bluuebunny/crossref_metadata_2025 huggingface dataset:
Palmar main line polymorphisms in cataracts
Authors: Padma T , Murty J S
Published: December 2008

The palm prints of patients with different types of cataract (total, nuclear, zonular, cortical and complicated) were analysed for main line terminations and compared with those of a random population. The cases were also grouped into congenital, juvenile and senile types for broader comparison.

The results showed significant variations for all the 4 main line terminations (D, C, B and A) in senile and cortical cataracts, while among other types of cataract, congenital cases differed significantly in D and A line, zonular in C and A line and nuclear in B and A line terminations compared with controls. A comparison of familial and isolated cases revealed significant differences for D and A line terminations only in cases of senile cataract. The main line terminations also indicated considerable sex-dependent heterogeneity among the diseased and control subjects.

The significance of the results obtained are discussed in terms of pleiotropic mechanisms leading to the formation of cataract.
Renewed bleeding of a posterior inferior cerebellar artery aneurysm during vertebral angiography
Authors: Drury P J , Powell T
Published: December 2008

The perangiographic rupture of a posterior inferior cerebellar artery aneurysm is described and discussed. Only 2 other cases of perangiographic rupture of posterior fossa aneurysms have been found in the literature, and there are fewer than 60 reports of ruptures of aneurysms at all intracranial sites.
The presentation, diagnosis and treatment of cervical osteoid osteoma
Authors: Walker A P
Published: December 2008

A case of cervical osteoid osteoma is reported, with a brief account of the diagnosis and treatment of these lesions. Cervical osteoid osteoma is rare but its pattern of presentation varies little and it should therefore be possible to suspect it on clinical grounds alone. Bone scanning is now regarded as more efficient than radiography in identifying the lesion but X-ray tomography will normally be required for the accurate localization needed before surgery.

Correct surgical treatment results in complete cure.
Rise in serum calcium and magnesium concentrations after vitamin D administration in hypocalcaemic hypomagnesaemic magnesium deficiency
Authors: Ghose R R , Wynford-Thomas D
Published: December 2008

A patient with hypocalcaemia and hypomagnesaemia secondary to small bowel resection and malabsorption was treated with synthetic vitamin D analogue, 1-alpha hydroxy vitamin D3. A prompt rise in serum calcium concentration and some days later a smaller and transient rise in serum magnesium concentration was observed. These changes in extracellular fluid composition presumably resulted from enhanced calcium and magnesium absorption associated with vitamin D activity.
Cervical pregnancy managed by local excision
Authors: Farghaly S A , Mathie J G
Published: December 2008

A patient with cervical pregnancy is described who presented with a history of 7 weeks’ amenorrhoea and painless vaginal bleeding. Examination revealed an intracervical mass, the internal os was closed and the external os was dilated. The cervical pregnancy is rare and is discussed.
A fatal case of Epstein-Barr virus infection with jaundice and renal failure
Authors: Davies M H , Morgan-Capner P , Portmann B , Wilkinson S P , Williams R
Published: December 2008

A fatal case of Epstein-Barr virus infection in a 17-year-old male is described. The patient presented with an illness clinically typical of infectious mononucleosis but death followed development of renal failure, jaundice and pulmonary failure. There was no absolute lymphocytosis nor a significant number of atypical mononuclear cells in his peripheral blood. However, heterophile antibody and Epstein-Barr virus-specific IgM were present.
Splenic peliosis associated with rupture in a renal transplant patient
Authors: Parsons M A , Platts M , Slater D , Fox M
Published: December 2008

A patient is described who, 2 years after renal transplantation, presented as an acute abdominal emergency due to a ruptured spleen. Histologically this displayed peliosis.
Intestinal amoebiasis for 36 years
Authors: Johnston J H , Stewart J B , Roberts D M
Published: December 2008

A case is reported of amoebic dysentery in a former soldier who had symptoms of Entamoeba histolytica infection for 36 years. It emphasizes the need for careful search for parasites in the stools of any patient with bowel symptoms because the consequences of wrong diagnosis are potentially catastrophic.
Arrhythmias in patients with hypereosinophilia: a comparison of patients with and without Löffler’s endomyocardial disease
Authors: Cohen J , Davies J , Goodwin J F , Spry C J
Published: December 2008

About one third of patients with Löffler’s endomyocardial disease have abnormal electrocardiograms and some develop arrhythmias and die suddenly. To assess the significance of these findings, continuous ambulatory ECG monitoring was performed for 48 hr on 6 patients with acute or chronic forms of Löffler’s endomyocardial disease, and the types and frequencies of arrhythmias were compared with recordings from 6 other patients with equally high blood eosinophil counts who did not have clinically evident cardiac disease. It was hoped that this would show whether arrhythmias were related to high blood eosinophil counts, cardiac injury or other factors.

Three of the patients with endomyocardial disease had multiple ventricular extrasystoles with episodes of ventricular arrhythmias and occasional supraventricular arrhythmias which had not been detected with conventional ECGs. These abnormalities did not occur in 2 of the patients with acute endomyocardial lesions who died, nor were they found in patients who did not have congestive cardiac failure or in the control patients. Rhythm disturbances appeared to be most closely related to the development of cardiac failure and they resolved after successful cardiac surgery.

