bluuebunny/crossref_metadata_2025 huggingface dataset:
A combination of cranial and peripheral nerve palsies in infectious mononucleosis
Authors: Mohanaruban K , Fisher D J H
Published: December 2008

A 44 year old woman presented with bilateral brachial neuritis and an isolated Bell's palsy. Subsequently she was found to have infectious mononucleosis. The association of cranial and brachial neuropathy has not previously been reported. Without any specific drug therapy she recovered completely within 5 months.
The association of non-Hodgkin's lymphoma with glomerulonephritis
Authors: Girón González J A , Yebra Bango M , Merino Morales F , Menéndez Caro J L , Diego Marín F J , Durántez Martínez A
Published: December 2008

Paraneoplastic glomerulonephritis is an infrequent complication in the course of non-Hodgkin's lymphoma (21 cases to date). We report a modality not previously described: mesangioproliferative glomerulonephritis and mixed lymphocytic lymphoma, and review the literature on the subject. The onset of the two processes was simultaneous. Antitumour treatment induced simultaneous remission of the lymphoma and glomerulonephritis.
Ultrasound diagnosis of portal vein thrombosis following splenectomy
Authors: Tudway D , Sangster G
Published: December 2008

We present a case of clinically unsuspected portal vein thrombosis occurring soon after splenectomy in a patient with chronic lymphocytic leukaemia. Ultrasound provided a means of easy and accurate diagnosis and allowed frequent reassessment of the thrombus during the period of its resolution under conservative management.
Lumbosacral plexopathy due to dermoid cyst of the greater omentum
Authors: Leno C , Combarros O , Berciano J
Published: December 2008

We describe the case of a 66 year old woman with a lumbosacral plexopathy secondary to the compression produced by a dermoid cyst of the omentum, a complication not previously reported.
Strangulated Spigelian hernia
Authors: Kirby R M
Published: December 2008

Spigelian herniae rarely present as emergencies. There have been two cases requiring emergency surgery at this hospital within the last 5 years, representing 2.4% of all abdominal wall herniae requiring urgent treatment for strangulation.
Psychosis with propranolol: still not recognized?
Authors: Cunnane J G , Blackwood G W
Published: December 2008

A 21 year old male developed hallucinations, personality change and severe depression following an increase in oral propranolol administration at recommended dosage levels. The symptoms improved markedly on stopping the drug. Without provocation, the patient developed further symptoms, mainly depressive, with marked suicidal impulses. Again, this quickly settled. The case identifies the need for careful observation of patients with psychiatric side effects from propranolol, following discontinuation of the drug.
A report of acute overdosage of the anti-serotonergic drug pizotifen
Authors: Griffiths A P , Penn N D , Tindall H
Published: December 2008

An acute overdosage of 30 mg of pizotifen causing a pyrexial illness is reported. The clinical features suggest that the effects of overdosage are principally due to the anticholinergic activity of this drug. Resolution of symptoms occurred after 10 hours, without specific therapy.
Co-secretion of calcitonin gene-related peptide, gastrin-releasing peptide and ACTH by a carcinoid tumour metastasizing to the cerebellum
Authors: Ghatei M A , Stratton M R , Allen J M , Joplin G F , Polak J M , Bloom S R
Published: December 2008

A carcinoid tumour presenting as Cushing’s syndrome is reported. Although no tumour mass could be initially identified the patient returned with first a liver and subsequently a cerebellar mass both of which were resected. Only at post-mortem was the lung primary discovered. ACTH, gastrin-releasing peptide (GRP) and calcitonin gene-related peptide were elevated in plasma before resection of the hepatic tumour. These peptides were demonstrated in both the hepatic and cerebellar tumours by immunocytochemistry and radioimmunoassay. This case illustrates the occasional tendency of primary lung carcinoids to remain small and clinically undetectable while generating secondary tumours which are symptomatic. It is suggested that immunological demonstration of GRP may be diagnostically helpful in directing attention to the lung as a primary site in neuroendocrine tumours which present in this fashion.
Stab injury--the experience of an East London Hospital 1978-1983
Authors: Stebbings W S L , Chalstrey L J , Gilmore O J A , Shand W S , Staunton M D , Thomson J P S
Published: December 2008

A retrospective review of 201 patients with stab wounds admitted to an East London Hospital over a period of six years was performed. There was no striking increase in the annual incidence of these injuries over the period reviewed. The majority of patients were young males who arrived at the Accident and Emergency Department after 1800 h on a Friday, Saturday, or Sunday and had consumed alcohol prior to admission. There were 47 abdominal injuries (23%), 69 thoracic (34%), 51 limb injuries (25%) and 34 injuries involving the head and neck (17%). Forty patients (20%) had injuries involving more than one site. Abdominal stabbings were managed by a selective approach resulting in 28 laparotomies of which only 2 (7%) were negative. Evisceration of small bowel or omentum was always associated with significant intraperitoneal injury.
Disseminated mucormycosis presenting with acute renal failure
Authors: Gupta K L , Joshi K , Pereira B J G , Singh K
Published: December 2008

An unusual presentation of disseminated mucormycosis as acute renal failure in a patient without any predisposing condition, is reported. The diagnosis was established at autopsy.
Pubic osteomyelitis presenting as irritable hip
Authors: Weinberg J R , Berman L , Dootson G , Mitchell R
Published: December 2008

