bluuebunny/crossref_metadata_2025 huggingface dataset:
Norwegian scabies following topical steroid therapy
Authors: Clayton Roger , Farrow Simon
Published: December 2008

Following an outbreak of scabies in a hospital ward, a correct diagnosis of Norwegian scabies was made in an eczematous patient whose skin had unexpectedly deteriorated with topical potent fluorinated cortico-steroid therapy.
Transient hypothyroidism after withdrawal of thyroxin therapy
Authors: Distiller L A , Joffe B I
Published: December 2008

Continued administration of large doses of thyroid may not produce hyperthyroidism in euthyroid individuals. Cessation of prolonged high-dosage thyroid replacement can cause transient clinical and biochemical hypothyroidism owing to pituitary suppression. A case is recorded in which both these phenomena are well demonstrated. This case highlights these basic endocrinological principles.
Sarcoidosis presenting with multiple tattoo granulomata
Authors: Iveson J M I , Cotterill J A , Wright V
Published: December 2008

A patient with sarcoidosis, multiple tattoo granulomata and arthritis is described. A combination of tattoo granulomata unrelated to any one colour in the tattoo and granulomatous inflammation elsewhere is indicative of sarcoidosis.
Objectivity in the classification of tumours of the nasal epithelium
Authors: Michaels L , Hyams V J
Published: December 2008

A survey of tumours derived from each of the four cell types of nasal epithelium is presented. Criticism is levelled at the adoption of additional terms for tissue types such as lympho-epithelium and transitional cell epithelium and tumours said to be derived from them. Electron microscopy is of assistance in classification particularly in the detection of evidence of keratin synthesis. The proposed classification of tumours of the nasal epithelium is:

(1) Pseudostratified columnar epithelium: (a) papillary adenoma, (b) papillary carcinoma.

(2) Squamous epithelium: (a) everted squamous papilloma, (b) inverted papilloma, (c) squamous carcinoma of any grade of differentiation from well differentiated to undifferentiated.

(3) Melanocyte: malignant melanoma.

(4) Olfactory neuroepithelium: olfactory neuroblastoma.
Ruptured popliteal cyst simulating deep vein thrombosis with false positive radiofibrinogen uptake
Authors: Gibbons D , Phillips M , Prossor Irene M
Published: December 2008

A case is described in which deep vein thrombosis of the calf was initially diagnosed on the basis of the clinical signs and the radiofibrinogen uptake in a patient suffering from rheumatoid arthritis. The correct diagnosis of ruptured popliteal cyst was later established by arthrography and phlebography. Attention is drawn to the unreliability of the radiofibrinogen uptake test in the presence of ruptured popliteal cyst and alternative diagnostic methods are discussed.
Cyclotron produced lead-203
Authors: Horlock P L , Thakur M L , Watson I A
Published: December 2008

Introduction

Radioactive isotopes of lead occur in the natural radioactive decay series and have been used as tracers since the early days of radiochemistry. These are 210Pb (t½—-20·4 y, radium D), 212Pb (t½—10·6 h, thorium B) and 214Pb (t½—26·8 m, radium B) all of which are separated from naturally occurring decay products of radium or thorium. There are in addition to these a number of other radioactive isotopes of lead which can be produced artificially with the aid of a nuclear reactor or a charge particle accelerator (Table 1).
Lead and haemoglobin synthesis: a review
Authors: White J M
Published: December 2008

It has been known for many years that lead poisoning is associated with both abnormal haemoglobinization of the red cell and red cell production. Thus Gould, Kullman and Shecket noted in 1937 that the treatment of cancer patients with lead resulted over several weeks in a progressive anaemia, reticulocytosis and erythroblastosis. Basophilic stippling of red cells was a prominent feature. Recently it has been realized that lead exposure does not invariably lead to anaemia in the adult, although in children it may be marked (Albahary, Guillaume and Martin, 1965; Boyett and Butterworth, 1962; Hutchinson and Stark, 1961; Watson, Deckers and Lichtman, 1962). The bone marrow morphology shows normoblastic hyperplasia and the presence of abnormal ringed sideroblasts, the last of which indicates that the controlled synthesis of haemoglobin within the cell is abnormal. This has now been confirmed by the finding that the synthesis of both globin and haem were inhibited by inorganic lead in vitro.
Duration of EEG sleep stages in different types of disturbed night sleep
Authors: Březinová Vlasta
Published: December 2008

The duration of each episode of any one electrophysiological sleep stage or any episode of intervening wakefulness was determined in three kinds of disturbed sleep, namely, in naturally impaired sleep of late middle-aged, normal people, in sleep after caffeine administration, and in sleep after hypnotic drug withdrawal.

When compared with the sleep of young people, the sleep of late middle-aged subjects was characterized by an increase in longer episodes of intervening wakefulness plus drowsiness, and by a decrease in longer episodes of sleep stages 3 + 4 and REM. The sleep after caffeine, compared with the baseline sleep, contained an increased proportion of longer episodes of intervening wakefulness plus drowsiness but no significant change in the episode duration of any of the sleep stages. In the case of the drug withdrawal sleep, compared with the sleep on hypnotic drug, there was no change in the episode duration of intervening wakefulness plus drowsiness but there was a significant shortening of episode duration for sleep stages 2 and 3+4, with a similar trend for REM sleep episodes.

