bluuebunny/crossref_metadata_2025 huggingface dataset:
Recovery of villous architecture in gluten enteropathy exacerbated by gastro-jejunal anastomosis
Authors: Weir D G
Published: December 2008

Two patients are described whose clinical condition deteriorated following gastric surgery for peptic ulceration. Both were demonstrated to be suffering from gluten enteropathy with generalized malabsorption which included lactose.

Following treatment with a gluten-free diet over a 2-year period the jejunal mucosa showed a marked improvement of villous architecture associated with a return of lactose absorption to normal in one patient. This supports the view that following a gastro-jejunal anastomosis the gastric secretion is not itself injurious to the jejunal mucosal structure.
Endocarditis parietalis fibroplastica (Löffler’s disease)
Authors: Jennings R C , Pengelly C D R
Published: December 2008

A case of endocarditis parietalis fibroplastica (Löffler’s disease) is described and the aetiology and pathogenesis briefly discussed. Some of the relevant literature is reviewed.
‘Spontaneous’ rupture of the healthy oesophagus
Authors: Toghill P J , MacGuire C F , Raut P S
Published: December 2008

The clinical features of four cases of ‘spontaneous’ rupture of the oesophagus are described together with the radiological changes.

It is emphasized that the diagnosis often may be made from simple penetrated views of the heart shadow with the patient in the erect position.
The systemic complications of ulcerative colitis
Authors: Watkinson Geoffrey
Published: December 2008

A brief review of some of the systemic lesions of ulcerative colitis has been made.

In 465 patients seen between 1948 and 1963 in Leeds, skin lesions occurred in 6·2%, colitic arthritis in 12·0%, sacro-iliitis in 18% and spondylitis in 6%. Eye lesions developed in 4% and liver disease in 2%.

The significance of some of these lesions has been reviewed.
Subdural haematoma: presentation and diagnosis on medical wards
Authors: Walker M E , Espir Michael , Shephard R H
Published: December 2008

The twenty-two adult patients with subacute and chronic subdural haematoma seen in Leicester during the last 7 years have been reviewed. The clinical manifestations and results of investigations are described. The diagnostic difficulties which may confront physicians are discussed, with special reference to cases with no history of head injury masquerading as strokes. Stress is laid on the points which help with the differentiation.
Repeated samples of fat obtained with a biopsy needle
Authors: Hunter C G , Kendrick R R
Published: December 2008

Repeated samples of fat obtained with a biopsy needle have on analyses led to an understanding of the pharmacodynamics of the organochlorine compound dieldrin in man.
Criteria for distinguishing normal and subnormal adrenocortical function using the Synacthen test
Authors: Greig W R , Boyle J A , Maxwell J D , Lindsay R M , Browning Margaret C K
Published: December 2008

The Synacthen test consists of the measurement of plasma corticosteroid concentrations by a fluorimetric method before (basal) and 30 min after a single intramuscular administration of 250 μg of tetracosactrin (Synacthen), a synthetic polypeptide with ACTH activity equivalent to that of natural corticotrophin.

In a control group of forty-five subjects the basal plasma corticosteroid level was not lower than 6 μg/100 ml (a lower limit of 5 μg/100 ml is accepted in the afternoon and evening), the increment was not less than 7 μg/100 ml and the plasma corticosteroid concentration after Synacthen was not less than 18 μg/100 ml. From these results the ‘6 (5), 7, 18’ rule was formulated and any patient who failed to satisfy at least two of these criteria was considered to have adrenocortical insufficiency.

The results of the Synacthen test were assessed in forty-six patients who had received long-term steroid therapy, and in fifteen patients with suspected or proven pituitary failure or Addison’s disease. Using the ‘6 (5), 7, 18’ rule patients who satisfied two or more of the criteria were considered as having normal adrenal function, while patients who failed to satisfy these criteria were diagnosed as having adrenal insufficiency. This separation of patients into those with normal and subnormal adrenal function on the basis of the Synacthen test results was found to be reliable as the same division was obtained when the corticotrophin infusion test was performed on groups of the same patients.

The Synacthen test was also carried out in a group of eighty ill patients who did not appear clinically to have endocrine disease and it was considered that the criteria previously determined for distinguishing between a normal and subnormal response to Synacthen were also applicable to this group of patients.

It is suggested that using these criteria the Synacthen test is a simple and reliable screening procedure for the detection or exclusion of adrenocortical failure. A total of 215 tests were carried out on 186 patients without any adverse effects.
Herpes encephalitis
Authors: Dudgeon J A
Published: December 2008

Herpes simplex infection of the CNS may occur as part of a generalized infection with visceral involvement or with the CNS alone involved. Aseptic meningitis due to herpes simplex is rare, but necrotizing encephalitis is being recognized with increasing frequency.

The distribution of lesions within the CNS and the mode of spread to and within the CNS are discussed.

Serological tests indicate that some cases are due to primary infection and others due to re-activation.

The importance of early diagnosis by electron and fluorescence microscopy and virus culture are discussed.

