bluuebunny/crossref_metadata_2025 huggingface dataset:
Vasopressin function in familial cranial diabetes insipidus
Authors: Baylis P H , Robertson G L
Published: December 2008

A family suffering from cranial diabetes insipidus, that extends over 4 generations, is described. Inheritance of polyuria was autosomal dominant. Vasopressin function was studied in members of the last 2 generations, 4 of whom had polyuria. Osmoregulation of vasopressin secretion was assessed by infusion of hypertonic saline. Plasma vasopressin remained undetectable in one patient, while 2 others had very blunted vasopressin responses to osmotic stimulation. Three non-osmotic stimuli were applied. Controlled hypotension produced by trimetaphan infusion and insulin-induced hypoglycaemia did not increase plasma vasopressin but apomorphine-induced nausea caused a minimal rise in plasma vasopressin to 0.7 pg/ml. Polyuria and thirst resolved with antidiuretic therapy in all patients studied.

Congenital absence of vasopressin as in Brattleboro rats is unlikely to account for diabetes insipidus in this disorder since small increases in vasopressin have been demonstrated in these patients. In view of previous post-mortem findings, familial cranial diabetes insipidus is most likely to be due to degeneration of vasopressin-synthesizing neurones.
Chlorpropamide-induced haemolytic anaemia
Authors: Saffouri B , Cho J H , Felber N
Published: December 2008

A newly diagnosed diabetic patient, recently started on chlorpropamide, required emergency admission because of sudden onset of weakness and syncope. In vitro testing confirmed the diagnosis of chlorpropamide induced haemolysis, and withdrawal of the drug resulted in clinical recovery.
Carcinoma of the pancreas presenting as mechanical obstruction of the colon
Authors: Tresadern J C
Published: December 2008

This purports to be the first recorded case of carcinoma of the pancreas presenting as a mechanical obstruction of the colon. The literature relating to some other rare modes of presentation is reviewed, and a comment made on the desirability of routine post-mortem studies.
Electrocardiographic changes following a cardiac stab wound. Case report and review of the literature
Authors: Shaw L M A , Lahiri A , Millar-Craig M W
Published: December 2008

A patient is described who sustained a cardiac stab wound which was associated with ECG evidence of a full thickness myocardial infarction. Subsequent investigation showed a localized area of dyskinesia on left ventricular angiography, but normal thallium myocardial perfusion and normal anatomy on coronary angiography. The patient was managed conservatively and made a complete and uneventful recovery. It is concluded that extensive ECG changes following a cardiac stab wound need not be associated with major coronary artery damage.
Poor rectal absorption of trimethoprim/sulphamethoxazole in treating Pneumocystis carinii pneumonia
Authors: Dorr Robert T , Powell J Robert , Heick Meredith , Barry David W
Published: December 2008

A 24-year-old female with Hodgkin’s disease and Pneumocystis carinii pneumonia was tested with trimethoprim/sulphamethoxazole (TMP/SMX) tablets. Because treatment failure was feared owing to chronic emesis potentially resulting in incomplete drug absorption, the same TMP/SMX dose was administered by rectal suppositories after the 5th day of oral dosing. The relative fractions (rectal/oral) or the suppository dose absorbed for TMP and SMX were 3.0% and 19.5% respectively. When TMP/SMX treatment is required and the oral route is not practical, the investigational i.v. preparation should be obtained.
Symptomatic hypopituitarism revealing a primary empty sella turcica
Authors: Velkeniers B , Desir D , Manicourt D , Chanoine F , Dupont M , Copinschi G
Published: December 2008

A 64-year-old nulliparous woman presented with clinical signs of thyroid and adrenocortical insufficiency. Subsequent hormonal investigations demonstrated a failure of all anterior pituitary functions. Pneumotomo-encephalography revealed a large arachnoid herniation, leading to the diagnosis of primary empty sella turcica syndrome with secondary panhypopituitarism. This unusual observation emphasizes the necessity of ruling out an empty sella turcica syndrome in patients with pituitary insufficiency.
Failure of cimetidine to suppress immunoreactive parathyroid hormone and hypercalcaemia in primary hyperparathyroidism
Authors: Mallett Richard B , Sainsbury Richard , Benton Kenneth G F
Published: December 2008

Cimetidine has been reported as suppressing the excess parathyroid hormone secretion and hypercalcaemia seen in hyperparathyroidism. A case of primary hyperparathyroidism is described, in which the level of circulating parathyroid hormone and hypercalcaemia remain entirely unaffected by cimetidine. The drug is implicated in the management of primary hyperparathyroidism unsuitable for surgery, but present evidence, as reviewed, is insufficient to recommend the use of cimetidine in this way.
Tuberculosis after jejuno-ileal bypass for morbid obesity
Authors: Werbin N
Published: December 2008

A patient contracted tuberculosis after 2 operations for morbid obesity. The difficulty in diagnosis and treatment is described. Jejuno-ileal bypass is a non-physiological operation, with many reported complications and side effects. Following this short experience the author and his colleagues have now abandoned this operation. Patients suffering from malnutrition as a result of slimming operations should be carefully monitored for tuberculosis.
Disturbances of sex hormones in anorexia nervosa in the male
Authors: McNab David , Hawton Keith
Published: December 2008

Sex hormone levels were measured in a male patient with anorexia nervosa throughout the course of his illness and recovery. Gonadotrophin levels returned to normal with weight gain but his testosterone remained low. Possible explanations for these findings are discussed.
Transient cerebral ischaemic attacks—management and prognosis
Authors: Roden S , Low-Beer T , Carmalt M , Cockel R , Green I
Published: December 2008

