studied with respect to the period over which the pain occurred and the amount of carbamazepine taken. Earlier referral for surgery is recommended for some of these patients and guidelines are given.
Diabetic ketoacidosis associated with outpatient treatment using continuous subcutaneous insulin infusion
Authors: Boulton A J M , Knight G , Drury J , Ward J D
Published: December 2008

The occurrence of ketoacidosis in out-patient diabetics treated with continuous subcutaneous insulin infusion (CSII) has received little attention. We report two such cases of ketosis, each precipitated by infection and occurring in patients previously well controlled on CSII. This report illustrates that the risk of ketoacidosis is ever present in insulin-treated patients, whether the insulin is infused by pump or injected intermittently.
Coexisting retroperitoneal and mediastinal fibrosis
Authors: Pang J , Vicary F R , Beck E R
Published: December 2008

A rare case of coexisting retroperitoneal and mediastinal fibrosis is reported. Increasing awareness of this association may lead to earlier recognition of significant symptoms and more effective therapy.
Severe ulcerative colitis during successful pregnancy
Authors: Greenfield C , Pounder R E , Craft I L , Lewis A A M
Published: December 2008

A 31-year-old patient presented with fulminant colitis during the 27th week of her first pregnancy. Despite failed medical treatment, colectomy was delayed because of the gravid uterus. A healthy child was delivered at 32 weeks by caesarian section, but a postoperative ileus appeared to induce transient colonic dilatation. A colectomy was performed 10 days post-partum. Both mother and child survived.
Fenoterol versus salbutamol nebulization in asthma
Authors: Hockley B , Johnson N McI
Published: December 2008

A double-blind crossover study was conducted in 10 stable asthmatics comparing 5 mg fenoterol with 5 mg salbutamol, both given via a Hudson nebulizer. Although both drugs caused significant bronchodilatation at the doses used, fenoterol had a significantly greater peak effect than salbutamol and its duration of action was 4 hr as opposed to 3 hr.
Extreme metabolic alkalosis with fludrocortisone therapy
Authors: Burns A , Brown T M , Semple P
Published: December 2008

We present an unusual case of extreme metabolic alkalosis resulting from severe hypokalaemia caused by unmonitored fludrocortisone therapy. Biochemical aspects of the disorder are discussed, as is the successful treatment with diuretics and potassium replacement. Some dangers of this therapy and necessary precautions are emphasized.
Tetany and osteolysis in light chain myeloma with amyloidosis
Authors: Bhakri H L , Cundy T F , Pettingale K W
Published: December 2008

A patient is described with light chain myeloma and amyloidosis in whom 2 unusual complications occurred, diffuse osteolytic lesions and tetany. These observations extend the previously recognized clinical spectrum of this disorder.
Peroneal muscular atrophy associated with cardiac conducting tissue disease: further observations
Authors: Lowry Patricia J , Littler William A
Published: December 2008

Two further cases of peroneal muscular atrophy associated with cardiac conduction abnormalities are described.
Fistulating duodenal diverticulum with associated vitamin B12 deficiency
Authors: Hughes Stephen , Marsh Michael N
Published: December 2008

A 72-year-old man with severe megaloblastic anaemia due to a benign duodeno-colic fistula originating from an antimesenteric duodenal diverticulum is described. Previous reports of fistulae from duodenal diverticula are reviewed.
Hemifacial spasm in tuberculous meningitis
Authors: Sandyk R
Published: December 2008

Hemifacial spasm developed in a 47-year-old man with tuberculous meningitis. The spasms ceased completely following vigorous antituberculous treatment. A selective compression of the facial nerve root along its exit at the brainstem by a localised inflammatory process is the most tenable explanation for the development of the hemifacial spasm.
Exercise-induced urticaria and angio-oedema with relief from cromoglycate insufflation
Authors: Hatty S , Mufti G J , Hamblin T J
Published: December 2008

The pathogenesis of physical urticarias is unknown and the treatment is often difficult and unsatisfactory. A patient with severe exercise-induced angio-oedema and urticaria is reported who responded dramatically to cromoglycate by insufflation and not when treated with orally active cromoglycate.
Spontaneous rupture of the spleen in early pregnancy
Authors: Lamerton A J
Published: December 2008

Spontaneous rupture of the spleen as a result of laceration by a rib exostosis is described. This unusual case serves to underline the diagnostic difficulties of the acute abdomen in pregnancy.
Compartment syndromes and the burnt patient
Authors: Batchelor A G G
Published: December 2008

