bluuebunny/crossref_metadata_2025 huggingface dataset:
Analgesics in cancer pain: results of a questionnaire
Authors: Robbie D S , Mennie A T
Published: December 2008

A questionnaire was sent to seventy-five doctors in a London cancer hospital enquiring about their use of analgesics in cancer pain.

In the 37 replies which were returned a wide range of analgesics was prescribed.

In the most painful and distressing conditions, opiates were always used with a strong bias towards diamorphine. However, it was claimed that mild non-narcotic analgesics given regularly often gave better and longer lasting reliefs than narcotics which were prescribed on a pro re nata basis.
Experiences with cutaneous ureterostomies in adults
Authors: Lien W M
Published: December 2008

Between 1963 and 1971, twenty-five adult patients underwent cutaneous ureterostomies. The operation was performed for neurogenic bladder in sixteen cases, malignant diseases in eight cases and congenital bladder neck obstruction in one case. Sixteen patients were alive and well at the time of writing. The follow-up period ranged between 5 days and 7 years. The results were analysed and advantages of this type of urinary diversion discussed.
The treatment of malignant ventricular tachycardia by aorto-coronary saphenous vein bypass graft
Authors: Ikram H , Jeffery R M , Parkins R A , Makey A R , Emery E R J , Stone D L
Published: December 2008

A 61-year-old man with a previous cardiac infarction had at least fifteen attacks of ventricular tachycardia which finally did not respond to either drug or electrical therapy. Angiography showed a blocked right coronary artery and a non-contractile portion of postero-inferior left ventricular wall.

An aorto to right coronary saphenous vein bypass graft was inserted, and although attacks of tachycardia occurred following the operation these were of short duration and reverted spontaneously.

He has been free of tachycardia for 5 weeks, with a greatly improved effort tolerance.
Retroperitoneal rupture of the duodenum due to blunt trauma
Authors: Strachan J C M
Published: December 2008

The subject is reviewed and a further case of retroperitoneal rupture of the second part of the duodenum due to blunt abdominal trauma in a child is reported. The equivocal initial clinical signs and characteristic X-rays are described.
Infantile nephrotic syndrome
Authors: Nagi N A , Nouri L
Published: December 2008

Four infants, two boys and two girls, with congenital nephrotic syndrome are reported in a single family. The disease process began during the first year of life. The disorder did not respond to corticosteroid therapy. One infant received cyclophosphamide therapy as well without avail. All four children died from intercurrent infection. The family tree is suggestive of an autosomal recessive inheritance.
Ergotamine-induced venous thrombosis
Authors: Mintz U , Bar-Meir S , De Vries A
Published: December 2008

A patient is described who developed venous thrombosis in the leg following an intramuscular injection of ergotamine tartrate.
Malignant mucocele of the appendix in a femoral hernia
Authors: Nayak I N
Published: December 2008

A case of malignant mucocele of the appendix caused by constriction of its base at the neck of a femoral hernial sac is described. No similar case has been found after a careful search of the literature.
The syndrome of dilutional hyponatremia
Authors: Misra D P
Published: December 2008

Three cases of dilutional hyponatremia are presented. All had ADH bio-assay at the height of biochemical abnormality and the values were found to be normal. The first two cases were due to cortisol deficiency. An interesting feature of these two cases was a high exchangeable sodium which was corrected by administration of cortisone, suggesting that cortisol plays some part in the distribution of sodium between the extracellular and the intracellular space. The third case occurred in association with urinary tract infection. Similar findings have been reported in elderly patients with pneumonia and have been presumed to be due to inappropriate secretion of ADH on indirect evidence. ADH assay has rarely been done and has never been found to be high. On the basis of the findings observed in the three cases, it is suggested that factors other than ADH excess and cortisol deficiency are involved in the production of dilutional hyponatremia.
Complications of dietary deficiency of Vitamin B12 in young Caucasians
Authors: Gleeson M H , Graves P S
Published: December 2008

The occurrence of dietary deficiency of Vitamin B12 is reported in two young caucasian adults. In one case megaloblastic anaemia occurred and in the other optic atrophy. The importance of the dietary history, the significance of folic acid intake and the inter-relationship of Vitamin B12 and cyanide detoxication are discussed.
Treatment of pulmonary tuberculosis in a patient on maintenance haemodialysis
Authors: Smith F W , Catto G R D , MacLeod M
Published: December 2008

A case of pulmonary tuberculosis in a patient on maintenance haemodialysis is reported. A 37-year-old man who had received intermittent haemodialysis for 5 years, developed pulmonary tuberculosis which was treated initially with isoniazid, sodium aminosalicylate (PAS) and rifampicin. Isoniazid and PAS were discontinued and treatment continued with rifampicin alone. One year later, the patient is well, has no evidence of active tuberculosis and undertakes his own dialysis at home.
The use of dialysis bath fluid as a vehicle for a drug with a narrow therapeutic index—Lithium chloride
Authors: Oakley W F , Clarke W F , Parsons V
Published: December 2008

A patient requiring regular haemodialysis treatment (RDT) for end stage chronic pyelonephritis, with a recurrent manic-depressive illness was successfully treated with lithium chloride by adding it to the dialysate, when other routes had failed.
Fatal outcome from administration of a salt emetic
Authors: Roberts C J C , Noakes M J
Published: December 2008

