bluuebunny/crossref_metadata_2025 huggingface dataset:
An epidemic of ECHO 6 virus infection
Authors: Mary A S , Swallow J H
Published: December 2008

Fourteen cases of infection with ECHO 6 virus in the Chelmsford area from August to December 1968 are described. A comparative account of the seasonal, geographical and age incidence is given, and its relationship to certain epidemiological aspects is discussed.

Aseptic meningitis occurred in eleven patients, pharyngitis in seven and myalgia in five. One patient suffered from pericarditis, a manifestation of this infection which has not hitherto been recognized. Another patient suffering from aseptic meningitis developed nephritis during the course of the illness, an association which has not been reported with ECHO 6 infection.

A relapse occurred in one patient with meningitis. No permanent ill-effects followed in any case.
Daunorubicin in acute leukaemia
Authors: Souhami R L , Prankerd T A J
Published: December 2008

Daunorubicin has been used in the treatment of six cases of acute lymphoblastic and thirteen cases of acute myeloblastic and mono-myeloblastic leukaemia.

Complete remissions were obtained in eight patients, three with acute lymphoblastic leukaemia and five with acute myeloblastic leukaemia.

Marrow aplasia makes the drug difficult to administer, but no patients died from this cause, in this series.

In some patients good remissions were obtained with relatively low doses of daunorubicin after preliminary treatment with 6-mercaptopurine.
A bedside computer in foetal assessment
Authors: Curran James T
Published: December 2008

The time has now come when mere survival of an infant can no longer be considered the index of successful obstetrics. It is thought that as many as one in ten surviving infants suffer some degree of damage in the process of labour. The two techniques to be described in this paper are attempts to derive methods for prognosing the ability of a foetus to withstand this process.

1. The Foetal Electrocardiogram: The examination of the FECG by the traditional methods of cardiology have proved very disappointing and unrewarding. If, however, the FECG is merely used as a means of recording the beat-to-beat interval of the foetal heart, statistical evaluation of this information can yield a valuable prognostic index.

2. The Foetal Ballistocardiogram: The purpose of the foetal heart (or for that matter the adult heart) is not to generate electrical signals but to propel blood through the circulation. One method of measuring this function in the adult is the ballistocardiogram and the application of modern signal recovery techniques has made it possible to derive the foetal ballistocardiogram.
Pneumatosis cystoides intestinalis
Authors: FitzGerald-Finch O P , Smith J C S , Galloway J K
Published: December 2008

A brief outline of the aetiology and pathogenesis of pneumatosis cystoides intestinalis is given followed by a review of four cases which have occurred in the Glasgow area recently. The radiological appearances of the condition are considered in detail.
Problems in histological interpretation in sarcoidosis
Authors: Drury R A B
Published: December 2008

The sarcoid granuloma has a histological structure that is similar to that seen in many other diseases. Some of its diagnostic features are negative, but an accurate diagnosis can be made from biopsy tissues if numerous, monotonously uniform granulomata are present. Histological confidence is often proportional to the number of granulomata seen in the specimen.

Mediastinal lymph nodes taken at mediastinoscopy have been positive in 90% of seventy-four patients with sarcoidosis.

Problems in the histological interpretation of Kveim biopsies may be due to failure to include the injection site in the biopsy, to inadequate sectioning of the specimen and to equivocal cellular reactions. Despite these difficulties, dual blind reading of sections of mediastinal lymph nodes and Kveim reaction biopsies from patients with sarcoidosis has shown that the observer variation that is likely to be of clinical significance is approximately 5% in each group.
Skin changes in sarcoidosis
Authors: Cronin Etain
Published: December 2008

The skin changes which occur in sarcoidosis are erythema nodosum and specific granulomata.

The incidence of erythema nodosum and its frequency in England and Scandinavia is contrasted with its comparative rarity among Negro patients in the United States. The various types of granulomata are described and classified. In contrast with erythema nodosum, granulomata are more common in Negro than in Caucasian patients.
The late stages of pulmonary sarcoidosis
Authors: Scadding J G
Published: December 2008

Pulmonary sarcoidosis is frequently preceded by bilateral hilar lymph-node enlargement (BHL). Although it is normally difficult to be certain in a patient without BHL that a stage of BHL has not in fact occurred in the past but been missed, there is good evidence that some cases of pulmonary sarcoidosis arise without preceding BHL. Although a prefibrotic infiltration of the lungs will usually show signs either of resolution or of developing fibrosis within 2 years, such an infiltration may remain apparently non-progressive, producing little functional defect, for much longer than this, and in such a case, substantial resolution remains possible. A high proportion of those who develop fibrosis show a characteristic pattern of strand-like fibrosis in the middle zones and lower part of the upper zones of the lungs, with emphysematous changes above and below. In densely fibrotic parts of the lungs, cavities may appear, probably from necrosis at the centres of large masses of hyaline fibrosis. A rare complication is the development of a ‘fungus ball’ due to the growth of Aspergillus in such a cavity.

Occasionally, fine focal fibrosis develops without distortion of lung architecture, but with severe disability.

A rare but important event is the development of bronchial stenoses. These may affect main, segmental or subsegmental bronchi, more especially the proximal parts of segmental or subsegmental bronchi.