Soft tissue swelling within an unyielding osteofascial compartment may lead to Volkmann’s contracture. This may result from a variety of direct insults to the compartment in the burned patient. It may also arise from the contraction, or apparent contraction, of the walls of the compartment.
Gammaglobulin therapy in burn management with a report on the treatment of a 5-year-old burn victim
Authors: Watkins John , Appleyard Neil
Published: December 2008

This communication reviewed briefly the immunological problems of the burn patient and the frequent complication of septicaemia. Antibiotic therapy alone is not sufficient. There is a case for boosting the patient’s natural immunity. Attempts to do so have been reported in the literature over the last 20 years and involve either infusion of exogenous immunoglobulin (IgG) or vaccination. Problems of the former ‘passive’ therapy largely involve transfusion reactions but this has been solved by enzymatic modification of the native IgG molecule to reduce its antigenicity. One such product, Gamma-Veinine, is available from the Behring Institute, Marburg.
Introduction
Authors: Beevers D G
Published: December 2008

There is an increasing awareness of the importance of ethnic factors in the pathogenesis, clinical features and treatment of many diseases (Donaldson and Taylor, 1983). This topic was the subject of a multidisciplinary conference held at the Birmingham Medical Institute in November 1982, and the present issue of the Postgraduate Medical Journal constitutes the conference proceedings. The proceedings of the first Birmingham Conference were published in the Journal in December 1981 (Vol. 57, pp. 747–792).
Ethnic differences in peak expiratory flow rate in Birmingham factory workers
Authors: Jackson S H D , Beevers D G , Cruickshank J K , Bannan L T
Published: December 2008

Among 698 Birmingham factory workers, Asian men (n = 75) tended to have lower peak expiratory flow rates (PEFR) than black (n = 156) or white (n = 138) men when age, height and smoking habits were accounted for. This trend reached statistical significance in Asian females (n = 20), despite a small sample size. There were no significant differences in PEFR between blacks and whites of either sex.
Malignant pleural mesothelioma at St Mary’s Hospital, Portsmouth—a review of 29 fatal cases
Authors: Harrison R N , Hibberd S C , Dadds J H
Published: December 2008

The clinical details are presented of 29 fatal cases of pleural mesothelioma in the majority of which there was a history of exposure to asbestos during dockyard work in Portsmouth. Chest pain, breathlessness and weight loss dominated the clinical picture. Analgesia and repeated pleural aspirations provided temporary relief but symptoms invariably progressed. The mean survival time was 39 weeks. Only one patient survived longer than 2 years from hospital presentation. At autopsy, extensive local spread was usual but a high proportion of patients also had metastases at distant sites.
Pulmonary involvement in angio-immunoblastic lymphadenopathy
Authors: Price D , Dent Richard G
Published: December 2008

Two patients are described who complained of dyspnoea and systemic symptoms. They were found to have angio-immunoblastic lymphadenopathy with extensive pulmonary involvement. In both cases, high dose corticosteroid therapy led to relief of symptoms and clearing of the diffuse radiographic shadowing seen in both lung fields.
Pitfalls in the diagnosis of asthma
Authors: Hetzel M R
Published: December 2008

Asthma is a common disease which affects at least 2% of the British population (Gregg, 1977). The last two decades have seen major advances in safe treatment with regular inhalation of sodium cromoglycate, selective beta2 stimulant drugs (salbutamol, terbutaline etc.) or beclomethasone. For the majority of asthmatics, these drugs can achieve excellent control and allow the patient to lead a normal life even if treatment with oral corticosteroids is also required. It is therefore depressing to note that there is, as yet, little evidence of a significant improvement in asthma mortality. A recent survey (British Thoracic Association, 1982) reported a mortality rate of 1·84 per 100,000, which indicates no real improvement on rates of 0·46-1·34 per 100,000 reported over the last century by Speizer and Doll (1968). Several recent studies of asthma mortality (Cochrane and Clark, 1975; Ormerod and Stableforth, 1980; British Thoracic Association, 1982) have highlighted two consistent problems; failure to diagnose and assess the severity of asthma by using simple respiratory function tests and, as a result, failure to implement adequate treatment. In this article, I would like to remind the reader of some of the more important pitfalls in the diagnosis of asthma.
Asthma presenting as cor pulmonale
Authors: Dunn A M , Hill L F , Wilson R S E
Published: December 2008