Two cases of pubic osteomyelitis presenting as a painful hip are reported. In both cases the diagnosis was delayed by the unusual presentation and by the limited radiological investigation. Pubic osteomyelitis is rare in childhood but should be considered in the differential diagnosis of the ‘irritable hip’.
Hyperventilation and Raynaud’s disease
Authors: Williams H , Freeman L J , Nixon P G F
Published: December 2008

A 42 year old woman with long standing Raynaud’s disease, unresponsive to medical and surgical treatment, was noted to have a typical history of the hyperventilation syndrome. Rewarming of the hands following cold challenge was markedly prolonged in the presence of hypocapnia. It is suggested that hyperventilation may have an aetiological role in maintaining digital artery spasm in Raynaud’s disease, which would benefit from recognition and treatment.
Internal medicine in The Netherlands
Authors: Elte J W F
Published: December 2008

In this overview various aspects concerning internal medicine in the Netherlands are discussed. Special attention is given to training, which is likely to be increased from 5 to 6 years in the near future. Current problems in internal medicine are mostly related to under-funding of health care and include unemployment (which necessitates reduction of training facilities), disagreement with the government about finances and an argument with the sickness funds concerning professional responsibility and the termination of free enterprise. Also the issue of task definition of the general internist is reviewed. Funding of research used to be mainly the task of the government. Problems with the national economy, however, have resulted in a reduction of the governmental contribution. Private research foundations related to patients’ associations, (pharmaceutical) companies and non-university hospitals have increased in importance.
Nocardia infection in splenectomized patients: case reports and a review of the literature
Authors: Abdi E A , Ding J C , Cooper I A
Published: December 2008

Opportunistic infections are increasingly becoming a problem in cancer patients amongst whom infection with Nocardia species is particularly difficult to detect due to the capricious natural history of the disease. Three cases of Nocardia infection in patients who had undergone splenectomy for haematological malignancy are presented. These cases illustrate the diverse mode of presentation, the natural history and the difficulties in early and accurate diagnosis of Nocardia infection. Despite the difficulties in arriving at the correct diagnosis, these cases highlight the importance of early institution of appropriate antibiotic therapy. Antibiotics should be given in adequate doses to control the initial infection and be maintained for a prolonged period to prevent relapses.
Guillain-Barré syndrome following acute head trauma
Authors: Duncan R , Kennedy P G E
Published: December 2008

A case of classical Guillain-Barré syndrome following acute head trauma is described. The association of Guillain-Barré syndrome with head injury per se is not well recognized, and a possible immunological explanation is proposed.
Myelodysplasia presenting as erythroderma
Authors: Chu P , Aitchison R , Jones P A E
Published: December 2008

Erythroderma has not previously been reported to be a feature of myelodysplasia. We report two cases of myelodysplasia presenting with erythroderma, one of which was associated with skin infiltration by blast cells.
Transient pancytopenia associated with parvovirus infection in paroxysmal nocturnal haemoglobinuria
Authors: Lakhani A K , Malkovska V , Bevan D H , Anderson M J
Published: December 2008

A 25 year old woman with a 15-year history of paroxysmal nocturnal haemoglobinuria developed transient pancytopenia following infection with human parvovirus B19. This is the first report of transient pancytopenia in a patient with an acquired haemolytic anaemia due to parvovirus. The possible mechanism of pancytopenia in such a case is discussed.
Cardiac bypass surgery with haemorrhagic endocrine sequelae
Authors: Khardori R , Bussing R C , Burns G M , Soler N G
Published: December 2008

Cardiac bypass surgery is associated with changes in haemostatis which can lead to bleeding. This report highlights two examples of such bleeding which led to unusual clinical presentations and endocrinological consequences: adrenal and pituitary haemorrhage.
Unusual causes of calf swelling--3. Popliteal vein obstruction by an osteochondroma of the proximal tibia.
Authors: Prosser A J , Brenkel I J , Pearse M , Gregg P J
Published: December 2008

Vascular complications of osteochondroma are uncommon. We report a case of popliteal vein obstruction by an osteochondroma, arising from the proximal tibia, in which the diagnosis was initially missed. The pathogenesis and management of these complications are discussed.
Subacute myelopathy caused by spinal venous infarction
Authors: Clarke C E , Cumming W J K
Published: December 2008

A 44 year old female presented with a subacute myelopathy in association with pelvic venous thrombosis. It is inferred from the temporal relationship of these events that the patient suffered a subacute spinal venous infarction. This is discussed along with the aetiology, anatomical distribution and management of the condition.
Ulcerative colitis complicated by disseminated intravascular coagulation
Authors: Muller S , Chesner I M , Sheridan J , Newman J
Published: December 2008

We report a case of chronic ulcerative colitis complicated by clinical evidence of disseminated intravascular coagulation and pathological evidence of intestinal ischaemia secondary to venular and capillary fibrin thrombi. This may well represent an example of univisceral Shwartzman reaction occurring in a sensitized target organ.
Amyloidosis in continuous ambulatory peritoneal dialysis
Authors: Beaman M , Boon A P , Michael J , Adu D
Published: December 2008