The natural history and pathogenesis of herpes simplex and B virus are discussed.
Reduction of excessive haematocrit levels in patients with polycythaemia due to hypoxic lung disesae by phenylhydrazine hydrochloride and pyrimethamine
Authors: Pengelly C D R
Published: December 2008

A series of fourteen patients with polycythaemia due to hypoxic lung disease has been treated with a combination of phenylhydrazine hydrochloride and pyrimethamine to reduce the haematocrit level, with doses usually of up to 100 mg/day (and rarely up to 150 mg/day) of the former and never more than 12·5 mg/day of the latter.

Successful reduction of the haematocrit level was achieved in every case without any significant thrombocytopenia, the lowest level ever occurring being 100,000 platelets/mm3 in two patients.

All the patients were improved symptomatically.
Uveitis: report of a 5-year survey
Authors: James D Geraint , Bowden P M A , Friedmann A I , Bowden A N , Fleck D G
Published: December 2008

During the first 5 years (1963-67) of a new Medical Ophthalmology Unit, 204 of the 1700 admissions had endogenous uveitis. It was anterior in 141 (70%), posterior in thirty-three (16%) and generalized in thirty (14%).

Acute uveitis in ninety-seven patients ended in the course of months whereas chronic uveitis in 107 was measured over the years, punctuated by relapses.

Sex distribution was equal, and the age at apparent onset of the first incident was evenly spaced in the third to sixth decades, with a mean age of 39 years (range 6-77). Uveitis, observed in twenty children of either sex, was more commonly posterior and chronic.

Clinical accompaniments of adult uveitis include rheumatoid arthritis, ankylosing spondylitis, respiratory infections, toxoplasmosis, sarcoidosis and helminth infestations in that order of frequency. No accompanying abnormality could be detected by clinical examination, radiology, haematology or other investigations in ninety-two (45%) patients.

It seems that widely cast investigative routines are not worthwhile in view of this poor return, and that instead, a few tests, selected by the clinico-radiological circumstances, might be equally fruitful. For instance, the Kveim-Siltzbach test is helpful in delineating sarcoid uveitis and the toxoplasma dye test in defining one form of posterior uveitis. In this series, the toxoplasma dye test titre was positive significantly more often in posterior than in anterior uveitis, and this was more evident in Negroes rather than Caucasians. Three-quarters of Negroes with choroiditis had toxoplasma dye test titres of 1: 16 and above.
Pre-peritoneal prosthetic herniorraphy
Authors: Tinckler Laurence F
Published: December 2008

The usual operations for inguinal hernia suffer from a number of undesirable features, which are briefly discussed.

A new operation is described, in which the sites for potential herniation are protected with a synthetic prosthesis, as in Usher’s method of incisional herniorrhaphy (1962).
Controversy on iron needs, intake levels, deficiency stigmata and benefits from iron supplementation
Authors: Walker Alexander R P
Published: December 2008

At present there is considerable controversy over many aspects of iron nutrition, including: (1) iron needs and intake levels; (2) the bearing of iron intake on haematological levels; (3) iron deficiency anaemia and deficiency stigmata; and (4) iron therapy, prophylaxis, and the haematological and clinical benefits accruing.

Differences of opinion prevail because of inadequacies of knowledge of the level of haemoglobin (or other parameter of iron status) below which unequivocal signs and symptoms of ill-health become manifest in the major proportion of those affected. Difficulties arise equally from lack of knowledge of the level of haemoglobin above which no clinical benefit, short-term or long-term, can be detected from iron supplementation.

Clarification of the situation can be obtained only by carrying out the same meticulous and time-consuming procedures that have been used in respect of requirements and deficiency stigmata of other nutrients. Comprehensive iron depletion studies, real and simulated, and repletion studies, including the use of placebos, will be required.

Epidemiological investigations bearing on haematological status and morbidity will also need to be undertaken, and include groups of subjects in both Western, and developing countries.
Combined carbenicillin and gentamicin for prophylaxis of post-operative infection following major abdominal surgery
Authors: Bloom S R
Published: December 2008

Bacteriological studies with carbenicillin and gentamicin individually and with the combination of these antibiotics suggest their effect to be additive in action and often synergistic. Of sixty-five organisms tested in vitro, the majority Gram-negative, forty-seven were resistant to ampicillin, thirty-seven to carbenicillin, twenty-four to gentamicin and only six to carbenicillin plus gentamicin.

Out of sixty-seven patients undergoing major abdominal surgery, thirty were randomly allocated to receive carbenicillin plus gentamicin post-operatively and of these one developed an infection. The other thirty-seven patients received either ampicillin or no antibiotic and nine developed infections.

The combined antibiotic regime seems suitable for prophylaxis for patients undergoing major abdominal surgery with a high risk of infection.
The radiology of small bowel lesions
Authors: Craig Oscar
Published: December 2008

The techniques of radiological examination of the small bowel are considered.

The importance of the routine barium meal and follow-through examination is stressed.

The vast majority of lesions present a diagnostic problem in interpretation rather than in detection.

Some examples of small bowel pathology are discussed and the need for interpretation in the light of the clinical picture is emphasized.

Important radiological signs to be appreciated are considered.
Experimental studies on intra-abdominal adhesions
Authors: Iijima Noboru , Inoue Kichi , Yamamoto Takashi , Gomi Fujiko
Published: December 2008

Various intra-abdominal adhesions have been produced in rats and mice.

Those animals given an intra-peritoneal injection of protoporphyrin showed a reduction of adhesion formation.

Its mechanism has been discussed in view of Ellis’s concept.