Fifty patients who had recently had a transient ischaemic attack took part in a double-blind cross-over trial of sulphinpyrazone 200 mg 4 times daily against placebo. Each treatment was given for 4 months. The incidence of recurrences was much greater in the initial 4 months but there was no difference between the 2 treatments. A follow-up of 39 of the patients showed that 2 years later 90% of those who had not had a recurrence during the 8 months had suffered no further neurological events whereas of those who did have a recurrence during the study only 47% had no further neurological events.
Malignant epithelioma of the liver
Authors: Burroughs A K , Barter S J , Jenkins W J
Published: December 2008

Carcinoma complicating congenital cystic conditions of the liver is rare. The authors report a primary malignant epithelioma of the liver in association with multiple intrahepatic biliary cysts, which are not usually considered to predispose to malignancy.
Pyrexia of unknown origin. Presenting sign of hypothalamic hypopituitarism
Authors: Marilus R , Barkan A , Leiba S , Arie R , Blum I
Published: December 2008

A 62-year-old man was admitted to hospital 10 times over 12 years because of pyrexia of unknown origin. Hypothalamic hypopituitarism was diagnosed by dynamic tests including clomiphene, LRH, TRH and chlorpromazine stimulation. Lack of ACTH was demonstrated by long and short tetracosactrin tests. The aetiology of the disorder was believed to be previous encephalitis. Following substitution therapy with adrenal and gonadal steroids there were no further episodes of fever.
Hypohyperparathyroidism: a model for renal osteodystrophy?
Authors: Junor B J R , Edward N
Published: December 2008

A child who presented with features of renal osteodystrophy but with normal renal function is described. Improvement occurred both on large doses of vitamin D and small doses of 1, alpha-hydroxy-vitamin D3 (1, alpha-OHD3). Investigations suggested that the primary defect was an impaired renal response to parathyroid hormone. The relationship between renal osteodystrophy, abnormalities of vitamin D metabolism and hypohyperparathyroidism is discussed and an alternative hypothesis for the development of renal bone disease suggested.
Oesophago-aortic fistula
Authors: Montgomery A C V , Chilvers A S
Published: December 2008

This report of oesophageal peptic ulceration communicating with the thoracic aorta, successfully treated, illustrates the importance of prompt recognition of major bleeding and early repair.
Death from a sharp stone. A fatal case of haemobilia
Authors: Broderick N J , Jones J S P , Cullen M H , Fletcher J
Published: December 2008

A case of fatal gastrointestinal haemorrhage due to haemobilia as a direct result of cholelithiasis is described. Erosion of a branch of the cystic artery by a stone was shown to be the source of the bleeding at post-mortem. The features of the haemobilia syndrome are discussed.
Adenocarcinoma of the stomach and Fanconi’s anaemia
Authors: Hill L S , Dennis P M , Fairham S A
Published: December 2008

A case of Fanconi’s anaemia is described. The patient developed gastric ulcers at 14 years and died of adenocarcinoma of the stomach at the age of 21 years. The need fully to investigate gastric pathology by endoscopy and biopsy, as well as radiology, is stressed. So far as the authors are aware this is the first description of adenocarcinoma of the stomach occurring in Fanconi’s anaemia, a condition known to predispose to malignancy.
Vomiting due to gastric stasis as the presenting feature in thyrotoxicosis
Authors: Parkin A J , Nisbet A P , Bishop N
Published: December 2008

A patient with severe thyrotoxicosis of the apathetic variant in whom vomiting was the prominent presenting symptom is described. An alternative mechanism for thyrotoxic vomiting is postulated.
Hypercalcaemia in alphacalcidol therapy
Authors: Paterson C R
Published: December 2008

Three women with hypoparathyroidism are described who developed severe symptomatic hypercalcaemia while being treated with alphacalcidol (1 alpha-hydroxycholecalciferol; One-Alpha). One sustained permanent renal damage. Alphacalcidol may have advantages over calciferol in its speed of action but poisoning may be more likely to occur. Frequent follow-up checks on the plasma calcium is needed for any patient on alphacalcidol. For long-term management calciferol may still be the drug of choice.
Plasma exchange in primary biliary cirrhosis
Authors: Keeling P W N , Kingston P , Bull J , Thompson R P H
Published: December 2008

The symptoms of patients with primary biliary cirrhosis are frequently intractable to traditional therapy. Three patients are reported in whom several symptoms were alleviated by plasma exchange, using a Hemonetics Model 30 cell separator.
Diabetic neuralgic amyotrophy
Authors: Williams Alan J
Published: December 2008

A rare neurological condition, neuralgic amyotrophy, in a diabetic is reported. Strong evidence for a causal relationship is suggested. Comment is made on striking similarities between the clinical presentation and course of both diabetic and neuralgic amyotrophy, inferring a similar end pathological process.
Glucose 6-phosphate dehydrogenase deficiency and cystic fibrosis
Authors: Congdon P J , Aggarwal R K , Littlewood J M , Shapiro H
Published: December 2008

A child born to Pakistani parents is described. He had both cystic fibrosis and G-6PD-deficiency. So far as can be ascertained, the occurrence of both these conditions in the same individual has not previously been reported.
Hypercalcaemia and phaeochromocytoma
Authors: Fairhurst B J , Shettar S P
Published: December 2008