Multiple ventricular extrasystoles and arrhythmias occurring in these patients with Löffler’s endomyocardial disease are probably due to metabolic changes in the heart associated with cardiac failure and mechanical changes related to valvular dysfunction rather than a direct effect of the eosinophils themselves on the heart.
Zinc metabolism in thyroid disease
Authors: Nishi Y , Kawate R , Usui T
Published: December 2008

This study was designed to evaluate the zinc metabolism in adults of both sexes with thyroid disease. Plasma and erythrocyte zinc concentration and urinary zinc excretion were investigated. The mean concentration of plasma zinc in hypothyroid patients and in euthyroid patients, previously either hyperthyroid or hypothyroid, was lower than that of control subjects, whereas no statistically significant differences were observed in plasma zinc values between hyperthyroid patients and control subjects. The average erythrocyte zinc level in patients with thyroid disease was significantly lower than that in control subjects. Erythrocyte zinc concentration was significantly decreased in hyperthyroidism compared with hypothyroidism, or patients previously either hyperthyroid or hypothyroid but now euthyroid. Increased urinary zinc excretion in hyperthyroidism was noticed compared to euthyroid and hypothyroid patients and to control subjects. Increased urinary zinc concentrations may result from increased tissue catabolism such as muscle. The results of this study suggest that abnormal zinc metabolism occurs commonly in patients with thyroid disease.
Melanosis coli in a child of four years
Authors: Price B A , Collins R E , Farley M D
Published: December 2008

A case of melanosis coli in a girl of 4 years is described. The condition is usually considered a disease of the aging bowel. In this case there was a history of constipation, and anthracene abuse.
A unique cause of small bowel obstruction
Authors: McMurray N , Maltby A C
Published: December 2008

A unique case of small bowel obstruction in an 83-year-old man is reported. The obstruction was produced by a carcinoma of the caecum. The caecum was lying in the scrotal sac of a large indirect inguinal hernia.
Complications of baclofen overdosage
Authors: Ghose K , Holmes K M , Matthewson K
Published: December 2008

A 39-year-old female patient who had been receiving 30 mg of baclofen daily for 5 months was admitted to the hospital about 12 hr after overdose of this drug (450 mg). On admission, she was comatose, flaccid, and in respiratory failure. Later she developed muscle twitchings and had several epileptic fits. She was treated symptomatically and became conscious within 36 hr. However, approximately 65 hr after the overdose she developed sinus tachycardia which was successfully treated with oral propranolol. Plasma concentrations, as measured on days 2 and 3, were within the therapeutic range but the elimination half-life was prolonged.
Black urine
Authors: Altmann P , Mansell M A
Published: December 2008

A patient is described in whom spontaneous blackening of the urine, due to melanin formation, resulted from treatment with alpha-methyldopa. The colour change became apparent only after the correction of a severe postoperative hyponatraemic alkalosis, the urinary pH had become alkaline, as melanin formation in acid urine is very slow.
Pattern of renal amyloidosis in Indian patients
Authors: Chugh K S , Datta B N , Singhal P C , Jain S K , Sakhuja V , Dash S C
Published: December 2008

Two hundred and thirty-three patients with renal amyloidosis were studied in an attempt to identify the incidence and pattern of the disease in northern India. The incidence of amyloidosis was 1.01% of 6431 post-mortems and 8.4% of 1980 renal biopsies from patients who presented with clinical evidence of glomerular disease. Two hundred and three patients (87.1%) had secondary amyloidosis, 22 (9.4%) had primary amyloid and 8 patients (3.5%) had amyloidosis associated with multiple myeloma. Tuberculosis of various organs was the commonest predisposing disease accounting for 59.1% of secondary amyloidosis, followed by chronic suppurative lung disease in 24.1%. Rheumatoid arthritis, chronic osteomyelitis and lepromatous leprosy were seen in a small percentage of patients (2 to 8%). Proteinuria of varying degree was present in all the 233 patients and 12.9% of them had a daily protein excretion of more than 10 g.

Post-mortem examination of 65 patients with renal amyloidosis showed that 75.3% also had amyloid deposit in the spleen, 63% in the liver, and 50.8% in the adrenals. Clinical evidence of disappearance of proteinuria was observed in 3 patients with secondary amyloidosis; in 2 of them, the regression of amyloidosis was confirmed by serial renal biopsy performed 3 and 5 years after the initial diagnosis.
Familial late onset oculopharyngeal muscular dystrophy
Authors: Isenberg D A , Kahn P
Published: December 2008

An English family is described several members of which have suffered from oculopharyngeal muscular dystrophy. No symptoms were noticed in any affected members of the family until aged at least 50 years. An autosomal dominant pattern of inheritance is clearly shown.
Haemolytic anaemia with hypernephroma
Authors: Bradley G W , Harvey M
Published: December 2008

A case is reported of Coombs’ positive haemolytic anaemia associated with hypernephroma. The anaemia regressed on removal of the tumour but returned when secondary deposits developed.
Obstructive sodium-losing nephropathy--a case report and review
Authors: Nunn P P , Owens C W I , Scholberg C B , Prichard B N C
Published: December 2008

The third case in the literature of sodium-losing renal disease due to obstruction is presented. The experimental evidence and limited clinical experience is reviewed which suggests that the sodium loss is due to an inappropriate response in the adaptive processes that are initiated by the loss of functioning nephrons. The immediate treatment is by replacement of sodium but in the long term the condition may be reversed by very cautious reduction in sodium intake. Definitive treatment may be indicated where obstruction is the cause and consequently this should be sought in all cases of salt-losing renal disease.
Colonic gall-stone ileus
Authors: Anseline P
Published: December 2008