A 29-year-old man with asthma presenting as right sided congestive cardiac failure is reported. There was rapid resolution of the heart failure with standard bronchodilator therapy and corticosteroid therapy.
Massive haematemesis and melaena from a Meckel’s diverticulum
Authors: Shaunak Sunil , O’Donohue John
Published: December 2008

A case of Meckel’s diverticulum in a middle-aged man presenting acutely with haematemesis and melaena is reported. Such a presentation has not to our knowledge been previously reported in this age group.
Transomental hernia causing intestinal obstruction in an elderly patient
Authors: Watt Patrick C H
Published: December 2008

This report describes the oldest recorded patient with a transomental hernia. She illustrates several important points in dealing with internal hernias in the elderly patient.
Erythema nodosum progressing to pyoderma gangrenosum as a complication of Crohn’s disease
Authors: Gellert A , Green E S , Beck E R , Ridley C M
Published: December 2008

Erythema nodosum occurs more frequently than pyoderma gangrenosum in Crohn’s disease. We report the occurrence of both lesions in a woman with Crohn’s disease and the transformation of one to the other. Pyoderma gangrenosum has been described at the site of previous trauma in Crohn’s disease and at the site of other skin conditions in other circumstances, but, to the best of our knowledge, actual progression from erythema nodosum to pyoderma gangrenosum has been reported on only one previous occasion in Crohn’s disease.
Bilateral retinal detachment in a case of Reiter’s disease
Authors: Belcon Michael C. , Bensen William G. , Zahoruk Ronald M.
Published: December 2008

A patient is described who developed co-existent Reiter’s disease and bilateral non-traumatic retinal detachment. Although numerous ophthalmological disorders are associated with Reiter’s disease and HLA-B27, to our knowledge this is the first report of co-existent retinal detachment. Although this relationship may be fortuitous, there are a number of immunological mechanisms common to both entities. Retinal detachment, unlike bilateral conjunctivitis and acute anterior uveitis, may be clinically asymptomatic and its sequelae prevented by appropriate ophthalmological assessment.
Immune complex mediated lung haemorrhage and nephritis—successful treatment with plasma exchange, haemodialysis and immunosuppressive drug therapy
Authors: Drew P. J. , Newland A. C. , Marsh F. P.
Published: December 2008

A 16-year-old boy developed an immune complex illness associated with lung haemorrhage, proliferative nephritis with crescents and renal failure. Treatment with plasma exchange, haemodialysis and immunosuppressive drugs resulted in a rapid reduction in levels of immune complexes and other mediators of inflammation and was associated with good recovery of renal and lung function. Subsequently, deterioration in renal function occurred whilst the patient was on treatment with prednisolone alone but this was reversed with a short course of plasma exchange and the addition of azathioprine. No further deterioration in renal or lung function has been observed during 18 months treatment with azathioprine and prednisolone.

Immediate plasma exchange and immunosuppressive drug treatment have been recommended for Goodpasture’s syndrome. Immune complex mediated lung haemorrhage and nephritis is the main clinical differential diagnosis. Our case suggests that the same treatment is effective for both conditions if given early, and that detailed renal and immunological investigations should not be allowed to delay this.
Spontaneous rupture of distal oesophagus (Boerhaave’s syndrome) with unusual clinical presentation of pneumoperitoneum
Authors: Witz M. , Jedeikin R. , ZagerM  , Shpitz B. , Elyashiv A. , Dinbar A.
Published: December 2008

We present a case of spontaneous rupture of the distal oesophagus that was accompanied by a pneumoperitoneum and was successfully treated surgically.
Polycystic ovarian syndrome in identical twins
Authors: Hutton C. , Clark F.
Published: December 2008

Two 21-year-old female twins are described. They presented simultaneously with hirsutism and oligomenorrhoea. Investigation showed they had polycystic ovaries, they were identical and were not cases of post-pubertal adrenogenital syndrome.
Hemipelvectomy for liposarcoma: an unusual case and course
Authors: Deutsch Alexander A. , Bachar A. , Reiss R.
Published: December 2008

A patient with liposarcoma of the upper thigh and pelvis treated by hemipelvectomy is described. Preoperative treatment with radiotherapy and chemotherapy induced regression and necrosis of the growth. The treatment of this tumour is discussed as well as the possibility that the pre-operative therapy converted an inoperable tumour into an operable one.
Prolonged coma and delayed peripheral neuropathy after ingestion of phenoxyacetic acid weedkillers
Authors: O’Reilly John F.
Published: December 2008