We report a 53 year old man with chronic renal failure on continuous ambulatory peritoneal dialysis. Following eight episodes of severe peritonitis over a 2 year period, he died and was found to have widespread AA amyloid at post-mortem.
Polyorchidism
Authors: Haddock G , Burns H J
Published: December 2008

Polyorchidism is an unusual abnormality of the genital tract in which supernumerary testes are present, usually within the scrotum. We report a recently encountered case, discuss the aetiology of the condition and suggest a course of management when encountered at operation.
The clinical use of cerebrospinal fluid studies in demyelinating neurological diseases
Authors: Harrington M G , Kennedy P G
Published: December 2008

The clinical diagnosis of definite multiple sclerosis is supported by abnormalities in the cerebrospinal fluid: variable mild pleocytosis and elevation of total protein, moderately elevated total IgG in most patients, and the almost invariable presence of discrete immunoglobulins after electrophoresis, the oligoclonal bands. The oligoclonal bands are non-specific, and are seen in most diseases of the nervous system, but their temporal uniformity in each patient with multiple sclerosis is characteristic. Prognostically, patients with a single episode of optic neuritis or paraesthesia who have oligoclonal bands are more likely to develop multiple sclerosis than if the spinal fluid were normal. In the Guillain-Barré syndrome, the spinal fluid total protein is transiently elevated, with no pleocytosis. Oligoclonal bands are usually found in the acute phase and only persist in those patients with chronic or relapsing polyneuropathy.
The incidence and causes of hypercalcaemia
Authors: Dent D M , Miller J L , Klaff L , Barron J
Published: December 2008

A prospective screen for hypercalcaemia in 58,053 hospital in-patients was conducted over 12 months. The incidence of hypercalcaemia was 0.6%, being transient in 19.2% of patients and sustained in the remainder. The most common causes in the sustained group were malignancy (45%) and primary hyperparathyroidism (16.5%). The incidence of primary hyperparathyroidism was 78/100,000 hospital in-patients, and its discovery was directly attributable to the survey in over half the cases.
Can thyroid stimulating hormone levels by TSH (IRMA) predict relapse of thyrotoxicosis following carbimazole treatment?
Authors: Wilson R , Semple C G , Reid A M , Glen A C A , McKillop J H , Thomson J A
Published: December 2008

Serum thyrotrophin receptor antibody (TRAb) and thyroid stimulating hormone (TSH) (IRMA) levels were measured in 38 patients at one month after the end of a course of carbimazole/T3 therapy for Graves’ disease. Despite the increased sensitivity of the IRMA assay a TSH measurement at this stage was found to be of no predictive value, in contrast to estimation of serum TRAb levels which correctly predicted relapse and remission in 90% of patients.
Combined irradiation and low-dose cyclophosphamide in the treatment of Graves’ ophthalmopathy
Authors: Teoh R , Woo J
Published: December 2008

The treatment of a patient with euthyroid Graves’ ophthalmopathy is described. A poor response was obtained from large doses of prednisone whereas a combination of orbital irradiation and low dose cyclophosphamide induced a dramatic resolution. As there is no fully satisfactory treatment for this condition, this combined therapy deserves further investigation.
Chronic renal failure and tuberous sclerosis: a rare association
Authors: Nimr A B , Patel P J , Tongia R K , Tamizuddin F
Published: December 2008

A 38 year old Saudi patient with tuberous sclerosis and chronic renal failure is described. The association of these two conditions has rarely been described. This case supports the observation that when chronic renal failure occurs in patients with tuberous sclerosis, cystic renal disease (with or without hamartomas) is more likely to be the underlying cause, rather than hamartomas alone.
Carcinoma of the duodenum
Authors: Carragher A , Russell C
Published: December 2008

We report two patients with primary adenocarcinoma of the duodenum who underwent successful pancreatico-duodenectomy (modified Whipple operation). One patient died from an unrelated cause three years following surgery whilst the other remains well and clinically free of disease 3 years after resection. An aggressive surgical policy in patients with this rare tumour seems justified.
Gastric outlet obstruction due to gall stones (Bouveret syndrome)
Authors: Ah-Chong K , Leong Y P
Published: December 2008

Gastric outlet obstruction by gall stone is a rare complication of a common disorder. Two cases are reported here. The investigations are conducted along the same lines as for pyloric stenosis. The diagnosis can be made with a barium meal or gastroscopy. Treatment is by surgical intervention after adequate resuscitation.
Antenatal appendicular perforation
Authors: Narasimharao K L , Mitra S K , Pathak I C
Published: December 2008

Antenatal appendicular perforation leading to localized meconium peritonitis and intestinal obstruction is reported in a premature neonate. The baby was successfully treated by a limited ileocaecal resection.
Should patients with haemoptysis and a normal chest X-ray be bronchoscoped?
Authors: Heaton R W
Published: December 2008

A review of bronchoscopic records over a 5 year period identified 41 patients who had undergone fibreoptic bronchoscopy after presenting with haemoptysis and a normal chest X-ray. Carcinoma of the bronchus was found in 4 patients (9.7%) and the procedure yielded a diagnosis in 8 of the 20 patients in whom a specific cause of their bleeding could be identified. The diagnostic yield is sufficiently high and the morbidity of the procedure sufficiently low to justify the investigation in patients presenting with haemoptysis and a normal chest X-ray.
Extra-corporeal shock wave lithotripsy
Authors: Pemberton J
Published: December 2008

