bluuebunny/crossref_metadata_2025 huggingface dataset:
Prostaglandins and the lung
Authors: Morley J
Published: December 2008

Evidence exists implicating prostaglandins as mediators of asthma and of chronic inflammation in the lung. In addition to their spasmogenic effects, PGs are also potent in vitro regulators of mediator secretion by basophils, mast cells, or lymphocytes. These regulatory effects of E-series PGs may have considerable significance in drug design and evaluation in both asthma and chronic inflammation.
Some clinical, social and psychological characteristics of migraine subjects in the general population
Authors: Crisp A H , McGuinness B , Kalucy R S , Ralph P C , Harris G
Published: December 2008

A very careful enquiry within adequate sub-samples of the general population of a market town and its surrounding villages has revealed (a) no special relationship between so-called tension headaches and migraine as defined; (b) a two-year prevalence of migraine more or less similar to that reported elsewhere, i.e. approximately 10% of males and 25% of females being affected; (c) a greater prevalence of migraine amongst professional and managerial classes; (d) similar clinical features to those commonly described before; (e) that approximately 50% of the subjects had consulted their general practitioners and/or other doctors on account of the headache; (f) that actual migraine female subjects are significantly more anxious and depressed than normal subjects whilst at the same time reporting themselves as more sociable than others; they also complain more of other functional somatic disturbance; (g) that such differences were not always detected in the smaller male sample who showed similar tendencies only in respect of anxiety and other somatic complaint; (h) that subjects who described themselves on the questionnaire as having migraine but who were not on careful scrutiny always found to have it, showed as a population a higher degree of neurotic disability, including phobic avoidance patterns, than the population who actually have the condition.

This study supports the view that migraine is associated with certain psychological characteristics, especially amongst females. The profile is that of undefended dysphoria coupled with a definite tendency to be outgoing and engaging in the world. The price is migraine and other somatic complaint.
Severe meprobamate poisoning: successful treatment with haemoperfusion
Authors: Crome P , Higgenbottom T , Elliott J A
Published: December 2008

Charcoal haemoperfusion used to treat a 56-year-old woman who had taken a very large overdose of meprobamate was followed by fully recovery. The plasma clearance of meprobamate was 153 ml/min and this compares favourably with values obtained for haemodialysis. The indications for haemoperfusion are reviewed.
Gastrointestinal haemorrhage from small bowel duplication
Authors: Johnstone M J , Clegg J F
Published: December 2008

A case is reported of duplication of the small bowel presenting with gastrointestinal haemorrhage. This is the first reported case in an adult. A review of the literature has been made and the pathogenesis discussed.
Carcinoma of the lung presenting with a myeloproliferative disorder. A report of two patients
Authors: McIllmurray M B , Ryrie D R , Fletcher J
Published: December 2008

A myeloproliferative disorder, similar to agonogenic myeloid metaplasia, has been described in patients with cancer. Two patients with carcinoma of the lung are described who presented with such a disorder but in whom there was no evidence of bone marrow fibrosis and in one of whom there was no evidence of bone marrow infiltration by tumor. The possible mechanism of this association is discussed.
Abdominal aortic aneurysms. Ultrasonic measurement of the transverse diameter and its prognostic significance in the light of pathological observations
Authors: McGregor J C
Published: December 2008

The risk of rupture of an abdominal aortic aneurysm is related to size. Pathological observations suggest that there is usually an asymmetric formation of mural thrombus in the aneurysm sac and that rupture occurs more commonly through the lateral walls where there would be less. Ultrasonic estimation of the transverse diameter of an aneurysm offers a useful clinical method of monitoring size and likelihood of rupture.
Recovery of hypothalamic-pituitary-adrenal function after intermittent high-dose prednisolone and cytotoxic chemotherapy
Authors: Wilson K S , Gray C E , Lidgard G P , Parker A C
Published: December 2008

Hypothalamic/pituitary and adrenal (HPA) function was assessed in ten patients who received intermittent high-dose prednisolone and cytotoxic chemotherapy for 5-40 months. Standard insulin hypoglycaemia (IHT), thyrotrophin-releasing hormone and tetracosactrin tests were performed 36 hr after the last dose of prednisolone and subsequently 10 days—52 weeks after completion of all chemotherapy. In the first tests there was evidence of impaired hypothalamic-pituitary function judged by peak adrenocorticotrophic hormone (ACTH), growth hormone (GH) and thyrotrophin (TSH) responses, and corresponding plasma corticosteroid responses were sub-normal in five patients. In the final IHTs, seven patients had persistently subnormal ACTH responses but all the corresponding plasma corticosteroid responses returned to normal. Mean peak corticosteroid responses to insulin and tetracosactrin and peak GH responses were significantly greater than in the first tests. Such chemotherapy regimens may have prolonged effects on hypothalamic/pituitary function but the demonstration of normal corticosteroid responses to hypoglycaemia and tetracosactrin indicates that these patients' stress responses will be normal as early as 10 days after treatment is stopped.
The syndrome of inappropriate antidiuretic hormone secretion associated with acute myocardial infarction
Authors: Hart G , Gokal R
Published: December 2008