A case is described of the death of a young female patient following the administration of a salt emetic after a relatively minor overdose of a proprietary analgesic containing aspirin. It is suggested that death occurred as a direct consequence of the salt ingestion and that the dangers of this method of inducing emesis should be more widely appreciated.
Principles of vascular control
Authors: Neil Eric
Published: December 2008

The distribution of nutrient materials to, and the uptake of waste products from, the tissues occurs only in the capillary bed. Arteriolar resistance ensures that blood enters the capillaries at a pressure only slightly higher than that of the colloid osmotic pressure of the blood. Arteriolar resistance is normally under the influence of a sparse sympathetic vasoconstrictor discharge superintended by the activity of ‘vasomotor centres’ in the brain stem. The activity of these ‘vasomotor centres’ is itself modified appropriately by afferent impulses from the sino-aortic baroreceptors.

Veins subserve mainly a capacity role but are also involved in veno-constrictor reflexes.
Sodium nitroprusside: theory and practice
Authors: Verner Ian R
Published: December 2008

Sodium nitroprusside, by a peripheral vasodilator action, is a powerful hypotensive drug. In contrast to established agents, its hypotensive action is accompanied by an unchanged or augmented cardiac output. Intravenous administration of sodium nitroprusside rapidly produces a profound and controllable hypotension. Normotension is swiftly restored by ceasing to infuse the agent, and antidotes are unnecessary. Its attributes make it especially suitable for neurosurgical anaesthesia, and although free cyanide is liberated during biotransformation, side effects are virtually absent provided that dosage is reasonable. Special contraindications to its use are hypothyroidism and altered cobalamin metabolism.
Microbiological and other hazards from seafoods with special reference to Vibrio parahaemolyticus
Authors: Barrow G I
Published: December 2008

The salient features of some of the more important microbiological health hazards to man from seafoods are reviewed briefly. They include poisoning, indirectly from toxins produced by certain marine algae or more directly by Clostridium botulinum, as well as infection with the marine bacterium Vibrio parahaemolyticus. Local culinary habits play a significant role in such kinds of illness, and food well cooked shortly before consumption is always preferable. Since established customs die hard, safety ultimately depends, not so much on arbitrary microbiological standards, but on hygienic production, correct storage and distribution, and on education in intelligent eating habits.
Food additives
Authors: Spencer Michael
Published: December 2008

Food additives are discussed from the food technology point of view. The reasons for their use are summarized:

(1) to protect food from chemical and microbiological attack;

(2) to even out seasonal supplies;

(3) to improve their eating quality;

(4) to improve their nutritional value.

The various types of food additives are considered, e.g. colours, flavours, emulsifiers, bread and flour additives, preservatives, and nutritional additives. The paper concludes with consideration of those circumstances in which the use of additives is (a) justified and (b) unjustified.
The production of safe foods
Authors: Baird-Parker A C
Published: December 2008

This article summarizes the steps that a food producer takes to ensure that bacterial food poisoning risks are minimized. These include microbiological control of raw materials, processes and the final products. The importance of good process control as the best means of reducing the food poisoning risks is emphasized.
Diabetes mellitus in Rhodesia: a comparative study
Authors: Wicks A C B , Jones J J
Published: December 2008

Diabetes mellitus in the African is compared with the disease in Western populations, where secondary diabetes is uncommon, and primary diabetes is often familial, and can usually be classified as growth-onset and insulin-dependent, or as maturity-onset and insulin-resistant, and particularly liable to vascular complications.

In contrast, amongst 107 newly diagnosed African patients admitted consecutively to Harare Hospital during a 1-year period, five patients had diabetic relatives, and in thirty-four patients, diabetes was clearly secondary to pancreatic and hepatic disease. A high proportion (72%) of the remaining maturityonset patients were found to be insulin-dependent, so that their diabetes may also have been secondary to pancreatic disease. Vascular complications seldom occurred.

After standardizing this population for sex and age, the modal age for onset of diabetes remained earlier than in Britain. Male patients were underweight and female patients overweight compared with healthy contrast groups. The proportion of diabetic patients in skilled occupations, living in urban areas, and with large numbers of children was no greater than for agematched non-diabetic hospital inpatients.
Possible genetic influences in familial sarcoidosis
Authors: James D Geraint , Piyasena K H G , Neville E , Walker A N , Hamlyn A N
Published: December 2008

Five families (three English, one Irish, one West Indian) contained eleven members with sarcoidosis, nine of whom have been investigated and followed. Their multisystem involvement and course was similar to that of other patients attending the Sarcoidosis Clinic at the Royal Northern Hospital. There were three brother-sister and two mother-offspring relations; it was not observed in a father-offspring relationship. It is noted that the course of one sister was considerably worse than that of her brother. The evidence suggests a recessive mode of inheritance for sarcoidosis susceptibility. Four other families are reported on in an Addendum.
The diagnosis of pulmonary embolism
Authors: Talbot S , Griffiths P D
Published: December 2008

A blind assessment of abnormalities of pulmonary scintiscans in patients with pulmonary emboli and other clinical conditions showed that there was no abnormality specific for pulmonary embolism. However, a normal lung scan virtually excluded pulmonary embolism and an area, or areas, of absent perfusion was confirmatory evidence of embolism, without infarction, if the chest radiograph was normal, and of embolism with infarction if the clinical and radiographic findings were compatible.

