bluuebunny/crossref_metadata_2025 huggingface dataset:
Benign chondrolipomatous tumour of the breast
Authors: Dharkar D D , Kraft J R
Published: December 2008

Cartilage associated with malignant neoplasms of breast has been known and documented for over 200 years. Benign breast tumours containing cartilage are rare. A case of such a tumour was encountered. Histologically it comprised multiple foci of mature benign cartilage in benign fibrous and adipose stroma. Other cases of similar tumours in the literature are reviewed.
Caverno-saphenous shunt in the treatment of priapism
Authors: Ihekwaba F N , Lawani J
Published: December 2008

The painful pathological condition of the penis, priapism, is usually associated with serious destructive changes which lead to impotence if treatment is with-held or delayed. Conservative therapy is slow, uncertain and usually ineffective. Early surgical decompression of the corpora cavernosa, repeated if necessary, is essential if impotence is to be averted. Two unusual cases of this condition recently seen at the University College Hospital, Ibadan, in which treatment had been delayed for periods previously thought to be too long for recovery are herein presented and the management described. It is advised that failure of the initial surgical operation calls for early re-operation to establish a new shunt.
Lysozyme and hypokalaemia
Authors: Mir M A , Lodha S C
Published: December 2008

Serum potassium, lysozyme and urinary lysozyme measurements were made in 98 patients with tuberculosis, 18 with sarcoidosis and 30 with acute myeloid leukaemia. Serum K concentration fell below 3·5 mmol/l in 17 of the 30 leukaemic patients and only 7 of these had raised serum lysozyme concentrations. None of the patients in the tuberculosis-sarcoidosis group with lysozymaemia or lysozymuria developed hypokalaemia. This study suggests that raised lysozyme concentrations are not causally related to hypokalaemia.
Endocrine abnormalities in primary hyperparathyroidism
Authors: Hamilton D V , Pryor J S
Published: December 2008

Endocrine abnormalities in 73 patients with primary hyperparathyroidism were studied: 8 patients were diabetic, 3 were thyrotoxic, 2 were hypothyroid, and one had a gastrinoma and carcinoid tumour. In 9 of these patients, carbohydrate metabolism and thyroid function were studied in detail pre- and 3 months postoperatively. In 6 patients following a glucose load, insulin concentrations were markedly elevated pre-operatively when compared with those found postoperatively. Likewise, in 7 patients, serum thyroxine was greater pre- than postoperatively. The aetiology of these changes and their relevance to the management of patients with primary hyperparathyroidism is discussed.
Lymphoma presenting as mononeuritis multiplex
Authors: Reid Alison C , Bone I
Published: December 2008

A case is reported of mononeuritis multiplex, the peripheral nerve lesions being caused by metastatic deposits of lymphoma in muscle. The patient also had a past history of a facial nerve palsy and the Guillain-Barré syndrome. This case portrays an interesting spectrum of unusual manifestations of neoplastic disease - both with regard to metastatic spread and peripheral neurological involvement.
Central pontine myelinolysis
Authors: Ibrahim N B N
Published: December 2008

This appears to be the first report of a case of central pontine myelinolysis associated with chronic alcoholism and liver cirrhosis in the United Kingdom. The pathological features and theories of aetiology are briefly discussed.
Rapid development of neurosyphilis in a long-standing diabetic
Authors: Gorsuch A N , Thin R N , Simmons P D , Cudworth A G
Published: December 2008

At the age of 50 years, a known diabetic presented with clinical features of diabetic neuropathy which on investigations proved to be taboparesis. The case is described as a reminder that tabes dorsalis, although rare in the United Kingdom at present, must be included in the differential diagnosis of diabetic neuropathy. In addition, the tabo paresis developed over a 5-year period, in contrast to the slow development classically described in this condition.
SLE syndrome, probably induced by labetalol
Authors: Brown R C , Cooke J , Losowsky M S
Published: December 2008

A 45-year-old woman developed polyarthralgia and muscle tenderness after 6 months’ therapy with labetalol 1800 mg daily. A raised ANF titre but normal DNA binding levels suggested a drug-induced SLE syndrome. Both symptoms and ANF titre improved when therapy was changed from labetalol to propranolol.
Chyluria associated with bronchial carcinoma
Authors: Morice A H , Wood J R
Published: December 2008

Chylous pleural effusion, though not chyluria, is a recognized association of carcinoma of the bronchus. A case of chyluria associated with squamous bronchial carcinoma is reported. Chyluria in this patient was successfully treated by dietary modification.
Potassium shift in thyrotoxic periodic paralysis
Authors: Feely John
Published: December 2008

A thyrotoxic patient who initially presented with periodic paralysis is described. Precipitation of an attack by a high carbohydrate diet was associated with only a modest fall in plasma potassium but with a marked rise in total blood cell potassium.
Torsion of the Fallopian tube in a premenarchal girl
Authors: Duffy Terence J
Published: December 2008

A case of isolated torsion of the normal Fallopian tube, masquerading as acute appendicitis, in a premenarchal girl is presented. The aetiology is considered and the literature reviewed.
Periodic paralysis complicating malaria
Authors: Senanayake Nimal , Wimalawansa Sunil J
Published: December 2008