A 72-year-old man developed the syndrome of inappropriate antidiuretic hormone secretion after sustaining an acute myocardial infarction. Other documented causes of this syndrome were excluded, and this case is therefore reported as a new association.
Pseudomonas pneumonia in status asthmaticus
Authors: Mungall I P F , Jackson E W , Dibble J B
Published: December 2008

A case of Pseudomonas pneumonia developing in a patient on treatment for status asthmaticus is described. The use of broad spectrum antibiotics, high dose steroids and humidifiers or nebulizers may be of aetiological importance. Pseudomonas pneumonia is increasing in prevalence although it has not previously been described in association with status asthmaticus. It carries a high mortality and its prevention is, therefore, clearly important.
Left ventricular function in ischaemic heart disease. A review
Authors: Khattri H N , Raphael M J , Sharma B , Steiner R E , Goodwin J F
Published: December 2008

The clinical significance of the abnormalities seen at left ventriculography in ischaemic heart disease is discussed. Aneurysms may be recognized when left ventriculography is combined with coronary arteriography to show the characteristic obliteration of the supplying artery. Localized areas of abnormal contraction seen at rest are almost certainly indicative of infarcts. Similar areas provoked by exercise or atrial pacing represent the site of acute ischaemia. The ischaemic ventricle may be recognized by abnormal response to exercise, even in the absence of angina. The abnormal response may be reversed by successful revascularization surgery.
Obsolete but dangerous antacid preparations
Authors: Robson R H , Heading R C
Published: December 2008

One case of acute hypercalcaemia and two of recurrent nephrolithiasis are reported in patients who had regularly consumed large amounts of calcium carbon-ate-sodium bicarbonate powders for more than 20 years. The powders had been obtained from pharmacists unknown to the patients' medical practitioners. It is suggested that these preparations were responsible for the patient's problems, and that such powders should no longer be freely obtainable.
Myocardial ischaemia in migraine sufferers taking ergotamine
Authors: Snell N J C , Russell-Smith C , Coysh H L
Published: December 2008

Two cases of acute myocardial ischaemia precipitated by oral ergotamine therapy for migraine are described from patients with no previous history of ischaemic heart disease. The relevant literature is briefly reviewed.
Phaeochromocytoma with nocturnal elevation of blood pressure
Authors: Yamamoto T , Jo T , Ishibashi T
Published: December 2008

A 47-year-old woman with phaeochromocytoma showed blood pressure changes characterized by the regular appearance of hypertension at night. The urinary excretion of catecholamines and their metabolites showed augmentation roughly parallel with the elevation of the blood pressure. During normotensive periods, the urinary excretion of catecholamines and their metabolites was elevated. The findings suggested that the pressor effect of catecholamine hypersecretion was compromised to a certain degree and that the regular nocturnal appearances of hypertensive paroxysm conceivably resulted from a spontaneous cyclic augmentation of the catecholamine secretion from the tumour.
Hyperosmolar non-ketotic diabetic coma induced by furosemide in modest dosage
Authors: Khaleeli A A , Wyman A L
Published: December 2008

A case of hyperosmolar non-ketotic diabetic coma in a patient treated with a modest degree of furosemide is reported.
Rupture of the spleen in a patient with a perforated duodenal ulcer and infectious mononucleosis
Authors: Gray Robin
Published: December 2008

A 72-year-old patient presented as a sealed perforated duodenal ulcer. This was later confirmed at operation when in addition a haemoperitoneum due to a lacerated friable spleen was discovered. The patient denied antecedent injury. The peripheral blood film was normal but a subsequent differential slide test for infectious mononucleosis was positive. Histology of the spleen showed hyperplasia of the red pulp in addition to capsular and trabecular infiltration with lymphocytes and atypical mononuclear cells confirming the diagnosis. Infectious mononucleosis in the elderly is rare and a complicating rupture of the spleen at this stage has not been reported previously. The diagnosis may depend on the histology alone because the peripheral blood film and serology can be negative. The possible role of the perforated duodenal ulcer is discussed.
Cytomegalovirus infection and the Guillain-Barré syndrome
Authors: Arnold A G , Lawrence D S , Corbitt G
Published: December 2008

A fatal case is described of the Guillain-Barré syndrome due to cytomegalovirus infection, which was associated with hepatitis, myocarditis and viral pneumonia.

Previous cases, which have usually run a benign course, are reviewed. Attention is drawn to the possible adverse effect of steroid therapy.
The use of dilute hydrochloric acid and cimetidine to reverse severe metabolic alkalosis
Authors: Rowlands B J , Tindall S F , Elliott D J
Published: December 2008

Two cases of severe metabolic alkalosis associated with gastric hypersecretion were successfully treated with dilute hydrochloric acid and a histamine H2-receptor antagonist given by intravenous infusion. This combined therapy with electrolyte replacement and suppression of gastric secretion is valuable in the control of this serious metabolic abnormality when conventional treatment is unsuccessful or contraindicated.
Gout without crystals on initial synovial fluid analysis
Authors: Romanoff N R , Canoso J J , Rubinow A , Spark E C
Published: December 2008