Calcification has been observed to develop in a characteristic symmetrical fashion in the hilar lymphnodes and occasionally in small foci in the lungs in about 5% of patients with pulmonary sarcoidosis who initially had BHL, followed for periods ranging from 5 to 20 years.

In the late stages of sarcoid fibrosis of the lungs, the specific granuloma may be no longer convincingly demonstrable.
Clinical use of the laparoscope
Authors: Buckle A E R , Grimwade J C
Published: December 2008

A technique for laparoscopy is described and the indications for operation and the laparoscopic findings in 406 patients detailed.
Pacing after myocardial infarction
Authors: Harris Alan
Published: December 2008

Experience of endocardial pacing in eighty-two patients with atrioventricular block after myocardial infarction is described. A unipolar pacing wire was passed into an antecubital fossa vein and passed into the right atrium and wedged into the apex of the right ventricle under radiological control using an image intensifier. All patients were attached to an external demand unit set at 60/min which will pace if there is asystole longer than 1 sec. The disadvantages of pacing are discussed.

A fall in mortality occurred from 71% of unpaced patients to 38% of thirty-seven patients where demand pacing was given. When suppressant drugs (lignocaine, procainamide and quinidine) were given in addition to pacing the mortality dropped to 11% of twenty-seven patients. The disadvantages of pacing are few and it is considered that suppressant drugs are only used with safety when a pacing system has been installed.
Haemocytic periodicity and periodic disorders: Periodic neutropenia, thrombocytopenia, lymphocytosis and anaemia
Authors: Reimann Hobart A
Published: December 2008

Evidence has accumulated of rhythmic numerical oscillation of each of the blood cells either independently or in combinations.

The cyclic changes originate in the marrow of some normal persons and animals without causing illness, and can be induced experimentally.

In more than 100 reported instances, periodic oscillations of various cells were accompanied by respective episodes of the disorders named in the title. The disorders may be transitory but usually recur throughout life and occasionally are fatal. All resist therapy. Features in common suggest an interrelationship of the haemal disorders and other disparate heritable periodic diseases.

Theoretically, the rhythms are regulated by ubiquitous, inherent, intracellular bioclocks controlled hypothalamically or neurohumorally in relation to a feedback mechanism. Reactions to long cycles are of greater clinical importance than disturbances arising from the circadian rhythm.
Psychiatric disturbance in chronic renal failure and its treatment by dialysis
Authors: Hailstone J Donovan
Published: December 2008

The psychiatric disturbance in patients with chronic renal failure is described and some of the aetiological factors reviewed.

A number of psychiatric problems arise during the course of treatment by haemodialysis, both among patients, relations and members of dialysis teams. Their course, treatment and prognosis are discussed.
Inappropriate secretion of antidiuretic hormone in Guillain-Barré syndrome
Authors: Davies Aeron G
Published: December 2008

Hyponatraemia occurred in five cases with severe Guillain-Barré syndrome who required assisted respiration.

In one, the syndrome of inappropriate secretion of ADH was demonstrated and probably accounted for the hyponatraemia in the other four. The water overload thus produced may have contributed to the neurological deterioration and the peripheral and pulmonary oedema seen in some of these cases.
General considerations in intermittent drug therapy of pulmonary tuberculosis
Authors: Fox Wallace
Published: December 2008

The advantages of intermittent chemotherapy for pulmonary tuberculosis are discussed and the results of several controlled trials summarized. Once-weekly therapy now appears a definite prospect.

The most appropriate approach to therapy at both national and individual physician level now seems to be a combination of unsupervised daily and supervised intermittent regimens.
Potentially serious side-effects of high-dose twice-weekly rifampicin
Authors: Poole Graham , Stradling Peter , Worlledge Sheila
Published: December 2008

Daily rifampicin in a single dose of 600 mg, combined with other drugs, usually streptomycin and isoniazid, was given to forty-nine patients for 3 months. It was planned to continue for another 15 months with twice-weekly rifampicin 1200 mg plus isoniazid 900 mg, but the high incidence of side effects led to cessation of the intermittent regimen when only two patients had completed 18 months.

Though there was no serious problem with daily treatment, eleven patients (22%) were unable to continue rifampicin on the intermittent regimen. In eight (16%) a pyrexial syndrome occurred. In one of these patients there was also temporary renal failure and in another, precipitous thrombocytopenia led to epistaxis and bleeding into the tongue and lips. Symptomless thrombocytopenia developed in two other patients, making three cases (6%) of thrombocytopenia in all.

In sixteen (33%) of the forty-nine patients antibodies to rifampicin were detected in the blood. Side-effects occurred in nine (56%) of these, including the three developing thrombocytopenia, but in only two (6%) of the thirty-three patients with no antibodies detected. This association of toxic reactions with antibodies is highly significant (P < 0·001).
Problems of drug resistance in tuberculosis—the newer anti-tuberculosis drugs
Authors: Crofton John
Published: December 2008

The value of ethambutol and rifampicin is now established but certain points about toxicity and effectiveness are still uncertain, in particular the failure rate if these two drugs are used together without a third.

Primary resistance to ethambutol has been described in the U.S.A. but seems rare in Britain. Acquired resistance to both drugs is now being seen in reference laboratories so that the drugs are already being wrongly used.