Episodic muscular weakness, commonly associated with alterations of serum potassium, is the cardinal feature of periodic paralysis. The combination of transient hyperkalaemia and rigors occurring during febrile episodes of malaria is suggested as the underlying cause which precipitated the muscular paralysis. Three patients with malaria who developed a similar paralysis during the paroxysms of fever are described to illustrate this.
Hormonal and blood pressure changes during converting enzyme inhibition by teprotide
Authors: VandenBurg M J , Sharman V L , Morton J J , Williams G H , Marsh F P
Published: December 2008

Changes induced by i.v. and subcutaneous teprotide in plasma renin, angiotensin I, angiotensin II, aldosterone and bradykinin were studied in a renal transplant patient with severe high renin hypertension, before and after trinephrectomy. The immediate reduction in BP produced by teprotide was not solely attributable to the inhibition of conversion of angiotensin I to angiotensin II, because there was also a transient increase in serum bradykinin; however, the prolonged antihypertensive effect of teprotide appeared independent of bradykinin. After trinephrectomy, teprotide lowered systolic BP but had no significant effect on diastolic BP or plasma bradykinin. beta-Blockade prevented the secondary increase in plasma renin which followed teprotide, thereby potentiating its anti-hypertensive effect.
Pituitary apoplexy (spontaneous pituitary necrosis)
Authors: Sachdev Y , Gopal K , Garg V K , Mongia S S
Published: December 2008

Pituitary apoplexy or spontaneous pituitary necrosis is an ill-understood clinical syndrome. It may occur as a neurological emergency requiring urgent interference in a patient with a known pituitary dysfunction or it may be responsible for drawing attention to an as yet unrecognized pituitary pathology. It has a bizarre clinical profile and an unpredictable neurological and endocrine course. Patients may die at once or may recover with or without endocrine/neurological deficit. Six cases of pituitary apoplexy with varied clinical presentation are cited.
Percutaneous transluminal dilatation of transplant renal artery stenosis
Authors: Rankin R N , Keown P A , Ulan R A , Stiller C R
Published: December 2008

Percutaneous transluminal angioplasty has been applied to the treatment of transplant renal artery stenosis in 3 patients, 2 with severe hypertension resistant to medical therapy, and one with graft dysfunction related to the presence of the stenosis in the early post-transplant period. The clinical courses of the patients before and after angioplasty are illustrated and the usefulness of the technique in this difficult situation stressed.
Cholecystitis and subphrenic abscess caused by Salmonella virchow
Authors: Billingham Julia D , Slack Mary P E
Published: December 2008

A case of cholecystitis caused by Salmonella virchow is reported. Following cholecystectomy a subphrenic abscess due to the same organism developed.
Polycythaemia vera presenting as an acute abdomen
Authors: Isles Christopher , Strachan R W
Published: December 2008

A patient who presented with severe abdominal pain was found to have an intrahepatic haematoma complicating previously undiagnosed polycythaemia vera (PV). Full recovery followed treatment with bed rest, control of hypertension, daily venesection and 32P. The hazards of surgery in uncontrolled PV are discussed and re-emphasized.
Pendred’s syndrome - consequences of thyroidectomy
Authors: Winearls Christopher G , Smith Roger
Published: December 2008

A 73-year-old-man with Pendred’s syndrome is described who presented with hypoparathyroidism and tracheal compression 31 years after thyroidectomy.
The evaluation of cefuroxime in the prevention of postoperative infection
Authors: Croton R S , Sykes D , Treanor J , Wake P , Green H T , Knowles M A , Eilon L A
Published: December 2008

Patients undergoing biliary surgery received either 750 mg cefuroxime i.m. with the premedication and then 8 hourly for 3 days ((group A) or 1.5 g cefuroxime i.v. at the time of induction of anaesthesia (group B) or not treatment (group C). Wound infections occurred in 3 out of 35 patients in group A, 1 out of 40 patients in group B and 11 out of 39 patients in group C (group B significantly different than group C, P less than 0.05). Eight patients (23%) in group C had chest complications. Cefuroxime was effective in the reduction of wound sepsis following biliary surgery and 1.5 g i.v. administered during induction of anaesthesia is the dosage of choice. The incidence of chest infection tended to be lower in patients receiving cefuroxime but many more patients would have to be studied for a conclusive result.
Anorexia nervosa with herpes simplex encephalitis
Authors: George G C W
Published: December 2008

Studies of patients suffering from anorexia nervosa appear to show an increased immunity to certain infections, as well as immunological deficiencies. This is the report of a patient with anorexia nervosa who developed herpes simplex encephalitis, a condition associated with lowered immunological defence mechanisms.
Myocardial infarction in familial hyper-alpha and hypo-beta-lipoproteinaemia
Authors: Rabkin Simon W , Ledwich Rodney , Mymin D
Published: December 2008

This is the documentation of an acute myocardial infarction in a 45-year-old woman with familial hyper-alpha- and hypo-beta-lipoproteinaemia. This dyslipoproteinaemia has been rarely associated with clinical evidence of ischaemic heart disease. Documentation of angiographically normal coronary arteries in this patient is consistent with the concept that increased alpha-lipoprotein (HDL) and low beta-lipoprotein (LDL) may prevent atherosclerosis. Thus, myocardial infarction in patients with this dys-lipoproteinaemia should be attributable to factors other than coronary atherosclerosis.
The diagnosis and management of patients admitted to hospital with acute breathlessness
Authors: Pearson S B , Pearson Elizabeth M , Mitchell J R A
Published: December 2008

