bluuebunny/crossref_metadata_2025 huggingface dataset:
Solitary cyst of the liver presenting as an abdominal emergency
Authors: Sood S C , Watson A
Published: December 2008

A case of torsion of a solitary non-parasitic cyst of the liver presenting as an acute abdominal emergency is described. Reference is made to the pathogenesis of such cysts, which occur infrequently and only rarely present with complications. A review of previous reports of complications in such cysts is presented.
Acute emphysematous cholecystitis
Authors: McKibbin A , Parks T G
Published: December 2008

A case of acute emphysematous cholecystitis is described. In reviewing the literature the clinical features, pathogenesis and treatment of this condition are discussed.
Use of the 198Au liver scan in assessing the therapeutic effect of penicillamine in Wilson’s disease
Authors: Chajek T
Published: December 2008

In a 14-year-old girl Wilson’s disease was found to be the etiologic basis of an active liver cirrhosis diagnosed months previously. Specific therapy with D-penicillamine caused remarkable clinical and biochemical improvement. Repeated liver scans using 198Au revealed increased liver uptake of the 198Au while the size of the spleen decreased. It is proposed that repeated liver scintiscanning may provide another easily performed and safe test for evaluation of the effect of therapy in these patients.
Clinical trials
Authors: Garnham J C
Published: December 2008

The choice of standard drugs to be used in clinical trials must be based on consideration of human absorption data, in vitro characteristics, possible interactions, comparative efficacy and safety, previous data regarding the standard in relation to the syndrome to be studied, and correlation of blood levels, effectiveness and safety.
The retail pharmacist
Authors: Haberfield G R
Published: December 2008

Though the exclusive use of approved names would simplify dispensing by a retail pharmacist, present standards of equivalence are not adequate to ensure that in these circumstances the patient would always receive the preparation best suited to his need. In the present situation, the decision about brands cannot be left to the retail pharmacist and doctors should therefore identify a particular product in their prescriptions by using the trade name.
The pharmaceutical company
Authors: Hoare R G
Published: December 2008

Trade name prescribing benefits the Pharmaceutical Industry by providing income to support research and development of drugs, and is essential to protect a company during the patent life of a product.
Antibiotics
Authors: Garrod L P
Published: December 2008

Reasons for prescribing antibiotics by official names are that the doctor is more likely to understand what he is prescribing, that it enables the literature to be internationally understood, and that non-branded products are less costly. The only reason to the contrary is that the original brands of some oral antibiotics are better absorbed than others.
Serum cholesterol and serum triglycerides in mental retardation
Authors: Lawlor T , O’Hara F , Birtwistle D T
Published: December 2008

Two hundred and thirty-four mentally retarded adult patients, 116 female and 118 male, whose ages ranged from 16 to 81 years had their fasting cholesterol and triglyceride concentrations determined whilst their blood was being taken for routine investigations during a seven week period. These values were compared with those of a healthy adult population who were being screened for these values at the same laboratory. The values of both cholesterol and triglyceride concentrations were found to be significantly lower in the hospital population. A survey of the diet of the hospital patients failed to account for these low values. No significant difference was found between epileptics and non-epileptics, mongols and non-mongols.
Parkinsonism and transient bilateral ptosis in systemic lupus erythematosus
Authors: Teoh P C , Richard A T Ng , Wong P K
Published: December 2008

Many neurological abnormalities have been described in systemic lupus erythematosus (SLE), but transient bilateral ptosis and parkinsonism are rarely encountered. This paper describes a young Malay girl with SLE who develops psychosis, bilateral ptosis and parkinsonism during an exacerbation of her illness. These neurological features disappeared after adequate treatment with cyclophosphamide. Though the pathogenesis of these neurological abnormalities is not clearly known, it is likely that transient bilateral ptosis is due to myoneural dysfunction not unlike that of myasthenia gravis. As for parkinsonism, it can probably be explained on the basis of ‘vasculitis’ of the basal ganglia leading to microinfarcts and encephalomalacia.
Hiatus hernia reflux syndrome
Authors: Edwards D A W
Published: December 2008

Some of the features of the syndrome, the mechanism of symptom production, and the role of radiology in diagnosis are defined. Current theories of the anti-reflux mechanism and recent concepts of the pathological changes involved are described.
Endoscopy in achalasia
Authors: Roesch W
Published: December 2008