It seems to be appropriate to use PPN for patients who may develop post-operative adhesions.
The hazard of electrocution during patient monitoring
Authors: Lee W R
Published: December 2008

The ever-present hazard in patient monitoring is electrocution resulting in ventricular fibrillation. Fire and explosion hazards are possibilities but seem to be very remote.

Iatrogenic electrocution can occur when:

(a) more than one piece of electrical equipment is connected to the patient.

(b) the distal end of an intracardiac electrode is handled.

(c) pericardiocentesis is carried out with ECG monitoring,

Under these circumstances, small currents, of the order of 100-200 μA, may cause ventricular fibrillation. There is evidence that the ventricular fibrillation threshold is substantially lowered by anoxia and acidosis but it seems to be unaffected by barbiturate anaesthesia.

This paper suggests that the physician or surgeon should understand the risks but may need the expert advice of an electrical engineer. Ventricular fibrillation which has occurred under these circumstances requires careful, expert investigation to establish whether or not it was electrically induced.
Aminoglutethimide: a ‘side-effect’ turned to therapeutic advantage
Authors: Hughes S W M , Burley D M
Published: December 2008

Aminoglutethimide was introduced as an anti-convulsant drug in the U.S.A. in 1960.

The occurrence of a number of side-effects, including several endocrine effects such as goitrogenesis, sexual precocity and virilization, led to its withdrawal.

Further investigation indicated that the drug inhibited adrenal biosynthesis, particularly of aldosterone, cortisol and androgens, probably by interfering with the conversion of cholesterol to delta-5-pregnenolone.

Aminoglutethimide has also been shown to modify the extra-adrenal metabolism of cortisol.

The possible clinical applications of these ‘side-effects’ are discussed.
Mass detection of bacteriuria by combination of two screening tests
Authors: Papanayiotou P , Papanayiotou K , Dontas A S , Marketos S G
Published: December 2008

The Uriglox screening test was compared with the modified Griess Nitrite test and with standard urine cultures in the detection of significant bacteriuria on 400 ambulant and asymptomatic residents of the Athens Home for the Aged. The modified Nitrite test alone detected 62%, and the Uriglox test 79% of the 103 cases with positive urine cultures in the examined group. There was significant overlap in the positive cases picked up by each screening test separately, the Uriglox test identifying more Klebsiella infections. Since there were no false-positive cases with either one of the employed tests, the cases identified by one or the other or both screening tests amounted to 95% of the total number of bacteriuric samples. The combination of the moderately sensitive but highly specific test of Nitrite, with the very sensitive test of Uriglox, can effectively substitute for the expensive and time-consuming quantitative bacterial counts with pour-plate techniques in mass screening for bacteriuria.
Definition of sarcoidosis
Authors: Scadding J G
Published: December 2008

The concept of sarcoidosis as a systemic disease arose from the recognition that certain clinical phenomena which were at first described as ‘diseases’ affecting a number of different organs and tissues had in common (i) a histological pattern which can be described in general terms as a non-caseating tuberculoid granuloma and (ii) possible concurrence in the same patient in various combinations. These two features constitute the basis for a workable definition:

Sarcoidosis is a disease characterized by the presence in all of several affected organs or tissues of epithelioid cell tubercles, without caseation though some fibrinoid necrosis may be present at the centres of a few tubercles, proceeding either to resolution or to hyaline fibrosis.

Because knowledge of the causation of sarcoidosis is fragmentary, investigators must be left free to examine every possible aetiological hypothesis. For this reason, the definition should contain no reference to aetiology.
Frequency of disordered calcium metabolism in sarcoidosis
Authors: Israel Harold L , Goldstein Robert A
Published: December 2008

A prospective study of total and ultrafiltrable serum calcium levels in 121 patients with sarcoidosis and thirty-eight control subjects revealed no significant differences. Two patients had hypercalcaemia (11·6 and 12·2 mg%) at the time of initial sampling; one spontaneously returned to normal. Retrospective analysis of 318 cases previously studied demonstrated persistent hypercalcaemia in eight of 262 negroes and two of fifty-six whites, with a male to female ratio of seven to three.

Serial calcium measurements in thirty-four patients and single determinations in eighty-seven patients taken during the course of 1 year failed to show seasonal fluctuation.

These observations suggest that calcium metabolism is normal in most patients with sarcoidosis. When persistent hypercalcaemia is found in a patient with sarcoidosis, careful study for associated hyperparathyroidism is essential, especially if the sarcoidosis is otherwise asymptomatic or inactive.
The Kveim test in leprosy
Authors: Rees R J W
Published: December 2008

From the older literature it has been claimed that a significant proportion of patients with the tuberculoid, but not the lepromatous, form of the disease, gave positive Kveim reactions. It is concluded, however, from a review of this older literature that none of the claims are based on studies using a validated Kveim antigen and that the majority of the readings were based on macroscopic, rather than microscopic assessment.

The International Study by Siltzbach on Kveim tests in leprosy patients using a validated antigen and assessed microscopically reveal no positive reactions among fifty-seven patients with all types of leprosy from Finland, Israel, Italy and Turkey. However, this same study on Japanese patients gave two positive and five equivocal Kveim reactions among ten lepromatous patients and one equivocal reaction among three tuberculoid patients. Our own studies in Malaysia with the same validated Kveim antigen used by Siltzbach and assessed microscopically gave one weak positive Kveim reaction among twenty-one lepromatous patients and four equivocal Kveim reactions among nine tuberculoid patients.