Thus a sleep disturbance might be characterized by increased stability of wakefulness, by decreased stability of sleep or both. Different types of sleep disturbance might require different types of treatment.
The relationship between smoking and migraine
Authors: Volans G N , Castleden C M
Published: December 2008

The theory that smoking could be implicated in the pathogenesis of migraine has been investigated in a prospective survey by the use of a questionnaire and the measurement of carboxyhaemoglobin (COHb) levels in patients attending a migraine clinic. There was a low incidence of smokers in patients attending for routine consultations and only a small percentage of patients thought that smoking was a cause of their headaches. This percentage was approximately the same both for migraine and for tension headaches. In patients attending with acute headaches, the incidence of smoking was also low, and raised COHb levels were found only in the smokers, most of whom did not consider smoking a cause of their symptoms. It is concluded that smoking is unlikely to be a factor in the aetiology or the exacerbation of migraine.
Acute reversible renal failure in G-6 PD-deficient siblings
Authors: Gulati P D , Rizvi S N A
Published: December 2008

Two G-6 PD-deficient siblings, who initially presented with intravascular haemolysis, and later developed acute oliguric renal failure, are described. Renal failure reversed as haemolysis regressed in both patients. The pathogenesis of this complication is reported to be multifactorial but in our patients tubular obstruction by haemoglobin casts is the most probable mechanism. The importance of recognizing this renal complication in G-6 PD-deficient subjects is stressed.
Recurring ‘red eyes’ due to seasonal hypercalcaemia
Authors: Smith M J , Hey G B
Published: December 2008

Recurrent hypercalcaemia associated with hypersensitivity to ultra violet light occurring in a patient who had had clinical sarcoidosis 14 years previously. Hypercalcaemia in sarcoidosis is a well known association, but it is less often realized that this hypercalcaemia may undergo seasonal variation (Taylor, Lynch and Wyser, 1963). The following case report describes recurring seasonal symptoms associated with hypercalcaemia which persisted for many years after the original diagnosis of sarcoidosis.
Inflammatory fibroid polyp of the ileum—a rare cause of intussusception
Authors: McGregor J C , Rao S S
Published: December 2008

A case of ‘inflammatory fibroid polyp’ in the terminal ileum is described. It occurred in a 38-year-old female and was associated with an ileo-ileal intussusception presenting as an acute intestinal obstruction. The macroscopic and microscopic features of this rare lesion are illustrated. It would appear to be an entity which may have been confused in the past with the haemangiopericytoma.
Carcinoma of the ampulla of Vater in a haemophiliac patient
Authors: Catford J , Zeegen R , Prosser I M , Naik E
Published: December 2008

A 42-year-old haemophiliac who presented with a cholestatic jaundice and repeated gastro-intestinal haemorrhage is described. The bleeding was initially thought to be due to the severity of the haemophilia itself rather than from any local cause and the jaundice thought to be due to a serum hepatitis. The correct diagnosis of ampullary carcinoma was eventually made after numerous barium studies, fibre-optic endoscopy and two laparotomies. A carcinoma was discovered at a second endoscopy some 12 months after initial presentation. Attention is brought to the rare association of ampullary carcinoma and haemophilia, and to the difficulties involved in diagnosis.
Bronchomotor tone and its modification by certain drugs
Authors: Kamburoff P L
Published: December 2008

The bronchial smooth muscle is described and its autonomic innervation discussed. The effect of certain physiological substances on the smooth muscle is discussed and also the consequence of blockade of the alpha receptors of the sympathetic nervous system. Indoramin, a powerful alpha blocker is also antihistaminic and this drug has been used therapeutically in the treatment of some asthmatics. Prostaglandin F2 beta has not yet been applied in human subjects.
Small airways disease
Authors: Stretton T B
Published: December 2008

Mechanisms of disease in the small air passages of the lungs are described, their effects on lung function considered, and some of the ways in which such disease may be recognized are discussed.
An appraisal of ketamine in the dressing of burns
Authors: Ward C M , Diamond A W
Published: December 2008

The use of ketamine to provide anaesthesia for the dressing and application of graft to burned patients has been assessed. In a small number of severely burned patients, it was found to be most satisfactory provided that the circumstances in which it was used were carefully controlled.
Symptomatic accessory lobe of liver with a review of the literature
Authors: Pujari B D , Deodhare S G
Published: December 2008

An accessory lobe of the liver with long well defined mesentery presenting as recurrent pain in abdomen in a Hindu female is described. This is the seventh case recorded in English literature. The embryological genesis of this anomaly and the possibility of preoperative diagnosis by various techniques is discussed.
Chronic hepatitis in polymyalgia rheumatica
Authors: Thompson K , Roberts P F
Published: December 2008

A review of the literature relating hepatic abnormalities with the giant cell arteritis, polymyalgia rheumatica syndrome is presented. A case of polymyalgia rheumatica with biochemical and histological abnormalities of the liver is described. It is suggested that a more detailed investigation of liver function should be made in patients with this syndrome where reasonably indicated.
Late presentation of intraperitoneal rupture of the urinary bladder
Authors: Williams N S
Published: December 2008