A controlled analysis of biochemical and electrocardiographic abnormalities associated with pulmonary embolism showed that abnormalities of liver function and blood urea were more frequent than in a group of patients suspected of, but not having, emboli. A similar analysis of the electrocardiograms showed that a Q3R3S1 with T wave inversion over the right ventricular leads and lead III (±avf) that developed or regressed was pathognomonic of embolism, but other features were of little value.

It is suggested that all hospital patients should have an electrocardiogram performed on admission so that serial changes may be assessed and that lung scanning should be used as a screening test in patients suspected of having pulmonary embolism.
Oral iron tolerance
Authors: Mitchell A B S
Published: December 2008

The tolerance of volunteer patients to various ferrous salt preparations, administered orally in equivalent doses of elemental iron, has been compared. The palatability of ferrous sulphate tablets, BP, given before meals was not improved by administration after meals, by sustained release formulation, or by substituting other ferrous salts. Intolerance was related to the number of tablets rather than to the dose of iron in a course. The liquid iron preparation was the least acceptable.

Ferrous sulphate tablets, BP, given before meals, approximate most closely to the hypothetical ideal iron preparation for therapeutic oral administration.
Rifampicin therapy in Escherichia coli gastroenteritis
Authors: Naveh Yehezkel , Friedman Abraham
Published: December 2008

Eight infants aged 2-4 months suffering from gastroenteritis associated with enteropathic Escherichia coli were treated with rifampicin. Seven of them had serotype 0125: B15 and the eighth had serotype 0126: B16. One of them had septicaemia due to E. coli 0125: B15. Five cases were initially treated with antibiotics and chemotherapeutic agents to which E. coli was shown to be sensitive but without results. Rifampicin was effective in curing gastrointestinal signs and eradicating the bacilli in seven of eight infants. The drug was given in a dose of 15-25 mg/kg/day divided into two equal parts, for 7 days in most of the cases. No untoward side effects were observed clinically in any of the cases. Our experience should encourage the use of this agent in controlling outbreaks of gastroenteritis caused by enteropathic E. coli.
Study of the lipid-lowering action of choloxin and Nilevar in patients with chronic renal failure
Authors: Wardle E N , Schardt W , Uldall P R , Brown Ann , Jonfiah Dorcas , Moore Audrey , Park Rosemary , Wood Elizabeth
Published: December 2008

Lowering of lipids in patients with chronic renal failure is advantageous but cannot be done by calorie restriction. In a controlled study the anabolic steroid norethandrolone (Nilevar) was found to lower triglycerides by 50%, while D-thyroxine (Choloxin) lowered the cholesterol by 25%. Both drugs increased the activity of lipoprotein lipase in spite of uraemic inhibition. Norethandrolone also reduced basal serum insulin levels. Norethandrolone seems appropriate for underweight patients and D-thyroxine for overweight patients, but side effects are more frequent than in non-uraemic patients.
Lactic acidosis and hyperamylasaemia associated with phenformin therapy
Authors: Williams D N , Knight A H , Goldberg D M
Published: December 2008

A case is described of lactic acidosis and hyperamylasaemia in a diabetic with impaired renal function treated with phenformin. Despite normal blood pressure and adequate tissue perfusion, the patient succumbed. No evidence of pancreatitis could be found at autopsy.
Rupture of the stomach following mouth-to-mouth respiration
Authors: Solowiejczyk M , Wapnick S , Koren E , Mandelbaum J
Published: December 2008

Successful repair and survival after rupture of the stomach in a patient who received mouth-to-mouth respiration is presented. We were able to find only one report in the literature where rupture of the stomach occurred following this manoeuvre—the patient did not survive. The possible aetiological factors and measures designed to avoid this complication are discussed.
Prevalences of leg and chest abnormalities in four South African schoolchild populations with special reference to vitamin D status
Authors: Richardson Barbara D , Walker Alexander R P
Published: December 2008

Prevalences of bowing and knock knee, measured at a standard stance, have been obtained on Negro, Coloured, Indian and Caucasian schoolchildren aged 7, 12, and 16-17 years. These two abnormalities were unexpectedly common, affecting about one-fifth and one-third of all children respectively. Ranges of prevalences of chest abnormalities were—Harrison’s sulcus, 0-5%, and pigeon chest, 0-2%. Prevalence of bowing increased with age. That of knock knee was little affected by age, but increased markedly with body mass. There was no age trend with prevalences of chest abnormalities.

Prevalences appeared unrelated to vitamin D intake. As to sunshine, the annual mean for the Transvaal is 8·4 hr daily. Results from radiological, skin pigmentation, and biochemical studies were non-contributory. Since a primary deficiency of vitamin D is evidently not the causal factor, one explanation is that a secondary deficiency is involved, arising from an impairment in metabolic availability. Further, a proportion of leg abnormalities may be physiological variants; moreover, it cannot be excluded that unknown factors may bear, or share, in responsibility.