It is suggested that, if at all possible, a third drug should be added to the rifampicin-ethambutol combination. The pros and cons of different drugs are discussed.

In future an increasing number of relapsing cases will already have received the new drugs. The clinician will therefore have to work out for each patient the drugs to which his bacilli are probably sensitive. A reliable drug combination for that individual can then be devised.

The principles of such an analysis are outlined and examples given.
Gallstones and flatulent dyspepsia: cause or coincidence?
Authors: Johnson Alan G
Published: December 2008

The pre-operative and postoperative incidence of flatulent dyspepsia was studied in 108 patients undergoing cholecystectomy. Ninety (83%) had pre-operative symptoms; of these forty-one (46%) were symptom-free after operation and twenty-two (24%) were improved but twenty-seven (30%) were no better. Patients with a well-functioning gallbladder, demonstrated radiologically, were relieved significantly more often than those with a poor or non-functioning gallbladder. Fatty food precipitated the symptoms in the majority of patients.

These figures suggest that there is neither a direct causal relationship between gallstones and flatulent dyspepsia nor is the relationship entirely coincidental. The implications of these findings for clinical practice are discussed.
Treatment of uncomplicated urinary tract infection in non-pregnant women
Authors: Mabeck C E
Published: December 2008

A study of placebo treatment of acute symptomatic urinary tract infection in non-pregnant women showed that about 80% obtained sterile urine spontaneously within 5 months. About one-half of these had recurrent infection within a year.

Antimicrobials produced a high immediate cure rate, but only 45% maintained sterile urine for 2 years. The recurrence rate was highest during the first 2 months after treatment, and thereafter nearly constant during the subsequent 20 months. Twenty-nine percent of recurrences were recrudescences and 71% reinfections. About one-sixth of the patients had a very high recurrence rate, 2·6 infections/year, as compared with 0·32/year in the remainder. Nearly all of these patients had their first recurrence within 5 months of the initial treatment. The probability of recurrence increased with the number of previous infections. Some patients, however, after a period with many recurrences, showed a remarkable decrease in recurrence rate.

If the aim of treatment is to keep periods of bacteriuria to a minimum, it is necessary to do frequent urine cultures for at least 6 months after elimination of bacteriuria.
Foetal acid-base status in clinical foetal distress and high risk casesThe material in this paper has been taken from an M.D. Thesis submitted to the University of Hong Kong.
Authors: Lee K H
Published: December 2008

The acid-base balance in 307 Chinese patients in labour was studied in Tsan Yuk Hospital, Hong Kong over a 15-month period. Fifty-six of these were normal cases, 200 cases exhibited clinical signs of foetal distress and the other fifty-one were high risk cases. The results showed that cases of clinical foetal distress had a significantly lower foetal pH than that in the normal control group. Of the different signs of clinical foetal distress, meconium was the least important and foetal tachycardia appeared to be more significant than the others. Cases of postmaturity and uterine inertia also gave a lower foetal pH than normal. It is concluded that foetal blood sampling is indicated in these types of cases.
The effect of methoxyflurane analgesia on renal function in burned patients: an investigation
Authors: Laird S M , Chrystal Kathleen M R
Published: December 2008

This paper reports an investigation into evidence of renal dysfunction following methoxyflurane analgesia for burns dressings.

Twelve patients were studied and small increases in serum uric acid were observed in all of them. This increase may have been dose-related.

Four patients had small but consistent increases in blood urea nitrogen and serum creatinine on the third post-dressing day.

No definite conclusions can be adduced and further research is needed.
Ketamine anaesthesia for burns surgery
Authors: Sage M , Laird S M
Published: December 2008

A study was set up to investigate whether the theoretical advantages ketamine offered as an anaesthetic in burns patients were real.

Patients under 35 kg body weight were anaesthetized by an intermittent intramuscular technique and patients over this weight with an intravenous technique.

The study showed that ketamine had distinct advantages, giving cardiovascular stability and avoiding intubation. It was especially useful in the very ill patients. There were few complications during the study which we are now trying to minimize.
Bullous lesions of the skin and mucous membranes in primary amyloidosis
Authors: Northover J M A , Presbury D G C , Pickard J D , Haskell R , Murray-Lyon I M , Keith D A
Published: December 2008

Four cases of primary amyloidosis are described in which bullous lesions of the skin or oral mucosa were a prominent clinical feature. Biopsy of such lesions and demonstration of amyloid by special staining may be of great diagnostic help.
The comparative value of amantadine and levodopa
Authors: Dallos Vera , Stone Patricia , Heathfield Kenneth , Allen Frank
Published: December 2008

Sixty-nine patients with Parkinson's disease were randomly allocated in a trial to compare the therapeutic effects of levodopa and amantadine. The patients were assessed clinically and scored by occupational therapy tasks and degrees of disability. Both drugs were used for 2 months; in the first 4 weeks the doses were gradually increased to 400 mg of amantadine or 4 g of levodopa respectively, and in the second 4 weeks' period the maximum tolerated dose was maintained throughout. Fourteen patients withdrew and these were excluded from the series. Of the fifty-five patients who completed the trial, thirty-four were taking levodopa and twenty-one amantadine.