A case of obstruction of the colon by a solitary, large gall-stone is described. This rare event usually occurs in elderly females in whom there is frequently an underlying pathological condition at the site of obstruction in the colon. The calculus usually migrates via a cholecystocolic fistula. Diagnosis may be assisted by plain abdominal X-ray and contrast radiography. Immediate operative treatment should be tailored to the patient’s general condition and the nature of the pathological changes.
Sipple syndrome: marked variability of the disease within a family and implications for management
Authors: Stevenson John C , Hillyard Carmel J , Spanos Evangelos , MacIntyre Iain , Ackroyd Nigel , Lynn John , Brown Morris J , Stevenson Bonnie M
Published: December 2008

Familial medullary carcinoma of the thyroid gland is often associated with phaeochromocytoma; this condition is known as Sipple syndrome. The rate of progression of the disease and the degree of malignancy of the medullary carcinoma may vary from family to family. Thus the nature and behaviour of this disease in any particular family influences the management of the thyroid carcinoma component. The authors measured plasma calcitonin and plasma catecholamines in 21 members of a family with Sipple syndrome. In one branch of this family 5 out of 7 members have so far been affected, 4 with metastases or recurrence of the carcinoma and 2 with development of phaeochromocytomas. In contrast, of the 14 members in the other 4 family branches, only 4 have had pathologically elevated plasma calcitonin concentrations following alcohol provocation, probably representing C-cell hyperplasia or very early neoplasia and apparently not progressing. None has evidence of phaeochromocytoma.

This family demonstrates a striking variability in the natural history of Sipple syndrome which, despite increasing discovery of more families with medullary thyroid carcinoma, has not been previously reported. In the light of this finding, a reappraisal of the management of the thyroidal component of this disease is necessary. It appears that radical neck surgery may be needed to prevent recurrence of the disease.
Haemophilus endocarditis
Authors: Emmerson A M , Perinpanayagam R M , Barnado D E
Published: December 2008

Two cases are presented of Haemophilus endocarditis in patients with presumed normal valves. One case was due to H. influenzae presenting as a typical case of infective endocarditis and the other was due to H. para-influenzae presenting as an acute pyrexia of unknown origin.

The difficulties in making the diagnosis and the optimal treatment are discussed.
Control of osteitis deformans using glucagon, calcitonin, and mithramycin
Authors: Condon John R , Surtees John , Robinson Victor
Published: December 2008

Glucagon, porcine calcitonin, and mithramycin were given to patients with Paget’s disease of bone. There was rapid complete relief of bone pain accompanied by biochemical improvement or normalization in all cases. Calcitonin and glucagon appear to have additive properties in Paget’s disease and the use of the 3 drugs in combination may reduce the incidence of side effects and the development of "drug resistance". The cost of treatment might also be reduced if periodic treatment as demonstrated in Case 1 is used.
A single-dose comparison of four slow-release theophylline preparations in normal subjects
Authors: Sharma J N , Blackett A , Johnston A , Hathway N R
Published: December 2008

The plasma theophylline concentrations produced by 4 different slow release formulations, Theograd, Theodur, Theolair-SR and Rona-slophylline were measured over a 24-hr period in 8 healthy subjects. All 4 preparations maintained plasma levels over 12 hr and had similar AUC values when the difference in theophylline content was taken into account. Paired saliva and plasma theophylline concentrations gave a ratio of 1: 0·38, saliva: plasma, but with a large inter and intra individual variation.
Blood vitamin status in chronic alcoholics after a single dose of polyvitamin. A preliminary report
Authors: Majumdar Sisir K , Shaw G K , Thomson Allan D
Published: December 2008

Blood vitamin status (B1, B2 and B6) was assessed by erythrocytic enzyme activation tests in 7 male and 1 female chronic alcoholics (mean age (±s.d.), 43·12 (13·7) years; range, 25-64 years) on admission and 6 hr later on the same day after oral administration of a single dose of polyvitamin. Seven out of 8 patients were found to be deficient in vitamin B1, 5 in B6 and none in B2. But after single-dose oral therapy, tendency to improvement of blood vitamin status was clearly evident in all patients. It is therefore suggested that a subgroup of chronic alcoholics may benefit from oral supplementation of vitamins. Clinical implications of vitamin deficiency in chronic alcoholics are briefly discussed.
Steroid-induced benign intracranial hypertension
Authors: Vyas C K , Bhatnagar V , Talwar K K , Sharma B K
Published: December 2008

A 41-year-old man whose systemic lupus erythematosus (SLE) had been successfully treated for 15 months with a daily maintenance dose of 5 mg prednisolone, developed benign intracranial hypertension (BIH) when the steroid was increased to 60 mg daily for recrudescence of SLE symptoms. The BIH remitted when the steroid was discontinued.
Varicella myocarditis producing congestive cardiomyopathy
Authors: Thandroyen F T , Asmal A C , Armstrong T G
Published: December 2008

A 14-year-old boy with proved varicella developed severe, intractable heart failure with the clinical features of congestive cardiomyopathy. Detailed investigations failed to disclose any alternative aetiological factor. It is proposed that varicella myocarditis was the cause of the acute congestive cardiomyopathy found in this patient.
Bromocriptine therapy in acromegaly. A long-term review of 35 cases
Authors: Sachdev Y , Gopal K , Garg V K
Published: December 2008