A patient with a phaeochromocytoma associated with hypercalcemia is described. The hypercalcaemia was corrected by removal of the phaeochromocytoma. Parathyroid hormone-like peptide was isolated from the tumour suggesting that ectopic parathyroid hormone production from the phaeochromocytoma was the explanation of the hypercalcaemia.
Closure of a gastrocolic fistula after treatment with cimetidine
Authors: Morgan Michael D L , Kapila Helen
Published: December 2008

A 66-year-old Englishman developed a gastrocolic fistula as a result of peptic ulceration. Treatment with cimetidine prompted unexplained closure of the fistula.
Severe hypertriglyceridaemia responding to insulin and nicotinic acid therapy
Authors: Smith Stephen R
Published: December 2008

A patient with unusually severe hypertriglyceridaemia (serum concentration initially 258 mmol/l or 22600 mg/dl) and hypercholesterolaemia is reported and discussed. The triglyceride elevation was found to reside within the very low density lipoprotein fraction and was probably attributable to the combination of diabetes mellitus and familial hypertriglyceridaemia. Treatment with insulin and restriction of dietary carbohydrate led to a 50% reduction in the triglyceride concentration, and the addition of nicotinic acid in modest doses led ultimately to a complete normalization of the patient’s lipid values. A close correlation was noted between the falling triglyceride concentration and the rising serum sodium concentration during the course of successful therapy. Overall, it is felt likely that this patient’s severe and reversible hypertriglyceridaemia was on the basis of excessively rapid lipolysis leading to high concentrations of very low density lipoprotein production. Combined therapy with insulin and nicotinic acid is recommended for other patients of this nature.
Long-term use of potassium perchlorate
Authors: Connell J M C
Published: December 2008

A case of Graves’ disease with potassium perchorate for 22 years without ill effect is described. Thyrotoxicosis recurred 4 weeks after the medication was withdrawn, suggesting that euthyroidism had been maintained by chronic use of the drug. As toxicity of perchlorate is probably dose related, it is suggested that long-term use of low dose perchlorate may be no more hazardous than alternative antithyroid therapy.
Recurrent erythema nodosum and pulmonary sarcoidosis
Authors: Macfarlane J T
Published: December 2008

The case is described of a female patient who has had 3 separate episodes of erythema nodosum, hilar lymphadenopathy and pulmonary infiltration due to sarcoidosis over 20 years, with complete remissions in between. This has not been reported before and it raises questions about the aetiology of sarcoidosis.
Polymyositis associated with Hodgkin’s disease
Authors: Fui S Ng Tang , Teoh R , Houston J C
Published: December 2008

A patient is reported who presented with severe polymyositis and pulmonary collapse with infection. Investigations failed to confirm an underlying bronchial carcinoma but post-mortem examination revealed unsuspected Hodgkin’s disease. The authors wish to draw attention to the rare but important association between polymyositis and treatable lymphomas.
Primary thrombocythaemia following splenectomy
Authors: O’Donnell J R , Bailey P A M , Erskine J G , Davidson J F
Published: December 2008

A 20-year-old male who required splenectomy following abdominal trauma was subsequently shown to have primary thrombocythaemia. This report illustrates the diagnostic problems associated with a refractory post-splenectomy thrombocytosis, and the therapeutic difficulties in the management of primary thrombocythaemia are discussed.
Arterial embolization in the management of liver tumour with recurrent hypoglycaemia
Authors: Bell G M , Buist T A S
Published: December 2008

A patient with recurrent hypoglycaemic episodes resulting from hepatic metastases of a malignant retroperitoneal haemangiopericytoma is described. Effective control of hypoglycaemia has been achieved by trans-catheter hepatic arterial embolization on 5 separate occasions.
Sequelae of a ‘magic mushroom banquet’
Authors: Harries Anthony D , Evans Valmai
Published: December 2008

Magic mushroom festivals are becoming increasingly common especially in some areas of Wales where the mushroom can be found in profusion. The authors report on the sequelae of one such festival, and point out the dangers of which the participants generally are unaware.
Spironolactone and diabetic ketoacidosis
Authors: Jariwalla A G , Lever A , Jones C R , Hall R
Published: December 2008

The authors describe a diabetic patient on spironolactone who, following a minor surgical procedure, developed ketoacidosis and life-threatening hyperkalaemia.
Bladder instability in patients with prostatic hypertrophy
Authors: Appell Rodney A
Published: December 2008

In 29 patients with urinary obstruction due to prostatic enlargement, medium-fill water cystometry was performed before prostatectomy and again 3 months after. A high incidence of detrusor hyperreflexia was observed pre-operatively, but findings were essentially normal 3 months after resection of the prostate. Possible mechanisms to explain these findings are developed. However, it was clear that the cystometric findings were not related to prostatic size.
Self-induced myocardial infarction
Authors: Carr Peter
Published: December 2008

A case of acute myocardial infarction and peripheral vascular insufficiency following overdose with ergotamine is described.
Spontaneous pneumothorax complicating Legionnaires’ disease
Authors: Bali A , Pierry A A , Bernstein A
Published: December 2008

Spontaneous pneumothorax is a known but rare complication of pneumonia in adults. A case is described of Legionnaires’ disease complicated by spontaneous hydropneumothorax. So far as is known such an association has not been reported previously.
Coeliac disease in identical twin infants
Authors: Lord C , MacGregor Gerald A
Published: December 2008