It is concluded from these results that, with the possible exception of Chinese and Japanese patients, false positive Kveim reactions are extremely rare in patients with all types of leprosy. Therefore in parts of the world where leprosy is endemic the Kveim reaction can still be accepted as an important confirmatory diagnostic test for sarcoidosis.

It is suggested that further surveys of Kveim reactivity be undertaken on Chinese and Japanese leprosy patients, since both have a similar ethnic origin, in order to determine whether such patients are more liable to elicit a granulomatous reaction to Kveim antigen.
The Kveim test in Crohn’s disease
Authors: Mitchell D N , Dyer N C , Cannon P , Hinson K F W , Willoughby J M T
Published: December 2008

Kveim tests were done in forty-eight patients with Crohn’s disease. Of forty-five with definite or probable Crohn’s disease, twenty-three had a positive Kveim test. This finding could be explained:

(1) By cross-reactivity between sarcoidosis and Crohn’s disease antigens;

(2) By an aetiological agent common to the two diseases, or

(3) By a property of the Kveim test material used in testing.
Renal involvement in sarcoidosis
Authors: Lebacq E , Verhaegen H , Desmet V
Published: December 2008

Among 152 sarcoidosis patients, 11% had hypercalcaemia, 62% had hypercalciuria and 13·8% had at least one renal stone. Impairment of renal function was mostly conspicuous in patients with hypercalcaemia. Twenty-five successful percutaneous renal biopsies were performed. Epithelioid granulomas were seen in ten cases, with inflammatory reaction more prominent than in other organs involved by sarcoidosis, due to simultaneous pyelonephritis. Thickening and hyalinization of capsular membrane and glomeruli as well as arterial walls were frequently encountered. Amyloid deposits could be seen in one case with chronic lung infection. Histopathological changes specific of sarcoidosis are related to an abnormal amount of serum gammaglobulins and calciuria exceeding 200 mg in 24 hr, which seem to be the best tests of involvement by the disease.

Tubular reabsorption of calcium was low in two patients with hypercalciuria, which was corrected after corticosteroid treatment.

High intestinal calcium absorption was lowered after hydrochlorothiazide had decreased urine calcium.
The tragedy of viral diagnosis
Authors: Herrmann Ernest C
Published: December 2008

The shortcomings of the methods commonly recommended for the diagnosis of viral infections are emphasized.

Most of them are laborious and expensive, and are of very little practical value to the clinician.

Nine years’ experience has confirmed that the use of a single swab, obtained during the acute stage of the illness, for bacterial culture and viral isolation (looking for cytopathic effects or haemadsorption) provides the diagnosis quickly in the great majority of viral infections.
A 2-year study of the efficacy and tolerability of prenylamine in the treatment of angina pectoris
Authors: Cardoe Neil
Published: December 2008

Twelve out-patients with established angina pectoris who had previously participated in a double-blind trial of prenylamine lactate continued to record their daily anginal attack rate and glyceryl trinitrate consumption over the subsequent 18 months. The improvement noted while taking prenylamine during the trial was maintained and a further double-blind study confirmed that this was, in fact, due to the administration of the drug, which was again shown to be significantly more effective than identical placebo in the prophylaxis of angina pectoris.
Experiences of intensive coronary care in a regional hospital
Authors: McAllen P M
Published: December 2008

Seven hundred and twenty-one patients were admitted during 22 months. Recent myocardial infarction was confirmed in 518. In this group, 115 (22%) died in hospital and 33 (6%) were resuscitated and left hospital alive. Prophylactic measures probably prevented cardiac arrest in a number of patients and contributed to lowering the mortality rate. Other factors influencing cardiac arrest and death were sex, age, time after onset of infarction and ECG pattern. Anticoagulants had no influence. The clinical presentation was most varied and several difficult diagnostic patterns are described.
Some mental symptoms in neurology
Authors: Behrman Simon
Published: December 2008

Cases are presented in which cerebral disease was associated with schizophrenic-like or manic-depressive-like psychoses, anxiety or obsessional states i.e. psychiatric disorders usually classed as ‘functional’.

Evidence is presented to suggest that this association is not due to chance.

The cerebral structural changes are characterized either by the presence of ‘focal’ lesions, e.g. multiple sclerosis, or by neuronal loss e.g. Huntington’s chorea. The probable mechanisms whereby these two types of structural changes effect psychiatric disturbances are discussed.

It is inferred that psychiatric disturbances will occur insofar as these cerebral structural changes exert an influence on the limbic systems.
Reasons against referral to the psychiatrist
Authors: Mezey Alex G , Kellett John M
Published: December 2008

Consultants practising clinical specialties other than psychiatry in six general hospitals were asked by questionnaire about reasons which might prevent the referral of patients to a psychiatrist. The purpose of the enquiry was to find out the causes of the discrepancy between the prevalence of psychiatric disorder among medical and surgical patients and the low rate of referral.

Forty-five per cent of the consultants were influenced by the patient’s dislike of referral; there was also evidence of marked dissatisfaction with existing psychiatric services at certain hospitals, felt chiefly by the younger consultants. Part-time consultants gave more reasons for non-referral, but there was no significant difference between medical and surgical specialties despite reported variations in referral practice.