Bromocriptine (CB-154, Parlodel, Sandoz) was given to 35 acromegalic patients for a period of 6-36 months. Basal and post-therapy endocrine functions including estimation of serum growth hormone (GH) profile; and GH kinetics during oral glucose tolerance test, augmented insulin tolerance test and thyrotrophin releasing hormone test were determined. The pituitary tumour size was delineated by a pneumoencephalogram. The mean GH levels ranged from 14 micrograms/l to 316 micrograms/l. Bromocriptine suppressed GH values to 5 micrograms/l or less in 16 patients and less than 10 micrograms/l in a further 6 patients. In 33 patients GH values fell to 50% of the basal value or less. There was no significant GH reduction in 2 ‘nonresponders’. Bromocriptine did not block the stress-induced GH secretion. It did not disturb pituitary functions other than prolactin which was suppressed much earlier and was maintained with smaller doses. GH suppression on the other hand was shortlived and rebounded when the drug was omitted. It had no adverse effect on tumour size in 2 patients having suprasellar extension of the tumour. Bromocriptine improved carbohydrate tolerance and sexual function although it did not affect insulin and gonadotrophin values. It seems reasonable to offer a trial of bromocriptine in all patients with acromegaly where therapy is deemed necessary as it is well tolerated, has insignificant side effects and no adverse drug interactions. Its high cost and prolonged course are obvious disadvantages. Caution should be exercised in cases with suprasellar extension and visual field involvement.
The association of oesophagitis with disease in the stomach and duodenum
Authors: Bateson M C , Bouchier I A
Published: December 2008

The records of all upper digestive endoscopies performed in one year in the Clinical Measurement Department of a teaching hospital serving a population of 250 000 were reviewed; 25% of patients had oesophagitis, which was usually associated with other significant findings such as peptic ulcer and gastroduodenal erosions. Only about 1 in 6 patients with oesophagitis had an endoscopically identified hiatus hernia. Oesophagitis was associated with gastric acid hypersecretion in both men and women.
Insulinoma masquerading as carotid transient ischaemic attacks
Authors: Illangasekera V L U
Published: December 2008

A patient who initially presented with classical internal carotid territory transient ischaemic attacks, on further investigations was found to have an insulinoma, the removal of which completely alleviated the symptoms. This appears to be an unusual form of presentation of a rare tumour. The possible mechanisms of focal neurological disturbances during hypoglycaemia are discussed.
Recurrent septic arthritis due to Pseudomonas sp
Authors: Dan Michael , Jedwab Medina , Shibolet Shlomo
Published: December 2008

Two episodes of Pseudomonas septic arthritis occurred in an 84-year-old diabetic man separated by a 6 year interval. Pseudomonas is an unusual cause of septic arthritis requiring vigorous antibiotic therapy. The recurrence of the infection may be related to the inadequate response to treatment in the first episode, however, the long interval remains unexplained.
Granulomatous vasculitis of the penis with glomerulonephritis
Authors: Vella E J , Waller D G
Published: December 2008

Wegener’s granulomatosis is characterized by a necrotizing granulomatous vasculitis of the upper and lower respiratory tract together with glomerulonephritis. Presentation is usually with symptoms referrable to the upper respiratory tract, the glomerulonephritis manifesting itself weeks or months later. A case is reported of a man presenting with a necrotizing granulomatous vasculitis of his penis who subsequently developed glomerulonephritis 18 months later.
Acute respiratory failure and CNS-depressing drugs
Authors: Gray J M B , Henry D A , Paice B , Gettinby G , Moran F , Lawson D H
Published: December 2008

Data from a drug surveillance programme were analysed to estimate the frequency with which patients with a diagnosis of respiratory failure had been exposed to CNS-depressing drugs. Eleven out of 37 patients with respiratory failure had received such medication. A detailed comparison of these patients and controls admitted to hospital because of respiratory disease who did not develop respiratory failure failed to reveal significant differences in drug usage. This unexpected finding suggests that patients with respiratory disease of equal severity may vary greatly in their tendency to develop carbon dioxide retention following administration of drugs with respiratory depressant properties.
Appendix abscess in a femoral hernial sac — case report and review of the literature
Authors: Watkins R M
Published: December 2008

The case of an appendix abscess situated in a rightsided femoral hernial sac is reported. The aetiology, diagnosis and treatment of this rare condition are discussed.
Congenital adrenal hyperplasia in a 66-year-old female
Authors: Wright A D , Harvey T C , Holder G , Anderson D C , Rudd B T
Published: December 2008

A 66-year-old genotypically female patient was reared as a man. Investigations showed a partial adrenal 21-hydroxylase deficiency, and pituitary gonadotrophin secretion typical of a post-menopausal woman.
Central pontine myelinolysis in association with Hodgkin’s lymphoma
Authors: Loizou Louis A , Rokos Jan
Published: December 2008

Central pontine myelinolysis was found histologically in a young man who died with Hodgkin’s lymphoma. Clinically he had developed a progressive peripheral sensory deficit, ataxia, quadriparesis, dysarthria, incontinence and drowsiness. This is the fifth case reported in the British literature. The pathogenesis and aetiology of this primary demyelinating disease are considered.
Reversible hypothyroidism after steroid replacement for Addison’s disease
Authors: Burrows A W
Published: December 2008