In achalasia oesophagoscopy should be used to rule out definitely carcinoma of the cardia involving the myenteric plexus of the lower oesophageal sphincter. An easy passage of the instrument through the narrow terminal segment is characteristic but not always possible due to extreme distortion. Syncopal attacks are rarely encountered.
Cardiac involvement in idiopathic haemochromatosis and the effect of venesection
Authors: Jachuck S J , Rai G S , Fossard C
Published: December 2008

Eight patients with idiopathetic haemochromatosis have been followed up for 2-15 years to study their cardiac state and the effect of repeated venesection in treating their disability. Five of these patients had no clinical cardiac disability. Serial electrocardiographs were done in five patients and significant abnormality was seen in three of them at the time of admission. After removal of excess iron the cardiac disability progressed in two patients and regressed in one other. One of these presented with palpitations and was found to have Wolff-Parkinson-White syndrome. Not one of our patients developed cardiac failure and the two deaths which occurred were the result of hepatic failure. At autopsy one of them was found to have metastases in the myocardium from a hepatoma, a complication we have not encountered in previous reports.
Primary acquired hypogammaglobulinaemia and auto-immune thyroiditis
Authors: Hilton Angela M , Doyle L
Published: December 2008

A patient with primary acquired hypogammaglobulinaemia and auto-immune thyroiditis is presented, an association which has not been described previously. The role of disturbances of cell-mediated immunity in the pathogenesis of the thyroid lesion is discussed.
Survival in renal cortical necrosis due to snake bite
Authors: Ramachandran S , Perera M V F
Published: December 2008

A case of acute renal cortical necrosis following snake bite is reported. The case illustrates that survival is possible in renal cortical necrosis following snake bite and that even in the presence of anuria or prolonged oliguria active treatment of the acute renal failure following snake bite is indicated.
Viral infections of the liver in childhood
Authors: Zuckerman A J
Published: December 2008

Hepatitis A and hepatitis B viruses and yellow fever virus are the most important causes of acute inflammation of the liver. Hepatitis is also frequently associated with other common viral infections such as cytomegalovirus (human herpesvirus 5) and EB virus (human herpesvirus 4). In addition, there are a number of viruses which occasionally display increased hepatotropism producing a clinical picture which is similar to classical hepatitis.
Genetic aspects of the Pi system
Authors: Cook P J L
Published: December 2008

α1-Antitrypsin can be shown to be polymorphic by starch gel electrophoresis. At present 19 different alleles are known which are inherited in an autosomal pattern and constitute the Pi system. In one phenotype called Pi type ZZ there is a virtual deficiency of plasma α1-antitrypsin and about 230 such babies are expected in England and Wales every year.
Neonatal hepatitis syndrome and alpha-1-antitrypsin deficiency: an epidemiological study in South-East England
Authors: Cottrall K , Cook P J L , Mowat A P
Published: December 2008

A prospective epidemiological study of the Neonatal Hepatitis Syndrome in S.E. England showed Alpha-1-Antitrypsin Deficiency (Pi ZZ) to be present in seven out of fifty-two patients. Data are considered from these seven patients, and from a further six cases from outside this area. The nature of acute illness, pathological changes on early liver biopsy, and short-term prognosis show considerable variability, but in general the hepatitis is more severe in patients with Alpha-1-A.T. deficiency than in those in whom no aetiological factor was found.
Organization of controlled trials in paediatric liver disease
Authors: Gray O P
Published: December 2008

There are very few controlled trials of treatment of liver disease in either adults or children. This is unfortunate because there are considerable uncertainties surrounding the effectiveness of the treatments in use. However, controlled trials present considerable difficulties to investigators in terms of organization and maintenance of enthusiasm. In order to gain the maximum information from trials it is imperative to categorize patients accurately. The planning of the trial requires an infinite attention to detail. The plan should be as simple as is possible to answer the questions. It is important that controlled trials should be restricted to 2 years, duration wherever possible. This allows the investigator’s interest to be maintained. In planning trials, it is important to remember that when the trial is mounted, the recruitment of patients is often considerably less than that which was expected. Because of the inadequacy of knowledge of effectiveness of treatment in liver disease it appears to be unethical to do anything other than controlled trials, henceforth.
Successful resuscitation in diabetic ketoacidosis: a strong case for the use of bicarbonate
Authors: Soler N G , FitzGerald M G , Bennett M A , Malins J M
Published: December 2008

Although severe acidosis is a life-threatening condition owing to its cerebral and cardiac effects, correction of the acidosis with alkali remains a controversial issue in diabetic ketoacidosis. A 22-year-old female patient in diabetic ketoacidosis who was successfully resuscitated after cardiac arrest is presented and a strong case is made for the administration of bicarbonate in severe cases of diabetic ketoacidosis.
Megaloblastic anaemia associated with the oral contraceptive pill
Authors: Meguid Michael M , Loebl Walter Y
Published: December 2008