The results showed an average 33% improvement on levodopa and 23% on amantadine as regards tremor, rigidity and akinesia and their total scores improved 26% and 18% respectively. More cases showed substantial improvement on levodopa.

There was little difference in response between 200 and 400 mg amantadine daily, but side-effects with 400 mg amantadine daily were more frequent and severe. Side-effects with levodopa were similar to those reported in previous trials but we also noted brown body fluids in three patients. The average effective dose of levodopa was lower than in previous reports, and the largest number of patients received benefit from 1·5 g daily. The superior effect of levodopa was shown.
Toxoplasma encephalitis in a raw steak eater
Authors: Hollins P J , Hoffbrand B I , Haffajee I M
Published: December 2008

A case of adult acquired toxoplasma encephalitis is described. The patient was in the habit of eating raw or very lightly cooked steak, and could have obtained her infection from this source.
Diabetes and related variables among the five main racial groups in South Africa: Comparisons from population studies
Authors: Jackson W P U
Published: December 2008

We have investigated the total prevalence of diabetes and related factors among representative, randomly chosen samples of the five ethnic groups living in Cape Town, and (East) Indians in Durban. Comparisons are hindered by differences in age distribution of the populations, while small, isolated groups were found to be unrepresentative. The variability of a single individual's blood sugar levels led us to require at least three abnormal values on 2 different days for a positive diagnosis. The use of different criteria for the diagnosis of diabetes varying from ‘lax’ to ‘stringent’ alters the discovered prevalence in our groups by the factor of approximately 2.

Mean blood glucose levels rose with middle age but never between childhood and early adulthood. Afternoon screening tests appeared valid, despite the agreed diurnal difference in glucose tolerance figures.

Both high screening blood glucose levels and diabetes itself were most common among Indians and coloured people and least among Whites and Bantu, each of the latter having a total diabetes prevalence of approximately 3·5% over age 15. It is noted that the Cape Coloured have more diabetes than any of the constituent races from which they originated.

The reasons for such racial differences are unclear—obesity cannot be the explanation here, since, to take one example, the fattest group of all, the Bantu women, have the lowest prevalence of diabetes. We found mild diabetes not uncommon among young people under 20 in the Indian, Malay and coloured population but none among White or Bantu. There was little difference between the sexes, and if anything the poorer people had more diabetes than the better-off.
Correlation between the foetal acid-base status and the Apgar scoreThe material in this paper has been taken from an M.D. Thesis submitted to the University of Hong Kong.
Authors: Lee K H
Published: December 2008

The foetal pH values of eighty-eight cases delivered within 30 min after foetal blood sampling were correlated with the 1-min Apgar score. With a pH of 7·20 or above the error of prediction was 1·3%. The error in cases with pH below 7·20 was 54·5%.

Significantly higher pH and lower δ base deficit were present in the low foetal pH group in vigorous, as opposed to depressed infants, suggesting that infusion acidosis was present in infants with a high Apgar score.

The degree of correlation between the foetal pH and the Apgar score was not significantly influenced by shortening the sampling-delivery interval to 15 min or lengthening it to 3 hr. The most significant factor affecting the degree of correlation in the present study was the setting of the critical pH. If the criterion of the critical pH was taken as 7·13 there would have been no false positive results and the error of prediction in cases delivered within 30 min of foetal blood sampling would be reduced to 1·1%.
Superior mesenteric vein thrombosis and oral contraceptives
Authors: Rose M B
Published: December 2008

Five cases are reported of superior mesenteric vein thrombosis occurring in women taking oral contraceptives.

The condition is reviewed, and its possible relationship to the drug discussed.
Survival of candida septicaemia treated with amphotericin B
Authors: Mitchell A B S , Hosking G , Magrath I T , Farthing C P
Published: December 2008

Candida albicans septicaemia occurred in an alcoholic woman who had severe hepatic dysfunction, and was further debilitated by multiple cardiac arrests, prolonged artificial ventilation, bronchopneumonia and Ps. aeruginosa septicaemia. She received broad spectrum antibiotics and corticosteroids, and needed prolonged intravenous cannulation. In vitro, a specific defect was demonstrated in her cell-mediated immune response to candida antigens. Examination of her serum showed normal immunoglobulins, and an adequate agglutination titre to these antigens.

Amphotericin B (800 mg intravenously over 19 days) was administered, and she survived. Hypokalaemia, anaemia, and peripheral neuropathy complicated therapy, and thrombophlebitis of a cannulated peripheral vein necessitated a vena caval catheter. There was no significant deterioration of renal function.

Toxic effects of other drugs were encountered—deafness following kanamycin, an encephalopathy when blood levels of carbenicillin were boosted by probenecid, and cardiac arrest when diazepam and phenobarbitone were administered to control an epileptic fit and delirium tremens. Prolonged intravenous cannulation was complicated by staphylococcal septicaemia.

A year later she died of peritonitis. Chronic pancreatitis was complicated by ascites, which became infected by E. coli. No residual C. albicans infection was found at necropsy.
Thyroid ‘hot’ nodules
Authors: Ramsay Ian , Richardson P J , Marsden Philip , McKerron C G
Published: December 2008

A retrospective analysis of thyroid scintiscanning at one hospital over a 3-year period revealed nineteen patients in whom a solitary, hyperfunctioning thyroid nodule was producing thyrotoxicosis.