An insulin-requiring diabetic patient who developed Addison’s disease is described. At diagnosis, investigations revealed biochemical hypothyroidism and these abnormalities resolved after replacement therapy for the adrenal failure only. The possible mechanism of this change is discussed in relation to the presence of organ-specific antibodies.
Myocardial infarction - a rare complication in Henoch-Schönlein purpura
Authors: Abdel-Hadi O , Greenstone M A , Hartley R B , Kidner P H
Published: December 2008

A 29-year-old man with previous Henoch-Schönlein disease presented with multiple systemic emboli and a myocardial infarction. Subsequent investigation by angiography showed normal coronary arteries. This appears to be the first reported case of Henoch-Schönlein disease and myocardial infarction probably due to coronary vasculitis.
Renal involvement in Gaucher’s disease
Authors: Siegal A , Gutman A , Shapiro M S , Griffel B
Published: December 2008

A patient with chronic Gaucher’s disease is described who developed glomerulopathy 24 years after splenectomy terminating in renal failure. The pathological changes of this very rare complication of Gaucher’s disease are described. The few similar cases reported in the literature are reviewed and the possible pathogenetic pathways discussed.
Anti-hypertensive therapy with propranolol during pregnancy and lactation
Authors: Taylor E A , Turner P
Published: December 2008

A hypertensive women was treated throughout pregnancy with propranolol 40 mg daily without complication. At delivery the umbilical cord plasma concentration was similar to that in the maternal venous plasma. Milk:plasma ratios were less than 1, although a higher ratio would be predicted. Estimated daily intake of propranolol in breast milk by the infant was about 3 micrograms. There appears to be no reason to advise women receiving propranolol to avoid breast feeding.
Pseudohypoparathyroidism presenting as severe Parkinsonism
Authors: Pearson D W M , Durward W F , Fogelman I , Boyle I T , Beastall G
Published: December 2008

A case of pseudohypoparathyroidism in a middle-aged female presenting with severe Parkinsonism is reported. Correction of serum calcium led to marked clinical improvement suggesting that symptoms and signs were exacerbated by hypocalcaemia and tetanic spasm. Calcification of the basal ganglia was not detected on skull X-ray but was revealed by computerized axial tomography.
Platelet monoamine uptake in relatives of patients with Huntington’s chorea
Authors: Ehsanullah Raihana S B , Turner Paul
Published: December 2008

Uptake of dopamine and 5-hydroxytryptamine (5-HT) by the platelets of 25 symptom-free relatives of patients with established Huntington’s chorea (HC) was not significantly different from that of control subjects. Platelet uptake of 5-HT in 3 subjects with early signs of the disease showed increased Km and Vmax values. Increased platelet uptake of 5-HT in patients with established HC was confirmed in a further 3 patients. It seems that this phenomenon appears with the clinical evidence of the disease. Further investigation of the nature of the platelet uptake abnormality may cast light on pathogenic factors in HC.
Pachydermoperiostosis (idiopathic hypertrophic osteoarthropathy)
Authors: Yu Y L , Turck W P G
Published: December 2008

A Chinese patient with the incomplete form of pachydermoperiostosis is described. Brief comments on the diagnosis, familial occurrence and management are given.
Mexiletine in human blood and breast milk
Authors: Lewis Angela M , Patel Lata , Johnston A , Turner P
Published: December 2008

Twelve paired samples of breast milk and blood were obtained, between the 2nd and 5th days after she had given birth, from a 30-year-old woman who was a 8-hourly propranolol (20 mg) and mexiletine (200 mg). Propranolol was detected in 9 of the samples of blood and in only 4 of the milk samples. Mexiletine was measurable in all samples, and the milk : plasma ratio varied between 0.79 and 1.89 with a mean of 1.45. However, the large volume of distribution of mexiletine makes it unlikely that the small dose of the drug received from the milk would be detrimental to the health of infants.
Antibiotic blood concentrations in patients successfully treated with tobramycin
Authors: Fiala Milan , Chatterjee Satya N
Published: December 2008

Thirty-nine patients with severe Gram-negative infections were treated with parenteral tobramycin. Thirty-one (79%) were cured of their infection. Tobramycin was most effective in the therapy of patients with urinary tract infections, arthritis and skin and soft tissue infections and relatively less effective in patients with septicaemia, pneumonia, and osteomyelitis. The infection was cured more frequently in patients who achieved a high ratio between the peak serum concentration of tobramycin and the minimal inhibitory concentration of tobramycin against the pathogenic organism (so-called therapeutic ratio). The ratio was greater than 4.0 in 11 of 13 (85%) assays performed in 12 cured patients, whereas this ratio was achieved in only 3 of 10 (30%) instances in 5 patients in whom the therapy failed (P less than 0.05). The latter group also included a greater proportion of patients with an ultimately fatal illness, such as lung cancer and uraemia, compared to the former successfully treated group. Adverse effects of tobramycin on renal function were transitory. No significant effect of tobramycin on the hearing was observed.
Failure of anti-hypertensive drugs to control blood pressure rise with isometric exercise in hypertension
Authors: O’Hare J A , Murnaghan D J
Published: December 2008

Isometric exercise causes a substantial rise in BP in normotensive and untreated hypertensives. The authors studied the isometric hand-grip test in 5 groups of treated hypertensives, namely β-blockers, β-blockers + diuretics, β-blockers + diuretics + vasodilators, alpha-methyldopa alone and labetalol. All groups showed a substantial rise in both systolic and diastolic BP, and the increments in BP differed little from that in normotensives. Some patients, despite multiple therapy, achieved increments of up to 60 mmHg from rest. Treated hypertensives with cardiac and cerebro-vascular disease are at risk performance isometric exercise.
Sex hormone-binding globulin concentrations in women with severe premenstrual syndrome
Authors: Dalton Maureen E
Published: December 2008