In five patients with acute arthritis in whom gout was eventually documented, an initial synovial fluid analysis failed to reveal urate crystals. Four of the patients were seen in one hospital during a period of 30 months in which 103 cases of gout were documented on initial aspiration. While this is an uncommon event, the importance of being able to make a definitive diagnosis of gout is such that re-aspiration of the same or other joints may be justified under certain circumstances.
The origins of atherosclerosis
Authors: Woolf N
Published: December 2008

The presence of atherosclerotic lesions in young adults suggests that early stages of atherogenesis occur during childhood. The relationship of intimal lesions in childhood to fully developed atherosclerosis is briefly discussed. Factors likely to promote lipid accumulation within the arterial wall and proliferation of connective tissue elements are reviewed with particular emphasis on endothelial cell injury and the possible consequences of this for intimal smooth muscle cell proliferation.
Coronary artery disease in children
Authors: Neufeld H N , Blieden L C
Published: December 2008

In this paper an attempt has been made to correlate the morphologicla aspects of childhood atherosclerosis. Some of the features described are directly related to atherosclerosis. Some of the other conditions described may be related to the subsequent development of atherosclerosis by damaging the vessel wall and thus stimulating the production of atherosclerosis. In other instances, as in the description of the ultrastructural features of the coronary arteries, the exact role of the changes described still remains to be elucidated.
Risk factors of CHD in children—a retrospective view of the Westland study
Authors: de Hass J H
Published: December 2008

Routine medical examinations have been carried out in children for many years, but more recently paediatricians have broadened their outlook to consider not only the health of the child until the age of 14 or 16 years but also his future health as an adult. Screening for risk factors for coronary heart disease (CHD) in children raises problems of normal values by sex and age, especially for serum cholesterol and blood pressure.

The results of a study of CHD risk factors in school children in Westland, Holland, are described. Although further information is needed it is concluded that in future paediatricians should accept a greater responsibility for preventive cardiology.
Smoking in childhood
Authors: Bewley B R
Published: December 2008

A longitudinal study of smoking in a cohort of 6000 children aged 11–12 years is being carried out in Derbyshire. One of the main objectives is to discover the factors which influence children to take up smoking. Once such factors are determined intervention methods can be developed to discourage children from smoking which, it is hoped, will result in a reduction in mortality and morbidity from cigarette smoking.
Blood pressure and its significance in childhood
Authors: Lauer R M , Rames L K , Clarke W R
Published: December 2008

Hypertension is an important accelerator of the atherosclerotic process. Detection in childhood may be important although longitudinal data are lacking of the prognosis of blood pressure measurement in childhood through adult life. The blood pressure of children should be measured.

In populations where salt intake is high, values for blood pressure increase with age. Populations who eat small quantities of salt are relatively free from hypertension. There is an epidemiological argument for limiting salt intake in children.

There are few data to indicate the level of blood pressure in children which should be treated. Children's blood pressures are labile and elevated levels are sustained only in a small minority. In these secondary causes, advice should be sought. In subjects with extreme persistent hypertension drug therapy should be considered; in subjects with values of blood pressure not so extremely raised surveillance should be maintained to prevent the development of sustained hypertension.
The role of the media
Authors: Jolly H
Published: December 2008

There is an increasing awareness on the part both of the media and the profession of the need to co-operate in providing information and education on medical matters. This co-operation should be strongly encouraged. Where children are concerned the opportunities for education are great.
A basis for migraine therapy — the autonomic theory reappraised
Authors: Johnson E S
Published: December 2008

The concept that migraine results from an initial vasoconstriction due to increased release of noradrenaline from the sympathetic nerves to cranial blood vessels has been reappraised in the light of recently acquired knowledge of the mechanisms of action of drugs used in the treatment of migraine, physiological and pharmacological evidence implicating noradrenaline, and the observations by others that several migraine variants may be associated with some degree of sympathetic overactivity. If the theory is correct, it suggests that both prophylaxis and management of the acute condition should be possible by means of selective alpha-adrenoceptor antagonism. The use of drugs with potentially dangerous vasoconstrictor properties appears to be unnecessary. The suggestion is made that the increased adrenergic activity might result from changes within the hypothalamus.
Calcium requirements in man: a critical review
Authors: Paterson C R
Published: December 2008

Many official bodies give advice on desirable intakes of calcium but no clear evidence of a calcium deficiency disease in otherwise normal people has ever been given. In Western countries the usual calcium intake is of the order of 800–1000 mg/day; in many developing countries figures of 300–500 mg/day are found. There is no evidence that people with such a low intake have any problems with bones or teeth. It seems likely that normal people can adapt to have a normal calcium balance on calcium intakes as low as 150–200 mg/day and that this adaptation is sufficient even in pregnancy and lactation. Inappropriate concern about calcium intake may divert attention and resources from more important nutritional problems.
Upper gastrointestinal endoscopy — a survey of patients' impressions
Authors: Walker B , Smith M J
Published: December 2008

One hundred and forty patients were followed-up within one year of upper gastrointestinal endoscopy. The incidence of disease, complications and influence of findings on treatment are outlined.
Pituitary coma with continuing menstruation
Authors: Mitchell D M , Webb S C , Hoffbrand B I
Published: December 2008

A case of pituitary coma with continuing menstruation is presented. This association is extremely rare, but a history of recent menstrual periods does not exclude advanced hypopituitarism from the differential diagnosis of severe hyponatraemia.
Hospital phobia: a rapid desensitization technique
Authors: Waxman D
Published: December 2008

The less disabling phobias do not normally present a problem in that the stimulus may be avoided. This would also apply to hospital phobia until an acute medical or surgical problem might arise, when avoidance could constitute a direct threat to life.