A pair of monozygous twins had coeliac disease in infancy, and all of their family carried the HLA-B8 antigen. Both genetic and environmental factors were involved in the aetiology.
Association of retroperitoneal fibrosis, proctitis and rectal stenosis
Authors: Manna R , Pigini M G , Pala M A , Caturelli E , Lanza-Tomasi M C , Zupi E
Published: December 2008

Retroperitoneal fibrosis (RF) in most cases is ‘idiopathic’. In the case reported, RF could be the result of a proctitis that followed a haemorrhoidectomy.
Haemorrhoids: a doctor’s dilemma
Authors: Deutsch Alexander A , Sternberg Ahud , Reiss Raphael
Published: December 2008

The different forms of treatment for haemorrhoids are described. These include conservative therapy, elastic band ligation, sclerotherapy, cryosurgery, anal dilatation, lateral sphincterotomy and formal surgery. Controlled trials comparing these methods of treatment indicate that surgery should be rarely performed. Of the remaining methods available, elastic band ligation or anal dilatation are recommended.
Jejunal villous changes associated with farmer’s lung
Authors: Robinson T J , Haire Margaret , McMillan S A , Nelson S D , Middleton D , Evans J P
Published: December 2008

Eighty-one patients with farmer’s lung were screened for evidence of coeliac disease by assessing their clinical features, haemoglobin indices, serum vitamin B12 and folic acid levels. HLA typing was carried out and the frequency of antireticulin and other auto-antibodies was determined. Two out of 21 patients selected for jejunal biopsy had subtotal villous atrophy, a further 6 had partial villous atrophy and 8 out of 21 had increased lamina propria cellularity. The group as a whole had an increased number of intra-epithelial lymphocytes in the jejunal musosa. Sera of 7 out of 81 patients contained antireticulin antibody compared with 2 of 81 control subjects, a difference without significance. Other autoantibodies were not more frequent in the patient than in the control group and were of normal incidence. HLA antigens were also similar in both groups.
Recurrent groin hernia
Authors: Cox P J , Leach R D , Ellis Harold
Published: December 2008

One hundred consecutive recurrences following repair of inguinal hernias have been studied; 62 were direct, 30 indirect, 7 pantaloon and one a femoral hernia. Half the indirect recurrences occurred within a year of repair and probably represented failure to detect a small indirect sac. Later indirect recurrences probably represented failure to repair the internal ring. Nine of the direct hernias were medial funicular recurrences and represented failure to anchor the darn medially. The rest of the direct recurrences were attributable to tissue insufficiency and could probably have been averted by larger tissue bites.

Recurrences following inguinal herniorrhaphy remain an all too common problem but can be reduced by meticulous surgical technique.
Secondary syphilis presenting with features of cranial arteritis
Authors: Drew P J T
Published: December 2008

The case of an elderly man with secondary syphilis is described. The clinical features at the time of presentation were suggestive of cranial arteritis and there was a substantial but incomplete response to corticosteroids. Subsequent treatment with penicillin proved highly effective.
Camphor intoxication treated by charcoal haemoperfusion
Authors: Mascie-Taylor Brian H , Widdop Brian , Davison Alexander M
Published: December 2008

A case of camphor intoxication in which lipid haemodialysis and charcoal haemoperfusion were applied is described. Although the patient recovered rapidly with no resultant sequelae, the analytical data indicated that extra-corporeal therapy was ineffective.
Efficacy of peritoneal dialysis in severe thiazide-induced hyponatraemia
Authors: Cundy T , Trafford J A P
Published: December 2008

A patient with severe thiazide-induced hyponatraemia (plasma sodium 99 mmol/l) is described, who had signs suggestive of cerebral oedema. Co-existent problems of cardiac and respiratory insufficiency were thought to make treatment with hypertonic saline hazardous. A 40-hr peritoneal dialysis successfully reversed both hyponatraemia and the associated cerebral signs, plasma sodium increasing at a rate of 0·83 mmol/hr. Peritoneal dialysis appears to be a safe and efficacious method of treating severe thiazide-induced hyponatraemia.
Racial differences in blood pressure: genetic and environmental factors
Authors: Sever P S
Published: December 2008

The present study shows that different racial groups (black and white) living in a similar environment have different levels of blood pressure. Furthermore the same ethnic group living in a dissimilar environment also has different blood pressure distributions: thus it seems that both genetic (racial) and environmental factors influence the levels of arterial pressure.

The data presented also reveal that there are racial differences in certain biochemical correlates of blood pressure, namely plasma renin activity and plasma noradrenaline concentration, and it is suggested that these observations may underline differing pathogenetic mechanisms for blood pressure elevation in blacks and whites.
Asthma and atopic disease in immigrants from Asia and the West Indies
Authors: Morrison-Smith John , Cooper Susan M
Published: December 2008

The clinical pattern of asthma and atopic disease was compared in 2331 children of European, Asian and West Indian parentage seen in Birmingham in the past 10 years. The main findings were that a higher proportion of children born in England of all races developed asthma within the first 4 years of life than children born abroad; the sex ratio of roughly 2 boys to every girl with asthma was similar in each race wherever born; the ratio of persistent to intermittent asthma was similar in each race wherever born; there was no difference in the proportion with eczema between the racial groups; hay fever and pollen allergy was less frequent in Asian and West Indian children even if born in England; hospital admission was more frequent in immigrant groups; positive skin reactions to grass pollen and domestic animals were more frequent in European children than in immigrants but positive reactions to house-dust mites were less frequent in European children.