A case of silent intraperitoneal rupture of the bladder is presented. The extreme biochemical abnormalities which may occur in this rare condition are well illustrated in this case.
Chlorpropamide and fibrinolytic activity in maturity onset diabetes mellitus
Authors: Alexander William D , Wensley R T , Price Geraldine , Hartog M
Published: December 2008

This study was performed to assess the effect of chlorpropamide therapy on the fibrinolytic activity of blood of maturity onset diabetics. Normal controls were also studied and the results compared with diabetics. Diabetics were found to have deficient fibrinolytic activity compared with non-diabetics but chlorpropamide did not appear significantly to affect this deficiency either in males or females when given therapeutically over a 6-month period.
Protective dietary factors in experimental ulceration—study of some Nigerian cereals and tubers
Authors: Elegbe R A , Bamgbose S O A
Published: December 2008

Rats fed on a supplement of millet, Guinea-corn, rice or maize given in addition to laboratory stock diet showed a high degree of protection against experimental ulceration following indomethacin administration. A higher degree of protection was shown when the rats were fed with the mixture of the four cereals and laboratory stock diet. The tubers did not offer protection, while a mixture of beans and millet, Guinea-corn, unpolished rice, and maize offered no protection. The significance of such findings with regard to the geographical distribution of duodenal ulcer in Nigeria is discussed.
Rhabdomyosarcoma of the heart
Authors: Ramu M
Published: December 2008

A case of rhabdomyosarcoma of the heart is described, which is one of the rare primary tumours of the heart documented in the literature. The presenting post-mortem appearances were noted.
The hamster as a model system for the study of influenza vaccines
Authors: Potter C W , Jennings R
Published: December 2008

A series of experiments was carried out in hamsters to determine their value as an experimental animal for the study of influenza virus infection and immunization. Hamsters could be infected intranasally with approximately 100 EID50 of unadapted influenza A/Port Chalmers/73 virus; infection produced serum HI antibody and virus was recovered from both nasal washings and from lungs. Inoculation of hamsters with influenza virus or inactivated influenza virus vaccine produced immunity to subsequent homologous virus challenge. Groups of hamsters were inoculated with graded doses of a number of different inactivated influenza vaccines: the serum HI antibody response varied greatly for the different vaccines. For some influenza vaccines, the antibody response of hamsters was promoted by prior heterotypic influenza virus infection, but in primed animals the same, wide variation in serum antibody response to different influenza virus vaccines remained. Using the hamster as an experimental model, 60 i.u. of an inactivated A/England/42/72 vaccine gave protection against challenge virus infection; however, 600 i.u. of surface antigen material, including only haemagglutinin and neuraminidase failed to give protection. Inoculation of hamsters with subunit antigens absorbed to alhydrogel gave immunity to challenge virus infection.
Preparation and properties of a novel influenza subunit vaccine
Authors: Bachmayer H , Liehl E , Schmidt G
Published: December 2008

Haemagglutinin and neuraminidase have clearly been shown to be responsible for the stimulation of immunity against influenza.

In the approach described, these two immunogens are selectively solubilized, leaving an intact subviral particle which contains lipid and non-protective components. The methods used can readily be adapted to large scale production.

The immunogenicity of such antigen-preparation was studied in different animal species. Antibodies against haemagglutinin and neuraminidase were measured in mice, hamsters, guinea-pigs and rabbits. In addition, mice-protection experiments were performed.

The immune response of volunteers to this type of subunit vaccine has also been evaluated (Kunz and Hofmann, 1975). Results of a first field trial indicate that the solubilization procedure did not alter the immunogenic properties of the two antigens.
Diverticula of the vermiform appendix: a report of nine cases
Authors: Chong K C
Published: December 2008

The incidence, clinical features and pathology of nine cases of diverticula of the appendix in Malaysians are reported. The findings are discussed and compared with those previously reported. The pathogenesis of the lesion in eight cases is unknown. The rare association of lumenal obstruction by a carcinoid tumour and diverticulum formation in the appendix is seen in one case.
Giant cell arteritis presenting as subclavian artery occlusion. A report of two cases
Authors: Swinson D R , Goodwill C J , Talbot I C
Published: December 2008

Two patients with the aortic arch syndrome and biopsy-proved but asymptomatic temporal giant cell arteritis are described. Corticosteroid treatment was followed by the return of peripheral pulsation in these two patients after an interval of a few months. A review of the literature suggests that of patients where giant cell arteritis causes subclavin obstruction there is an undue predominance of women, compared to the sex ratio found in giant cell arteritis overall.
Pulmonary oedema in meningococcal meningitis
Authors: Frankel R J , Bennett E D , Borland C D
Published: December 2008

Two cases of meningococcal meningitis complicated by pulmonary oedema are described. The pulmonary arterial wedge pressure was raised in the one case studied. Profound sympathetic over-activity may be the cause of the pulmonary oedema occurring in this situation. If this is so, adrenergic blockade would appear to be a rational approach to therapy.
Contraceptive pill-induced porphyria cutanea tarda presenting with onycholysis of the finger nails
Authors: Byrne J P H , Boss J M , Dawber R P R
Published: December 2008