Elucidation may be forthcoming by investigating the interrelationship between vitamin D status and frequency of leg abnormalities during and after puberty; in addition, results of serial studies of prevalences of abnormalities from birth to post-adolescence would be illuminating.
Rubella polyneuropathy
Authors: Tomlinson I W
Published: December 2008

Two cases of polyneuropathy occurring after rubella infections are described, together with the nerve biopsy and serological findings.
Phenothiazines and the electrocardiogram
Authors: Raj M V Jeeva , Benson R
Published: December 2008

Fifty-nine (42%) of 140 schizophrenic patients taking phenothiazines were found to have abnormal electrocardiograms. The abnormalities included T wave changes, S-T depression, P-R and Q-T prolongation, persistent sinus tachycardia (110 or more/min) and right bundle branch block.

In forty-eight (34%) of the fifty-nine patients, the ECG abnormalities disappeared after stopping the phenothiazine and reappeared on its resumption.
Asymptomatic autoimmune liver disease in scleroderma
Authors: Gupta M M , Warnes T W , Watson L
Published: December 2008

A case is described of scleroderma with asymptomatic autoimmune liver disease. The patient presented with the features of CRST syndrome (calcinosis, Raynaud’s phenomenon, sclerodactyly and telangiectasia) and a raised plasma alkaline phosphatase was found on routine investigation. It is suggested that this latter biochemical finding is likely to indicate associated autoimmune liver disease in patients with scleroderma.
Monitoring the fetoplacental unit—the placenta
Authors: Chard T
Published: December 2008

The non-steroidal tests available to determine the well-being of the fetoplacental unit are reviewed. The author’s experience with measurements of human placental lactogen (HPL) is described in detail since this measurement has provided a great deal of new and useful information.
Lactation and the physiology of prolactin secretion
Authors: McNeilly A S
Published: December 2008

Prolactin in man appears to form an essential part of the complex of hormones necessary for milk secretion and lactation. Levels of prolactin during pregnancy gradually increase towards term, and remain elevated for up to 6 weeks post partum. The lactogenic effects of prolactin appear to be blocked at the mammary gland by the elevated levels of fetoplacental steroids secreted during pregnancy. The immediate decline in steroid levels at delivery removes this block to prolactin and milk secretion ensues.

The amenorrhoea associated with both puerperal lactation and galactorrhoea appears to reflect failure of cyclical discharge of gonadotrophins and anovulation. This appears to be due to peripheral inhibition of steroidogenesis by the elevated levels of prolactin associated with these situations. No consistent changes in circulating levels of prolactin occur during the menstrual cycle, but changes in prolactin levels within the follicular fluid of the developing ovarian follicle indicate a specific and permissive role of prolactin in steroidogenesis.
Water intoxication associated with oxytocin infusion
Authors: Ahmad Audrey J , Clark Elizabeth H , Jacobs Howard S
Published: December 2008

During a mid-trimester abortion with high dose oxytocin infusion and intravenous fluids, a patient developed an acute dilutational hyponatraemia and coma. The relationship of water intoxication and synthetic oxytocin infusion is discussed and the literature reviewed.
Behçet’s disease and the alimentary tract
Authors: Parkin J V , Wight D G D
Published: December 2008

Two patients with perforation of the alimentary tract in Behçet’s disease are described. One of these is believed to be the first recorded case of oesophageal perforation in this condition, while the second is one of the few survivors of bowel perforation. The literature, aetiology and treatment are reviewed.
Introduction
Authors: Oakley C M , Olsen E G J
Published: December 2008

Cardiologists have been slow to employ cardiac biopsy in the elucidation of the all too common and lethal disorders of heart muscle (cardiomyopathies). In other disciplines, tissue diagnosis is now a prerequisite and the nephrologist and hepatologist have been greatly aided in the advancement of their subjects by the ready availability of living tissue from the diseased organs. Although techniques of cardiac biopsy have been available for over a decade, biopsy has been undertaken frequently in only a very few centres in the world and little information has come from it to date.
The relation between function and causation in cardiomyopathy
Authors: Oakley C M
Published: December 2008

Definition

Cardiomyopathy is defined as ‘heart muscle disorder of unknown cause or association’ (Oakley, 1972).
Technique of endomyocardial biopsy—including a description of a new form of endomyocardial bioptome
Authors: Richardson P J
Published: December 2008

The technique of endomyocardial biopsy which was developed by Konno and Sakakibara, 1963, and was further reported by Sekiguchi and Konno, 1969; Konno, Sekiguchi and Sakakibara, 1971, and Somers et al., 1971, has meant that it is now possible to study the myocardium of patients suspected of having intrinsic abnormality of the muscle structure by histological, histochemical and electron microscopic examination. This is particularly applicable to the cardiomyopathies, and it is in this context that the majority of biopsies which we have performed have been done (Table 1). The advantage of the Konno technique over limited thoracotomy (Weinberg et al., 1963; Sutton et al., 1964) is that it avoids an anaesthetic and a relatively major operation, and unlike transthoracic needle biopsy (Sutton, Sutton and Kent, 1956; Sutton and Sutton, 1960) the samples obtained usually contain endocardium, in addition to myocardium, sufficient for examination.
The effects of hyperosmolal coronary perfusion on the haemodynamic, metabolic and ultrastructural changes of myocardial anoxia
Authors: Brachfeld Norman , Erlandson Robert , Christodoulou James , Smithen Charles
Published: December 2008