Although phobic illness is a common problem the small number of cases of hospital phobia recorded may represent the tip of the iceberg beneath which could be many phobic patients who deny their symptoms and risk their health because of their irrational fear.

A case of hopsital phobia in a pregnant patient with suspected disproportion was treated by a rapid desensitization technique using hypnosis. After five sessions of 30 min each, the patient was symptom free.

This simple method of desensitization, if more widely known would considerably minimize the risk caused by concealment of the phobic problem.
Guillain-Barré syndrome after rubella
Authors: Saeed A A , Lange L S
Published: December 2008

A case of polyneuropathy (Guillain—Barré syndrome) developing only 6 days after rubella infection in a 26-year-old woman is described. Serological confirmation of the viral infection by detecting the specific IgM antibody has not been previously reported in any of the rubella cases associated with the syndrome.
Rhinocerebral zygomycosis treated with amphotericin B
Authors: Hanley S P
Published: December 2008

Rhinocerebral zygomycosis is a rare, often fatal opportunistic fungal infection involving the cranial tissues. A diabetic patient with normal humoral and cellular immunity who was successfully treated with amphotericin B and surgery is reported.
Benign polypi at the site of uretero-rectal anastomosis
Authors: Narayana A S , Kelly D G , Duff F A
Published: December 2008

A case of benign polypi at the site of uretero-rectal anastomosis is herein reported. Nine other similar cases are reviewed. Possible aetiology and diagnosis are discussed.
Hostile interaction in a general hospital ward leading to disturbed behaviour and bulimia in anorexia nervosa: its successful management
Authors: Cohen S I
Published: December 2008

A girl of 17 years with severe anorexia nervosa, treated on a medical ward in a teaching hospital, developed bulimia, stole food, was sometimes doubly incontinent, behaved angrily, and aroused the hostility of patients and staff. The growth of a vicious circle of hostility is described and it was hypothesized that the hostility had aggravated the bulimia. On the basis of this hypothesis the situation was clarified with the patient and staff, attitudes changed, the patient's appetite dropped within a day from about six times to one-and-a-half times the normal and her behaviour became normal. The significance of these events is briefly discussed.
An investigation of the immune response of patients suffering from anorexia nervosa
Authors: Armstrong-Esther C A , Lacey J H , Crisp A H , Bryant T N
Published: December 2008

Patients suffering from anorexia nervosa rarely appear to develop the common cold or influenza. This study examines the immunological response of fifteen female anorexia nervosa patients of both the vomiting and carbohydrate-abstaining type and compares them with a control population matched for age and occupation. Both anorectics and control populations received the admune influenza vaccine. Initially both groups had similar haemagglutination inhibition titres against the three different viral antigens: A/HK; A/PC; A/Eng. However, the anorectics showed over a 2-month period a higher titre of antibody especially to the Hong Kong virus: this was sigignificant. Cellular immune responses were measured using a tuberculin and a macrophage inhibition test, no significant difference between the two groups was obderved. These results which support the clinical findings are discussed.
The spectrum of paracetamol (acetaminophen) overdose: clinical and epidemiological studies
Authors: Hamlyn A N , Douglas A P , James O
Published: December 2008

In a regional survey of paracetamol overdose, 201 patients were admitted to hospital over 12 months. Chronic alcoholism was present in 10% of cases. Over 25% of patients were females aged 20 years or less. Initial blood paracetamol levels were in the toxic range in 16% and histologically severe liver damage eventually found in 20% of those biopsied. This finding corresponded to a serum aspartate aminotransferase of 600 i.u./l or more. Renal failure severe enough to require peritoneal dialysis developed in 1%. Elevated serum amylase was recorded in 22% of a 108-patient subset. Evidence of myocardial damage was found in 11.6% of an eighty-six patient subset. An unfavourable prognosis was indicated by a prothrombin ratio of 20% or less and hepatic coma, the overall mortality being 3.5%.

The apparent safety of this useful analgesic is compromized by its widespread employment in parasuicide. This, the insidious and delayed onset of toxicity in overdose and ineffectiveness of late treatment argues for controlling availability to the general public.
Granulomatous sarcoid nephropathy
Authors: Ford M J , Anderton J L , MacLean N
Published: December 2008

When sarcoidosis of the renal parenchyma occurs it is rarely of major clinical significance. The clinical features and post-mortem findings of a case of subacute uraemic syndrome due to severe granulomatous involvement of the kidney by sarcoidosis are described. The case is unusual in that granulomatous sarcoid nephropathy resulted in death from renal failure within 4 months of onset of symptoms in the absence of clinically apparent sarcoidosis.
Gastro-cutaneous fistula following anterior gastropexy
Authors: Mackie D B , Whitaker M J F , Gent A E
Published: December 2008

Two patients are described who developed a gastric fistula to the anterior abdominal wall following anterior gastropexy. Both fistulae closed spontaneously without any specific treatment. It is suggested that the fixation of the stomach to the anterior abdominal wall allows the fistula to discharge externally thus preventing peritoneal contamination with its serious consequences.
Diagnosis and natural history of congested (dilated) cardiomyopathies
Authors: Oakley C
Published: December 2008

The diagnosis of primary dilated cardiomyopathy depends on the recognition of a dilated poorly contracting left ventricle with increased end-diastolic and end-systolic volumes in the absence of a detectable cause. The diagnosis is made only after exclusion both of structural heart disease and of known causes of secondary heart muscle disorder.