A case of porphyria cutanea tarda induced by oral contraceptive pill therapy is reported, and its unusual presenting sign of onycholysis of the finger nails is noted. Reference is made to the rarity of nail changes in porphyria and the regression of the onycholysis in the patient following therapy is outlined.
Ethylene glycol poisoning
Authors: Vale J A , Widdop B , Bluett N H
Published: December 2008

Although an uncommon cause of death in Great Britain, ethylene glycol poisoning is potentially serious in that renal and cardiopulmonary failure and central nervous system dysfunction can occur when doses of the order of 100 ml or more are ingested. A case is described in which a child who swallowed approximately 100 ml of ethylene glycol was treated by prolonged peritoneal dialysis. In addition, measures were taken to correct a marked acidosis. Substantial amounts of ethylene glycol were removed by the dialysis fluid and the child made a complete physical and mental recovery.
Anti-inflammatory action of corticosteroids
Authors: Greaves M W
Published: December 2008

The anti-inflammatory action of corticosteroids is complex. At a cellular level, they cause redistribution of granulocytes, resulting in increased circulating granulocytes and reduced tissue pools. They also cause lymphopenia. The significance of these phenomena in relation to the anti-inflammatory activity of steroids is unknown. The most obvious pharmacological effects of corticosteroids are seen on blood vessels. They cause adrenergically mediated vasoconstriction and non-competitive antagonism of vasodilation due to prostaglanin E and bradykinin. Prostaglandin formation is inhibited by corticosteroids but whether this is due to an effect on enzymic synthesis or release is uncertain. Corticosteroids stabilize the lysosomal membrane preventing release of lysosomal enzymes in vitro but the significance of this in vivo is debatable.
The effect of γ-adrenoreceptive antagonists on the morbidity and mortality in cardiovascular disease
Authors: Fitzgerald J D
Published: December 2008

The effect is critically reviewed of chronic administration of beta-adrenoreceptor antagonists on morbidity and mortality in angina pectoris and myocardial infarction. There is inconclusive evidence that the abrupt cessation of therapy with these agents may increase morbidity and mortality in angina pectoris. The type of anginal patient in which this may occur is not yet defined and neither is the mechanism. There is no evidence that beta-antagonists prolong the life of anginal patients. In the acute phase of experimental myocardial infarction, these drugs reduce mortality but do not do so in man. There is increasing evidence that they prolong life if administered to patients surviving the acute phase of myocardial infarction. The need for further studies is discussed.
Acrylamide poisoning
Authors: Kesson C M , Baird A W , Lawson D H
Published: December 2008

A small epidemic of acrylamide poisoning amongst workers in the construction industry is described. The clinical features of this condition are reviewed and two cases are described in which residual neurological problems persisted for over 1 year. The literature on acrylamide poisoning is reviewed and it is recommended that this substance should only be handled in the open air or in well ventilated areas. Its use in confined spaces such as tunnels appears to be unduly hazardous.
Myxoedema coma presenting in status epilepticus
Authors: Woods K L , Holmes G K
Published: December 2008

A 71-year-old woman with myxoedema coma presenting in status epilepticus is reported. Although this complication of myxoedema coma is considered to be fatal the patient described responded dramatically to treatment and remains in good health.
The clinical features and management of pituitary apoplexy
Authors: Lloyd M H , Belchetz P E
Published: December 2008

The clinical features and management of three patients presenting with pituitary apoplexy are described. They illustrate the difficulty of differentiating pituitary apoplexy from other acute neurologic conditions. One of the patients is the first reported case of pituitary apoplexy occurring in a histologically proved craniopharyngioma. Two of the cases reported were treated conservatively and recovered without seriouplexy as a neurosurgical emergency. The relationship between radiotherapy and pituitary apoplexy is discussed.
Lactate production in McArdle's disease
Authors: Baksi A K , Buxton P H , Cochrane P , Hughes R R
Published: December 2008

A case of McArdle's disease in a man is described in detail and a less complete study of his family is reported. This patient showed the classical features of McArdle's disease and the diagnosis was confirmed by muscle biopsy. Unlike other reported cases of this disorder, this case showed a normal rise in blood lactate levels on ischaemic exercise. This apparently paradoxical finding is discussed. It is suggested that a normal rise in the level of blood lactate on ischaemic exercise should not exclude myophosphorylase deficiency.
Screening for bacteriuria: Microstix and dipslides
Authors: Hamilton-Miller J M , Brumfitt W , Brooks S J , Bakhtiar M
Published: December 2008

The Microstix system has been tested, in parallel with dipslides, for suitability as a screening technique for the detection of bacteriuria. Results obtained using each method on 228 urine specimens were assessed by comparison with the results of quantitative counts. Dipslides had a higher sensitivity (86-7%) than Microstix. The best specificity (100%) was obtained from those results (77-6%) where both components of the Microstix system were in agreement. Advantages of Microstix are its greater shelf-life and its compactness.
Hypophosphataemia and phosphorus requirements during intravenous nutrition
Authors: Tovey S J , Benton K G , Lee H A
Published: December 2008