Recovery from anoxia has been evaluated in the isovolumic non-recirculating paced perfused rat heart. Seventy studies were performed consisting of 15 min of aerobic perfusion (AP); AP+15 min anoxic perfusion; and AP+15 min anoxic perfusion+15 min reoxygenation (recovery). Krebs-Ringer-bicarbonate+5 mmol glucose (KRB) (290 mmol) was compared to KRB+mannitol (350 mmol). Mannitol decreased myocardial water content. It improved recovery of haemodynamic function after reoxygenation. With KRB alone left ventricular systolic peak pressure (LVSP) decreased 32% and maximum dP/dt by 50%. With mannitol added LVSP decreased 18% and dP/dt 21% (P<0·01). KRB and mannitol did not differentially affect total coronary flow, lactate and glucose extraction, tissue glycogen, creatine phosphate or adenine nucleotide concentrations.

No difference in submicroscopic appearance was noted with either perfusate during aerobic perfusion. Anoxic hearts perfused with isosmolal KRB demonstrated the most severe ultrastructural alterations including mitochondrial swelling with disruption of cristae and extraction of matrix components, myofibrillar fusion and contraction bands, and subsarcolemmal oedema and vacuolization. These changes were only partially reversed during reoxygenated perfusion. However, cellular changes were reversed or markedly improved during both the anoxic and reoxygenation perfusion periods with hyperosmolal solutions. When studied by silicone rubber injection of the microcirculation, only focal capillary endothelial cell swelling was noted and no difference in arteriolar or capillary filling was observed with either perfusate. Mannitol appears to improve LV function by direct myocardial osmotic action unrelated to enhanced energy production.
The coronary arteries in active viral cardiomyopathies
Authors: Burch G E
Published: December 2008

These studies reveal that in mice, Coxsackie B4 and EMC viruses produce not only myocardial disease but extensive disease of the myocardial capillaries, coronary arteries, aorta and mesenteric arteries and veins and other arteries and veins. These lesions impair luminal calibre and, in turn, lead to myocardial ischaemia. This ischaemia contributes further to the myocardial damage. It is postulated that viruses initiate arteriosclerosis in man. A 19-year-old man who died of Coxsackie B4 viral cardiomyopathy had changes in the aorta noted on light and electron microscopy which are compatible with atherosclerosis. The relationship of these aortic changes to the viral infection can only be opened to speculation. Nevertheless, all of these studies establish a new concept of the possible initiating cause of arteriosclerosis, a common and extremely important disease of man.
Effect of ethanol infusion on the ultrastructure of human myocardium
Authors: Klein H , Harmjanz D
Published: December 2008

To study the influence of a moderate dose of ethanol on the ultrastructure of myocardium in patients with heart disease, a 7·5% solution of ethanol was infused in six patients with myocardial and valvular disease, who underwent diagnostic cardiac catheterization. Before and after infusion of ethanol an endomyocardial biopsy was performed and the specimens were examined by electron microscopy. After ethanol all six patients revealed alterations in the mitochondrial structure and three of them also showed significant dilatation of the sarcoplasmic reticulum. Cardiac output increased in three of the patients, whereas in two patients a decrease of cardiac output was measured.

The results suggest that the infusion of even small amounts of ethanol is able to provoke structural alterations of myocardial cell organelles and, therefore, possible impairment of myocardial function.
New approach in studying cardiac muscle cell injury
Authors: Rona G , Boutet M , Hüttner I
Published: December 2008

A new approach for investigating the mechanisms and evolution of cardiac muscle cell injury was presented by applying fine structural extracellular protein tracers in the catecholamine-induced cardiac muscle cell injury model. The results with these diffusion tracers indicated striking functional changes at the level of coronary microcirculation followed by early permeability alteration of cardiac muscle cell membranes, thus suggesting the role of these factors in myocardial changes which develop without narrowing or obstruction of coronary arteries.
Introduction
Authors: Goodwin John
Published: December 2008

We will make a start with apologies from me, because owing to a conflict of responsibilities, I am afraid I cannot stay until the end. So I would like at this point just to make one or two comments on what has gone before. I think it has been an extraordinarily useful day, mainly because it has exposed the enormous areas of ignorance that we still have in this particular field. I would like particularly to congratulate Celia Oakley and Eckhardt Olsen for organizing the meeting in this way. It is the first attempt to study cardiac biopsy and to look at the problem of cardiomyopathy in a co-ordinated and not isolated way by merely gathering a great deal of data which, unless linked with something practical, are of very little value. We are in the position that Braunwald quoted a little time ago at a similar meeting—like a number of blind men trying to diagnose an elephant. We all go around looking at it, and we all pull its trunk and its tail and some say ‘Ah! this thing is obviously absolutely uniform; it has two similar organs at each end and they are the same’, and others say ‘Nonsense, it is clearly a thing which has a front and a back’. Until we get some sort of overall view, we will go on in this state. This is the situation that cardiomyopathy is in at the moment, but the biopsy and the modifications of technique that will follow will give us a much better idea in the future. The biopsy technique is comparable in a way to the development of the sphygmomanometer or the ophthalmoscope. We are at a stage of evolution, just beginning to get some idea of what may be going on, and we want to look at as many things as we can. I take Dr Rona’s point very well, that there may be considerable abnormalities without any obvious visual disturbance, and we certainly ought to look at virology, immunology, enzymology and the factors that produce a functional disturbance, and not merely the ‘tombstone’ that George Burch has described. There is no question but that endomyocardial biopsy ought to continue. It is absolutely vital to the further study of this group of diseases, but it must be applied with discretion. There are obvious ethical problems involved; for instance, at the present time we cannot say to a patient, with absolute certainty, that this investigation is going to help us to treat his particular disease. Therefore, I think endomyocardial biopsy ought to be done as part of a co-ordinated research programme into cardiomyopathies, combined with other methods of investigation, and as part of a full diagnostic regime. If you look at it in this way and not as an occasional recourse, we have got a tremendously exciting time ahead.
The plasma membrane in cardiomyopathy
Authors: Nayler Winifred G , Burian W
Published: December 2008