It is concluded that general hospital psychiatric units have a role to play in improving the relationship between psychiatrists and other specialties so that referral practice can meet the needs of the patient.
Comparison of propranolol and LB 46 (prinodolol) on hyperthyroid tachycardia
Authors: Arbab A G , Turner P
Published: December 2008

LB 46 (prinodolol) a β-adrenergic receptor blocking drug which is more potent than propranolol in euthyroid subjects, is less effective in inhibiting hyperthyroid tachycardia. This is probably due to its intrinsic sympathomimetic activity.
Psychiatry in a postgraduate teaching hospital
Authors: Abrahamson David
Published: December 2008

A study is presented of 217 adults referred for psychiatric assessment from the wards of a postgraduate teaching hospital.

The pattern of referral and the disproportionate importance of disturbed behaviour amongst referrals from non-medical wards are discussed. The main diagnostic groups, namely, affective disorders, organic states, psychogenic somatic symptoms and attempted suicide, are tabulated and discussed. Complex problems of diagnosis and management were common and are considered under five headings: multiple pathology; the effects of intensive treatment procedures; language and cultural differences, and difficulties in follow-up.

It is concluded that the problems met in this specialized setting are likely to become general as intensive treatment and diagnostic procedures become more widespread.

The importance of organic reactions is stressed and their relative neglect by both psychiatrists and physicians commented on. The frequency of social precipitants of affective disorders and attempted suicide, however, is considered to emphasize the range of activities required of the psychiatrist in even the most technologically advanced centres.
The musculo-skeletal features of hypothyroidism
Authors: Golding Douglas N
Published: December 2008

Patients with hypothyroidism may present in rheumatism departments with muscle pain and weakness, acroparaesthesiae or less commonly definite myopathy. Osteolytic lesions are rare and require further study.
Radiological changes in hepatic amoebiasis
Authors: Ramachandran S , Jayawardena D L N , Perumal J R A
Published: December 2008

Radiological abnormalities were observed in 88·3% of patients with the syndrome of hepatic amoebiasis. While this figure is higher than those reported in previous studies, it appears that it is due to the large number of patients who showed an elevation of the diaphragm in the right lateral views of the chest. It was observed that a proportion of the patients with an elevation of the right dome of the diaphragm in the lateral views showed no significant elevation in the postero-anterior views, these patients constituting a radiologically distinct group. It is thus important that lateral views of the chest should be performed routinely in all cases of suspected hepatic amoebiasis.

Cases of proved hepatic abscesses also conform to one or other of the radiological groups described. Abscesses situated inferiorly or anteriorly in the liver could be associated with an elevation of the right dome of the diaphragm.

While chest radiology is of importance in the diagnosis of the syndrome of hepatic amoebiasis, it is not peculiar to this syndrome alone and is of only relative diagnostic value in clinically differentiating the cases where pus may be demonstrated from the cases where pus may not be demonstrable.
Myocardial infarction during pregnancy: report of two cases with a review of the literature
Authors: Husaini M H
Published: December 2008

Two further cases of myocardial infarction during pregnancy are reported.

From the review of the literature of forty-three cases of myocardial infarction during pregnancy and labour, it appears that myocardial infarction in the last trimester and labour is frequently fatal.

Short-term anticoagulant therapy to suppress any thrombo-embolic tendency is desirable.

Termination of pregnancy is indicated for patients in cardiac failure or persistent angina. For patients who are well, either assisted vaginal delivery or Caesarean section are equally good.
Tuberculin sensitivity in tuberculosis
Authors: Scadding J G
Published: December 2008

It is generally accepted that patients suffering from Mycobacterium tuberculosis infections show positive tuberculin skin tests, with certain rare exceptions. Recognized causes of these exceptions include extreme illness, whether due to extensive tuberculosis or to other severe disease, and certain viral infections, notably measles. It is not so generally recognized that a few patients with pulmonary tuberculosis, generally of rather indolent type, who are not acutely ill, persistently fail to react to tuberculin; and that the range of tuberculin sensitivity observed in patients with the more usual forms of tuberculosis is very wide.

The effect of cortisone in diminishing the size of tuberculin reactions in patients with pulmonary tuberculosis is directly related to the degree of sensitivity; reactions produced by small doses of tuberculin in patients with high sensitivity are greatly diminished or inhibited, while those produced by 100 T.U. in patients with low sensitivity are not significantly altered. Patients with tuberculosis can be desensitized to tuberculin by increasing injections of tuberculin under chemotherapy cover. In patients who have been so desensitized, the addition of cortisone to tuberculin in an intradermal test produces positive reactions in 70%. Among patients with sarcoidosis giving no reaction to 100 T.U., about half react when cortisone is added.

These observations show that in patients with sarcoidosis, a negative tuberculin test cannot be taken to exclude M. tuberculosis infection.
Tuberculous cervical lymphadenopathy
Authors: Newcombe J F
Published: December 2008

Forty-five cases of tuberculous cervical lymphadenopathy have been treated by a combination of early surgery and long-term chemotherapy. The majority of these patients have been immigrants of Asiatic origin.

The posterior cervical group of nodes has been the most commonly involved. The site of primary infection was not identified.