The natural history is still largely unknown and is probably as variable as the likely causes. The left ventricular disorder does not cause symptoms until heart failure supervenes except for occasional patients who develop an early atrial or ventricular dysrhythmia, conduction defect, chest pain or murmur of mitral regurgitation. This period of latency may be short, prolonged or even permanent since it is unlikely that all cases progess to the point of failure. A few patients recover normal or near-normal cardiac function. The interplay between high blood pressure, hypertensive heart failure and dilated cardiomyopathy is illustrated by patients who recover from heart failure to become hypertensive and vice versa and in current treatment with vasodilators and diuretics for patients at either end of the spectrum.
Prognosis and possible presymptomatic manifestations of congestive cardiomyopathy (COCM)Supported in part by grant of Deutsche Forschungsgemeinschaft, SFB 30 Kardiologie Düsseldorf.
Authors: Kuhn H , Breithardt G , Knieriem H-J , Köhler E , Lösse B , Seipel L , Loogen F
Published: December 2008

In order to find evidence of prognosis and of presymptomatic manifestation of congestive cardiomyopathy (COCM) in fifty-eight patients, the extent of morphological changes of endomyocardial catheter biopsy (EMCB), clinical and haemodynamic data were correlated to the clinical course. In addition, clinical, haemodynamic, angiographic, morphological and His-bundle electrographic studies were performed in patients with left bundle branch block (LBBB), normal left ventricular end-diastolic volume, and normal coronary arteries (n = 43).

Related to a 10-year mortality rate of 70% from the onset of symptoms, COCM is one of the most severe heart diseases. Endomyocardial catheter biopsy (EMCB) allowed clear prognostic separation in patients with COCM and seems to be of diagnostic value in patients with only slightly enlarged hearts and in patients with a short history of symptoms. The studies also revealed much evidence that at least some patients with LBBB, normal left ventricular end-diastolic volume (LVEDV) and normal coronary arteries exhibit an early stage of COCM. In these patients especially EMCB with severe changes of heart muscle cells and/or impaired left ventricular function may indicate subsequent COCM. So that there is now a new indication for performing EMCB.
Total exchangeable potassium in response to amiloride
Authors: Pearce V R , Antcliff A C , Beevers D G , Hamilton M
Published: December 2008

The use of amiloride is described in twenty-four hypertensive patients who became hypokalaemic as a result of thiazide diuretic therapy in spite of oral potassium supplments. Amiloride caused a significant rise in exchangeable potassium, exchangeable potassium/kg body weight, and plasma potassium, together with a significant fall in plasma total carbon dioxide, body weight, systolic and diastolic blood pressures.

These results suggest that amiloride has a useful role in this type of patient.
Achalasia of the cardia in elderly patients
Authors: Lock M R , Ellis H
Published: December 2008

Achalasia of the cardia frequently presents as dysphagia in middle age. In the elderly, dysphagia is usually due to a neoplasm of the oesophagus or cardia. The authors have been interested to see five patients over the age of 70 presenting with oesophageal symptoms due to achalasia which is uncommon in this age group and may be mistaken for neoplastic disease.
Presentation of primary hyperparathyroidism to a general medical unit
Authors: Sheridan P
Published: December 2008

Four patients with hyperparathyroidism who presented in atypical or uncommon ways to a general medical unit are described.

The unusual features are discussed and the value of modern procedures for localization of a parathyroid tumour is confirmed.
Auto-immune Addison's disease in identical twins
Authors: Simmonds J P , Lister J
Published: December 2008

Identical male twins are described, one of whom presented with clinical symptoms of Addison's disease whereas the other was shown to have a deficient adrenal cortical response to stimulation tests. Both had positive adrenal cortex antibodies.
Cyclical release of vasoactive intestinal polypeptide (VIP) from a pancreatic islet cell apudoma
Authors: Devine B L , Carmichael H A , Russell R I , Joffe S N
Published: December 2008

A patient is described who presented with the classical symptomatology and profound electrolyte disturbance of the Verner-Morrison syndrome due to a pancreatic apudoma secreting vasoactive intestinal polypeptide (VIP). Diagnosis was confirmed by plasma VIP as measured by a radio-immunoassay technique now available. It is suggested that the cyclical nature of the symptoms in this case was due to cyclical release of VIP from the tumour in response to an unknown stimulus. Perfusion studies confirmed the excess secretory state of water, sodium and chloride in the small intestine. Symptoms were completely abolished by surgery and the progress is being monitored by means of serial plasma VIP estimations to detect any early recurrence of metastatic disease.
General features of persistent virus infections
Authors: Mims C A
Published: December 2008

Persistent virus infections are discussed from the virus point of view in terms of the bodily sites in which the infection persists. Glands and body surfaces are thought to be significant because they give the virus protection at the topographical level from immune forces, and because they are appropriate sites for the shedding of virus to the exterior. Germ cells are relevant sites because infection can thus be transmitted vertically from generation to generation in the host. The central nervous system, however, is generally a ‘dead end’ from which there is no shedding to the exterior. Persistance in blood may be relevant when continued arthropod transmission becomes possible. Most persistent viruses infect lymphoreticular tissues, and this is interpreted by suggesting that it results in an impaired immune response to the infecting virus, which in turn favours persistence.