A 27-year-old housewife suffered from severe headaches for a period of 2 years which developed after she started taking an oral contraceptive pill. During this time she gradually developed folic acid deficiency anaemia. This resulted from the inhibition by ‘the pill’ of the intestinal conjugase system required to deconjugate polyglutamic folate. The patient’s headache did not recur after stopping the pill and her anaemia improved with folic acid supplement. The relation between folic acid metabolism and ‘the pill’ is discussed.
Coma following treatment of very severe arterial hypertension, with improvement after dexamethasone therapy
Authors: Farrow L J , Wood J B
Published: December 2008

We describe two patients with very severe arterial hypertension, who were treated vigorously and effectively with hypotensive drugs. Both promptly developed gross neurological abnormalities, yet recovered fully after treatment with dexamethasone. We have found no similar published reports. We believe that these cases illustrate an important risk of treatment of severe hypertension, and we suggest that cerebral oedema developed, and was then relieved by dexamethasone.
Clostridium welchii and Bacillus cereus infection and intoxication
Authors: Hobbs Betty C
Published: December 2008

Clostridium welchii type A is a common agent of food poisoning when allowed to proliferate to large numbers in cooked foods, usually meat and poultry. The main factors of importance are survival of the spores, frequently found on raw products, through the cooking process, and possible contamination of cooked meats transferred to unclean containers; subsequent germination of spores and rapid multiplication of the vegetative cells during long slow cooling and non-refrigerated storage lead to heavy contamination. The toxin responsible is different from the soluble antigens, and its formation in the intestine is associated with sporulation.

Large numbers of Cl. welchii of the same serological types in food and faeces is the main diagnostic factor. Important preventive measures are rapid cooling and cold storage to prevent growth.

Bacillus cereus is an aerobic sporulating organism commonly found in cereals. Outbreaks described from Europe have a different aetiology with regard to food vehicles, incubation period and symptoms from those that have been reported recently in the U.K. from fried and boiled rice. The spores survive through cooking procedures and grow out to cells which sporulate readily in the cooked food and which are assumed to produce toxin in the food. Large numbers of B. cereus are found in foods causing illness and, as with Cl. welchii, the main preventive measure is inhibition of growth by quick cooling and cold storage of foods cooked ahead of requirements. A comparative table of the characteristics and clinical symptoms of Cl. welchii and B. cereus is given.
Staphylococcal food poisoning and botulism
Authors: Gilbert R J
Published: December 2008

Staphylococcal food poisoning and botulism are caused by the ingestion of food containing exotoxins. Outbreaks of both are still a problem in many countries. This paper attempts to summarize information relating to these illnesses, together with advice on how their incidence may be reduced, or better still prevented.
Bacterial challenges in food
Authors: Collee J G
Published: December 2008

Qualitative and quantitative aspects of bacterial challenges that might be encountered in food are discussed with reference to recognized and relatively unrecognized hazards. Mechanisms of pathogenicity are reviewed and the populations at risk are noted. The bacterial content of food as it is served at table merits more study. The challenge of prevention by education is discussed. Indirect bacterial challenges in our food are considered. The real challenge of diagnosis depends upon an awareness of a complex range of conditions; the importance of effective communication with efficient laboratory and epidemiological services is stressed. There is an increasing need for care in the preparation and distribution of food.
Mites and house dust mite allergy in bronchial asthma in Northern Zambia
Authors: Buchanan D J , Jones I G
Published: December 2008

Of 100 asthmatic patients prick tested for allergy to Dermatophagoides pteronyssinus, 88% were positive compared with only 14% of controls. A significantly greater proportion of dust samples from the houses of the asthmatics contained Dermatophagoides mites. The house-dust mite D. pteronyssinus, constituted 90% of the mites identified, other pyroglyphid mites, Cheyletus and Glycophagus making up most of the remainder. This study confirms that allergy to D. pteronyssinus is an important factor in the aetiology of asthma in Ndola. It is suggested that prevention of asthmatic attacks could be directed towards mite control and hyposensitization.
A study of the pharmacokinetics of clindamycin in normal subjects and patients with chronic renal failure
Authors: Eastwood J B , Gower P E
Published: December 2008

A single dose of 150 mg clindamycin was given to nine patients with terminal renal failure being treated by maintenance haemodialysis and the blood levels were measured. Four of these patients were studied during haemodialysis and five between haemodialyses. Clindamycin (150 mg) was also given orally to four normal subjects.