The authors have studied 352 emergency medical admissions during a summer period and 355 during the winter months to identify 177 patients who had been treated for breathlessness. Multiple and rapidly changing treatments have been taken to indicate diagnostic uncertainty. Using this model, the authors have shown that there is much more uncertainty in winter than in summer and that the working diagnosis of chest infection or asthma is particularly likely to be associated with multiple treatment. It is questionable whether the stereotyped descriptions of diseases in standard text books provide an adequate basis for emergency treatment decisions and it is considered that the diagnostic value of investigations such as chest radiography needs further careful scrutiny.
Plasma sex hormone concentrations in men with hypertension treated with methyldopa and/or propranolol
Authors: Taylor R G , Crisp A J , Hoffbrand B I , Maguire A , Jacobs H S
Published: December 2008

Serum concentrations of LH, FSH, testosterone and prolactin were measured in patients with hypertension treated with propranolol (34 cases), methyldopa (13 cases), and methyldopa + propranolol (11 cases). The results were compared with those obtained in 18 controls (hospital out-patients). There were no differences in these hormone concentrations in the various groups, and no difference between those complaining of impotence (13 cases) and those with normal sexual function.

Impotence in hypertensive men on treatment with methyldopa cannot be explained by abnormalities in secretion of the reproductive hormones.
A double-blind controlled trial of the effect of sodium cromoglycate in preventing relapse in ulcerative colitis
Authors: Whorwell P J , Whorwell G M , Bamforth J , Colin Jones D , Down P , Edwards A , Gent A E , Golding P , Gough K R , Hellier M D , Isaacson P , Loehry C A , Milton-Thompson G J , Smith C L , Waldram R P , Wright R
Published: December 2008

A double-blind controlled trial of the effect of sodium cromoglycate (SCG) in preventing relapse in ulcerative colitis has been completed in 100 subjects. In patients already taking sulphasalazine, SCG did not prove to be of any additional benefit. However, in patients not on any other maintenance therapy, the relapse rate was 40% for SCG as compared with 75% for placebo. A large study of the effect of SCG in patients intolerant of sulphasalazine is indicated.
Behçet’s syndrome and neutropenia
Authors: Leonard R C F , Thompson R B
Published: December 2008

A case is described of Behçet’s syndrome in which the active phases of the disease were associated with a profound neutropenia in contrast to the expected finding of normal or raised neutrophil count.
Malignant testicular tumours in non-twin brothers
Authors: Finan P J
Published: December 2008

Multiple examples of testicular tumours within a family are rare and the Testicular Tumour Panel noted a familial incidence in only 0·5% of 995 cases reported. A further case of testicular tumours in non-twin brothers is reported together with a brief review of previous publications.
A practical approach to the investigation of the hyperprolactinaemic patient
Authors: Shalet S M , Chapman A J , Whitehead E , Beardwell C G
Published: December 2008

Pituitary function was assessed in 39 patients with previously untreated hyperprolactinaemia. Primary hypothyroidism, drug-induced hyperprolactinaemia and chronic renal failure were excluded in all patients. All of the 22 patients (group 1), who had either a normal pituitary fossa or a minor radiological change on lateral skull X-ray, had completely normal pituitary function with the exception of 2 who were partially growth hormone-deficient. However, 9 of the 17 patients with macroadenomas (group 2) had a deficit of one or more anterior pituitary hormones. After the lateral skull X-ray 13 patients in group 1 had further neuroradiological investigations. In only one was a minor abnormality noted which had not been observed on the plain film and this was not of practical significance.

In centres where hyperprolactinaemic patients with a normal pituitary fossa or a minor radiological change on lateral skull X-ray are treated with bromocriptine, further neuroradiological investigations and dynamic tests of pituitary function are not required.
Lupus nephritis and lupus band test
Authors: Adam B A , Wang F , Looi L M , Prathap K
Published: December 2008

Twenty-seven patients with histologically confirmed lupus nephritis were studied to identify the incidence of lupus band and its significance to histological patterns of nephritis and complement levels. It was found that the kidney involvement is 2.5 times more frequent in lupus band positive patients. The association of a positive lupus and low C3 level signifies the presence of diffuse proliferative glomerulonephritis rather than membranous glomerulonephritis. The results, together with earlier reports, are discussed.
Septicaemia in the elderly
Authors: Madden J W , Croker J R , Beynon G P
Published: December 2008

A retrospective study was made of 44 elderly patients with bacteraemia treated in the period 1974-1980. Positive blood cultures in 5 cases were considered clinically insignificant. Twenty-six of the remaining 39 patients were found to have a Gram-negative bacteraemia, mainly associated with urinary tract infection. Abnormalities of liver function were common but 5 jaundiced patients with Gram-negative infection were shown to have stones in the common bile duct. The value of blood cultures as a diagnostic aid in the non-specifically ill elderly patient is emphasized.
Hilar tuberculosis in a patient with osteosarcoma
Authors: Cantwell B , Masterson J , Fennelly J J , Lynch V
Published: December 2008

A case of hilar tuberculosis in a patient with osteosarcoma is described illustrating the importance of accurate diagnosis in this unusual association. This occurrence is discussed in the light of the use of potentially immunosuppressive treatments for osteosarcoma.
Clinical toxicology of ‘magic mushroom’ ingestion
Authors: Peden N R , Macaulay K E C , Bissett Ann F , Crooks J , Pelosi A J
Published: December 2008