It is suggested that the biological function of virus transformation and the integration of viral into host cell DNA is that it enables the infection to persist in the host and undergo reactivation. Papovaviruses, adenoviruses and oncornaviruses are considered from this point of view.
Polyarteritis presenting with thrombocytosis and palliated by plasma exchange
Authors: Hamblin T , Oscier D
Published: December 2008

A 66-year-old patient with polyarteritis nodosa presented with thrombocytosis and was found to have circulating immune complexes. Treatment by plasma exchange produced symptomatic improvement and lowered both the platelet count and the level of immune complexes. While plasma exchange is a useful technique in investigating the pathogenesis of the disease, predisolone is a more convenient way of treating it.
The treatment of lupus nephritis by methyl prednisolone pulse therapy
Authors: Dosa S , Cairns S A , Lawler W , Mallick N P , Slotki I N
Published: December 2008

Four patients with proliferative glomerulonephritis due to systemic lupus erythematosus were treated with intravenous methyl prednisolone ‘pulse’ therapy. In all, eight courses of therapy were given, three for acute oliguric renal failure; and on each occasion there was a good response to the treatment. Clinical, histological and immunological details of the patients are presented. The diagnosis, treatment, and monitoring of disease activity in lupus nephritis are discussed in the light of this experience.
Coronary artery surgery: indications and recent experience
Authors: Robinson P S , Coltart D J , Jenkins B S , Webb-Peploe M M , Braimbridge M V , Williams B T
Published: December 2008

The comprehensive experience of coronary artery surgery in a Cardiothoracic Unit over a 31-month period is reviewed. Hospital mortality for elective bypass grafting was 3·9% overall and 2·5% in those with good pre-operative left ventricular function. Major influences on hospital mortality were pre-operative left ventricular function, extent of coronary artery disease and extent of the surgical procedure undertaken in terms of number of aortocoronary grafts inserted, coronary endarterectomy and particularly concomitant valve surgery or aneurysm resection.

Follow-up experience shows 74% of grafted patients to be symptom-free and 85% symptomatically improved one year after surgery with 70% symptom-free and 80% improved at two years. Early post-operative deaths appear related to early graft closure and recurrence of symptoms postoperatively to late graft closure or progression of coronary disease in the native circulation. The study provides a guide to the relative risks of coronary artery surgery for symptomatic coronary artery disease and expected symptomatic results in the early follow-up period.
Axial volvulus of Meckel's diverticulum
Authors: Osborne M P , Hamilton G , Shalley M
Published: December 2008

Two cases of axial volvulus of a Meckel's diverticulum associated with a diverticular band are described. In both cases, the pre-operative diagnosis was of acute appendicitis. The importance of further exploration if the appendix is insufficiently inflamed to acount for the symptoms and signs is emphasized.
Epidemiological approaches to ‘epidemic neuromyasthenia’: syndromes of unknown aetiology (epidemic myalgic encephalopathies)
Authors: Thomas M
Published: December 2008

The study of future outbreaks of ‘epidemic neuromyasthenia’ syndromes would be easier if there were a standing advisory arrangement for the co-ordination of basic standart studies, diagnostic tests and long term survey of patients. It is proposed that this might be achieved by establishing an ‘EN Outbreaks Panel’ at Colindale which, in addition to epidemiologists and virologists might include specialists in infectious diseases, neurology and psychiatry and other fields. The approach to such a panel would be through the Communicable Diseases Surveillance Centre (CDSC) when outbreak is suspected. Arrangements could then be made by the CDSC with the Epidemiological Research Laboratory and the Virus Reference Laboratory to assist immediate investigations and for a follow-up to ascertain the incidence of sequelae, as well as for long storage of sera and other specimens.
A prospective study of the factors affecting anticoagulant control in a hospital out-patient clinic
Authors: Shepherd A M M , Christopher L J , Stevenson I H , Henney C R , Brown Y
Published: December 2008

Anticoagulant control (as indicated by the percentage of Thrombotest values outside a defined range) was determined in out-patients attending a hospital anticoagulant clinic and the influence of patients' age and sex, indication for anticoagulation, concurrent drug therapy and duration of anticoagulant treatment studied. Of these factors, duration of treatment was most important, control being particularly poor in the first 6 months (40% of Thrombotest values outside the 5–15% range, compared with 17% in patients treated with anticoagulants for more than 2 years). Control was also influenced by patients' age and the data supported previous evidence of an increased sensitivity to anticoagulants in the elderly.
Clinical course following diabetic ocular palsy
Authors: Leslie D , Ellis C
Published: December 2008

Eleven patients who had a diabetic ocular palsy were reviewed. Clinical evidence of microangiopathy or atherosclerosis was infrequent, thus such a palsy does not presage subsequent diabetic complications nor do these observations support the suggestion that diabetic ocular palsies are caused by vascular disease.
The immunological evaluation of levamisole treatment in cancer patients
Authors: Verhaegen H , de Cree J , de Beukelaar A , de Cock W , Verbruggen F , Krug F
Published: December 2008

The effect of levamisole on different immunological parameters was studied in patients with various malignant diseases.