Extra-corporeal shock wave lithotripsy (ESWL) has proved to be a revolutionary advance in the treatment of renal stone disease. It, itself, is non-invasive but may necessitate or be used as an adjunct to more invasive auxiliary procedures. The basic principles of lithotripsy, the clinical experience thus far and probable future applications are discussed.
Guillain-Barré syndrome associated with herpes zoster
Authors: Hart I K , Kennedy P G E
Published: December 2008

A case of Guillain-Barré syndrome following herpes zoster is described. This is a rare association and the possible pathogenesis is discussed.
Paroxysmal kinesigenic choreoathetosis in hyperthyroidism
Authors: Drake M E
Published: December 2008

Paroxysmal kinesigenic choreoathetosis is an unusual movement disorder often triggered by attempts to use the limbs, and has sometimes been associated with diffuse or focal brain injury. We report its occurrence in hyperthyroidism, with which choreoathetosis has rarely been described in the past without known cause. Choreoathetosis has also occurred with other metabolic and toxic disorders, and the mechanism is uncertain. The development of involuntary movements activated by limb motion during hyperthyroidism suggests an influence by thyroid hormone or metabolic state on motor neurone excitability or motor system organization.
Compression of the optic chiasm due to a lymphoreticular malignancy
Authors: Howard R S , Duncombe A S , Owens C , Graham E
Published: December 2008

A patient is described who presented with visual loss due to infiltration of the optic chiasm by chronic lymphocytic leukaemia. This case demonstrates intracranial infiltration as a primary presentation of chronic lymphocytic leukaemia without lymphoreticular involvement and, to our knowledge, is the first report of a chiasmal syndrome due to this lymphoproliferative disorder.
Cerebral scintigraphy--the phoenix rises again
Authors: Shepstone B J
Published: December 2008

This paper reviews the development of cerebral scintigraphy from its early days of planar imaging with simple technetium-99m labelled compounds to the recent revival of the technique in the form of positron-emission and single-photon emission tomography. A short explanation of instrumentation and radiopharmaceuticals is given as a prelude to a description of both techniques in normal and pathological situations. Particular emphasis is placed on the more readily-available single-photon emission-tomographic techniques using labelled amines in the functional investigation of disorders not readily diagnosed by computed tomography.
Relapse of idiopathic pulmonary haemorrhage and glomerulonephritis associated with cytomegalovirus (CMV) infection
Authors: Chan C N , Lai F M , Lai K N , Pang J A
Published: December 2008

A 49 year old man who developed idiopathic pulmonary haemorrhage and glomerulonephritis responded initially to immunosuppressive treatment and plasmapheresis. However, he died later from massive pulmonary haemorrhage and necropsy showed cytomegalovirus infection of the lungs. We propose that relapse of pulmonary haemorrhage may be associated with cytomegalovirus infection and that preventive measures against acquiring the virus through blood products should be considered for elective transfusions in view of the relatively good long term prognosis of this syndrome.
An unusual case of oesophageal rupture treated by transhiatal oesophagectomy
Authors: Park K , Crofts T J , Chung S C S , Li A K C
Published: December 2008

Spontaneous rupture of the oesophagus is an uncommon surgical emergency. A case is presented in which the extensive nature of the rupture precluded standard methods of treatment and was treated by transhiatal oesophagectomy.
Penile hyperexcitability with recurrent ejaculations as the presenting manifestation of a case of rabies
Authors: Udwadia Z F , Udwadia F E , Rao P P , Kapadia F
Published: December 2008

A patient with rabies presented with penile hypersensitivity and recurrent ejaculation. This preceded the more classical manifestations such as hydrophobia and aerophobia by approximately 8 hours. A review of the literature reveals that a variety of urogenital symptoms may rarely occur in rabies. Ours is however the first report documenting the occurrence of these symptoms at the onset of the disease in an autopsy proven case of rabies. Damage to the amygdaloid nucleus has been postulated to be the basis of these urogenital symptoms. This correlates well with our autopsy findings of extensive neuronal damage and Negri bodies in the temporal poles.
Osteitis pubis in a 78 year old female
Authors: Catania J , Fullerton K J
Published: December 2008

Osteitis pubis has been reported following pelvic surgery, childbirth and in athletes. We describe a case involving an elderly woman, in which none of the predisposing factors were present. Difficulties in diagnosis, with particular reference to the elderly, are highlighted.
Haemolytic anaemia associated with splenic haemangiomata
Authors: Radhi J M , Wallis J P , Mansy H
Published: December 2008

We describe a 33 year old woman who developed unexplained haemolytic anaemia following renal transplantation and who was found to have multiple splenic haemangiomata. This case demonstrates that splenic haemangiomata may be a cause of haemolytic anaemia in the absence of abnormalities in coagulation.
Left ventricular thrombosis in acute transmural myocardial infarction
Authors: Chamsi-Pasha H , Barnes P C
Published: December 2008

To determine the incidence and natural history of left ventricular thrombosis in acute transmural myocardial infarction we performed serial two-dimensional echocardiography in 51 patients. Seventeen patients had inferior infarcts. None of these developed left ventricular thrombosis. The remaining 34 patients had anterior infarcts. Ten of these developed left ventricular thrombus at an average of 4 +/- 2 days after admission. All patients with left ventricular thrombosis had apical akinesia or dyskinesia.