A drug-induced change in the fine morphology of the plasma membrane of heart muscle cells is described. Thus, in rabbits the chronic administration of oxyfedrine caused a marked proliferation of the plasma membrane. At the same time the mitochondria became swollen and vacuolated, and there was evidence of lysis of myofibrils. These changes are not accounted for in terms of the release of endogenous stores of catecholamines.
Summing up
Authors: Abelmann Walter H
Published: December 2008

The symposium was opened by Drs Oakley and Olsen with a review of the clinical, haemodynamic, and pathological spectrum of cardiomyopathy. The advances made since the last Ciba Symposium devoted to this topic 10 years ago were highlighted. The emphasis has shifted from classification to biological mechanisms and pathogenesis. Major areas of ignorance were identified. Although the technique of transvenous myocardial biopsy was introduced by Konno 10 years ago, it has not been taken full advantage of in the much needed attack on the unanswered questions.
Measurement of blood pressure—a routine test in need of standardization
Authors: Thulin T , Andersson G , Scherstén B
Published: December 2008

Some of the different factors that can influence the measurement of blood pressure are discussed. It is essential that those engaged in the care of patients with high blood pressure should standardize the measurement of blood pressure so that the established routine is followed at each attendance. This is especially important today because so many people perform blood pressure checks.

It is important to use the correct cuff and manometer. When considering costs, one should remember that the measurement of blood pressure is an inexpensive examination, but that poor equipment will prove costly both for the patient and for the community medical programme.
Transplantation of lymphocytes and immune lymphocytes in sarcoidosis and in malignant lymphadenomas
Authors: Kohout J
Published: December 2008

When lymphocytes of a homologous donor are transferred intracutaneously to another person a local reaction of delayed type is seen at the site of transfer 24-48 hr later (‘normal lymphocyte transfer reaction’). When sensitized lymphocytes of the recipient afterwards are transferred back to the donor in normal cases the local reaction is much stronger (‘immune lymphocyte transfer reaction’). When the recipients were patients with acute sarcoidosis or with Hodgkin’s disease of stage III and IV, the normal lymphocyte transfer reaction was considerably weaker than in normal cases. The reaction of patients with chronic sarcoidosis was similar to normal controls, likewise the reaction of early cases of Hodgkin’s disease. In back transfer of sensitized lymphocytes of above mentioned recipients to the donors the immune lymphocyte transfer reaction was stronger in acute sarcoidosis than in stage III of Hodgkin’s disease, but always weaker than in normal cases. The reactions of patients with chronic sarcoidosis were similar to normal controls. The investigations show a parallel to the findings with passive transfer of delayed type sensitivity.
Hypocalcaemic response to streptomycin in malignant hypercalcaemia
Authors: Roediger W E W , Ludwin D , Hinder R A
Published: December 2008

We report a case of malignant hypercalcaemia associated with primary hepato-cellular carcinoma in whom streptomycin produced a notable and reproducible fall in serum calcium. A hypocalcaemic response to streptomycin has been reported from experimental animals but not previously from man.
Haemolysis associated with diazoxide, used for the control of hypertension
Authors: Best R A , Clink H M
Published: December 2008

Diazoxide, an agent used occasionally in the control of hypertension, has been associated with three haemolytic episodes in one patient. It is suggested that the mode of action is similar to that of diaminodiphenyl sulphone (dapsone) in acting as an oxidant stress to the ageing erythrocyte.
Thyrotoxic pretibial myxoedema in Asian patients in Singapore
Authors: Kee C W , Cheah J S
Published: December 2008

Over a 5-year period, three cases of thyrotoxic pretibial myxoedema were encountered. The incidence of pretibial myxoedema in Chinese thyrotoxic patients in Singapore was 0·7% (0·3% in females and 1·6% in males). One of the three patients also had thyroid acropachy. The incidence of thyrotoxic pretibial myxoedema in Singapore is compared with that in the literature and the aetiology briefly reviewed.
Skin metastases in carcinoma of the stomach
Authors: Adam B A , Murugasu R
Published: December 2008

A patient who presented with cutaneous nodules had carcinoma of the stomach. The histochemistry of the dermal infiltrate gave a clue to the primary site. Autopsy revealed metastases in all the organs of the chest and abdominal cavity. The invasion of the testis and the gingiva was unusual. Cutaneous metastases from a visceral malignancy probably indicate an early fatal termination.