It was considered that most differences could be explained on the basis of differences in environmental conditions and were unlikely to be of genetic origin.
Malaria in children in Birmingham in the 1970s
Authors: Addy D P , Mathew P M
Published: December 2008

Thirty-two children with malaria were admitted to Dudley Road Hospital, Birmingham, in the 1970s. None was admitted before 1974 and there was a rapid increase after that. All the infections were due to Plasmodium vivax and occurred in children of Asian immigrant families who had been born in or had visited India or Pakistan apart from one infant born in England who acquired the disease transplacentally. All presented within 12 months of entering or re-entering the United Kingdom. The clinical features of the 32 patients have been analysed and it is suggested that more effort should be made to educate travellers about the need for anti-malarial chemoprophylaxis and the necessity to continue it for one month after return.
Ethnic differences in perinatal mortality
Authors: Terry P B , Condie R G
Published: December 2008

Of the 3869 normally formed, singleton deliveries in Dudley Road Hospital in 1979, 3690 were to either European (1644), Indian (1087), Pakistani (556) or West Indian (403) mothers. The perinatal mortality rates in the Indian group with birth weights of 2000 - 2999 g and 3000 - 3999 g were higher than in any of the other ethnic groups (11·5/1000 and 6·7/1000 respectively).
Ethnic differences in self-poisoning
Authors: Wright N , Trethowan W N , Owens J
Published: December 2008

Factors associated with self-poisoning have been compared between the immigrant communities of West Birmingham and the local indigenous population. The annual rate of admission to hospital with self-poisoning is increasing most rapidly in the West Indian community which, together with the Asian, shows a lower mean age and greater incidence than the Caucasian population. Reasons for overdosage and admissions offered by the various ethnic groups are also compared.
The penetration of metronidazole into synovial fluid
Authors: Sattar M A , Sankey M G , Cawley M I , Kaye C M , Holt J E
Published: December 2008

Six patients with non-infected synovial effusions, associated either with inflammatory or degenerative arthropathy and requiring diagnostic or therapeutic aspiration, were given a short course of 400 mg metronidazole (Flagyl) 8-hourly for 3 doses. Serum and synovial fluid (SF) were sampled frequently during this time, and assayed for metronidazole by a specific high pressure liquid-chromatographic method. It was found that concentrations of metronidazole in SF reached those in serum after a short time-lag, and thereafter approximated to the serum concentration. With this regimen, metronidazole concentrations were readily achieved in synovial fluid, above the minimum inhibitory concentrations for most susceptible anaerobes. These results indicate that the drug freely enters the synovial fluid and suggests that metronidazole would prove effective in the treatment of septic arthritis due to anaerobic bacteria.
The metabolic effects of moderately severe upper gastrointestinal haemorrhage in man
Authors: Foster K J , Alberti K G , Binder C , Holdstock G , Karran S J , Smith C L , Talbot S , Turnell D C
Published: December 2008

The metabolic effects of moderately severe gastrointestinal haemorrhage were investigated in man. Before resuscitation, patients had raised circulating concentrations of glucose, lactate, alanine, glycerol and cortisol. After urgent operation for haemorrhage, metabolite concentrations were similar to those of control patients having elective abdominal surgery, but insulin concentrations were higher and cortisol lower in haemorrhage patients. There were no significant differences in nitrogen excretion between haemorrhage patients and their controls, but urinary 3-methyl-histidine excretion by haemorrhage patients was lower indicating decreased muscle protein breakdown. Decreased amino acid release from muscle might account for previously reported imparied wound healing after haemorrhage.
Surgical treatment in asymptomatic patients with duodenal ulcers as a prophylaxis against haemorrhage
Authors: Bucknall T E , Wastell C
Published: December 2008

In a group of 17 patients who underwent surgery for chronic duodenal ulceration because of past bleeding but without current symptoms, one patient re-bled with a follow-up of 81 patient years, as compared to one bleed over 6.8 patient years before surgery. This suggests that surgery is protecting these patients against recurrent episodes of haemorrhage.
An embedded fingernail
Authors: Eke N , Little K
Published: December 2008

A case of an embedded fingernail is reported. The increased curvature of the nail plates is considered aetiologically important. Treatment was by the method first described by Winograd for an embedded toenail.
‘Angiodysplasia’ of the tongue with acquired von Willebrand’s disease
Authors: Wood G M , Losowsky M S
Published: December 2008

A case of acquired von Willebrand’s disease is reported in which the patient developed a swelling on the dorsum of the tongue. Histology of this lesion closely resembled that described in angiodysplasia of the colon.
Temporary cardiac pacing via the oesophagus
Authors: Cooper David N
Published: December 2008

Two cases are reported in which temporary cardiac pacing was performed using an oesophageal electrode. The benefits and disadvantages of this technique are discussed.
Acute renal failure associated with diflunisal
Authors: Wharton J G , Oliver D O , Dunnill M S
Published: December 2008

The case of a 44-year-old man with acute oliguric renal failure due to tubulo-interstitial nephritis after 3 months’ diflunisal is reported. The possible mechanisms are discussed.
Hypokalaemic periodic paralysis precipitated by diuretic therapy and minor surgery
Authors: Boulton A J M , Hardisty C A
Published: December 2008

A case of hypokalaemic periodic paralysis was diagnosed following a severe postoperative attack in a patient whose previous episodes of weakness had been labelled hysterical. Subsequent mild attacks of weakness were precipitated by diuretic therapy. Patients with this condition should not be treated with any drug that may induce hypokalaemia.
Monozygotic twins with ulcerative colitis
Authors: Mayberry J F , Dew M J , Morris J S
Published: December 2008