The clinical features are reported in 27 cases of ‘magic mushroom’ ingestion. Mydriasis and hyperreflexia were common as were disorders of perception and affect. Psilocybe semilanceata appears to have been the species of fungus involved.
The diagnosis of Ménétrier’s disease
Authors: Ward M W N , Sarner Martin , Whittaker M G , Clark C G
Published: December 2008

Two cases of Ménétrier’s disease are reported to illustrate the clinical presentation and diagnosis of this unusual condition. The literature has been reviewed of all the reported cases to establish the relative importance of the individual symptomatology, the value of the diagnostic methods, and to highlight the diagnostic pitfalls. Recognition of the barium meal appearances and snare biopsy at gastroscopy may avoid the necessity of diagnostic laparotomy.
Recurrent apnoeic attacks as a manifestation of epilepsy
Authors: Walls T J , Newman P K , Cumming W J K
Published: December 2008

A case is reported of epilepsy associated with recurrent apnoeic attacks. These episodes were modified by treatment and by the passage of time. Central respiratory arrest may be an unrecognized feature of epilepsy in other patients.
Atropine treatment for baclofen overdose
Authors: Ferner R E
Published: December 2008

A healthy 17-year-old girl took a single large dose (420 mg) of baclofen. She was conscious on admission to hospital, but within 3.5 hr of overdose showed signs of marked cerebral, cardiac and respiratory depression, flaccidity and hypothermia. Eight hours after overdose, atropine administered i.v. produced a worth-while increase in cardiac output, ventilation and temperature, lasting for about 90 min. This is of therapeutic and theoretical interest, and supports the veiw that baclofen leads to cholinergic dominance.
Hypoparathyroidism associated with systemic lupus erythematosus
Authors: Hajiroussou V J
Published: December 2008

A case of hypoparathyroidism and systemic lupus erythematosus is reported. It is believed that an association between the 2 diseases has not been described previously.
The effect of folate analogues on thymidine utilization by human and rat marrow cells and the effect on the deoxyuridine suppression test
Authors: Deacon Rosemary , Perry Janet , Chanarin I , Lumb M
Published: December 2008

The deoxyuridine (dU) suppression test assesses the capacity of marrow cells or activated lymphocytes to convert exogenous dU into thymidine. In addition, the effect of the added cobalamin or folate on the result is used to determine the nature of the deficiency in megaloblastic marrows. This study shows that folates have a considerable effect on the uptake of labelled thymidine by marrows from patients with megaloblastic anaemia in the absence of added dU. Less thymidine was taken up by megaloblastic marrow cells if they were first incubated with 5-formyltetrahydrofolate, 10-formyltetrahydrofolate or tetrahydrofolate. 5-Methyltetrahydrofolate increased thymidine uptake in cobalamin-deficient marrows and reduced thymidine uptake in folate-deficient marrows. These results could be explained if added folates facilitated utilization of endogenous dU. However, the addition of folates or cobalamin did not affect the validity of a dU suppression test with human marrow. More marked changes were present on the addition of folates to rat marrow cells both from control and nitrous oxidetreated animals.
Mortality in acute upper gastrointestinal haemorrhage: a six-year survey from the University Hospital of Wales
Authors: Mayberry J F , Counsell B R , Penny W J , Rhodes J
Published: December 2008

In a retrospective survey of normal hospital practice, 583 patients were admitted between March 1972 and 1978 because of haematemesis or melaena. Sixty (10·3%) of these patients died; most deaths occurred in elderly patients (mean age 75 years) 75% of whom had a serious medical problem which complicated the situation. Malignancy, cardiovascular disease and respiratory problems were the most commonly associated factors. The attitude towards both emergency investigation and surgical intervention was very conservative and any reduction in mortality would require a concerted effort to deal with the special problems in elderly patients who are at particular risk.
Complete recovery of spinal cord compression following parathyroidectomy
Authors: Ganesh Alka , Kurian Susy , John Lily
Published: December 2008

A case is reported of spinal cord compression at T2 level caused by a brown tumour of primary hyperparathyroidism involving the posterior arch of the vertebra. The spontaneous regression of cord compression following parathyroidectomy is documented clinically and radiologically.
Continuous infusion of papaveretum for relief of postoperative pain
Authors: Saha S K
Published: December 2008

Postoperative analgesia, once established initially by the titration method, is sustained with a flexible regime of papaveretum, infused continuously with a portable syringe pump. The initial analgesic requirement (IAR) for titrating the pain threshold level, was between 4 and 10 mg of papaveretum and the maintenance dose between 1 and 1·66 mg/hr for the first 24 hr and between 0·83 and 1 mg/hr for the second 24 hr. There was no significant association between IAR and the maintenance dose (P<0·2) nor was there any correlation between the maintenance dose, body weight, age, sex or nature of operations. The results in 70 patients are encouraging.
Bordetella bronchiseptica infection in stage IV Hodgkin’s disease
Authors: Stoll David B , Murphey Shelia A , Ballas Samir K
Published: December 2008

It is well known that patients with lymphoproliferative disorders have an altered immune status and are susceptible to opportunistic and non-opportunistic infections. The authors report the first case of a patient with advanced Hodgkin’s disease who developed pneumonia caused by the animal pathogen Bordetella bronchiseptica. The most likely source of this organism was the patient’s dog. While B. bronchiseptica is often responsible for outbreaks of pneumonia and septicaemia in wild and domestic animals, its role and incidence in human infections is not known. It is felt that patients with underlying lymphoproliferative diseases and pneumonia should be questioned about any contact with animals.
The ‘tumour overkill syndrome’. A potentially lethal complication of cancer chemotherapy
Authors: Slevin M L , Cotterill A M , Bell R , Lister T A
Published: December 2008