Most of the patients had clinical features referable to hyperthyroidism and in the majority a solitary nodule was palpable in the neck which was found to correlate well with the location of the ‘hot’ nodule on scanning. Cardiac failure was present in 21% and atrial fibrillation occurred in 37%.

The 131I uptake by the thyroid was of little value in deciding whether or not the patient was toxic, but there was good agreement between serum protein bound iodine determinations and measurement of serum thyroxine and resin uptake tests. There appeared to be no relationship between the size of the nodule and its degree of activity.
Thyrotoxicosis in Nigeria—a study of forty-six patients
Authors: Olurin E O
Published: December 2008

In a review of 874 Nigerian patients with various types of thyroid gland disorders, forty-six patients were found to be thyrotoxic (5·3%), supporting the common observation of many authors that thyrotoxicosis is rarer in the African than in Europe and North America where thyrotoxicosis accounts for 20–50% of all thyroidectomies. The incidence of thyrotoxicosis is higher in the female than male though there is a higher proportion of males in this series than in the United Kingdom. There is a higher incidence of secondary thyrotoxicosis than has been reported elsewhere.

The clinical features of hyperthyroidism in the Nigerian are no different from those reported in other countries, though our patients tend to report rather late. Primary thyrotoxicosis occured a decade earlier in this series than in Britain. Two of the forty-six patients had adenocarcinoma of the thyroid although only in twenty-seven patients was thyroid tissue available for histological examination. Laboratory investigations were essential in borderline cases, especially estimation of the PBI in those with multinodular goitres.

The standard methods of treatment by antithyroid drugs, 131I and surgery were employed with immediately satisfactory results, though the follow-up was so poor that it is impossible to evaluate the late effects of treatment.
Calcification of the basal ganglia apparently presenting as a schizophreniform psychosis
Authors: Hall Peter
Published: December 2008

A patient with gross basal ganglia calcification is described, whose condition was associated with severe psychotic symptoms and in whom the clinical picture was not typical of hypoparathyroidism, pseudohypoparathyroidism or pseudo-pseudohypoparathyroidism.

Calcification of the basal ganglia may occur in a variety of infections, toxic and metabolic disorders, particularly hypoparathyroidism, pseudohypoparathyroidism, toxoplasmosis and some anoxic conditions (Moskowitz, Winickoff & Heinz, 1971).

Though there is doubt as to the precise diagnosis in the present case, familial calcification appears to be the most probable.
Primary haemorrhagic thrombocythaemia with Philadelphia chromosome
Authors: Ghosh M L
Published: December 2008

A case of primary haemorrhagic thrombocythaemia with the Ph1 chromosome is described and its relation with myeloproliferative disorders is discussed.
Implanted-pacemaker-induced dysrhythmia and its management
Authors: Jachuck S J
Published: December 2008

Five cases of implanted-pacemaker-induced dysrhythmia are described and factors precipitating such dysrhythmias are discussed.

The efficacy of practolol in the treatment of such dysrhythmias is shown and its use as a prophylactic antidysrhythmic agent has been suggested.
Comparison of propranolol and Ro 3-3528 in hyperthyroid tachycardia and dysrhythmias
Authors: Phillips Eileen M , Turner Paul , Houghton Joan , Ferriman D G
Published: December 2008

Ro 3-3528, a non-selective β-adrenoceptor blocking drug which lacks intrinsic activity, produces a dose-response effect in hyperthyroid tachycardia, and shows no dysrhythmic properties. In hyperthyroid patients, β-blocking drugs of this nature are preferable to those possessing intrinsic sympathomimetic activity, which may have dysrhythmic properties in this condition.
Thiazides and hypokalaemia in diabetic ketoacidosis
Authors: Alberti K G M M , Hockaday T D R
Published: December 2008

In a series of forty-one episodes of diabetic coma or pre-coma, three patients had plasma potassium values of less than 3.0 mEq/l. All three had been taking thiazide diuretics with only one receiving oral potassium supplements. None was previously known to be diabetic, representing 18% of the new diabetics in the series. The mean plasma potassium for the other new diabetics was 4·7 ± 0·2 mEq/l. These findings emphasize that adequate potassium supplements should be given with thiazide diuretics to diabetic subjects and to those with an increased risk of developing the disease.
Amyloidosis complicated by intractable postural hypotension
Authors: Yuill G M
Published: December 2008

A patient is described in whom the nephrotic syndrome caused by amyloidosis was complicated by intractable postural hypotension. An account is given of his treatment with a combination of monoamine oxidase inhibitors and sympathomimetic pressor agents, after a failure of conventional therapy.
An unexpected abdominal mass
Authors: Thomas Meirion
Published: December 2008

An unusual complication of ectopic pregnancy, presenting during post-menopausal life, is reported. As hospital services become available to previously medically isolated communities, early diagnosis and treatment will make such cases as this rare.
Megaloblastic anaemia due to trimethoprim-sulphamethoxazole therapy in uraemia
Authors: Yuill G M
Published: December 2008