Monozygous twin sisters developed ulcerative colitis within 7 years of each other. Both had distal colitis confirmed by histology and radiology. Their maternal grandmother subsequently developed the disease. The long interval between the onset of the disease in the twins suggests a role for environmental factors in addition to genetic influences. Although about five hundred sets of twins with ulcerative colitis may be expected in Britain, this is the first set to be reported.
The incidence of radiologically demonstrable aneurysm and arteriovenous malformation in spontaneous subarachnoid haemorrhage
Authors: Barraclough C R
Published: December 2008

The incidence of radiologically demonstrable aneurysm and arteriovenous malformation (AVM) in patients admitted to the Midland Centre for Neurosurgery and Neurology (MCNN) with the diagnosis of spontaneous subarachnoid haemorrhage (SAH) between 1959-80 inclusive was determined. Bilateral carotid angiography (BCA) showed 65·8% to have one or more aneurysms and 7·5% an AVM, each figure including 0·6% with both conditions. When BCA was negative, 65·8% proceeded to vertebral angiography (VA) and of these 12·5% were shown to have an aneurysm and 4·2% an AVM.

The probability of demonstrating an aneurysm by either of these radiological methods is an important factor in deciding whether or not to proceed to angiography, especially in patients presenting an above average anaesthetic or operative risk, bearing in mind the high mortality of untreated aneurysm in this condition and the improved prognosis when successful surgical management is possible.
Penicillin sensitivities of gonoccocci, in 1977-80 from a peripheral health district, and their clinical correlation
Authors: Rahman M
Published: December 2008

Penicillin sensitivities of gonococci isolated from a peripheral health district were observed during 1977-80 by determining the minimum inhibitory concentrations (MIC) of penicillin. During the same period, outcome of penicillin treatment in patients with gonorrhoea was also observed and recorded. Penicillin resistance, as defined, was found in 19·3% strains in these years, but there were year-to-year variations. None of the strains was a penicillinase producer. Association of higher MICs of penicillin with therapeutic failures was not observed in this study until the MICs were greater than 1·0 mg/l. The findings are discussed together with reviews from other published works.
Causes of ano-rectal bleeding
Authors: Dehn T , McGinn F P
Published: December 2008

The causes of ano-rectal bleeding as the only symptom in 110 patients were studied. A diagnosis was obtained in 77% of patients after clinical examination, sigmoidoscopy and proctoscopy, increasing to 97% after radiology and colonoscopy. Anal causes of bleeding were found in 81% of the patients, while a source in the rectum or colon accounted for only 16%.
Prescribing non-steroidal anti-inflammatory drugs: a prospective study of patients’ preference
Authors: Scott D L , Low-Beer T S , Roden S , Takavarasha L
Published: December 2008

Thirty-six patients with rheumatoid arthritis were allocated at random to one of 3 groups prescribed 4 different non-steroidal anti-inflammatory drugs (NSAID). Each drug was given for one week over 4 consecutive weeks in a balanced order. The patients were then asked to select one NSAID for continuation therapy and were followed-up 6 months later. The success of the patient selection method was compared with that of physician selection by retrospectively surveying NSAID prescribing in 164 patients attending 2 other rheumatology units over a 5-year period.

Only 72% of patients in the prospective study felt able to choose one of the NSAIDs and 31% of these had discontinued the chosen drug within 6 months. In the retrospective study, 40% changed their NSAID within 6 months.
An excursion into self-monitoring of blood glucose in children
Authors: Swift Peter G F
Published: December 2008

Ten adolescent diabetic children monitored blood glucose (BG) concentrations during a British Diabetic Association holiday camp in Denmark. The range of results was wide but revealed a mean pre-breakfast (fasting) BG of 9·8 mmol/l and a mean BG before the main evening meal of 13·2 mmol/l. Before the evening meal eight of ten children had BG concentrations in excess of 13 mmol/l. There was a significant correlation between mean BG concentrations and glycosylated haemoglobin.

The procedure was well accepted and proved to be of considerable educational value. It clearly revealed the children whose diabetes was satisfactorily controlled and those in whom adjustments of management were required. It is suggested that similar phases of self-measurement of BG in their homes will clarify the diabetic control of many children and thus help to improve it.
Myxoedema presenting with severe laryngeal obstruction
Authors: Erwin L
Published: December 2008

A patient with myxoedema developed severe laryngeal obstruction following an upper respiratory tract infection. Attention is drawn to this unusual but potentially fatal complication of myxoedema.
Inappropriate antidiuretic hormone secretion in Wernicke’s encephalopathy
Authors: Cooles Philip E , Borthwick Leslie J
Published: December 2008

A case of the syndrome of inappropriate secretion of antidiuretic hormone in association with Wernicke’s encephalopathy is described, where both responded to intravenous vitamin B complex. Thiamine may be life-saving in hyponatraemia with neurological signs due to Wernicke’s encephalopathy.
Multifocal follicular carcinoma of thyroid following radiotherapy for Hodgkin’s disease
Authors: Nicol Fiona , McLaren Kathryn M , Toft Anthony D
Published: December 2008

A 21-year-old white male developed multifocal follicular carcinoma of the thyroid gland 17 years after receiving neck irradiation (3000 rad) for Hodgkin’s disease. The tumour was unique in that follicular carcinoma has not previously been reported as having a multifocal origin, even after high dose radiotherapy.
Hepatic sinusoidal ectasia in association with Hodgkin’s disease
Authors: Bain Barbara J , Coghlan Shirley J , Chong K C , Roberts Sydney J
Published: December 2008