Seven patients with acute illnesses developed hypophosphataemia whilst receiving intravenous nutrition which included a fat emulsion, Intralipid, a possible source of phosphorus. The authors' observations cast doubt on the bio-availability of the phosphorus contained in the phospholipid content of the fat emulsion. The currently recommended allowance of phosphorus for this type of patient appears to be too low and it is suggested that 0-5-0-75 mmol/kg body weight be provided, preferably as a neutral phosphate solution. Sine hypophosphataemia can occur at various time intervals after starting intravenous nutrition and precede clinical sequelae it is recommended that routine serum phosphate measurements are made in all patients receiving this treatment.
Teeth, vomiting and diet: a study of the dental characteristics of seventeen anorexia nervosa patients
Authors: Hurst P S , Lacey L H , Crisp A H
Published: December 2008

Seventeen anorexia nervosa patients were examined dentally and their dietary histories and eating habits studied. Analysis of the data confirmed earlier observations dental deterioration associated with anorexia nervosa. The deterioration included a pattern of enamel dissolution in cases of vomiting, regurgitation, and/or the consumption of large amounts of citrus fruits; and an altered caries response due to abnormal carbohydrate consumption. Despite the patient's probably insistent denial of 'anorectic' eating habits, the general practitioner should consider the existence of anorexia nervosa in the presence of such abnormal features, especially in young women. The relationship of these findings to larger populations with similar eating habits is discussed.
Free perforation of the small bowel in Crohn's disease
Authors: Croft R J
Published: December 2008

A rare case of free double ileal perforation in previously asymptomatic and undiagnosed Crohn's disease of the terminal ileum is described. At operation, a primary resection and anastomosis of the diseased bowel was performed. The management of free perforation in Crohn's disease is discussed, together with a review of the literature. It is suggested that the absence of steroids in a previously undiagnosed case may favour primary resection and anastomosis.
Interaction between warfarin and sulphamethoxazole
Authors: Tilstone W J , Gray J M B , Nimmo-Smith R H , Lawson D H
Published: December 2008

A patient is described in whom there was strong circumstantial evidence of an interaction between warfarin and co-trimaxazole. To test the validity of this hypothesis a series of in vitro and in vivo human studies were untaken. The results indicate that interaction may occur in which the sulphamethoxazole moiety of co-trimoxazole displaces warfarin from its binding sites on plasma albumin. Nevertheless, this interaction occurs only at high plasma levels of warfarin and is most likely to be clinically significant only in patients receiving high doses of warfarin who have low plasma albumin concentrations. These studies indicate that the use of co-trimoxazole is not contra-indicated in patients receiving warfarin therapy, but care should be exercised, especially in patients with high plasma warfarin:albumin ratios.
A rare presentation of splenic rupture
Authors: Gibbs T J , Sells R A , Bellingham A J
Published: December 2008

Traumatic rupture of the spleen is a well known problem, complicating many types of abdominal injury. In contrast, a spontaneous rupture is a rare occurrence, mainly associated with a large spleen resulting from infections, the most common in this country being infectious mononucleosis. It is also a rare complication of leukaemias and lymphomas and the case presented here demonstrates a peculiar diagnostic problem.
Longitudinal bone growth of the human femur
Authors: Sissons H A , Kember N F
Published: December 2008

A study is presented of the histological structure and growth rate of the growth plate at the distal end of the femur in normal children. From a comparison of quantitative histological information from post-mortem specimens with measurements on serial radiographs it is estimated that the distal growth plate contributes about 66% of the total longitudinal growth of the bone. The marked differences between rodent and man indicate that caution is required in extrapolating data from these animals to man.
Dermatoglyphs in skeletal dysplasias
Authors: David T J
Published: December 2008

Finger and palm print patterns (dermatoglyphs) are formed in very early pregnancy, at about the same time the limbs are developing, and their formation probably depends upon the surface contours of the palms and soles during morphogenesis. Dermatoglyphs are useful in skeletal dysplasias for the detection and study of syndactyly and symphalangism, for dating the onset and the dysplasias, for demonstrating and dating asymmetry, and sometimes for providing specific diagnostic features.
Bone dysplasias and mental functioning
Authors: Jancar J
Published: December 2008

Fourteen patients suffering from various degrees of bone dysplasia and mental handicap with superimposed neuroses or psychotic episodes are reported. Known biochemical and chromosomal causes are noted. Mental states associated with syndromes and mental malfunctioning or impairment because of skeletal defects or other factors are briefly discussed. High IgE was noted in the three cases of bone dysplasias suffering from chromosomal anomalies. Importance of early diagnosis, treatment and genetic counselling in bone dysplasias to prevent mental disorder is emphasized.
Hereditary angio-oedema with mesangiocapillary glomerulonephritis
Authors: Plaza J , Malasit P , Kerr D N
Published: December 2008

A patient with hereditary angio-oedema (HAO) developed mesangiocapillary glomerulonephritis (MCGN) under observation. HAO is characterized by an inherited defect of complement-deficiency of C1 esterase. MCGN is often associated with another complement abnormality which leads to depression of serum C3 and there is some evidence that the complement abnormality precedes the nephritis. The coincidence of these two rare diseases in the present patient, and in one previously described, suggests that other complement abnormalities may predispose to the development of MCGN.
Severe pulmonary disease and hyperviscosity in macroglobulinaemia
Authors: Banham S W , Bateson M C
Published: December 2008