A patient is described in whom malignant hypertension led to oliguric renal failure. A course of trimethoprim and sulphamethoxazole (co-trimoxazole) was prescribed for an intercurrent urinary tract infection and appeared to precipitate a megaloblastic anaemia which responded satisfactorily to folic acid.
Monozygous twins with hypothyroidism and diabetes mellitus
Authors: Mitchell I , Lawson A A H
Published: December 2008

Monozygous twins with diabetes mellitus and autoimmune hypothyroidism are described. The onset of the hypothyroidism was simultaneous, but one twin had had insulin-dependent diabetes mellitus for 9 years while the other twin developed insulin-independent diabetes concurrently with the hypothyroidism. Two other siblings had diabetes mellitus and one of them had a goitre, possibly lymphadenoid. The aetiology of autoimmune hypothyroidism is discussed, and evidence is presented which supports suggestions that diabetes mellitus may be an autoimmune disease.
Fractionation of the influenza virus with the object of producing subunit vaccine
Authors: Hoyle L , Barker Sheila M
Published: December 2008

Attempts have been made to produce a subunit influenza vaccine containing haemagglutinin and neuraminidase but free of lipid and nucleic acid.

Disintegration of virus with Nonidet P40 followed by selective dialysis was only partially successful, but by disintegration with sodium dodecyl sulphate followed by ether extraction and precipitation with ammonium sulphate a product was obtained in which the content of ribonucleic acid was reduced to 1% and the lipid content to less than 5% of the amounts present in the original virus.

When A1 strains of virus and some strains of virus A were shaken with n-butanol only the ribonucleoprotein (S antigen) was found in the aqueous phase and the procedure affords a very simple method of producing pure S antigen for use in serological diagnosis.
Features of a successful therapeutic fast of 382 days' duration
Authors: Stewart W K , Fleming Laura W
Published: December 2008

A 27-year-old male patient fasted under supervision for 382 days and has subsequently maintained his normal weight. Blood glucose concentrations around 30 mg/100 ml were recorded consistently during the last 8 months, although the patient was ambulant and attending as an out-patient. Responses to glucose and tolbutamide tolerance tests remained normal. The hyperglycaemic response to glucagon was reduced and latterly absent, but promptly returned to normal during carbohydrate refeeding. After an initial decrease was corrected, plasma potassium levels remained normal without supplementation. A temporary period of hypercalcaemia occurred towards the end of the fast. Decreased plasma magnesium concentrations were a consistent feature from the first month onwards. After 100 days of fasting there was a marked and persistent increase in the excretion of urinary cations and inorganic phosphate, which until then had been minimal. These increases may be due to dissolution of excessive soft tissue and skeletal mass. Prolonged fasting in this patient had no ill-effects.
Appendicitis, fibre intake and bowel behaviour in ethnic groups in South Africa
Authors: Walker Alexander R P , Richardson Barbara D , Walker B Faith , Woolford Atholie
Published: December 2008

Information on appendicectomy-prevalence was secured on 15,317 16–20-year-old South African pupils and students—Negroes, Coloureds (Eurafricans), Indians and Caucasians. Data were also obtained on crude fibre-intake, frequency of defaecation, and transit-time of digesta.

Among students, 18–20 years, appendicectomy was very uncommon in rural Negroes (0·5%) and periurban Negroes (0·9%), slightly more common in urban Negroes (1·4%), but very common in Caucasians (16·5%); prevalences in Coloured and Indian groups were low (1·7 and 2·9%). Rural Negroes had a far larger fibre-intake, greater frequency of defaecation, and much shorter transit-time; yet, in the four ethnic groups in urban areas, despite wide differences in appendicectomy-prevalence, data on these variables were similar. Differences in other aspects of the bowel milieu intérieur must therefore be sought.

Corresponding studies were made on 1325 Caucasian pupils in Homes; their diet is less sophisticated (in respect of fibre, sugar and fat-intakes) than that of the general population. Pupils had slightly greater defaecation-frequency, lesser transit-time, and an appendicectomy-incidence only 23% of that of an appropriate control-group.

The conclusion is reached that the causes of appendicitis are wholly environmental.
Diabetes insipidus associated with an empty sella turcica
Authors: Matisonn R , Pimstone B
Published: December 2008

A patient with severe diabetes insipidus for 14 years was found to have an enlarged and eroded sella turcica with greatly reduced pituitary tissue on pneumo-encephalography. It is suggested that the permanent diabetes insipidus may have resulted from growth of an intrasellar tumour, which subsequently infarcted spontaneously. Thyroid and pituitary-adrenal function nevertheless remained good, which accounts for persistence of the diabetes insipidus.
Haemolytic anaemia in myelomatosis
Authors: Pengelly C D R , Mondal B K , Barua A R
Published: December 2008

A case of IgA myelomatosis with a haemolytic anaemia is described. No auto-antibodies could be found and the mechanism of the haemolysis was obscure.

Haemolytic anaemia is a rare complication but a search of the literature has revealed a few cases with a comparable shortening of red cell life-span, most without auto-antibodies but some with a positive Coombs' test.
Some veterinary aspects of the eradication of brucellosis
Authors: McDiarmid A
Published: December 2008

An outline is given of some criteria which must be met for the eradication of brucellosis in this country. The incidence of this zoonosis and the financial loss it causes are considered, along with the ultimate benefits to be derived by the farming industry and public health from its eventual eradication.