Histological examination of biopsy material proved the most reliable diagnostic method.

Possible alternative methods of managing these cases are discussed.
Myocardial involvement in infectious hepatitis
Authors: Nagaratnam N , De Silva D P K M , Gunawardene K R W
Published: December 2008

Four cases with myocarditis due to infectious hepatitis are described. Infectious hepatitis, though it pre-dominantly affects the liver could be a disseminated illness and myocarditis, usually benign, could be a serious complication as in one of the cases in this series.
Clinical experience with metolazone in fifty-two African patients: synergy with frusemide
Authors: Gunstone R F , Shani H G P , Njemo D , Wing A J , Sabuka E M W
Published: December 2008

The use of metolazone (Zaroxolyn), a new diuretic, in fifty-two African patients is described. The drug was found to be safe and moderately effective when used alone, but combined with frusemide it proved to be of great value in patients whose fluid retention was refractory to other diuretics.
Cysts of the menisci of the knee
Authors: Raine G E T , Gonet L C L
Published: December 2008

A review of a series of 249 consecutive meniscectomies reveals an overall incidence of cysts of the menisci of 20%. Trauma in younger patients, and degeneration in older patients, appear to be causal factors.
Minimal dose of histamine for maximal acid secretion in control subjects and patients with duodenal ulcerPart of the work was supported by a grant from TNMC and BYL Nair Charitable Hospital Research Society.
Authors: Desai H G , Zaveri M P , Antia F P
Published: December 2008

Dose-response curves were obtained from forty adult male control subjects and forty patients with duodenal ulcer by administering 1·6, 2·0, 2·4, 2·8, 3·2-mg doses of histamine acid phosphate (HAP) subcutaneously.

The results showed that the minimal dose of HAP for MAO for patients with duodenal ulcer was significantly greater than that required for control subjects.

A significant positive correlation between the minimal dose of HAP, independent of body weight, for MAO and the maximal acid secretory capacity of an individual was observed both in control subjects and patients with duodenal ulcer.
Body weight and maximal acid outputPart of the work was supported by a grant from TNMC and BYL Nair Charitable Hospital Research Society.
Authors: Desai H G , Zaveri M P , Antia F P
Published: December 2008

Dose-response curves were obtained from forty male control subjects and forty male patients with duodenal ulcer from India on the subcutaneous histamine test.

The body weight and maximal acid output (MAO) showed a positive correlation just significant at the 5% level in control subjects (P=0·05) but not in patients with duodenal ulcer.

The values of MAO on dose-response curves are comparable in control subjects but are appreciably lower in patients with duodenal ulcer from India compared with those from Britain and North America. However, the values expressed as μEq/kg body weight are considerably higher in both groups of subjects from India compared with those from western populations.
Analgesia for the dressing of burns in children: a method using neuroleptanalgesia and Entonox
Authors: Baskett P J F
Published: December 2008

The use of neuroleptanalgesia combined with Entonox for burns dressing in children is described.

The combination has proved satisfactory on forty-nine occasions.

There has been no evidence of respiratory depression.
Biochemical changes in burned patients
Authors: Hinton Pamela
Published: December 2008

Some of the biochemical changes that may occur after severe burns are described.

Not all of them require active therapy, and attempts to correct them may be more harmful than beneficial to the patient.
Problems of anaesthesia in the burnt child
Authors: Bush Gordon H
Published: December 2008

The problems of providing satisfactory anaesthesia for the burnt child, both in the initial treatment, in repeated dressings and in the correction of subsequent deformities are discussed, and the dangers and complications of general anaesthesia emphasized.
General anaesthesia in the adult burned patient
Authors: Howie Constance C M
Published: December 2008

Every burned patient must be given adequate relief of pain during repeated dressings, and this demands both a skilled anaesthetist and a suitable technique.

The problems arising during general anaesthesia in burned patients are discussed.
Giant gas-filled cyst of sigmoid colon. Report of a case and review of the literature
Authors: Sibson D E , Edwards A J
Published: December 2008

The largest recorded gas-filled cyst of the sigmoid colon, in a man of 67, is presented. The literature of the other recorded cases is reviewed. The gas in the cyst was analysed and a suggestion put forward that bacteria play some part in the aetiology of the gas in the cyst.
Antazoline in the treatment of cardiac arrhythmias
Authors: Shah S S , Vaidya C H , Doshi H V
Published: December 2008

Antazoline was administered in sixty-five episodes of various types of cardiac arrhythmia.

A complete suppression of the ectopic beats was achieved in five out of six episodes of premature atrial systoles and in twenty-one of the twenty-four episodes of ventricular premature systoles.

Conversion to sinus rhythm was observed in seven out of ten and four out of five episodes of paroxysmal atrial and nodal tachycardia respectively.

Six out of ten episodes of ventricular tachycardia were controlled by intravenous therapy. However, the drug proved to be ineffective in cases of atrial fibrillation.

The side-effects were few and transitory, consisting of nausea, vomiting and drowsiness.
Lactic acidosis occurring during phenformin therapy
Authors: Tomkins A M , Jones R , Bloom Arnold
Published: December 2008

A case of severe lactic acidosis is described in a diabetic taking phenformin who was otherwise healthy. Substitution of metformin for phenformin did not lead to a recurrence of the lactic acidosis.
Six cases of poisoning after a parenteral organic mercurial compound (Merthiolate)
Authors: Axton J H M
Published: December 2008

The case histories of four children and two adults who were accidentally given toxic amounts of Merthiolate are recorded. The possible modes of action of Merthiolate in causing symptoms are discussed.