A case of prolonged coma and delayed peripheral neuropathy is reported following self-poisoning with a widely available domestic weedkiller containing phenoxyacetic acids. Attention is drawn to the potential toxicity of these weedkillers which may be delayed in onset, and to the possibility of spontaneous recovery from neurological abnormalities which may be severe and prolonged or late in onset.
Mortality from coronary heart disease-trends for the Republic of Ireland
Authors: Hickey N. , Mulcahy R. , Daly L. , Graham I.
Published: December 2008

A study of certified mortality between 1968 and 1981 indicates that mortality from all causes commenced to decline from the mid 1970s in the Republic of Ireland. This trend was apparent for both sexes and for all ages except for men aged 55–64 years. A similar trend of lesser magnitude is suggested for coronary heart disease mortality in males, but not in females.

The decrease in the percentage of male cigarette smokers in the population which is also reflected in a marked decline of smoking among male coronary patients, may be related to the trends in mortality.
Patients’ evaluation of a post-myocardial infarction teaching programme administered by nurses
Authors: Jenkins B. , Mayberry J. F. , Kent S. , Colbourne G.
Published: December 2008

Two-hundred and twenty-eight patients admitted to a District General Hospital Coronary Care Unit with a confirmed myocardial infarction were given a detailed information session by nurses. Information included a detailed programme of exercise during convalescence and attitudes toward diet, smoking and sexual intercourse. Patients were asked to assess the value of these sessions using questionnaires administered during convalescence.

Between 76% and 91% of patients considered the presentation necessary and there was a significant improvement in their understanding of what an infarction was. More than 80% of patients found a booklet entitled Recovering from your Heart Attack particularly helpful. The great majority of patients believed that more health education should be given at school and that members of the general public should be taught the techniques of cardio-pulmonary resuscitation.

The teaching programme appears to have reduced the admitted smoking habits of patients. On admission 56% of patients were smokers. This fell to 7% at the end of 3 weeks, but had risen to 17% at 6 months.
Phaeochromocytoma and acute cardiovascular death (with special reference to myocardial infarction)
Authors: Cohen C. D. , Dent D. M.
Published: December 2008

The causes of death, as determined by autopsy, in 10 patients dying from the acute effects of phaeochromocytoma were myocardial infarction (five patients), left ventricular failure (two patients), cerebral haemorrhage (two patients) and circulatory collapse with malignant phaeochromocytoma (one patient). Most patients died shortly after admission during the course of a fulminant cardiovascular illness and the underlying tumour was unsuspected in eight instances. The clinical features and post-mortem cardiovascular findings are reviewed.
Basal ganglia calcification and psychosis in Down’s syndrome
Authors: Thase Michael E.
Published: December 2008

A case of basal ganglia calcification (diagnosed in vivo) and schizophreniform psychosis occurring in a young adult with Down’s syndrome is reported. A stress-vulnerability model is suggested. Because of the relatively high prevalence of basal ganglia calcification to Down’s syndrome, this population appears well suited for systematic study of the neuropsychiatric aspects associated with this neurological condition.
Pasteurella multocida pneumonia complicated by Staphylococcus aureus
Authors: Martyn V. , Swift D.
Published: December 2008

A 71-year-old woman presented with acute non-cardiogenic pulmonary oedema. She proved to have a Pasteurella multocida pneumonia, with blood stream invasion by the organism, and required positive pressure ventilation for 53 days.

Penicillin G., the drug of choice for this infection, failed to reverse the steady decline in her arterial oxygen-tension, and it was only after treatment with chloramphenicol and prednisolone that she began to improve.

Serological tests strongly indicated the presence of a Staphylococcus aureus infection and the delay in giving antibiotics appropriate to this second pathogen may have been the reason for the patient’s initial downhill course.
Breast mycobacterial infection in a haemodialysis patient
Authors: Modai D. , Weissgarten J. , Reiff R. , Siegal B. , Gabizon D.
Published: December 2008

Mycobacterial infection is relatively common among patients maintained on haemodialysis and may present in uncommon locations and acquire an unusual course. We present a patient in whom a breast mass was found to be caused by primary mycobacterial infection. This is to our knowledge the first report on breast mycobacterial infection in a haemodialysis patient.
Amoebic granuloma—an unusual cause of caeco-colic intussusception
Authors: Patra S. B. , Giri D. D. , Shukla G. N. , Mehta H. S.
Published: December 2008