Two cases of acute leukaemia of Burkitt type in whom chemotherapy was associated with the ‘tumour overkill syndrome’ are described. One patient died with severe metabolic derangement which followed chemotherapy. In the other, an intensive programme of allopurinol administration, alkalinization of the urine and forced diuresis was instituted before chemotherapy, thus correcting the initial biochemical abnormalities and modifying those which occurred after chemotherapy. This approach prevented a fatal outcome, allowing the patient to survive to achieve bone marrow remission.
Cardiovascular mortality among immigrants to England and Wales
Authors: Marmot M G , Adelstein A M , Bulusu L
Published: December 2008

The Office of Population Censuses and Surveys (OPCS) is analysing mortality of immigrants to England and Wales. On average, immigrants are healthier and have a lower mortality then people who remained in the country of origin—demonstrating the ‘selection’ effect of migration. For cardiovascular diseases, the mortality of immigrants reflects the pattern in the country from which they came. Thus, immigrants to England and Wales from France, Spain and Italy (low-rate countries) have a low standardized mortality ratio from ischaemic heart disease. Immigrants from the West Indies and Africa have a high mortality from hypertension and cerebrovascular disease. It is noted that the mortality from ischaemic heart disease is high among immigrants from India and Pakistan.
Pneumatosis cystoides intestinalis associated with pyloric stenosis
Authors: Padwell A , Kopelman C
Published: December 2008

Pneumatosis cystoides intestinalis is a rare condition characterized by the presence of gas-filled cysts in the bowel wall. A case is reported which was associated with peptic ulcer and in which there was involvement of the ileum and pre-pyloric region of the stomach. Stomach involvement is a rare occurrence. Chronic pneumoperitoneum was also present. The mechanism of its occurrence is discussed.
Assessment of chronic aortic valve disease in adults
Authors: Harries A D , Griffiths B E
Published: December 2008

Chronic aortic valve disease is often tolerated for a long period of time with little in the way of symptoms, but once symptoms develop, the downhill course is often rapid. Medical therapy may alleviate symptoms of congestive heart failure and angina, but does not alter the natural history of the disease. The recent advances of cardiac surgery have, however, considerably improved the prognosis of most patients. Some patients with aortic regurgitation, though, will develop progressive congestive heart failure despite aortic valve replacement. Others with severe aortic stenosis will die suddenly while awaiting surgery as will a small number who previously had been asymptomatic. The information that comes from cardiac catheterization as well as the non-invasive investigation of cardiological disease, greatly enhanced by the introduction of the echocardiogram, has provided the physician with a better understanding of the particular problems in question and, therefore, the potential to solve them. This article aims to review the means by which high-risk groups can be identified, in order that their outlook may be improved especially with respect to the timing of surgical intervention.
Delayed halitosis-a rare cause
Authors: Lawson R A , Carroll K
Published: December 2008

A 38-year-old tuberculous male Pakistani presented with halitosis and a cough especially marked when lying on his left side. Barium swallow demonstrated a fistula between oesophagus and left main bronchus. Anti-tuberculous therapy and repeated cauterization failed to close the fistula. Thoracotomy confirmed a congenital oesophago-bronchial fistula. Division and suture resulted in cure.
Normotensive cardiomyopathy and malignant hypertension in phaeochromocytoma
Authors: Shapiro L M , Trethowan N , Singh S P
Published: December 2008

A patient with two different presentations of phaeochromocytoma is described. She initially presented with normal blood pressure and heart failure following a prolonged feverish prodrome. A provisional diagnosis of myocarditis or early congestive cardiomyopathy was made and she improved with digoxin and diuretics. Eighteen months later, after a period of normotension free from heart failure, she developed malignant hypertension with recurrence of heart failure. A phaeochromocytoma was surgically removed, with return to normal of blood pressure and cardiac status. It would seem that the initial presentation of the phaeochromocytoma was a catecholamine-induced myocarditis without hypertension and this resolved with the subsequent development of malignant hypertension. The possible mechanisms responsible for this are discussed and it is concluded that phaeochromocytoma should be considered in patients who have heart failure and persistent features of myocarditis.
Malign effects of splenectomy—the place of conservative treatment
Authors: Werbin Nahum , Lodha Kiran
Published: December 2008

In this review article the incidence is discussed of overwhelming post-splenectomy infection (OPSI), which is especially likely to occur in children and when splenectomy is carried out for haematological disorders. Long-term broad spectrum antibiotics or the use of polyvalent pneumococcal vaccine are often advocated as prophylactic measures under these circumstances.