Five out of the six patients died, and necropsy showed extensive renal tubular necrosis in each case, and in two, evidence of diffuse intravascular coagulation.
Cardio-thoracic ratio in Negroes in Southern Africa
Authors: Walker Alexander R P , Richardson B D , Wadvalla M , Walker B F
Published: December 2008

Negro groups in West, Central and Southern Africa, also in Jamaica, have mean cardio-thoracic ratios significantly greater than those in corresponding age-sex groups of Caucasians.

To throw more light on the situation, studies on young and elderly Negroes have been made in certain groups in Southern Africa, also on local Caucasian groups. Only slight differences in ratio were found between local Negro groups, and Caucasian groups in South Africa, also in Wales and Tecumseh (U.S.A.). Yet ratios in Negro males from Malawi and Mozambique, resident in South Africa, were significantly greater than values in local Negroes. High ratios are not therefore invariable for Negroes. The difference observed relates to heart, not thoracic diameter. Since the phenomenon, which concerns heart position, is apparent in the young, almost certainly it is of ethnic origin. Investigations on cardiomegaly in African populations must take this factor into reckoning. Its presence or absence locally may readily be assessed by determining ratios in relatively small numbers of young people of both sexes.
Arteriosclerosis, amputation and peptic ulcer
Authors: Bouhoutsos J , Barabas A P , Martin Peter
Published: December 2008

In a series of 400 consecutive patients with arteriosclerosis seen in two peripheral vascular clinics, we confirm the previously reported association with peptic ulcer. The incidence was almost 25% both in patients with occlusive disease (300) and with aneurysm (100). The accepted expectation of peptic ulcer in the same age-group is 6 or 7% (Jones, Kirk & Bloor, 1970; McManus, 1966).

Patients with peptic ulcer, or the history of one, had a significantly higher amputation rate than those without a peptic ulcer.
Pleural effusion in relapsing pancreatitis
Authors: Manns J J
Published: December 2008

A case of relapsing pancreatitis complicated by massive pleural effusion is described and the difficulties in confirming the diagnosis are illustrated. The possibility of a pancreatic encephalopathy is also considered.
Successful resection of mycotic aneurysm of the superior mesenteric artery
Authors: Kumana C R , Foley R J E
Published: December 2008

A patient with subacute bacterial endocarditis is presented in whom an intra-abdominal mycotic aneurysm was diagnosed prior to the development of cardiac signs. The patient was successfully treated for his endocarditis and the aneurysm which proved to be arising in a branch of the superior mesenteric artery was resected.
The lack of value of hepato-jugular reflux as a sign of heart failure
Authors: Singh S P , Haider R
Published: December 2008

An investigation was carried out of the diagnostic value of hepato-jugular reflux in patients with heart failure.

The effect of abdominal compression on superior vena cava pressure was assessed in patients with and without heart failure. In four of the six patients without congestive cardiac failure, during compression, whether applied in the right hypochondrium or left iliac fossa, there was a significant rise in vena cava pressure. A similar response was also observed in three patients with congestive heart failure.

Hepato-jugular reflex is not a reliable sign of incipient heart failure.
Ethanol absorption after gastric operations, and in the coeliac syndrome
Authors: Cotton P B , Walker G
Published: December 2008

Rapid absorption of whisky has been demonstrated in subjects who had undergone partial gastrectomy or vagotomy and pyloroplasty. Delayed absorption occurred in patients with the coeliac syndrome. These facts are of social and possibly legal significance.
Colonic motility in man
Authors: Parks T G
Published: December 2008

Studies of the motor activity of the large intestine have led to a better understanding of the normal physiology of this organ. The disturbed patterns which occur in functional and pathological states are easily recorded by modern technology. While of limited use as a diagnostic aid, investigation of the motor activity has contributed significantly to elucidate the aetiology of various disorders of colonic function.
The treatment of jaundice due to liver metastases by quadruple chemotherapy
Authors: Hughes J , Stoker T A M
Published: December 2008

This is a report of seven patients with jaundice due to extensive hepatic secondary deposits, who were treated with combination chemotherapy.

In six cases the jaundice was relieved and biochemical and liver function tests improved.

Three patients survived for 1 year or longer.
The Cronkhite-Canada syndrome
Authors: Cotterill J A , Hughes J P , Day J L , Paulley J W , Turk E
Published: December 2008

The eighteenth patient and seventh survivor with the Cronkhite-Canada syndrome is described. A remission of 9 years followed gastrectomy and steroid therapy. Findings on seventeen other patients described in the literature are reviewed.

The histological features are discussed in detail. The jejunum, though macroscopically normal, showed oedema, increased vascularity and mucous gland secreting activity. The possible importance of this increased vascularity in the aetiology of this syndrome is discussed.
Acute renal failure and lithium intoxication
Authors: Lavender S , Brown J N , Berrill W T
Published: December 2008

A case of acute renal failure is reported in a patient with severe lithium intoxication. Renal biopsy showed damage in the proximal tubules with less marked changes in the glomeruli and interlobular arteries.