A case of amoeboma presenting as an intussusception, encountered for the first time in this institute, is reported. The diagnosis was only made postoperatively. The importance of awareness of such lesions in the tropics, in view of the efficiency of trial antiamoebic therapy, is discussed.
Herpes simplex type 2 meningitis treated with acyclovir
Authors: Levy D. M. , Sagar H. J.
Published: December 2008

A case of meningitis due to a primary genital herpes simplex type 2 infection, and its prompt response to therapy with intravenous acyclovir is reported. This complication of genital herpes is probably underdiagnosed and it is worthwhile searching for evidence of genital herpetic lesions in a young patient presenting with viral meningitis.
Psoriasis and Paget’s disease
Authors: Monk Barry
Published: December 2008

A case is described of localized psoriasis developing in response to Paget’s disease of the underlying bone.
Medullary sponge kidney presenting with hypokalaemic paralysis
Authors: Jayasinghe K. S. A. , Mendis B. L. J. , Mohideen R. , Ekanayake R. , Sheriff M. H. R. , Dharmadasa K.
Published: December 2008

Medullary sponge kidney associated with a defect in urine acidification is rare and usually of no clinical significance. We report a case presenting as hypokalaemic paralysis due to associated congenital distal renal tubular acidosis.
Hyperthyroidism due to inappropriate TSH secretion with associated hyperprolactinaemia—a case report and review of the literature
Authors: Spitz Irving M. , Sheinfeld Maxim , Glasser Benjamin , Hirsch Harry J.
Published: December 2008

A patient with inappropriate thyrotrophin (TSH) secretion is described. She initially presented with classical hyperthyroidism during pregnancy, responded to propylthiouracil and, subsequently, had a normal delivery. Hyperthyroidism persisted and 7.5 months later a subtotal thyroidectomy was performed. After a further 16 months, mild symptoms of hyperthyroidism recurred. She again responded to propylthiouracil, but developed galactorrhoea. At that stage, it was noted that she had persistently elevated circulating TSH in the presence of elevated T4 and T3 levels. Her symptomatology was mild, although objective indices of thyroid activity, including pulse rate, BMR, sex hormone binding globulin and cholesterol, were indicative of hyperthyroidism. CT scan and tomography of the sella were normal.

She had a markedly exaggerated TSH response to thyrotrophin releasing hormone (TRH). Basal TSH and responsiveness to TRH was suppressed by high dose dexamethasone. The TSH response to TRH was partially suppressed by exogenous T3, but there was no effect on basal TSH levels. TSH also decreased slightly with L-dopa and bromocriptine. Circulating TSH rose markedly during methimazole administration. TSH α and β subunits were elevated and appropriate for the high TSH. In addition, both subunits increased following TRH. The patient had basal hyperprolactinaemia with an impaired prolactin (PRL) response to TRH and metoclopramide. PRL suppressed with L-dopa and bromocriptine. The remaining anterior pituitary function was intact. Most of the laboratory findings argue against the presence of a TSH producing pituitary tumour and the most likely cause for inappropriate TSH secretion in this patient is selective resistance of the thyrotroph to thyroid hormones. A mild element of peripheral resistance might also be present. The hyperprolactinaemia could be related to lactotroph resistance to thyroid hormone.

The complexities of treatment in this patient are stressed. Therapy was initially attempted with low dose dexamethasone, but this had no effect. T3 treatment produced an exacerbation of her symptomatology and did not influence basal TSH, thyroid hormones, or 131I uptake. Bromocriptine administration for 11 months partially suppressed basal TSH without influencing T3 and there was an increase in T4. Methimazole did decrease her T4 and T3, but TSH and PRL rose to even greater levels. Her hyperthyroidism was eventually controlled with an ablative dose of 131I. Thyroid hormone will be given in an attempt to suppress her TSH.
Treatment of asthma in a general practice
Authors: Shee C. D. , Poole D. , Cameron I. R.
Published: December 2008

We examined the general practice treatment of 67 patients diagnosed as asthmatic. Compliance with treatment was poor in one-third of patients with severe asthma. Inhaled steroids were under-prescribed and our findings suggest that some severe asthmatics are receiving less than adequate therapy.
Regional migratory osteoporosis
Authors: Major G. A. C.
Published: December 2008

The case history of a patient with regional migratory osteoporosis and associated electromyographic abnormalities is reported.

The changes seen in this patient suggest that radiculopathy secondary to traumatic ischaemia may be the pathogenic basis of this disorder.