Metastatic lesions to the skin from internal malignancies are rare and the incidence has been reported to vary from one to 2·7% (Gates, 1937; Beerman, 1957). Most reports quote lung and the breast as the primary site of malignancy although other sites including the stomach are not uncommon. The metastases, either single or multiple, may be the initial manifestations of the internal malignancy.
The diagnostic problem of multiple intracranial tumours—case report of a pituitary chromophobe adenoma and cerebellar haemangioblastoma
Authors: Mohr P D , Fletcher P , Anderson J M , Jefferson J M
Published: December 2008

The clinical and pathological details of a case in which a pituitary chromophobe adenoma and a cerebellar haemangioblastoma occurred simultaneously are presented and the diagnostic problems discussed. This is a rare combination considering the disparate tissue origin of the two tumours.
A case of acute mercury vapour poisoning
Authors: Eastmond C J , Holt S
Published: December 2008

A case is reported of a research chemist who was briefly exposed to a high concentration of mercury vapour and who developed symptoms of systemic poisoning, but who had a normal urinary excretion of mercury. This latter is not considered to refute the diagnosis. The literature is briefly reviewed.
A 6-year survey of human brucellosis in a rural area of north-western England and north Wales
Authors: Poole Pauline M
Published: December 2008

Experiences in the investigation of human brucellosis during a 6-year period are described and the diagnostic value of the various simple laboratory procedures compared. Patients were divided into three groups on the results of the investigations. Patients in groups I and II showed serological evidence varying in degree, which indicated past infection or repeated exposure to infection. Patients in group III were those suffering from active infection during the investigations. The diagnosis, personal information, clinical features and progress of patients in group III are recorded in some detail. Individual case histories of seven veterinary surgeons are given.
A method of determining daily nitrogen requirements
Authors: Lee H A , Hartley T F
Published: December 2008

A simple formula for calculating daily nitrogen requirements and balance is presented. A close correlation was observed between calculated and actual nitrogen balance studies. For better precision a different correction factor is suggested for patients receiving protein hydrolysates and crystalline amino acid solutions. This formula will greatly aid those who have to devise complete intravenous nutrition regimes for patients whose condition varies daily. The biochemistry required for application of this formula is within the capacity of any small hospital laboratory.
Traumatic pancreatitis with peripheral fat necrosis
Authors: Cochran K M , Mason J R , Davidson J S H
Published: December 2008

Direct damage to the pancreas occurs in about 5% of closed abdominal injuries, many of which arise from major accidents. The fixed retro-peritoneal site of the pancreas makes it particularly vulnerable to trauma by the steering column in cars not being constructed to modern safety requirements. As these injuries become more common, and as the number of survivors of such trauma increases, the longer term complications of trauma to the pancreas will become more common. A case is described demonstrating some of these complications arising from peripheral fat necrosis.
Effect of portacaval anastomosis on renal blood flow in cirrhosis—preliminary results
Authors: Ring-Larsen H , Hesse B , Stigsby B
Published: December 2008

The established end-to-side portacaval shunt is not effective in normalizing the decreased renal blood flow in patients with cirrhosis of the liver. The ability of the side-to-side shunt to offer this effect remains to be decided, and will be so when patients with this type of shunt are added to this study.
General discussion
Authors: Williams Roger
Published: December 2008

Professor H. E. de Wardener (London): Why do you call the renal failure of cirrhosis ‘functional’? Renal failure means abnormal renal function so you are talking of ‘functional abnormal renal function’!! What you have is a renal vasoconstriction and so a reduced glomerular filtration rate. If a reduced filtrate enters normal tubules all the sodium is resorbed. Find another word for it, e.g. ‘renal failure with low sodium’. I think that what you mean by functional renal failure is reversible renal failure.
Natriuretic hormone—its possible role in fluid and electrolyte disturbances in chronic liver disease
Authors: Kramer Herbert J
Published: December 2008

Besides intrarenal physical factors and aldosterone, a natriuretic hormone has been postulated to modulate renal tubular sodium resorption in order to maintain body fluid homeostasis. To investigate the possible role of a natriuretic activity in sodium retention of chronic liver disease, the effects of plasma and plasma fraction IV from patients with cirrhosis of the liver and ascites on sodium transport of the isolated frog skin and on renal sodium excretion in the rat were compared to the antinatriferic and natriuretic effects of plasma from healthy subjects. While plasma from healthy individuals obtained following acute expansion of the extracellular fluid volume (ECV) significantly inhibited potential difference (PD) by -43·8 ± 5·5% and short circuit current (SCC) by -41·3 ± 1·7% when applied to the inner skin surface, control plasma and plasma from patients with liver cirrhosis and ascites affected PD by -3·8 ± 4·7% and -5·2 ± 3·7% and SCC by -7·3 ± 4·6% and -11·7 ± 2·5% respectively.

Similar effects on PD and SCC were observed with plasma fractions IV.