A case of Waldenstrom's macroglobulinaemia with various clinical manifestations of the condition is presented. Hyperviscosity and respiratory complications are discussed with a brief review of the literature.
Prostaglandins and model aspects of thrombosis
Authors: Westwick J
Published: December 2008

The possible role of prostaglandins (PGs) in thrombosis was determined by examining their effects in models of thrombosis which included platelet aggregation (in vitro), blood flow (in vivo) and thrombus formation (in vivo). It was found that blood flow and thrombosis can be effectively modulated by the various types of prostaglandins produced by the blood and the vascular tissue.
Malignant lymphoma and extensive viral wart formation in a patient with intestinal lymphangiectasia and lymphocyte depletion
Authors: Ward M , Le Roux A , Small W P , Sircus W
Published: December 2008

A patient is described, the subject of a previous report (Ross et al., 1971), who subsequently developed gross peripheral mosaic warts and a malignant small bowel lymphoma in association with marked lymphocyte depletion.
Chronic active hepatitis, haemolytic anaemia and Listeria monocytogenes bacteraemia
Authors: Chadwick R G , Graham J M
Published: December 2008

The association of chronic active hepatitis with haemolytic anaemia is well known. Both conditions may respond to steroid therapy which, in common with other causes of suppressed T-lymphocyte function, predispose to many types of infection. A case is described in which transient Listeria monocytogenes bacteraemia occurred and the patient recovered without antimicrobial therapy.
A comparison of unrefined wheat and rice diets in the management of duodenal ulcer
Authors: Malhotra S L
Published: December 2008

Twenty-one chronic duodenal ulcer patients in a rice-eating area were put on to an unrefined wheat diet and twenty-one continued on their previous rice diet. After 5 years only 14% of the first group had had relapses compared with 81% of the second group. A similar 5-year relapse rate (80%) was obtained in a group of thirty patients from another area with a more varied rice diet. The author attributes this difference to the increased mastication required by the unrefined wheat diet, which is associated with an increase in saliva, lower stomach acidity and reduced bile output.
Dermal gangrene. A rare complication of warfarin therapy
Authors: Hardisty C A
Published: December 2008

Two cases of dermal gangrene following warfarin therapy are described and a review of the literature is given.
Acute renal failure from the use of acetazolamide (Diamox)
Authors: Higenbottam T , Ogg C S , Saxton H M
Published: December 2008

The clinical histories of two patients are presented, who both developed haemorrhagic anuria after a short course of therapy with the carbonic anhydrase inhibitor, acetazolamide (Diamox). The clinical findings, in particular the radiological changes, are illustrated in this potentially fatal condition. The therapeutic success of immediate relief of the ureteric obstruction is emphasized and it is hoped that this report will act as a reminder of the importance of this agent as a cause of anuria.
Potassium depletion in heart failure and its relation to long-term treatment with diuretics: a review of the literature
Authors: Morgan D B , Burkinshaw L , Davidson C
Published: December 2008

There have been many studies which suggest that patients with heart failure were potassium depleted. This depletion has been attributed to the use of potent diuretics, and these are now given with either potassium supplements or potassium-retaining diuretics. A detailed examination of the studies suggests that the reported decrease in body potassium compared with the results in healthy persons is not due to the diuretics. It can be partly explained by a failure to match patients and controls in terms of age, and the remaining difference can be explained by muscle wasting. There is therefore no evidence of a potassium depletion in these patients with heart failure.
Multiple endocrine adenomatosis (Type I) and familial hyperparathyroidism
Authors: Jung R T , Grant A M , Davie M , Jenkins D , Chalmers T M
Published: December 2008

Hyperparathyroidism is the commonest presenting feature in multiple endocrine adenomatosis Type I (MEA Type I), the other manifestations may be delayed for many years or appear only in relatives. A family now diagnosed as MEA Type I, who was previously thought, in 1965, to have familial hyperparathyroidism due to chief cell hyperplasia is now described. The importance is stressed of family surveillance and long-term follow-up in all cases of primary hyperparathyroidism. Those tests that are essential in the long-term surveillance of the patients and their first degree relatives are discussed.
Advanced carcinoma of the prostate — does the pre-treatment Leydig cell function determine the response to orchidectomy?
Authors: Houghton A L , Jacobs H S
Published: December 2008

In a study of twenty patients there was no support for the hypothesis that the response to orchidectomy of patients with advanced prostatic cancer depends on pre-operative Leydig cell function. The only significant prognostic factor was the histological grade of the primary tumour.
Gastro-colic fistula secondary to benign gastric ulceration
Authors: Taylor R
Published: December 2008

An 80-year-old woman developed osteoarthritis of the knees as a complication of her obesity. Indomethacin treatment precipitated gastric ulceration, which led to the formation of a gastro-colic fistula.
Carcinoma of the gall bladder presenting as a retrograde intussusception of the duodenum
Authors: Williams N S , Shorey B A
Published: December 2008

A case of carcinoma of the gall bladder presenting as a retrograde intussusception of the duodenum is described. Although this is a rare presentation of the disease, adequate radiography and endoscopy will help to establish the diagnosis.
Sub-acute thyroiditis and hepatitis in a case of infectious mononucleosisThis case was presented at a meeting of the Royal Academy of Medicine in Ireland, on 14th February, 1977.
Authors: Fennell J S , Tomkin G H
Published: December 2008