Lithium was withdrawn, and after treatment with peritoneal dialysis the patient regained normal renal function.

The accumulation of lithium is known to lead to acute renal failure in the rat and the dog, and this report provides further evidence that it may do so in man.
Accentuation of ichthyosis vulgaris due to associated leprosy
Authors: Shah A P , Shah S S , Doshi H V
Published: December 2008

A case of ichthyosis vulgaris associated with tuberculoid leprosy is reported. Ichthyotic scales were markedly accentuated within the anaesthetic patches of leprosy.

The probable mechanism of the accentuation of ichthyosis by leprosy is discussed.
Abdominal trauma: a report of 129 cases
Authors: Bates T
Published: December 2008

A retrospective study of 129 cases of abdominal trauma admitted to a district general hospital over the 8 years 1964–71 is reported. Road traffic accidents accounted for 60% of the cases and had a much higher mortality than domestic or industrial accidents.

Laparotomy was carried out in eighty-eight patients, but two patients with a ruptured abdominal viscus died without operation because the diagnosis was not recognized.

There were seventy-four cases of renal injury of which thirty-nine were treated conservatively and thirty-four were explored through a laparotomy incision. The indication for urgent operation in every case was the suspicion of an associated intraperitoneal injury and in all but three this was confirmed. Only one injured kidney was explored through the loin after an interval. Nephrectomy was carried out in eight cases (11%).

The commonest finding at laparotomy was rupture of the spleen, of which there were fifty-three cases. Major hepatic injuries and rupture of the duodenum carried a very high mortality. In all four cases of retroperitoneal rupture of the duodenum there was a delay in diagnosis of at least 24 hr due to the late onset of physical signs.

The overall mortality of patients with proved rupture of an abdominal viscus was 17% but in twenty patients (22%) there was a delay in diagnosis and this group carried a 30% mortality.

A diagnostic peritoneal tap was carried out in only fifteen cases, but in nine (60%) gave a false negative result.

The place of diagnostic peritoneal lavage in the management of abdominal trauma is discussed.
Stumbling blocks in the study of diamorphine
Authors: Twycross R G
Published: December 2008

Although the centenary of the discovery of diamorphine is soon to be celebrated, much work remains to be done before its mode of action is thoroughly understood. The main stumbling blocks facing the would-be investigator can be summarized as follows: (1)Diamorphine in solution has a limited shalf-life.(2)The potency ratio of diamorphine to morphine is still a matter of dispute.(3)No basic studies appear to have been carried out on the fate of orally administered diamorphine.(4)Current methods of assay are not sensitive enough to detect diamorphine or its metabolites in serum after the administration of the drug when given in therapeutic amounts.(5)The undersirable side-effects of diamorphine may vary according to posture and mobility.(6)As the metabolic handling of the drug may be different in the two sexes, provision for a between-sex comparison should be included in the design of a clinical trial of diamorphine.
Sjögren's syndrome, dysimmunoglobulinaemia and malignant disease
Authors: Thomas Peter
Published: December 2008

The occurrence of carcinoma in situ in the stomach and dysimmunoglobulinaemia in a patient who had Sjögren's syndrome is described. This is believed to be the first report of such a case to be found in the literature.

Although carcinoma has occasionally been described, in this syndrome its occurrence is probably coincidental and not part of the disease process. There is a greater incidence of lymphoid tumours in Sjögren's syndrome than in the general population. Corticosteroid therapy favourably influenced the immunoglobulin abnormalities and some of the clinical manifestations of the disease.

A brief review of the literature concerning Sjögren's syndrome, auto-immunity and malignant disease is included.
Hypogammaglobulinaemia with Whipple's disease
Authors: Cochran M , Gallagher J C , Cook M G , Peacock M
Published: December 2008

The patient, a 54-year-old housewife, was well until the age of 40 years when she developed repeated infections. During the next 10 years recurrent attacks of diarrhoea also appeared and were associated with weight loss, increased skin pigmentation, and later the occurrence of arthralgia and polyserositis. She was found to have deficiencies of IgG and IgA. A malabsorption syndrome was established and shown to be due to Whipple's disease by jejunal biopsy. She also had hypocalcaemia and osteomalacia. Weekly injections of human gammaglobulin had no effect on either the diarrhoea or the arthralgia, although the severity of respiratory infections was reduced. Intramuscular injections of vitamin D failed to restore the serum calcium to normal. Continuous oral tetracycline was followed by marked symptomatic improvement, disappearance of the diarrhoea and some weight gain. Steatorrhoea however persisted and the jejunal histology showed only slight improvement. The serum calcium returned to normal possibly as a result of correction of a magnesium deficiency. The relevance of the hypogammaglobulinaemia to the Whipple's disease is discussed, and a search of the literature shows six other cases where both disorders were associated.
Pulmonary reaction to furoxone
Authors: Collins J V , Thomas A L
Published: December 2008

A patient is reported in whom an acute pulmonary reaction resulted from the ingestion of Furoxone (furazolidine), a member of the nitrofurantoin group of drugs. A positive lymphocyte transformation test to Furoxone was found. This is thought to suggest that Type IV (Gell & Coombs, 1968) thymus dependent hypersensitivity may be implicated in such pulmonary reactions.