After mild splenic trauma, conservative surgery or partial splenectomy may be indicated in some cases. Where trauma is more severe and the spleen cannot safely be preserved there may be a place for autotransplantation of splenic slices, for example into a pocket of omentum, and there is some experimental support for this technique.
Livedo reticularis and cerebro-vascular disease
Authors: Stephens W P , Ferguson I T
Published: December 2008

Three cases are described in which extensive livedo reticularis was associated with premature cerebrovascular disease. The patients presented with transient cerebral ischaemic attacks and gradually developed permanent neurological damage with intellectual impairment. The value of detailed neuropsychological testing to identify bilateral cortical abnormalities is demonstrated. CAT scanning may reveal multifocal cerebral infarction. The nature of this condition is not understood.
Altered quinidine disposition in a patient with chronic active hepatitis
Authors: Powell J Robert , Conrad Kenneth A , Okada Robert , Guentert Theodor W , Riegelman Sidney
Published: December 2008

A 49-year-old female with chronic active hepatitis and ventricular ectopic activity was given i.v. 600 mg quindine gluconate (4·4 mg/kg). Quinidine plasma concentrations were analysed by high pressure liquid chromatography and plasma protein binding by equilibrium dialysis. The pharmacokinetic values were total body clearance 0·11 l/kg/hr, elimination half-life 41·5 hr, volume of the central compartment 2·26 l/kg, volume of distribution from the area under the curve 6·5 l/kg, and 19% unbound in plasma. Based on the limited information available, quinidine dosing should be markedly decreased in patients with severe liver dysfunction.
Sulphasalazine-induced cerebral lupus erythematosus
Authors: Rafferty P , Young A C , Haeney M R
Published: December 2008

A 19-year-old girl with ulcerative colitis presented in coma. Subsequent investigation showed this to be due to sulphasalazine-induced cerebral lupus erythematosus.
Leucoplakia of the oral cavity, smoking and arylhydrocarbon-hydroxylase inducibility
Authors: Andréasson Lars , Korsgaard Rolf , Trell Erik , Björlin Gunnar , Mattiasson Ingrid , Trell Lena
Published: December 2008

In a consecutive series of 53 cases of oral leucoplakia, smoking history, oro-dental status and arylhydrocarbon-hydroxylase (AHH) inducibility were assessed. There was an increased association of leucoplakia with smoking, particularly in the male cases, but no remarkable findings as to dental status. Overall, there was a slightly higher frequency of cases with high AHH inducibility than expected from a normal control population. This difference was confined to the smokers, where there was a statistically highly significant over-representation of high AHH inducibility and under-representation of low AHH inducibility. The figures in the non-smoking patients were close to the expected.
Atrio-ventricular block after administration of lignocaine in patients treated with prenylamine
Authors: Grenadier E , Keidar S , Alpan G , Palant A
Published: December 2008

Four patients are described who exhibited prolonged Q-T intervals, multiple ventricular premature beats and ventricular tachycardia of the ‘torsade de pointes’ configuration whilst on treatment with prenylamine. In two of these patients, advanced atrio-ventricular block was established immediately following intravenous administration of lignocaine. The arrhythmia and the atrio-ventricular blocks were successfully controlled by ventricular pacing. The hazard of the simultaneous administration of these two drugs is stressed.
Clinical diagnosis by transcutaneous Doppler ultrasound
Authors: Wyse R K H
Published: December 2008

Transcutaneous Doppler ultrasound represents a convenient, reliable technique for the non-invasive diagnosis and assessment of a rapidly increasing number of diverse circulatory disorders.
Warfarin-induced vasculitis: A dose-related phenomenon in susceptible individuals?
Authors: Howitt A J , Williams A J , Skinner Craig
Published: December 2008

A case of warfarin-induced skin vasculitis in a 52-year-old female is reported. Bilateral breast involvement occurred but without progression to necrosis as in previously described cases. The pathogenesis is discussed and prescribing recommendations made in an attempt to avoid the complication in susceptible individuals.
Mixed connective tissue disease presenting as trigeminal neuropathy
Authors: Edmondstone W M , Price D K , Shepherd T H , Gooddy W W
Published: December 2008

A 25-year-old man presented with an isolated trigeminal neuropathy 13 months before developing myalgia and lymphadenopathy. The onset of Raynaud’s phenomenon 2 months later suggested a diagnosis of mixed connective tissue disease (MCTD) and this was confirmed by high serum titres of speckled pattern antinuclear antibody, and antibody to ribonuclear protein.
Strongyloidiasis and chronic urticaria
Authors: Corsini A C
Published: December 2008

Two patients with strongyloidiasis developed chronic urticaria. The cases provide support for inappropriate interactions of the effector mechanisms in helminthiasis resulting in urticaria in man.
A new weight-reducing drug with novel properties
Authors: Wheatley David
Published: December 2008

Ciclazindol, a tetracyclic compound originally developed as an antidepressant, was compared to placebo in a double-blind trial involving 114 individuals who were at least 15% overweight. Following a one week control period patients were allocated to active or placebo groups by random distribution for a period of 4 weeks and this was followed by a final one-week observation period.

The mean weight loss of 47 patients who completed the trial on ciclazindol was 6·95 lbs (3·13 kg) and of 48 patients who completed the trial on placebo it was 5·0 lbs (2·25 kg) a difference which is statistically significant in favour of ciclazindol (P < 0·05).