A viral aetiology for sub-acute (de Quervain's) thyroiditis has long been postulated although proof has been elusive. Infectious mononucleosis has been associated with sub-acute thyroiditis in only two papers, and histological evidence of sub-acute thyroiditis was lacking in both. A case of sub-acute thyroiditis, confirmed by histology, occurring in a patient with infectious mononucleosis is now reported.
Duplication of the rectum
Authors: Kelly M J , Everett W G
Published: December 2008

A case of duplication of the rectum is presented and the literature reviewed.
Continuity of care for patients with malignant disease
Authors: Wills L A
Published: December 2008

The first year of running a new continuing Care Unit for patients with malignant disease demonstrated the importance of continuity of care in their management after curative measures have ceased to be appropriate. This was achieved by regular home visiting by Unit ataff, liaison with home care services and the promise of readmission whenever necessary. As a consequence good relationships with patients, relatives and community services were built up, the average duration of in-patient stay was reduced to 19.6 days and more effective episode care was possible, this being integrated with an understanding of the overall problem.
Unexplained absence of an ovary and uterine tube
Authors: Sirisena L A W
Published: December 2008

A case is reported of an incidental laparotomy finding of absence of left ovary and ipsilateral distal Fallopian tube. This is the fourth case to be reported in the English language literature. The three previous cases are reviewed and the probable aetiology discussed.
Special investigations in COCM: biochemical analysis of cardiac biopsies
Authors: Torp A
Published: December 2008

The introduction of the endomyocardial biopsy method has permitted unique possibilities to investigate the myocardium. Compared to several other methods described, it is superior for taking serial biopsies on one or more occasions. With already available methods, examination of heart muscle biopsies can be extended to a wide variety of biochemical analyses. The ultimate application of repeated or periodic tissue sampling is the potential of combining static and dynamic studies.
Herbal medicines and veno-occlusive disease in India
Authors: Datta D V , Khuroo M S , Mattocks A R , Aikat B K , Chhuttani P N
Published: December 2008

Six cases are described of veno-occlusive disease (VOD) after medicinal herb ingestion. The herb Heliotropium eichwaldii, taken by three patients, was found to contain the toxic pyrrolizidine alkaloid, heliotrine. Two patients presented with fulminant hepatic failure while the other four patients had a clinical picture suggestive of decompensated cirrhosis. The medical use of this herb may possibly be responsible for a significant proportion of acute and chronic liver disease in India, making it of public health importance.
Demeclocycline in the treatment of the syndrome of inappropriate antidiuretic hormone release: with measurement of plasma ADH
Authors: Padfield P L , Hodsman G P , Morton J J
Published: December 2008

A patient with the syndrome of inappropriate antidiuretic hormone release (SIADH) following head injury and meningitis was studied during treatment with demeclocycline, a drug known to produce a reversible nephrogenic diabetes insipidus. No changes were observed during six days of demeclocycline 1200 mg/24 hr but urine output increased significantly, with the production of a dilute urine, when the dose was increased to 2400 mg/24 hr. The patient lost weight, and all biochemical features of the syndrome were rapidly corrected despite an unchanged fluid intake and despite the persistence of high plasma levels of ADH. The rise in serum sodium was accompanied by mild sodium retention, as measured by external balance and exchangeable sodium.

A complication of treatment was the development of acute renal failure possibly induced by a nephrotoxic effect of high circulating levels of demeclocyline. On stopping demeclocyline renal function returned to normal and, after some delay, SIADH returned, and was still present 9 months after initial presentation. This confirms earlier reports of the efficacy of demeclocycline in SIADH; but the authors advise caution against increasing the dose above 1200 mg/24 hr.
Comparative trial of perhexiline maleate and oxprenolol in patients with angina pectoris
Authors: Pilcher J
Published: December 2008

A random single-blind study of oxprenolol against perhexiline has been undertaken in angina pectoris. Both drugs were effective in treatment (P<0·01) but perhexiline was better than oxprenolol (P<0·05), 12 of the 14 patients preferring perhexiline. Offset against this was the greater incidence of side effects with perhexiline, including one patient who later developed peripheral neuropathy. Despite the greater efficacy of perhexiline, it is suggested that side effects should preclude its routine prescription as a drug of first choice in angina pectoris. It should remain of value in the special situations of resistant angina and angina with heart failure or bronchospasm, when its use should be carefully monitored for these side effects.
Viral causes of psychiatric disease
Authors: Crow T J
Published: December 2008

Current evidence on the role of viruses in the causation of psychiatric illness is reviewed. Herpes simplex encephalitis is relatively well defined but a wider role for this virus, particularly in relation to affective disorders, is suggested by some Scandinavian surveys of antibody titres in psychiatric populations. The extent to which influenzal illnesses and infectious mononucleosis may lead to neurotic, and occasional psychotic, episodes is the subject of controversy. The clinical literature is reviewed on the occurrence of encephalitis-like illnesses with prominent psychiatric and behavioural features. It is pointed out that no reliable criterion exists for differentiating these illnesses from such psychiatric syndromes as schizophrenia. It is suggested that neglect of this borderland area, and perhaps preconceptions concerning the features of ‘organic’ and ‘functional’ psychiatric disease, may have led to an underestimate of the possible role of viruses in the causation of psychiatric disease.
Clinical and haematological screening in recurrent aphthae
Authors: Hutcheon A W , Dagg J H , Mason D K , Wray D , Ferguson M M , Lucie N P
Published: December 2008

A series of 328 consecutive out-patients with recurrent aphthae were screened for deficiencies of iron, folic acid and vitamin B12, by examination of the peripheral blood, by assays of serum vitamin B12 and corrected whole blood folate, and estimation of the serum iron and total iron binding capacity; deficiencies were demonstrated in 45 patients (13·7%). Of these, 31 were deficient in iron, 15 in folic acid and 11 in vitamin B12; 11 patients had combined deficiencies.