Levamisole restored tuberculin-negative delayed hypersensitivity reactions and increased the sensitivity to 1-nitro-2,4-dichlorobenzene challenges. It also increased low E-rosette formation of T-lymphocytes and enhanced the clearance of a lipid emulsion by the reticulo-endothelial system.

Levamisole had no effect on serum immunoglobulin levels but increased serum haemolytic complement activity.
Intraperitoneal noxythiolin and povidone-iodine in experimental peritonitisBased on a paper presented to the Surgical Research Society, January 1977.
Authors: Gilmore O J A , Houang Elizabeth T , Reid Claire , Shaw Elizabeth J
Published: December 2008

The efficacy of intraperitoneal noxythiolin and povidone-iodine was compared in mice and rats with induced Gram-negative peritonitis. Noxythiolin 1% solution reduced the mortality of mice from 65 to 41% (P < 0·1) but was ineffective in rats. Povidone-iodine (6·0–7·5 mg available iodine/kg body weight) significantly reduced the mortality of both mice (P < 0·001) and rats (P < 0.01) in treated animals compared to matched controls. The mortality rate of rats treated with povidone-iodine was significantly less than those treated with noxythiolin (P < 0·01).
Hydatid disease with hilar lymphadenopathy
Authors: Seager J , Seal R M E , Bray P T
Published: December 2008

Enlargement of bronchopulmonary lymph nodes is unusual in hydatid disease. In the case described the radiographic appearance and the findings at operation suggested pulmonary tuberculosis. Immune mechanisms involved in the response to hydatid disease are discussed.
The syndrome of diabetes insipidus, diabetes mellitus and optic atrophy (DIDMOA) with diabetic cheiroarthropathy
Authors: FitzGerald G A , Greally J F , Drury M I
Published: December 2008

Two sisters with diabetes mellitus and optic atrophy are described. One of them also has vasopressin responsive diabetes insipidus. Both have diabetic cheiroarthropathy, an unusual deformity of the hands.
Myxoedema coma. A report on five successfully treated cases
Authors: Khaleeli A A
Published: December 2008

Five consecutive cases of myxoedema coma treated successfully with intravenous triiodothyronine and later oral thyroxine are described. All were hypothermic and had biochemical evidence of advanced myxoedema. Co-existent disease, notably diabetes and anaemia, was common.
Rectal bleeding in the first month of life
Authors: Levene M I
Published: December 2008

Sixty-nine infants were examined who presented with rectal bleeding in the first month of life. In 64% of these children no cause was found. Infantile diarrhoea, haemorrhagic disease of the newborn and anal fissure were the most common diagnoses made. The mortality in the entire group was <3%. It is concluded that rectal bleeding in this age group is a relatively benign condition and in certain cases hospital admission may not be required.
Anorexia nervosa presenting as foot drop
Authors: Schott G D
Published: December 2008

A patient with anorexia nervosa is reported whose presentation with foot drop was to a neurological department. Bilateral peroneal nerve palsies were subsequently demonstrated. The aetiology of these transient palsies is discussed.
Some aspects of the role of viruses in cancer
Authors: Potter C W
Published: December 2008

The cells of tumours induced by many oncogenic DNA viruses, or cells transformed in vitro, contain virus-specific T and transplantation antigens; these have been described for SV40 virus, polyoma virus and adenoviruses. The investigation of viruses as causes of malignant disease in man has sought to establish whether tumour cells possess these virus-specific proteins; however, to date and with the limitations of present techniques, this enquiry has not demonstrated the above viruses as causal of human cancer. More recent studies with herpesvirus type 2 (HSV-2) have shown this virus to transform animal and human cells in culture, and induce cancer in experimental animals: for these reasons, many researchers have suggested that this agent may be an agent of some forms of cancer, in particular carcinoma of the cervix. The possible association of HSV-2 with human malignant disease is discussed.
Severe bronchial asthma requiring ventilation. A review of 20 cases and advice on management
Authors: Webb A K , Bilton A H , Hanson G C
Published: December 2008

The natural history and outcome of 20 asthmatics who required mechanical ventilation is reviewed. Seven of these patients died. The majority of the deaths could have been prevented if: (1)The patient had been followed-up in an asthma clinic and had been fully informed of the danger of an asthmatic attack.(2)The medical staff had been trained more fully in the evaluation and management of a severe asthma attack.

Careful sequential assessment will enable timely transfer of patients with severe bronchial asthma to a unit experienced in their management.
Leptospirosis and acute renal failure—clinical experiences and a review of the literature
Authors: Kennedy N D , Pusey C D , Rainford D J , Higginson A
Published: December 2008

About 50 cases of leptospirosis are diagnosed each year in the United Kingdom, with an overall mortality of 5%. Renal failure, in association with jaundice, is commonly held responsible for this figure. Over a period of 18 years, 6 cases of leptospirosis complicated by renal failure were treated at the Royal Air Force Renal Unit; there were 4 survivors. The 2 deaths occurred before the unit policy of daily haemodialysis and total parenteral nutrition, and were both from haemorrhagic complications.