The trial demonstrated a marked placebo effect resulting in loss of weight in these patients, but the drug effect was significantly greater.
Thyrotoxic crisis following eclampsia and induction of labour
Authors: Menon V , McDougall W W , Leatherdale B A
Published: December 2008

A patient was diagnosed to be thyrotoxic and commenced on medications, but it was not known that she was 13 weeks pregnant at the time. She failed to take the medications and presented at 25 weeks with eclampsia and thyrotoxic crisis. Her management is discussed.
Pathological stage IE lymphoma of the testis treated by local surgery alone
Authors: Kissin M W , Kark A E
Published: December 2008

Testicular lymphoma is a rare tumour. Usually it is found in old men as part of a generalized lymphoma, and it carries a poor prognosis. We report a 30-year-old man with pathological stage IE lymphoma of the testis who has been successfully treated following staging laparotomy and splenectomy by radical orchidectomy alone. Localized testicular lymphoma is a small specific group with a good prognosis.
Painful brachial plexopathy: an unusual presentation of polyarteritis nodosa
Authors: Allan S G , Smith C C , Towla H M A , Downie A W , Clark J C
Published: December 2008

An elderly man was admitted to hospital with an unusual painful bilateral brachial neuropathy, which progressed in spite of high dose corticosteroid therapy. Polyarteritis nodosa, characterized by widespread arteriolar involvement, was shown at post-mortem.
Renal failure as a suspected adverse reaction to benoxaprofen
Authors: Fine Wilfred , Tallis R C , Osman K M
Published: December 2008

A 77-year-old woman suffering from osteoarthritis was treated with benoxaprofen. She developed diarrhoea, skin rash and renal failure.

Renal failure has not been reported before as an adverse reaction to benoxaprofen.

The case is discussed in the context of multisystem and immunological response to benoxaprofen.
Anorexia nervosa occurring in patients with diabetes mellitus
Authors: Roland J M , Bhanji S
Published: December 2008

Three patients with insulin dependent diabetes mellitus who developed anorexia nervosa are described. Unlike the few cases already reported the patients’ diabetes proved very difficult to control with dire consequences in each case.
Amoebic ulcer of the penis
Authors: Parkash Satya , Ananthakrishnan N , Ramakrishnan K , Topno Margaret , Aurora A L
Published: December 2008

This is a report of a rare entity—an amoebic ulcer of the penis. The gross loss of glans and terminal urethra was repaired by a new technique using an island based anterolateral dartos flap.
Ligation of the external iliac artery for post-transplant nephrectomy bleeding
Authors: Brown M W , Bradley J A , Hamilton D N H
Published: December 2008

Two patients who had transplant nephrectomy performed for rejection of a previously transplanted human cadaver allograft kidney subsequently developed complications due to a false aneurysm of the external iliac artery. Treatment was successfully carried out by ligation of the external iliac artery without any significant ischaemic problems in the corresponding lower limb.
Collagenous colitis: the clinical and morphological features
Authors: Colina F , Munoz-Yagüe M T , Solis-Herruzo J A , Vazquez G , Perez-Barrios A
Published: December 2008

A woman aged 23 years is described who had watery diarrhoea and colicky abdominal pain with normal results on sigmoidoscopy and barium enema. Rectal biopsy showed a thick layer of collagen in the lamina propria below the free epithelial surface. This lesion extended throughout the length of the descending colon. The only change revealed by electron microscopy was an increase in the thickness of the sub-epithelial collagen layer which is normally present in the colon. The maturation of the fibroblasts was normal. The lesion in this patient may be considered as a small change from the normal situation. This lesion is typical of ‘collagenous colitis’ of which only three other cases have as yet been published.
An evaluation of the Bishop scoring system in relation to a method of induction of labour by intra-vaginal prostaglandin
Authors: Houghton D J
Published: December 2008

This paper is a prospective study of the outcome of labour in 109 patients with favourable and unfavourable cervices in whom labour was induced by intravaginal prostaglandin, with supplementary syntocinon infusion where necessary. There were 61 primigravidae and 48 multigravidae. The rate of operative intervention was virtually no higher than in those labours of spontaneous onset. The length of labour varied inversely with the Bishop score of the cervix before induction, with a coefficient of correlation of -0·995 for primigravidae and of -0·929 for multigravidae. Bishop score was shown to be a poor indicator of the number of doses of prostaglandin needed for successful induction.
Acute exacerbation of upper airway obstruction in acromegaly
Authors: Rees P J , Hay J G , Webb J R
Published: December 2008

A 71-year-old man with acromegaly is described. Investigations for dyspnoea and daytime somnolence showed upper airway obstruction but not sleep apnoea. An upper respiratory tract infection precipitated stridor which required urgent tracheostomy.
Renal vein thrombosis complicating primary hyperparathyroidism
Authors: Smallman Lesley A
Published: December 2008

The clinical and pathological findings in a fatal case of primary hyperparathyroidism presenting with a serum calcium of 6·18 mmol/litre and associated with renal vein thrombosis are described. Profound dehydration is thought to be the mechanism involved.
Reversible agranulocytosis in association with cimetidine and hepatic failure
Authors: Lewis D S , Beck E R
Published: December 2008

A patient is described who developed agranulocytosis in the context of hepatic failure and cimetidine therapy. The close temporal relationship between discontinuation of the drug and granulopoietic recovery is considered to imply a role for cimetidine in the mechanism of the agranulocytosis.
Hypoglycaemia following removal of phaeochromocytoma: case report and review of the literature
Authors: Chambers Stephen , Donald Richard A , Espiner Eric A , Nicholls M Gary
Published: December 2008

Hypoglycaemia may complicate removal of a phaeochromocytoma, but its pathogenesis is not well understood. The sixth such case in the world literature is reported together with details of glucose tolerance testing and hormone levels before and after extirpation of an adrenal phaeochromocytoma. The mechanism of hypoglycaemia probably relates to a sudden decrease in circulating catecholamines which allows a rebound increase in insulin release and in peripheral glucose uptake. It is suggested that blood sugar levels should be monitored routinely after surgery for phaeochromocytoma.
Hyperthyroidism with periodic paralysis, acropachy, pre-tibial myxoedema, transient atrial fibrillation and myopathy
Authors: Guan R , Cheah J S
Published: December 2008