Sex hormone binding globulin (SHBG) binding capacity was measured in 50 women with severe premenstrual syndrome and 50 age-matched controls. The binding capacity was significantly lower (P = 0.001) in the patients. This finding suggests that the levels of SHBG binding capacity could be useful in the diagnosis and may help to explain the aetiology of the premenstrual syndrome.
Tinnitus in a patient with beta-thalassaemia intermedia on long-term treatment with desferrioxamine
Authors: Marsh M N , Holbrook I B , Clark Christine , Shaffer Jon L
Published: December 2008

A women with β-thalassemia intermedia, and iron overload following many years’ treatment with oral iron, was treated with subcutaneous desferrioxamine. During the course of this treatment she developed tinnitus, which was considered to be a rare complication of the use of this chelating agent. The mechanism of this effect is not understood.
Chronic lymphatic leukaemia terminating as erythroleukaemia
Authors: Al-Hilali Mahir M , Edgcumbe John O P , Joyner Miles V
Published: December 2008

Terminal development of acute leukaemia in chronic lymphatic leukaemia is well recognized but often difficult to classify. A case with an unequivocal erythroblastic termination is described, occurring after 18 months’ treatment with chlorambucil.
Light chain plasmacytoid lymphocytic lymphoma
Authors: Tabilio Antonio , Mecucci Cristina , Falini Brunangelo , Martelli Massimo F
Published: December 2008

A case of plasmacytoid lymphocytic lymphoma characterized by the exclusive finding of a λ-light chain paraprotein, in the absence of heavy chains, is described. The immunoperoxidase study on bone marrow biopsy sections confirmed the production and secretion of the only λ-light chain.
Surgical treatment of hypertrophic obstructive cardiomyopathy in the elderly
Authors: Kafetz Kalman
Published: December 2008

Three elderly patients with hypertropic obstructive cardiomyopathy which was successfully treated by surgery are described. The role of surgery in the management of older patients with this condition is discussed.
Basal and postprandial serum concentrations of pancreatic polypeptide in pancreatitis and after pancreaticoduodenectomy
Authors: Lamers C B H W , Diemel J M
Published: December 2008

Basal and postprandial serum concentrations of pancreatic polypeptide (PP) were measured in 22 normal subjects, in 6 patients with a history of acute pancreatitis, in 21 patients with chronic pancreatitis and in 6 patients with previous pancreaticoduodenectomy. Eighteen of the 21 with chronic pancreatitis and all 6 with pancreaticoduodenectomy had abnormally low serum PP-responses to the standard test meal, while all patients with a history of acute pancreatitis had normal postprandial increases in serum PP. The impaired serum PP-responses to food in patients with chronic pancreatitis were not related to the aetiology of pancreatitis, to glucose tolerance, to exocrine pancreatic function (absorption of fat) or to pancreatic calcifications. It is concluded that impaired postprandial serum PP responses in patients with pancreatitis indicate damage to the pancreas.
Effect of glucose on plasma concentrations of individual non-esterified fatty acids of non-diabetic and insulin-independent diabetic men
Authors: Yue Kenneth T N , Phillips Phillis E , Davis James W , Graham Barbara A
Published: December 2008

The composition of plasma non-esterified fatty acids was investigated during glucose tolerance tests to determine changes in individual fatty acid concentrations after glucose administration and to determine whether differences existed between the individual fatty acid concentrations of maturity-onset diabetic and non-diabetic men. The mean fasting total non-esterified fatty acid concentration of the 9 diabetics was greater than that of the 12 non-diabetics studied. After glucose ingestion, the mean total non-esterified fatty acid concentrations of both groups decreased. Gas chromatographic analysis of the plasma non-esterified fatty acids of 6 diabetic and 6 non-diabetic men revealed that the concentrations of palmitic, stearic and oleic acids were significantly higher in the diabetic men in the fasting state. With the sole exception of stearic acid in the non-diabetic patients, the mean concentration of each of the 6 plasma non-esterified fatty acids determined decreased in both groups after glucose ingestion. At 1, 2 and 3 hr after glucose ingestion, there were no longer any significant differences between the mean concentrations of individual plasma non-esterified fatty acids of the non-diabetic and diabetic men.
Once-daily metoprolol for hypertension
Authors: Ward M J , Roland J M , Banks D C
Published: December 2008

In a randomized cross-over trial the antihypertensive effect of metoprolol given once daily was compared with its effects after twice-daily dosage. Metoprolol given as a single morning dose had a useful antihypertensive effect for 24 hr and may be given in this way for the treatment of hypertension.
Omphalocele: experience in the African tropics
Authors: Ihekwaba F Nwabueze
Published: December 2008