Patients with anterior myocardial infarction and akinesia or dyskinesia of the apex are at high risk of developing left ventricular thrombosis. Peak aspartate aminotransferase and lactate dehydrogenase enzyme activity were of little value in identifying this high risk group.
The carpal tunnel syndrome in hypertensive patients treated with beta-blockers
Authors: Emara M K , Saadah A M
Published: December 2008

We report the development of the carpal tunnel syndrome in 3 hypertensive men (aged 46-58) treated with beta-blockers (propranolol in two patients and metoprolol in the 3rd) for 8-11 years. Known causes of carpal tunnel syndrome were excluded in each case. Withdrawal of the beta-blocker was followed by complete resolution of symptoms and signs after a period of 8-10 weeks. No evidence of recurrence could be detected during follow-up of 7-18 months. The possible mechanisms of drug-induced carpal tunnel syndrome are briefly discussed.
The swallowed foreign body: is it in the nasopharynx?
Authors: Parker A J , Bingham B J , Osborne J E
Published: December 2008

Children with a history of a suspected swallowed radio-opaque foreign body should undergo radiographic examination of the nasopharynx even in the absence of symptoms and signs. Failure to identify and remove an object at this site can result in potentially fatal consequences.
Estimation of glomerular filtration rate from the serum creatinine concentration
Authors: Smith S A
Published: December 2008

In patients with renal failure the dose of renally excreted drugs should be reduced in proportion with the degree of impairment of glomerular filtration: in this situation it is appropriate to measure the glomerular filtration rate in order to determine accurately the correct dose. However, as 24 hour urine based creatinine clearance measurements are time consuming and inaccurate, the parameter most often used to estimate renal function in clinical practice is the serum creatinine concentration. An isolated serum creatinine concentration is unsatisfactory for this purpose as it depends on creatinine production, which is related to muscle mass, as well as on renal elimination of creatinine. A variety of formulae and nomograms have been devised to assist clinicians in predicting the glomerular filtration rate from a stable serum creatinine concentration and the patient’s sex, age and weight (or height). Although some of these formulae have been available for over 15 years, the majority of doctors cannot estimate accurately the glomerular filtration rate from these parameters. It is proposed in this paper that biochemistry results computers should employ one of these formulae to calculate the glomerular filtration rate/70 kg, using the age and sex information provided on the request form, each time a serum creatinine concentration is reported. These formulae are invalid in several well defined clinical situations which could be briefly outlined on the report.
Effect of nivazol in Nelson’s syndrome
Authors: Ball J A , Williams G , Yeo T H , Joplin G F
Published: December 2008

We report the use of nivazol in a patient with Nelson’s syndrome. Nivazol was highly effective in reducing ACTH secretion but, contrary to reports of its use in other primates, in our patient nivazol did have systemic glucocorticoid effects.
Myalgias and muscle contractures as the presenting signs of Addison’s disease
Authors: Shapiro M S , Trebich C , Shilo L , Shenkman L
Published: December 2008

Severe generalized myalgias and muscle contractures of the lower extremities were the major initial manifestations of adrenal insufficiency in a 26 year old black male. The intensity of increased skin pigmentation was not fully appreciated until the patient’s skin colour was compared to that of his brother. Replacement with physiological doses of gluco- and mineralocorticoids was associated with complete amelioration of symptomatology.
Cardiac arrest associated with hypokalaemia in a patient receiving mithramycin
Authors: Bashir Y , Tomson C R V
Published: December 2008

The case is reported of a patient who developed severe hypokalaemia, leading to cardiac arrest, while receiving mithramycin for painful Paget’s disease. The patient was also receiving antihypertensive and anti-anginal treatment including bendrofluazide, but plasma potassium before the administration of mithramycin was normal. Hypokalaemia has been reported in previous studies of the use of mithramycin but has received little attention. The drug should be used with great care in patients with cardiovascular disease and in those receiving diuretics.
Failure of penicillin prophylaxis in laboratory acquired leptospirosis
Authors: Gilks C F , Lambert H P , Broughton E S , Baker C C
Published: December 2008

A laboratory technician developed leptospirosis following accidental inoculation, despite prompt administration of parenteral penicillin by an accepted regimen of post-exposure prophylaxis. Another technician was similarly exposed and was given doxycycline; no illness or serological conversion followed. The implications of these cases are discussed and recommendations made for post-exposure chemoprophylaxis with doxycycline.
The low plasma testosterone levels of young Indian infarct survivors are not due to a primary testicular defect
Authors: Sewdarsen M , Jialal I , Naidu R K
Published: December 2008

A case control study was performed to determine whether the hypotestosteronaemia described in men with coronary artery disease could be the result of primary testicular dysfunction. Testicular function was assessed by comparing the response of 10 young Indian men with myocardial infarction to human chorionic gonadotrophin (HCG) injection to that of 10 healthy age and weight matched controls.