In contrast to fraction IV from ECV-expanded individuals, which caused marked diuresis and natriuresis when injected in the rat, fraction IV of plasma from cirrhotic patients failed to affect urinary flow rate, free-water clearance or renal sodium excretion. The results suggest that at least some patients with cirrhosis of the liver and sodium retention may lack an adequate humoral natriuretic activity sufficiently to promote renal sodium excretion.
Discussion
Authors: de Wardener H E
Published: December 2008

Professor W. Andrews (London): I’m going to toss in a few more pieces of jig-saw and hope that the speakers will be able to fit things into this fascinating picture. For instance, volume receptors have been found in both the mesenteric vein and the liver. Recently—though not yet published—it has been shown that some hepatic nerves are susceptible to changes in osmotic pressure (large molecules only) within the physiological range, although they are not affected by changes in ionic pressure. Some other receptors, reported by certain authors to be osmoreceptors, are in fact specific sodium receptors and are only stimulated by changes in sodium concentration relative to other ions present.
Discussion
Authors: de Wardener H E
Published: December 2008

Dr J. Libman (London): In what percentage of cirrhotic patients can the ascites be controlled by spironolactone alone? If spironolactone is not sufficiently effective is there any point in adding another distal diuretic such as amiloride?
Renal tubular acidosis in chronic liver disease
Authors: Golding Peter L
Published: December 2008

Renal tubular acidosis of the gradient or classic type, thought to be due to a disorder of the distal tubule, has been found to occur in 32% of 117 patients with chronic liver disease. Whilst the cause of this disorder is probably multifactorial, immunological mechanisms are considered to play a major role. The presence of this disorder might well be a cause, rather than the result of, the various electrolyte abnormalities seen in patients with chronic liver disease.
The Rhodiascit system—individual response to reinfusion possibly related to angiotensin sensitivity. Preliminary results
Authors: Van Waes L , Schurgers M , Demeulenaere L
Published: December 2008

Results are reported of the effect of ascites reinfusion with concentration in seventeen patients. Complications were few and best results were obtained when the patient was also given frusemide during the reinfusion. The diuretic response to the reinfusion appeared to be determined by the pre-existing sensitivity of the circulation to intravenously administered angiotensin.
Clinical experience with the Rhône-Poulenc ascites reinfusion apparatus
Authors: Moult P J A , Parbhoo S P , Sherlock S
Published: December 2008

Ascitic ultrafiltration and reinfusion of protein concentrate is of value in selected patients and is, in general, well tolerated. Patients with massive ascites and an unsatisfactory response to diuretic therapy are most suitable, but those with ascitic infection, pulmonary oedema, and terminal liver disease are excluded. Although two of our patients had malignant ascites, reinfusion is not recommended for such patients.

Persistent pulmonary oedema was a contributory cause of death in two patients, and was attributed to reinfusion. Intraperitoneal haemorrhage may occur from a perforated collateral vein and close observation of patients must be continued after the peritoneal catheter has been removed.

A clogged ultrafilter was cleared with urokinase, and further studies of this are indicated.

After ultrafiltration about half the patients were satisfactorily controlled with diuretic drugs, although there is no evidence that reinfusion produces a sustained improvement in diuretic responsiveness.
Concentration-reinfusion (CR) of ascitic fluid in the treatment of decompensated liver cirrhosis with diuretic-resistant ascites
Authors: Ventura E , Zeneroli M L
Published: December 2008

The ascites concentration-reinfusion as current therapeutic procedure is probably too expensive (but less expensive than desalinated human albumin) and in our opinion it is not a substitute for the diuretic drugs in diuretic-responsive ascites.

On the other hand, this method plays an important role in the management of diuretic-resistant ascites. The mechanical extraction of the sequestered fluid and the infusion of a concentrated derivative into the blood stream beyond the portal blockade aim to restore the ‘effective’ blood volume, renal perfusion and GFR. This effect may induce a new responsive state of the kidney to diuretic drugs and may correct the functional renal failure.

In addition, a well concentrated ascites supplies autologous proteins to those patients with gross abnormalities of serum protein concentrations.
Infectious diseases: fortieth and final annual review of significant publications
Authors: Reimann Hobart A
Published: December 2008

According to recent comment, the importance of infections and the interest in them have reached a nadir.1 But, by reviewing these Reviews published annually since 1935, infectious diseases actually have increased in importance, if not in interest. For example, the death rate from infections is about the same now as it was in 1935, but depends upon different causal microbes. Some diseases have almost disappeared only to be replaced by others. Great advances in the knowledge of viral infections, microbic biology and immunology; the multiplicity of vaccines and antimicrobic drugs, their proper use and limited value; the unceasing resurgence of epidemics; the rising incidence of iatrogenic and nosocomial infections; and the recognition of exotic diseases imported from persistent endemic areas are largely beyond the grasp of generalist physicians and surgeons. They require specialized knowledge and undiminished interest.
L-dopa and carbidopa (sinemet) in the management of parkinsonism
Authors: Critchley Edmund
Published: December 2008

Parkinsonism is a degenerative disease. A weakening in the responsiveness to dopamine replacement therapy affects many patients: thus 45% fail to maintain their initial improvement after 2 years’ and 50% after 3 years’ medication. However, by reducing the peripheral and systemic side actions of dopamine through the selective introduction of sinemet, a decarboxylase inhibitor+L-dopa combination, a partial amelioration of as much as 35% at 2 years, or 20% at 3 years, can be achieved. There is evidence, also, that the initial choice of anti-parkinsonian therapy may be critical to the long term prognosis.