Diagnostic tests, vaccination policy, financial incentives, educational methods, the question of notification, and the necessity for full collaboration between the medical and veterinary professions are discussed in relation to the problem as a whole.

The debates in the House of Commons and the House of Lords are mentioned as historic landmarks in the campaign against brucellosis in this country, and the progress of the present eradication scheme is summarized.
Veterinary aspects of rabies
Authors: Blamire R V
Published: December 2008

Rabies occurs in domestic animals and wildlife in most parts of the world. Affected mammals invariably die and the disease is greatly feared by man. Control measures can be effective in domestic animals but are difficult to apply in situations where wildlife is affected. Wildlife rabies is spreading southwards in Europe. New legislation has recently been introduced to strengthen the safeguards against importing the disease into Great Britain. Persons should be made aware of this legislation and the dangers of illegally introducing susceptible animals to this country.
A brief review of anthrax in domestic animals
Authors: Smith I M
Published: December 2008

Although there exists in the U.K. a high degree of control of industrial and agricultural anthrax in man and anthrax in animals originating either from animal products or from materials contaminated by contact with them, total control of anthrax in this country seems unlikely to follow until the disease is eliminated from livestock in the enzootic areas abroad. This view rests on the probability that any contamination of agricultural land by anthrax spores is unlikely to be permanent in Britain.
Successful treatment of collagenous sprue with combination of prednisolone and gluten-free diet
Authors: Holdstock D J , Oleesky Samuel
Published: December 2008

A case is described of adult coeliac disease with subepithelial collagen in a jejunal biopsy (‘collagenous sprue’) which responded well to treatment with prednisolone in addition to a gluten-free diet. The indications for corticosteroid treatment in adult coeliac disease are discussed in the light of the findings. It is suggested that collagenous sprue may represent the most severe form of adult coeliac disease, and the presence of sub-epithelial collagen in a jejunal biopsy may be the strongest indication for treatment with the combination of a gluten-free diet and corticosteroids.
The management of malignant pleural effusion
Authors: Sutton M L
Published: December 2008

Several effective methods exist for the control of malignant pleural effusion: the most effective is iodized talc poudrage, but the relatively short survival times associated with malignant effusions from bronchogenic carcinomas make less elaborate methods more appropriate. 70–80% of malignant effusions can be controlled by intrapleural instillation of Mustine or the antimalarial drug quinactine. Preliminary removal of as much fluid as possible is an important contributory factor to success. Radioactive colloidal gold is obsolete in pleural effusions.
Triplets—one ectopic, two intrauterine
Authors: Khan A A
Published: December 2008

A case of ovarian ectopic conception, complicating a simultaneous twin intra-uterine pregnancy is described, in which the operative diagnosis was confirmed by histological examination.

Such cases are extremely rare and comment is made upon this with references.
Respiratory syncytial virus infections
Authors: Gardner P S
Published: December 2008

RS virus was isolated from 10·5% of the specimens examined in the MRC/PHLS hospital survey and from 0·9% of those in the general practice survey. The highest isolation rates were in infants with lower respiratory tract infections. Dyspnoea, wheezing and cough were the predominant clinical features. The differences in the rates between hospital and general practice and newer methods of diagnosis of RS virus infection are discussed.
Parainfluenza virus infections
Authors: Clarke Suzanne K R
Published: December 2008

Parainfluenza viruses types 1, 2 and 3 were found in 2·5%, 0·8% and 1·6% respectively of patients examined in the MRC/PHLS general practice survey and in 2·2%, 0·7% and 2·7% of those in the hospital survey. Type 3 infections were found earlier in life than type 1, while type 2 infections tended to be detected in older children. These viruses were found most frequently in croup and laryngitis but were also common causes of coryza and lower respiratory infections, especially in general practice. The epidemiology and diagnosis of parainfluenza virus infections are discussed briefly.
Rhinovirus infections
Authors: Higgins P G
Published: December 2008

One hundred and seventy-five rhinoviruses were isolated from 4·4% of patients in the general practice survey and 44 from 1·8% of children in the hospital survey. Isolations were made at all times of the year and although isolated most frequently from cases of common cold rhinoviruses were also found in association with other respiratory syndromes.
Influenza virus infections
Authors: Grist N R
Published: December 2008

Ninety-six strains of influenza A and 113 influenza B were found in the two MRC/PHLS surveys. In the general practitioner survey the majority of strains were isolated from cases diagnosed as influenza but in hospital most came from cases diagnosed as having other respiratory infections. In the latter survey isolation rates were higher in upper respiratory tract infection than in lower ones but in the general practice survey this trend was reversed. Influenza-like symptoms tended to increase with age, while coryza and vomiting was commoner in the younger age groups. The frequency of influenza virus infections found in the survey is compared with those found in Glasgow over the last decade and their effect on the incidence of lower respiratory tract infection discussed.
The management and outcome in children admitted to hospital
Authors: Court S D M
Published: December 2008

2418 children aged 0–14 years were admitted to hospital with respiratory infections; 2396 recovered and 22 (0·9%) died.