The basal testosterone levels in the patients were significantly lower (12.71 +/- 1.36 nmol/l vs 16.51 +/- 0.79 nmol/l; P = 0.01) and the basal oestradiol levels significantly higher than the controls (120.67 +/- 8.81 pmol/l vs 94.05 +/- 8.23 pmol/l; P = 0.02). There was no difference in the sex hormone binding globulin concentrations. However, following HCG stimulation the patients demonstrated a normal response with a 2-fold increase in testosterone. There was no difference in the testosterone and oestradiol levels of the patients and controls following HCG stimulation.

This normal response in our patients demonstrates that the hypotestosteronaemia in Indian men with myocardial infarction is not due to a primary testicular dysfunction but probably is a result of increased aromatization of testosterone to oestradiol.
The shaking limb--a lacunar syndrome
Authors: Nagaratnam N , Ghougassian D F , Lewis-Jones M
Published: December 2008

A 76 year old man with shaking movements of the fingers, weakness of the arm and lacunar infarctions on computed tomographic scan is described. The shaking limb should be included in the group of lacunar syndromes.
Autoantibodies in Indian-Asians with insulin-dependent diabetes in the UK
Authors: Odugbesan O , Fletcher J A , Sanders A , Bradwell A R , Botazzo G F , Barnett A H
Published: December 2008

Classical insulin-dependent diabetes mellitus (IDDM) is relatively uncommon in Indian-Asians whether in India or in the UK and this may be related to immunogenetic factors. We have studied the presence or absence of islet cell antibodies and other auto-antibodies in 36 subjects with IDDM and 41 controls, all of Indian origin. Islet cell antibodies (ICA-IgG) were found in 8 subjects with IDDM but in none of the controls. Four of the 8 patients with ICA-IgG also possessed the complement fixing variety (CF-ICA). There was no definite association between possession of ICA and HLA-DR antigens. Thyroid antibodies were commoner in patients (22%) compared with controls (7%) as were parietal cell antibodies (8.3% vs 4.8%). None of the patients or controls had adrenal antibodies.

The frequency of organ-specific antibodies in Indian-Asians with IDDM is similar to that of white Caucasians. The overall frequency of ICA is, however, lower than that reported for white Caucasians although the temporal distribution is similar. We conclude that even though the prevalence of IDDM in Indian-Asians is lower than in white Caucasians there is no evidence that different immunological mechanisms are involved in the pathogenesis of IDDM in the two groups.
Cerebellar disturbance in psittacosis
Authors: Shee C D
Published: December 2008

A previously fit man developed psittacosis with marked cerebellar symptoms and signs. He was febrile but not confused, and he responded rapidly to treatment with erythromycin. Even if respiratory symptoms are minimal, psittacosis and other atypical pneumonias should be considered in any patient presenting with fever and cerebellar involvement.
A case of metachronous aneurysm of the infrarenal abdominal aorta
Authors: Millard F C , Powis S J A
Published: December 2008

The case history of an 84 year old woman presenting with a metachronous aneurysm of the infrarenal abdominal aorta is presented. At operation this second aneurysm was replaced by a further straight tube Dacron inlay graft. This report raises the important question as to whether the whole of the infrarenal aorta should be replaced when resecting an infrarenal abdominal aortic aneurysm, rather than the more conventional approach of suturing the graft to the neck of the aneurysm above and the aortic bifurcation below.
Retinal vasculitis
Authors: Sanders M D , Graham E M
Published: December 2008

Evidence is now accumulating on both clinical and experimental grounds that the retina is an a priori source of inflammatory activity. Reactive inflammation in the retina may produce many of the clinical signs previously ascribed to uveal inflammation. Autoimmune mechanisms are probably responsible for the majority of cases of retinal vasculitis. Autoimmune retinal vasculitis occurs without other classical signs of inflammatory response in any other parts of the body. When associated systemic manifestations occur they may reflect different underlying immunopathogenic abnormalities.

Thus in diseases with predominantly arterial involvement (e.g. systemic lupus erythematosus, polyarteritis nodosa) the retinal arteries bear the brunt of this disease. In Behçet’s disease the systemic involvement is usually venous and ocular involvement produces diffuse capillary and venous inflammation with areas of retinal necrosis and major vascular occlusion. The retinal appearances differ from sarcoidosis in which a granulomatous response produces characteristic periphlebitis. Finally, autoimmune retinal vasculitis produces diffuse capillary and venous damage, without any systemic signs.

In the next decade the search will be for the identification of the specific antigens initiating these disparate retinal features. Retinal S antigen is a potent antigen, but rhodopsin, interphotoreceptor binding protein, and transducin all need further experimental investigation. Precise documentation will herald the dawn of new therapeutic measures based on a sound immunological fabric.
The changing face of chemotherapy
Authors: Brumfitt W , Hamilton-Miller J M T
Published: December 2008

The historical development of antibiotics has been summarized. Three distinct phases are discernible. The first (from historical times to about 1900) involved mostly folk remedies. The second (1900-c. 1940) was ushered in by Paul Ehrlich’s development of the concept of ‘selective toxicity’ and saw the establishment of arsenicals and sulphonamides. The third, lasting to the present day, started with the exploitation of the pioneering studies of Fleming, Dubos and Waksman on antibiotic production by soil fungi. This latest phase has continued with the improvement of natural products by the skills of the medicinal chemist. The properties and evolution of three major groups of antibiotics, penicillins, cephalosporins and aminoglycosides are fully described. Finally, pathways of possible future evolution of antibiotics are outlined.
Carcinoma of the gall bladder--can we do anything?
Authors: Chattopadhyay T K , Kumar A , Kapoor V K , Sharma L K , Kapur M M , Kapur B M L , Dhawan I K
Published: December 2008