A case of thyrotoxicosis presenting with periodic paralysis and later complicated by acropachy, pretibial myxoedema and transient atrial fibrillation is described. This association has not been reported previously. Possible aetiological links are discussed.
Treatment of the Budd-Chiari syndrome in polycythemia vera by repeated percutaneous transluminal angioplasty of a hepatic vein stenosis
Authors: Nishikawa M , Miyoshi S , Imai Y , Tarui S , Seki K , Minami Y , Kawata S , Nakamura H
Published: December 2008

This report is of a 63-year-old man with polycythemia vera who developed the Budd-Chiari syndrome due to right hepatic vein stenosis. Diagnosis was made by laparoscopy and liver biopsy, and confirmed by hepatic venography. The patient was treated by percutaneous transluminal angioplasty, and recovered completely from ascites, leg oedema and venous stasis. No pulmonary embolism was observed. One month after angioplasty, a second laparoscopy and liver biopsy showed a marked improvement in hepatic congestion and haemorrhagic necrosis, thereby confirming the effectiveness of this technique in treating the Budd-Chiari syndrome. Further treatments with percutaneous transluminal angioplasty were required with a good clinical outcome.
Pulmonary Munchausen’s syndrome
Authors: Bush A , Collins J V
Published: December 2008

The scarred abdomen of the patient with Munchausen’s syndrome is a familiar physical sign. We report on a man with Munchausen’s syndrome who had not multiple laparotomies but two thoracotomies.
Hypercalcaemia due to immobilization of a patient with Paget’s disease of bone
Authors: Nathan A W , Ludlam H A , Wilson D W , Dandona P
Published: December 2008

A man with Paget’s disease of bone was admitted with a fractured neck of femur. On admission he was normocalcaemic, but with immobilization he rapidly became hypercalcaemic, despite a normal diet and no medication. The hypercalcaemia responded to calcitonin. Although hypercalcaemia is often quoted as complicating the immobilization of such patients, well documented uncomplicated cases have rarely been reported.
Uterine and ovarian leukaemic relapse during bone marrow remission in acute lymphoblastic leukaemia
Authors: Cantwell B , Cantwell D , Fennelly J J
Published: December 2008

A patient with acute lymphoblastic leukaemia who developed ovarian and uterine leukaemic relapse while in bone marrow remission is described. Pelvic relapse is rarely reported during the clinical course of leukaemia in females. Pelvic ultrasonography, a non-invasive procedure, was of value as an aid in detecting pelvic relapse.
Electrical cardioversion for persistent atrial fibrillation after treatment of thyrotoxicosis
Authors: Emery P , Staffurth J S
Published: December 2008

A review of 22 patients with atrial fibrillation after the treatment of thyrotoxicosis, who underwent elective electrical cardioversion, showed that only 45% were still in sinus rhythm at 2 years and 36% in the long term (mean 7·4 years). There were no significant differences in factors assessed between those persisting in sinus rhythm and in those who relapsed. A delay in the initial curative treatment of thyrotoxicosis may be a factor in influencing the outcome.
Effect of non-suckling on the pH of breast milk and its possible relationship with breast cancer
Authors: Malhotra S L
Published: December 2008

The pH of breast milk was determined in 10 lactating mothers after interrupting suckling from one of the breasts, alternately for 120 hr during the 1st, 12th and the 16th postpartum weeks. The milk from the unsuckled breasts had a slightly higher pH at all three times, being slightly alkaline as compared with the suckled breasts from which the milk was slightly acidic. There were differences also between the three diurnal feeds, the pH being higher in the last diurnal samples. If this temporary experimental stoppage of breast feeding is akin to decline of breast feeding, the changes in the pH of breast milk caused by it may provide clues to the mechanism of the long-suggested possible carcinogenic effect of a fall in the prevalence of breast feeding. An alkaline milieu surrounding epithelial cells causes hyperplasia, cell atypia and a marked increase in mitotic activity, changes which are a prelude to neoplasia. The causative relationship of late age at first birth does not find support in the thesis of the alkaline milieu in the aetiology of breast cancer presented here.
Primary peritonitis in children and adults
Authors: Armitage T G , Williamson R C
Published: December 2008

Five cases of primary peritonitis are presented, with a sixth related case of pneumococcal peritonitis secondary to a ruptured ovarian cyst. The patients comprised 4 young girls who recovered, and 2 elderly females who died. Pneumococci were isolated in 3 patients; no organism was found in the other 3. One case of primary measles peritonitis has no apparent precedent.
Neurofibrosarcoma in Von Recklinghausen’s disease presenting with hypochromic anaemia
Authors: Bell J M , Ritch A E , Donovan I A
Published: December 2008

A patient with Von Recklinghausen’s disease who developed a retroperitoneal neurofibrosarcoma is described. The presenting clinical picture was one of hypochromic anaemia with a large mass palpable in the left hypochondrium. At operation the tumour was found to be invading the small intestine with resultant blood loss. The patient had presented 21 years before with unexplained severe iron deficiency anaemia.
Neurotensin-secreting carcinoma of the bronchus
Authors: Wood J R , Wood S M , Lee Y C , Bloom S R
Published: December 2008

Neurotensin, a neuroendocrine peptide present in gut and brain has previously been found in pancreatic tumours secreting several other peptides. We report here the first case of a patient with a neurotensin-secreting adenocarcinoma of the bronchus.