Of the 45 aphthae patients with deficiencies, 29 had anaemia or demonstrable abnormalities in the red cell indices or stained blood film, and the essay results were confirmatory. In the remaining 16 patients, no red cell changes were present, and diagnosis depended entirely on reduced levels of serum vitamin B12, whole blood folate or iron saturation of transferrin; such latent deficiencies occurred only with iron and folic acid, whereas all patients with vitamin B12 deficiency even without anaemia had morphological changes in the blood.

Individual patients with a deficiency could not be distinguished from those without a deficiency on the basis of clinical examination of the mouth ulcers. However, aphthae patients who also had glossitis or angular cheilitis were more likely to suffer from such deficiencies.

Thirty-nine of the deficient aphthae patients available for follow-up were assessed at least 6 months after appropriate replacement therapy; 23 showed a complete remission of ulcers, 11 were improved and 5 were not helped.

It is suggested that the considerable incidence of deficiencies found in this series and the clinical and haematological response to replacement therapy confirms the need for full screening of patients with re-recurrent aphthae. Since 16 out of 45 of these patients had no anaemia or morphological abnormalities in the peripheral blood, their deficiencies would have been missed on routine haematological examination alone; for this reason it is recommended that screening should also include estimation of the serum iron and total iron-binding capacity, whole blood folate and, possibly vitamin B12.
Limb salvage by femoral profundaplasty
Authors: Pollock A V
Published: December 2008

One hundred and seven profundaplasties have been performed for rest pain or gangrene due to advanced arterial degeneration below the inguinal ligament. Local anaesthesia was used for 78 operations. There were 19 early failures (2 deaths and 17 amputations) and 16 later amputations. During 4·5 years of follow-up, 25 other patients have died. The results for diabetic gangrene were worse than for other indications.
Clonidine-induced dilutional hyponatraemia
Authors: Burrows A W , Gribbin B
Published: December 2008

A patient with a dilutional hyponatraemia induced by clonidine is decribed.
The search for the ideal influenza vaccine
Authors: Davenport F M
Published: December 2008

The history of the development of influenza virus vaccine is traced from its origin with experimental studies of influenza virus in ferrets and mice and the first trials in man. Knowledge of the basis of immunity to the viruses in experimental animals and in man has grown steadily over the years and has been essential to successful immunization. Virus variation affecting the surface antigens of the virus is seen as the principal obstacle to the application of vaccines in man. So significant are the changes occurring during antigenic drift that former concepts of a polyvalent vaccine cannot provide a solution of the problem of the composition of vaccines. Disrupted virus vaccines appear to provide the answer to the prevention of vaccine reactions.
Bile acid, neutral sterol and faecal fat excretion in subjects treated with fenfluramine and its relationship to fenfluramine-induced diarrhoea
Authors: Sian M S , Rains A J
Published: December 2008

Bile acid, neutral sterol and faecal fat excretion was studied over a period of 9 weeks in a group of 16 healthy subjects before, during and after administration of fenfluramine. Statistical analysis revealed a significant increase in bile acid excretion during the drug phase (P < 0.02); and during recovery period of 3 weeks (P < 0.05). Faecal neutral sterol, as the total of coprostanol and cholesterol elimination was also enhanced after fenfluramine. Coprostanol was replaced by cholesterol in 12 subjects. Faecal fat was studied in 6 subjects, the excretion increased during the drug phase (P < 0.05), and remained elevated during the post-drug period (P < 0.01). The composition of the bile acids remained unaltered in all the subjects except 3 who had a fenfluramine-induced watery diarrhoea; and these excreted chenodeoxy and cholic together with smaller amounts of secondary bile acids. A higher excretion of bile acids was found in the 8 overweight subjects (P < 0.01) before ministration of fenfluramine.

These results are discussed in an attempt to correlate the effect of fenfluramine with changes in bile acid and neutral sterol excretion, and its relationship to fenfluramine-induced diarrhoea.
Riedel's thyroiditis leading to severe but reversible pituitary failure
Authors: Kelly W F , Mashiter K , Taylor S , Joplin G F
Published: December 2008

This patient with histologically proved Riedel's thyroiditis had hypothyroidism of sufficient severity to cause panhypopituitarism, and it was this which first brought him to medical attention. The beneficial effects are described of surgery in relieving severe dysphagia and stridor, and of prednisone in softening and shrinking the hard neck mass. The extent of pituitary failure, and the degree of recovery on treatment with thyroxine are reported, together with details of 4 other cases of Riedel's thyroiditis seen by one of the authors (S.T.).