A retrospective review of 143 cases of carcinoma of the gall bladder is presented. The disease was more common in females in the 5th and 6th decades. Pain, anorexia, weight loss and jaundice were the common presenting symptoms, and hepatomegaly and palpable gall bladder the common signs. Laboratory and radiological investigations were merely confirmatory as the diagnosis in a majority of the cases was clinically obvious. Aspiration cytology and laparoscopic biopsy were of help in obtaining histological diagnosis. Only 47 patients were considered fit enough to undergo laparotomy. In a majority of these patients biopsy alone was possible while palliative procedures were performed in the others. The operative mortality was 18% even in this selected group of patients, due to the poor general condition and the advanced stage of the disease at the time of diagnosis. Curative resection may be possible and long term survival is expected in incidentally found carcinoma at cholecystectomy. The only hope lies in prevention by prompt treatment of patients with benign biliary disease.
A descriptive survey of uncontrolled methicillin-resistant Staphylococcus aureus in a twin site general hospital
Authors: Barrett S P , Gill O N , Mellor J A , Bryant J C
Published: December 2008

Over a five year period beginning in 1981, during which control measures were applied intermittently, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) isolates increased steadily within a twin site general hospital. A retrospective chart review of 154 patients identified in 1984-1985 showed that the MRSA ‘definitely’ contributed to three deaths (2%) and ‘probably’ contributed to a further 15 (10%). The prolonged median duration of hospital admission (22 days) before first isolation of MRSA, together with the clustering of cases in time on certain wards, suggested that most, if not all, affected patients acquired the MRSA in hospital. As the virulence of MRSA in our outbreak appeared the same as that reported from teaching hospitals, MRSA control measures need to be comprehensively applied in general hospitals.
Colonic bleeding due to rupture of an isolated iliac artery aneurysm into a caecal carcinoma
Authors: Aladgem D , Mazor A , Kashtan H , Ostrzega N , Barak Y , Wiznitzer T
Published: December 2008

We describe a case of a fistula between an atherosclerotic aneurysm of the right common iliac artery and a caecal carcinoma, causing massive colonic bleeding. A fistula between a true aneurysm and a carcinoma of the colon has not to our knowledge been previously reported. Various aspects of this case are discussed from a pathogenetic point of view.
Anorectal melanoma
Authors: Jalleh R P , Pathmanathan R , Krishnan M M S , Mukherjee A
Published: December 2008

Four cases of anorectal melanoma are presented. The authors believe that this is the first report of the occurrence of this tumour in Malays. Advanced disease at initial presentation accounts for the poor prognosis observed in this series. Surgery remains the principal treatment modality, although controversy exists regarding optimal extent of resection.
Diagnosis easily missed--upper urothelial tumour
Authors: Mufti G R , Virdi J S
Published: December 2008

Four patients with transitional cell tumour of the renal pelvis and ureter who had atypical presentations are described. The associated presenting problem delayed an earlier diagnosis in two patients and facilitated it in the other two.
Attitudes to a hospital based terminal care scheme
Authors: McKee C M , Rajaratnam G , Lessof L
Published: December 2008

Two years after the establishment of a terminal care support team, the team perceived that a number of patients were not being referred to them, and many of those seen were referred at a very late stage in their illness. We sent a questionnaire to all clinicians and ward sisters in the district to elicit their knowledge of the team and attitudes to their role. Although most respondents had cared for terminal patients in the previous 6 months, over a quarter were not aware of the existence of the team. The lack of awareness was most common among junior medical staff, many of whom were spending relatively short times in the district. The study indicated a requirement for good communication between terminal care teams and other professionals and a need to inform junior staff about available facilities. A requirement for training in terminal care was also identified.
Delayed sudden death after ingestion of MCPP and ioxynil: an unusual presentation of hormonal weedkiller intoxication
Authors: Dickey W , McAleer J J A , Callender M E
Published: December 2008

A patient who died in asystole less than 18 h after ingestion of ‘Clovercide Extra’, a combination hormonal weedkiller containing ioxynil and 4-chloro-2-methyl phenoxypropionic acid, is described. Previous reports describe coma as an early event following ingestion of these herbicides. In contrast our patient, although showing other characteristic features, including metabolic acidosis, tachycardia, pupillary constriction and pyrexia, remained conscious until the terminal event. Absence of coma does not appear to be related to a more favourable outcome.
Still’s disease and myocarditis associated with recent mumps infection
Authors: Ward S C , Wiselka M J , Nicholson K G
Published: December 2008

We describe a 16 year old patient who developed Still’s disease with evidence of myocarditis. A rise in the mumps ‘V’ antigen indicated that the disease was associated with recent mumps infection.
Aeromonas hydrophila septicaemia and muscle abscesses associated with immunosuppression
Authors: Slevin N J , Oppenheim B A , Deakin D P
Published: December 2008