A patient developed abnormal liver function tests in association with hepatic sinusoidal ectasia concurrently with relapse of Hodgkin’s disease. Tests returned to normal following successful chemotherapy for the Hodgkin’s disease. Sinusoidal ectasia and the related condition, peliosis hepatis, should be recognized as rare non-infiltrative manifestations of Hodgkin’s disease.
Splenectomy in agnogenic myeloid metaplasia: factors of possible prognostic significance
Authors: Penchas S , Sukenik S , Steinwel A , Benbassat J
Published: December 2008

The available data of 338 cases of splenectomy in agnogenic myeloid metaplasia published since 1940 were retrieved from the literature and analysed. Postoperative survival was significantly shorter in patients with anaemia, massive splenomegaly or elevated serum alkaline phosphatase. Younger age or normal platelet counts were associated with a longer postoperative survival than that in older patients and in patients with low platelet counts respectively. The shortest median postoperative survival was found in: patients in whom serum alkaline phosphatase exceeded twice the upper limit of the normal; patients with anaemia (less than 10 g/dl haemoglobin) and massive splenomegaly (above 3 kg); and patients with anaemia and a splenic weight less than one kg.
Pulmonary embolism—a long-term follow-up
Authors: MacIntyre D , Banham S W , Moran F
Published: December 2008

Fifty-three patients without pre-existing cardiac or pulmonary disease were reviewed 5 to 9 years after angiographically proved pulmonary embolism. Ten of the 42 (24%) with an initial predisposing factor for embolism had died, including 6 from a previously diagnosed medical condition. In this group there was no significant residual disability among survivors and no late recurrence of embolism. By comparison, there were 6 deaths among the 11 in whom no predisposing factor was identified (55%), including 3 from neoplasm and 2 from recurrent embolism with cardiac failure.

The identification of a predisposing factor at the time of embolism was associated with a significantly better long-term prognosis.
Hemiagenesis of the thyroid gland and T3 hyperthyroidism
Authors: Matsumura Luiza K , Dib Sergio A , Russo Ewaldo M K , Maciel Rui M B , Chacra Antonio R
Published: December 2008

A patient with hemiagenesis of the thyroid gland who presented with T3 toxicosis is described. The diagnosis of thyroidal hemiagenesis was established through the administration of thyroid stimulating hormone and a thyroid scintiscan.

T3 thyrotoxicosis is a previously unreported clinical presentation of thyroid hemiagenesis.
Echocardiographic visualization of the anatomic causes of mitral regurgitation resulting from myocardial infarction
Authors: Donaldson Robert M , Ballester Manuel , Rubens Michael B , Yacoub Magdi H
Published: December 2008

A murmur of mitral regurgitation in patients with congestive heart failure after an acute myocardial infarction suggests a surgically correctable cause of the heart failure. Six patients who presented in this manner and who later underwent surgery have been evaluated by two-dimensional echocardiography (2DE). The underlying anatomical cause of the mitral regurgitation was correctly identified as papillary muscle rupture (2 cases), ruptured chordae tendineae (1 case) and papillary muscle fibrosis (3 cases).

Two-dimensional echocardiography is useful in evaluating patients with congestive heart failure who develop a systolic murmur after acute infarction, as it can detect surgically correctable structural defects.
Neurological manifestations of paranasal disease: problems in prognosis
Authors: Livingstone I R , Hall K , Cumming W J K , Foster J B
Published: December 2008

Early diagnosis of sphenoidal sinus mucocoeles presenting with visual loss is important as appropriately timed surgical intervention may improve the visual deficit. Two cases of sphenoidal sinus mucocoeles presenting with visual symptoms are reported in whom the diagnosis was only established at a late stage. A third case thought on clinical and radiological grounds to have a sphenoidal sinus mucocoele causing visual symptoms was found to have a frontal astrocytic glioma eroding through the ethmoidal sinus. These case reports stress that the definitive diagnosis in cases of sphenoidal sinus mucocoele is often delayed and that the pre-operative distinction between sphenoethmoidal sinus mucocoeles and other lesions involving the spheno-ethmoidal region may not always be possible.
Stenosis of the colon following acute pancreatitis
Authors: Brearley Stephen , Campbell Duncan J
Published: December 2008

Two patients who had developed incomplete large bowel obstruction were shown to have colonic stenoses on barium enema. At laparotomy, inflammatory masses secondary to acute pancreatitis were found in both patients, though pancreatitis had not been suspected clinically. Resection of affected bowel in such cases is contra-indicated and the stenoses usually resolve spontaneously.
Corticosteroid induced remission of oesophageal involvement in mixed connective tissue disease
Authors: Pines Amos , Goldhammer Ehud , Kaplinsky Naomi , Bregman Joseph , Frankl Otto
Published: December 2008

Oesophageal involvement is known to be one of the most severe and resistant manifestations of connective tissue diseases, mainly progressive systemic sclerosis (PSS). A patient who had manifestations of systemic lupus erythematosus, PSS and polymyositis is described. Since some features of mixed connective tissue disease (MCTD) respond to corticosteroid treatment, fluocortolone was administered and both clinical and radiological remission of the oesophageal involvement were observed. At the same time, there was also a marked improvement of the cutaneous lesions. In view of the described observation, it seems advisable to try this treatment for oesophageal manifestations of MCTD.
Kocher-Debré-Sémélaigne syndrome and congenital nystagmus
Authors: Radhakrishnan K , Walia B N S , Venkateswarlu K , Mann S B S
Published: December 2008