Omphalocele, the congenital anomaly of the anterior abdominal wall in the newborn, is a serious condition with a grave prognosis. Sac rupture, occurring in 25% of cases in Ibadan is associated with a high mortality. Although its embryogenesis is now better understood, its underlying aetiology remains obscure. Prematurity and low birth weight have no causal relationship to the condition, but a preponderance among the lower socio-economic groups in Ibadan is observed. Thirty-three cases seen over a 5-year period at the University College Hospital, Ibadan, Nigeria, constitute an unusually high incidence, suggesting that the condition may be aetiologically related to umbilical hernia which is known to be commoner in African than in Caucasian infants. Overall treatment results remain unsatisfactory for all types and mortality is still high. In those centres, particularly in the developing countries with scarce resources, conservative management should be the primary treatment modality for all intact sacs but staged procedures utilizing prosthetic materials should be reserved for the large ruptured sac.
Acute inflammatory polyradiculoneuropathy following type A viral hepatitis
Authors: Johnston C L W , Schwartz M , Wansbrough-Jones M H
Published: December 2008

A case is described of acute inflammatory polyradiculoneuropathy (Guillain-Barré syndrome) following a recent infection with type A viral hepatitis. This association has not previously been reported. The neurological disturbance was unusual in being predominantly sensory.
Acute pancreatitis induced by acute organophosphate poisoning?
Authors: Moore P G , James O F
Published: December 2008

A 32-year-old male with acute organophosphate poisoning developed hyperglycaemia, glycosuria and ketonuria soon after admission to hospital. Serum amylase estimations suggested a diagnosis of acute pancreatitis. He required insulin therapy to control his hyperglycaemia and the organophosphate poisoning was successfully managed by artificial ventilation, an infusion of pralidoxime and intermittent atropine. He was discharged on the 17th hospital day with no permanent physical sequelae.
Gastrointestinal amyloidosis complicating psoriatic arthropathy
Authors: Willoughby C P , Banerji A , Bennett M K , Jewell D P
Published: December 2008

A patient is described who developed gastrointestinal amyloidosis complicating psoriatic arthropathy. The presenting symptom was progressive dysphagia due to oesophageal involvement. Other clinical features included gastric ulceration with melaena, intestinal pseudo-obstruction and evidence of impaired renal function. The oesophageal symptoms improved after endoscopic dilatation of the cardia. Colchicine was used in an attempt to slow down progression of the condition.
Adverse reactions to drugs and their physico-chemical properties
Authors: Lewis J G
Published: December 2008

Physico-chemical factors can be related to adverse reactions. Their importance is that safer drugs can be made at the stages of design, delivery and metabolism.
The importance of good blood pressure control in the prevention of stroke recurrence in hypertensive patients
Authors: Johnston J H , Dunn F G , Beevers D G , Larkin H , Titterington D M
Published: December 2008

One hundred and twenty-four patients (70 men and 54 women) who were treated for hypertension after a stroke, between 1968 and 1976, were studied. Twenty-one (11 men and 10 women) developed a second stroke after a mean period of just over 2 years. The women who had a stroke recurrence had higher initial systolic and diastolic blood pressure (BP) as well as higher achieved BP. The men with recurrence had no significant difference in initial BP but had higher BP on treatment. Patients who achieved BP of <160 mmHg systolic or 90 mmHg diastolic had a low incidence of recurrent stroke. Good BP control in hypertensive patients prevents stroke recurrence but may be difficult to achieve.
Tropical pulmonary eosinophilia in a Saudi Arabian female
Authors: Gatus B , Khan M A
Published: December 2008

The first recorded case of tropical pulmonary eosinophilia from Saudi Arabia is reported. A 57-year-old female presented with paroxysmal cough, wheezing and shortness of breath. The white cell count was 27·0 × 109/l with 80% eosinophils, the serum IgE was grossly elevated and there were flitting pulmonary opacities on X-ray. Following treatment with diethylcarbamazine the patient’s symptoms were relieved dramatically, the white cells, eosinophil counts and the serum IgE returned to normal and the pulmonary opacities cleared. The source of filarial infection is uncertain.
Generalized choreiform movements as a complication of methyldopa therapy in chronic renal failure
Authors: Neil E M , Waters A K
Published: December 2008

A patient who developed bilateral choreiform movements in association with methyldopa therapy and deteriorating renal function without evidence of cerebrovascular disease is reported.
Intra-arterial blood pressure and cardiovascular responses in black and white hypertensives
Authors: Rowlands David B , Watson Robert D S , Stallard Terence J , Littler William A , de Giovanni Joe
Published: December 2008

Sixteen black hypertensive patients were matched for age, sex, casual blood pressure and socio-economic status with 16 white hypertensives. All patients underwent continuous intra-arterial ambulatory monitoring of blood pressure, assessment of baroreflex activity and pressor response to exercise and cold. No differences were observed in the blood pressure and cardiovascular responses between the group.
Tuberculosis in Asians
Authors: Innes J A
Published: December 2008

The incidence of tuberculosis among Asian immigrants in the United Kingdom greatly exceeds that in the white population. There are differences in the age-and sex-distribution of cases and in the frequency of of the disease at various sites, non-respiratory disease being disproportionately common. These differences are described and the need for more vigorous application of case finding and preventive measures is discussed.
Adult Asian osteomalacia
Authors: Melikian V
Published: December 2008

Twenty-four patients from the Indian sub-continent with osteomalacia were treated with calciferol 1·25 mg daily for periods of up to 8 years. Despite the large dose of calciferol, no vitamin D toxicity (hypercalcaemia) occurred.
Anaphylactic shock in an infant after feeding with a wheat rusk. A transient phenomenon
Authors: Rudd Peter , Manuel Peter , Walker-Smith John
Published: December 2008