Previous respiratory illness had been experienced by 5·6%; 2·6% had congenital heart disease and 0·6% cystic fibrosis.

Antibiotics were given in every category of illness; the frequency varied from 68% in colds to 97% in pneumonia. Oxygen was given to 14% of children with croup, 29% with bronchiolitis and 13% with pneumonia. No child with upper respiratory infection or croup died. The case mortality in the 1295 children with lower respiratory infections was 1·7%: 0·6% in bronchitis, 0·7% in bronchiolitis, and 3·1% in pneumonia.

Pathogenic infective agents were isolated in half the deaths; and in 36% predisposing malformations or disease were present.

With a limited study of management and outcome deductions must be made with caution. It suggests, however, that therapy based on understanding of the infective agents and the respiratory dysfunction to which they give rise is not as yet generally applied.
Further observations from an experience of 660 cases of stereotactic tractotomy
Authors: Knight Geoffrey
Published: December 2008

A study of the results of some 660 cases of stereotactic tractotomy shows that these have been consistent through a 12-year period, more than 50% of cases of resistant depression can be set free of medical care and another 25% at least can be improved. Comparable results are also obtained in obsessional illness and anxiety states, particularly those in which there is a depressive component.

The original localization of the target site described in 1964 has not required modification but pathological studies and anatomical research has revealed new features concerning the anatomical connections affected by this operation.

The lesion beneath the head of the caudate nucleus does not extend quite so far as the substantia innominata and should therefore be called subcaudate tractotomy. Connections from the anterior cingulate region and posterior orbital cortex are severed at this site but amygdalo-hypothalamic fibres are not interrupted directly, however; the projection from the amygdala to the dorsal median nucleus sends a radiation to the posterior orbital cortex which is divided here. In addition, important projections from frontal cortex to hypothalamus which bring the external milieu into association with the limbic system pass downwards through the target area beneath the head of the caudate nucleus and are also divided at this point, the localized lesion, therefore, produces a marked effect upon fibres which are concerned in emotional activity. The wellnigh specific effect in cases of depression raises the question whether the operation acts by modifying the intensity of emotional reactivity through limbic connections or has a more specific effect upon the cause of abnormal reactivity through fronto-hypothalamic connections exerting an influence on monoamine production in the hypothalamus.
Stereotactic limbic leucotomy—a follow-up study of thirty patients
Authors: Kelly Desmond , Mitchell-Heggs Nita
Published: December 2008

This prospective study reports the results of stereotactic limbic leucotomy at a mean of 17 months following surgery. Clinical improvement had occurred in twenty-four (80%) of the patients, fifteen (50%) of them being symptom free or much improved. Fourteen of sixteen patients suffering from obsessional neurosis were improved, as were five of seven with chronic anxiety and the degree of improvement at 17 months was superior to that at 6 weeks. Psychometric scores of anxiety, obsessions and neuroticism were all significantly reduced at 17 months. The mean depression scores were also significantly reduced and this result was superior to that reported in a previous study of ‘free-hand’ operations.

Adverse effects were not a problem following limbic leucotomy. Emotional blunting, disinhibition, post-operative epilepsy and excessive weight gain were not encountered, and intelligence was unaffected by the operation. Limbic leucotomy is a much more limited and precise procedure than older ‘free-hand’ operations which we have studied, but its therapeutic effects are comparable and in obsessional neurosis, superior.
Blood volume studies in chronic obstructive non-specific lung disease: a comparison of the bronchitic and emphysematous patients
Authors: Cocking J B , Darke C S
Published: December 2008

Blood volume measurements were made on forty-five patients with chronic obstructive non-specific lung disease. Thirty patients were considered to have the features of predominant emphysema, and fifteen had more bronchitic characteristics. Mean red cell volume was 100·8% of the predicted normal volume in the emphysematous group, whereas that of the bronchitic patients was 121·8% predicted. The emphysematous patients were not on average polycythaemic, because they were both less hypoxic and also had a subnormal polycythaemic response to hypoxia; in constrast a quantitatively normal response occurred in the more bronchitic subjects. The pathogenesis of the subnormal response occurring in the emphysema group is discussed. Mean plasma volume was similar but slightly reduced in both groups, being 92·1% predicted in the emphysema patients and 95·7% predicted in the remainder.
Acute onset diabetes due to an ACTH secreting oat cell carcinoma of the bronchus
Authors: Soler Norman G
Published: December 2008

Diabetes of acute onset led to this patient's referral to hospital. Following investigation, it became apparent that the diabetes was only part of the wider clinical picture produced by an ACTH secreting oat cell carcinoma of the bronchus.
Retroperitoneal haemorrhage and neuropathy complicating anticoagulant therapy
Authors: Curry P V L , Bacon P A
Published: December 2008

Nine cases of retroperitoneal haemorrhage complicating anticoagulant therapy are reported. Six cases were receiving heparin for myocardial infarction: an incidence of 4·3% of patients on such treatment. All the cases presented with pain, six had neurological involvement and one patient died.

The incidence of this complication is higher than previously noted. Retroperitoneal haemorrhage requires a high index of clinical suspicion for early diagnosis and treatment if serious sequaelae are to be prevented.