We report a case of septicaemia and muscle abscesses due to Aeromonas hydrophila. The patient was immunosuppressed due to Hodgkin’s disease and treatment with cytotoxic chemotherapy. The abscesses resolved after prolonged antibiotic therapy. Organisms that were once considered rarely pathogenic are emerging as increasingly important in causing potentially lethal infections in immunosuppressed patients.
Jejunal carcinoma associated with non-absorbable suture material
Authors: Leinhardt D J , Smart P J , Howat J M T
Published: December 2008

A case of adenocarcinoma of the jejunum arising at the site of non-absorbable surgical material is reported. This appears to be a unique observation.
Problems of myeloma in a community
Authors: Flanagan N G , Ridway J C , Jain A , Platt C C , Irving A G
Published: December 2008

The presenting features of 120 consecutive cases of myeloma diagnosed in a single unit were examined. Screening tests on routine laboratory samples increased the detection rate but did not significantly reduce the percentage of cases presenting with late stage disease. Morbidity was closely related to the incidence of bone involvement already present at diagnosis. About one fifth of cases had reported suspicious symptoms for some considerable time before further investigation was forthcoming. Almost half had ‘benefitted’ by having concurrent disease which often led to the discovery of myeloma at an early stage. These findings, together with the wide variety of symptomatology and few physical signs, stressed the critical importance of having a high index of suspicion and thus taking suitable blood samples without unnecessary delay.
A novel means of comparing the bioequivalence of two formulations of tripotassium dicitrato bismuthate (De-Noltab)
Authors: Coghill S B , Shepherd A N
Published: December 2008

Tripotassium dicitrato-bismuthate (TDB) has a topical action in the upper gastrointestinal tract. Absorption is minimal and the blood levels are therefore irrelevant to the assessment of bioavailability. TDB is however detectable in the stomach and duodenum by conventional electron microscopy. Following oral administration of two different formulations of TDB tables to patients attending a gastroscopy clinic, duodenal biopsies were obtained and examined by electron microscopy. The amount of electron dense drug precipitate was quantified. No difference could be detected between the two formulations.
Oral bowel lavage preparation for colonoscopy
Authors: Burke D A , Manning A P , Murphy L , Axon A T R
Published: December 2008

Colonoscopy is a commonly performed diagnostic and therapeutic procedure in most general hospitals, which requires effective bowel preparation to be worthwhile. We report the effect of replacing a diet, laxative and bowel washout preparation with oral bowel lavage using a balanced electrolyte formulation, in our unit. The preparation was acceptable to patients, medical and nursing staff, generally preferred to previous preparations by those who had experienced them, allowed a more complete colonoscopy with an excellent quality of view, and was less expensive in nursing time. We regard oral bowel lavage as currently the method of choice for bowel preparation prior to colonoscopy in the majority of patients.
Pulmonary endometriosis mimicking an acute abdomen
Authors: Grunewald R A , Wiggins J
Published: December 2008

A case of pulmonary endometriosis is reported, to illustrate the classic catamenial symptoms of the disease. The patient also developed symptoms and signs suggesting a perforated abdominal viscus; laparotomy was normal and the features may have resulted from a previously unreported effect of diaphragmatic endometrial foci.
Retinal pigment epithelial change and partial lipodystrophy
Authors: Davis T M E , Holdright D R , Schulenberg W E , Turner R C , Joplin G F
Published: December 2008

Cuticular drusen and retinal pigment epithelial changes were found incidentally in a 27 year old Lebanese woman during assessment of partial lipodystrophy. Her vision was normal despite involvement of both maculae. The patient had hypocomplementaemia, but serum C3 nephritic factor was absent and renal function was normal. She had impaired glucose tolerance and a continuous infusion of glucose with model assessment (CIGMA) test revealed low normal tissue insulin sensitivity and high normal pancreatic beta cell function. Mild fasting hypertriglyceridaemia (2.0 mmol/l) may have been secondary to impaired insulin sensitivity. Endocrine function was otherwise normal apart from a completely absent growth hormone response to adequate hypoglycaemia. The simultaneous occurrence of partial lipodystrophy and retinal pigmentary epithelial and basement membrane changes appears to be a newly recognized syndrome.
The skull in chronic sarcoidosis
Authors: Landsberger D , Rav’e D , Friedman G
Published: December 2008

A report of a 63 year old woman with giant osteolytic skull lesions simulating metastatic disease, and generalized cutaneous lesions is presented. Biopsy of a skin lesion revealed non-caseating granulomas compatible with sarcoidosis. The literature dealing with calvarial sarcoidosis is reviewed.
Systemic sclerosis in association with multiple primary pulmonary malignancy--a marker of internal malignancy?
Authors: Goodfield M J D , Millard L G
Published: December 2008

Multiple pulmonary malignancy is uncommon and has not been reported in association with systemic sclerosis. We now report such a case in which it is likely that the connective tissue disease occurred as a marker of the internal malignancy. Systemic sclerosis is not generally a reliable indicator of malignant change, but it is possible that in patients who are immunosuppressed, either therapeutically or inherently, the onset of systemic sclerosis should prompt investigation for an underlying cause.
Spontaneous pneumoretroperitoneum in a renal transplant recipient
Authors: Gleeson M J , McMullin J P
Published: December 2008

A case of a spontaneous pneumoretroperitoneum in a 16 year old renal transplant recipient is reported. This fatal complication of immunosuppression has not been reported previously.