A 11-year-old boy with hypothyroidism developed generalized muscle hypertrophy and proximal muscular weakness. Electromyographic findings were suggestive of myopathy. He had had congenital nystagmus (CN) since early infancy. Although the association of childhood hypothyroidism and CN has been documented before, the triad of hypothyroidism, hypertrophic myopathy and CN exhibited by the patient is believed to be unique.
Acute hearing loss in giant cell arteritis
Authors: Francis D A , Boddie H G
Published: December 2008

A case of giant cell arteritis presenting with acute hearing loss which was reversed by corticosteroid therapy is described
Cerebral involvement in primary mixed cryoglobulinaemia
Authors: Pines Amos , Goldhammer Ehud , Kaplinsky Naomi , Frankl Otto
Published: December 2008

Primary mixed cryoglobulinaemia was diagnosed in a 65-year-old woman and confirmed on post-mortem examination. The patient had the classical findings of purpura, arthralgia, renal failure, mixed cryoglobulins in the serum and rheumatoid factor activity. The patient presented with haemolytic anaemia and later developed rectal bleeding, but the most prominent feature was an acute psychosis with electroencephalographic changes, that was attributed to the disease and responded well to corticosteroids. Primary mixed cryoglobulinaemia should be included in the differential diagnosis of central nervous system involvement in systemic connective tissue diseases. This complication should not be missed since it seems to respond well to corticosteroids and/or to plasmapheresis if diagnosed in time.
Amyloidosis complicating psoriasis
Authors: Amir-Ansari B , Joekes A M , Parkinson M C
Published: December 2008

A man aged 59 years with a 39-year history of psoriasis, for which treatment had included steroids and methotrexate, developed renal failure caused by amyloidosis. Post-mortem revealed widespread amyloid deposits but no evidence of other disease classically associated with amyloidosis.
Liver abscess due to an unusual strain of Yersinia enterocolitica
Authors: Fothergill Judith , Mulira A E J L , Skirrow M B
Published: December 2008

A 46-year-old man with long standing diabetes mellitus suffered a spontaneous liver abscess due to an unusual strain of Yersinia enterocolitica (biotype 3, serotype 05). Isotope and ultrasound scans were particularly valuable in the diagnosis and management of a difficult clinical problem.
Low-dose captopril in the treatment of severe refractory hypertension associated with renal failure
Authors: Bell G M , Doig A , Watson M L , Muir A L , Winney R J
Published: December 2008

Six patients with severe refractory hypertension and chronic renal failure were treated with a low dose of captopril (mean daily dose 75 mg) in combination with dietary sodium restriction, frusemide and either metoprolol, labetalol or prazosin. Sustained control of blood pressure was achieved in all six patients. Adverse effects noted were severe hyperkalaemia (2 patients), skin rashes (2 patients) and taste disturbance (1 patient).
Childhood cervical enterogenous cyst presenting with hemiparesis
Authors: Woo P Y C , Sharr M M
Published: December 2008

The clinical features of a cervical enterogenous cyst in a one-year-old boy mimicked those of an intracranial mass. Following removal of the cyst the neurological signs rapidly disappeared. The literature is reviewed from histological and clinical aspects and a classification of these cysts is proposed.
Symptomatic papillary tumour of the pulmonary valve
Authors: Cooper Linda Carol
Published: December 2008

Papillary ‘tumours’ are small pedunculated lesions of the valve cusps and result from wear-and-tear. They are therefore frequent post-mortem findings in older patients. The vast majority are clinically silent, though occasionally such lesions when on the aortic valve may produce symptoms of myocardial or cerebral ischaemia. None has been known to cause symptoms when in the right side of the heart.

A 52-year-old woman is reported who had transient episodes of right ventricular outflow obstruction related to the presence of a papillary tumour on the pulmonary valve. Extensive radiotherapy to the chest wall was thought to be a causal factor.
Pneumomediastinum as a complication of fast bowling in cricket
Authors: Clements M R , Hamilton D V
Published: December 2008

The case is described of a 15-year-old patient who developed acute pneumomediastinum and bilateral pneumothoraces whilst playing cricket. He made a rapid and uncomplicated recovery.
Factors affecting resolution of pericardial effusions in primary hypothyroidism: a clinical, biochemical and echocardiographic study
Authors: Khaleeli A A , Memon N
Published: December 2008

Echocardiography detected pericardial effusions in five out of six consecutive untreated patients with severe primary hypothyroidism and suspected myopathy, whereas the chest X-ray suggested only one. During L-thyroxine replacement, serial echocardiograms detected decrease in the size of the effusions in all the patients. This occurred before the serum thyroid stimulating hormone (TSH) levels had significantly changed, although there was a small but significant rise in serum thyroxine. In one patient complete resolution of the effusion occurred before the patient became euthyroid, a previously unreported finding.

Small voltage complexes, T-wave inversion and non-specific T-wave flattening were the commonest electrocardiographic abnormalities noted. The former invariably and the latter two abnormalities frequently, reverted to normal before the patient became biochemically and clinically euthyroid. T-wave inversion in a particular lead, however, did not invariably do so, suggesting that permanent structural change might possibly have occurred.

The plasma creatine kinase (CK) was raised in four patients, and markedly raised at levels usually associated with muscular dystrophy, in two. At the onset of resolution of the pericardial effusions, the total plasma CK had fallen significantly in all patients in whom it was raised.