The authors believe that patients with leptospirosis and progressive renal impairment should be managed in renal units experienced in the management of the hypercatabolic patient, and that this should improve their prognosis.
Influenza in a geriatric unit
Authors: Gowda H T
Published: December 2008

An outbreak of influenza A (resembling A/Victoria/3/75) occurred in 2 geriatric wards in February 1976 and, out of 19 patients, 3 died. Of the patients who were at risk, 30% were affected.

Immunization for influenza in the elderly just before the winter is suggested. The procedure is simple and inexpensive. The recommendations of the DHSS (U.K.) for the use of influenza vaccine to practising doctors is, therefore, welcome.

The suitable treatment appears to be that of repeated immunization with inactivated vaccine. Amantadine in the elderly population may also be effective, and is worthy of trial.
Local cutaneous allergy to monocomponent insulin
Authors: Borsey D Q , Malone D N
Published: December 2008

A case is described of a patient who developed local cutaneous hypersensitivity soon after commencing treatment with monocomponent insulins (MCI). This appears to be the first record of such a case.
Comparison of two coronary prognostic indices
Authors: Habib T , Taylor D J E , Dalton R
Published: December 2008

Two coronary prognostic indices for patients treated in a coronary care unit, namely the Norris Index and the Chapman-Gray Index were compared. Both were found to be reliable but the Chapman-Gray Index with its ready reckoner was more convenient and was subject to fewer subjective data.
Liver and gastrointestinal function in pregnancy
Authors: Seymour C A , Chadwick V S
Published: December 2008

Difficulties arise in the interpretation of liver tests in the pregnant subject, since some values increase (alkaline phosphatase) whilst others remain unchanged (transaminases) or fall during pregnancy. The diagnosis and management of some causes of jaundice in pregnancy, such as viral hepatitis, gall stones, benign intrahepatic cholestasis and acute fatty liver of pregnancy are discussed.

Little is known about the commonest symptoms of pregnancy (nausea, vomiting and constipation) other than that they might be due to hormonally induced alteration of sphincter tone. However, pre-existing bowel disease has a greater effect on pregnancy. Fertility is reduced in poor nutritional states (e.g. coeliac and Crohn's diseases) and an increased occurrence of spontaneous abortion has been noted. For inflammatory bowel diseases, the time of onset is important in determining the outcome of pregnancy. Relapse in the disease is commonest in the first trimester and in the puerperium. Treatment of these conditions is essentially as in the non-pregnant subject. The controversial subject of sulphasalazine and steroid usage in pregnancy is discussed.
Metabolic changes in pregnancy relevant to diabetes mellitus
Authors: Lind T
Published: December 2008

The alterations in carbohydrate metabolism during pregnancy are discussed and possible mechanisms for these changes are put forward. It is stressed that the raised levels of plasma glucose, the enhanced response to insulin and the decreased tissue sensitivity to insulin are all features of normal pregnancy. It may be difficult to distinguish this from very early forms of diabetes mellitus during pregnancy, the detection of which is briefly considered.
Haematemesis during oral aminophylline treatment
Authors: Mackay A , Ramsay L E , Eppel M L , Oliver J S
Published: December 2008

Two cases of gastrointestinal bleeding in patients being treated with continuous-release aminophylline tablets are reported.
Neoplastic autovagotomy causing gastric stasis
Authors: Thomas W E G , Fletcher M S
Published: December 2008

Neoplastic autovagotomy causing atonic gastric stasis is extremely rare. Two cases are reported in which marked gastric stasis was complicated by a bezoar and a gastric volvulus respectively. Both cases were associated with a left hilar bronchial carcinoma, and malignant invasion of the vagus nerve may have been the underlying cause.
Severe orthostatic hypotension associated with carcinoma of the bronchus
Authors: Green C J , Breckenridge A M , Wright F K
Published: December 2008

A patient is described who had severe orthostatic hypotension. An account is given of his treatment with a monoamine oxidase inhibitor and tyramine. At post-mortem, 8 months after the illness began, a small oat cell carcinoma of the bronchus was found. It is suggested that the orthostatic hypotension was a nonmetastatic manifestation of the underlying carcinoma.
Carcinoid tumour as a complication of ulcerative colitis
Authors: Hay D J , Curt J R N
Published: December 2008

Patients with long-standing ulcerative colitis have an increased chance of developing a carcinoma of the colon, especially when the inflammatory process involves the entire colon, but no case of a carcinoid tumour of the colon occurring in a patient with ulcerative colitis has been reported.
Birmingham Medical Research Expeditionary Society 1977 Expediton: thyroid function and acute mountain sickenss
Authors: Wright A D
Published: December 2008

In a study of 17 subjects plasma-thyroxine-binding globulin and plasma thyroxine concentrations rose during a high altitude trek. An early and sustained rise in plasma reverse triiodothyronine occurred independently of changes in plasma thyroxine and was probably related to physical exertion. Similar changes in thyroid function were found in subjects most affected and least affected by acute mountain sickness.