A 10-week-old male infant presented with a history of recurrent diarrhoea and vomiting and in a state of collapse. After much fruitless investigation he was challenged with a wheat rusk and developed life-threatening anaphylactic shock followed by watery diarrhoea due to monosaccharide intolerance. This immediate type hypersensitivity to wheat rusk was transient, the infant being able to tolerate dietary wheat at the age of 14 months.
Acute dermatomyositis associated with a staphylococcal infection
Authors: Heagerty A M , Byrom N P , Cookson J B
Published: December 2008

A case is reported of dermatomyositis developing in a woman with staphylococcal osteomyelitis. After treatment for the infection, the dermatomyositis resolved and no other cause for it has been found. Dermatomyositis has not previously been described in conjuction with a staphylococcal infection.
Parotid and submandibular duct calculi in three successive generations of one family
Authors: Bullock K N
Published: December 2008

A case is reported of chronic calculous parotitis beginning in a 12-month-old child. Further questioning revealed a history of parotid calculi in her mother and submandibular calculi in her maternal grandmother. The features which indicate the diagnosis of parotid calculous disease are discussed and, from a review of the literature, some observations are made on management.
Oesophageal stricture associated with emepronium bromide therapy
Authors: Fellows I W , Ogilvie A L , Atkinson M
Published: December 2008

Emepronium bromide, a drug used to control urinary frequency, has been reported as causing oesophageal ulceration but not stricture formation. This paper presents 3 cases in which the use of emepronium bromide preceded development of an oesophageal stricture and suggests that the drug played a causative role.
Pulmonary aspergilloma, an unusual complication in Wegener’s granulomatosis
Authors: Martens J
Published: December 2008

A patient with a limited form of Wegener’s granulomatosis is presented. The disease was complicated by the development of an aspergilloma in the excavated pulmonary infiltrate.
Glandular fever-like syndrome, pulmonary eosinophilia and asthma associated with carbamazepine
Authors: Lewis I J , Rosenbloom L
Published: December 2008

An 8-year-old boy is described who developed hypersensitivity to carbamazepine manifested by fever, rash, lymphadenopathy, hepatosplenomegaly and asthma with eosinophilia. The abnormal reaction resolved rapidly following cessation of the drug.
Male infertility due to sulphasalazine
Authors: Tobias R , Coetzee T , Sapire K E , Marks I N
Published: December 2008

A male patient presented with infertility and was found to have severe oligospermia and a low serum testosterone. Three months after stopping sulphasalazine, both abnormalities returned to normal and his wife subsequently became pregnant.
Small intestinal perforation in Wegener’s granulomatosis
Authors: McNabb W R , Lennox M S , Wedzicha J A
Published: December 2008

A case of Wegener’s granulomatosis complicated by small bowel ulceration and perforation is described. Following laparotomy, with bowel resection, haemodialysis and immunosuppressive therapy, a full recovery was achieved including reversal of severe renal failure.
Reactive arthritis
Authors: Hind C R K
Published: December 2008

Reactive arthritis is a rare complication of certain infections. The similar features and HLA associations with the seronegative arthropathies have raised the possibility that the latter may be forms of reactive arthritis. This review describes the clinical and epidemiological features, and the recent advances in our understanding of the underlying pathogenesis of reactive arthritis.
Broncho-pleural fistula complicating rheumatoid lung disease
Authors: Sharma S S , Reynolds P M G
Published: December 2008

A 57-year-old man with severe rheumatoid arthritis complicated by lung disease developed a bronchopleural fistula. Initially he had a symptomless pleural effusion but later a cavitated rheumatoid lung nodule ruptured giving rise to a broncho-pleural fistula which took 19 days to heal.
Amyloidosis of the liver causing jaundice
Authors: Cox Robert
Published: December 2008

A case of primary amyloidosis of the liver causing jaundice is described. Attention is drawn to the rarity of the condition. A precise pre-operative diagnosis would have spared the patient a laparotomy.
Idiopathic obstructive eosinophilic enteritis with raised IgE: response to oral disodium cromoglycate
Authors: Gilinsky N H , Kottler R E
Published: December 2008

A 65-year-old man with a 20-year history of recurrent abdominal pain and vomiting was found to have eosinophilic enteritis affecting the muscularis layer of the distal ileum. Tests for malabsorption were negative. The IgE was raised but there was no evidence of an allergic predisposition. The symptoms, eosinophilia, and radiological abnormality responded to oral disodium cromoglycate.
Myotonic dystrophy complicated by peripheral vascular disease
Authors: David A S , Quin R O
Published: December 2008

A case of myotonic dystrophy complicated by peripheral vascular disease is described. No obvious explanation was found to account for this. A review of the literature revealed a few similar cases. The possibility that disordered peripheral circulation may be a rare feature of myotonic dystrophy is proposed.
Pulmonary embolism presenting as adult respiratory distress syndrome—support for a hypothesis
Authors: Williams Adrian J , Yauch David C , Finberg Stephen N , Santiago Silverio M , Fisher H Kenneth
Published: December 2008

Adult respiratory distress syndrome (ARDS), or non-cardiogenic pulmonary oedema, has only rarely been associated with pulmonary embolism. In this case study the association is further documented and the occurrence of pulmonary oedema confined to unobstructed portions of the pulmonary capillary bed is illustrated.
Cholestatic jaudice due to toxoplasma hepatitis
Authors: Tiwari I , Rolland C F , Popple A W
Published: December 2008

A case of toxoplasma hepatitis presenting with cholestatic jaundice is described. The diagnosis was based on serological testing and evidence of hepatitis on biopsy.