The mean serum half-life in the normal subjects was 2·15 hr. For the dialysis patients the mean serum half-life off dialysis was 1·58 hr while that on dialysis was 1·85 hr.

There is evidence that clindamycin is excreted normally in chronic renal failure and that blood levels are not affected by haemodialysis. Normal adult doses, 150-300 mg four times a day, can be given safely in patients with chronic renal failure.
Bile peritonitis—a report of fifteen patients
Authors: Ellis Harold , Adair H M
Published: December 2008

Fifteen patients with bile peritonitis are presented. One followed a gunshot wound, six resulted from acute cholecystitis and nine were consequent upon biliary tract surgery. The aetiology, clinical picture and management are reviewed.
Traumatic aortic incompetence following road traffic accident
Authors: Irving J B
Published: December 2008

This case report describes the presentation and treatment of a case of aortic incompetence, resulting from a road traffic accident. The relevant literature is briefly reviewed.

Aortic incompetence due to trauma has been described following non-penetrating chest injuries, such as kicks from horses (Barie, 1881), falls from heights and crushing accidents (Kissane, Koons and Clark, 1948; Levine, Roberts and Morrow, 1962). Despite the frequency of road traffic accidents, there have been no recent reports of traumatic aortic valve damage.
Pericarditis during chronic haemodialysis therapy
Authors: Mitchell A G
Published: December 2008

Pericardial disease in a haemodialysis unit has been reviewed. It is suggested that in addition to the well established uraemic pericarditis there is a pericarditis with a different clinical course occurring in patients on chronic haemodialysis and with an incidence in this series of 18%.
The effect of intravenous Aminoplex 5 on serum gastrin and gastric secretion
Authors: Chatamra K , Pigott H W S , MacNaughton J I , Wastell C
Published: December 2008

Aminoplex 5 (Geistlich Ltd), which contains the essential amino-acids in laevo form plus sorbitol and 5% ethanol, may be infused intravenously for at least one hour in patients who are undergoing prolonged nasogastric suction without fear of great gastric hypersecretion of acid.
Pseudomonasosteomyelitis following puncture wounds
Authors: MacKinnon A E
Published: December 2008

Puncture wounds of the foot are rarely followed by serious complications but in 1968 Johanson reported eleven cases of osteomyelitis, the infecting organism being Pseudomonas aeruginosa in each instance. He described the typical features of these infections which were confirmed by Minnefor, Olsen and Carver (1971) and Hagler (1971).

This paper records a further case of Pseudomonas osteomyelitis and the previously recorded cases are reviewed. Attention is drawn to the importance of surgical as well as antibiotic treatment of these infections.
Atrial fibrillation and hyperthyroidism: a new look at their relationship and therapy with lidoflazine
Authors: Bruyneel K , Verhaegen H , De Vil Ch
Published: December 2008

Various kinds of dysrhythmias are found in association with hyperthyroidism but especially atrial fibrillation. The causal relationship of chronic atrial fibrillation and the endocrine disorder is controversial, as is its therapeutic management. Six patients with this particular combination of disorders were treated with lidoflazine: a new anti-anginal drug with anti-arrhythmic activity. All six patients returned to sinus rhythm on lidoflazine treatment although still hyperthyroid and remained in sinus rhythm during the follow up period ranging from 5 to 14 months. This occurred independently of antithyroid treatment. Some evidence is put forward that dysrhythmias and most commonly chronic atrial fibrillation are triggered off by hyperthyroidism or other disorders but that they are maintained by permanent cardiac damage due to arteriosclerosis, hypertension, coronary heart disease or rheumatic valve disease.

Successful chemical cardioversions and maintenance of sinus rhythm can be obtained independent of the thyroid function. Our results confirm the anti-arrhythmic activity of lidoflazine.
Renal failure and suprarenal calcification after secondary haemorrhagic disease in a newborn baby
Authors: Moncrieff M W , Hargreaves H
Published: December 2008

A newborn baby who was severely asphyxiated at birth developed secondary haemorrhagic disease which was treated successfully with intravenous heparin. However, she was later found to have supra-renal calcification, chronic renal insufficiency and hypertension. It is felt that prompt treatment of conditions that predispose to secondary haemorrhagic disease is very important as, once this has occurred, treatment may not prevent permanent damage to vital organs.
Polymeric IgA myeloma, hyperlipidaemia and xanthomatosis: a further case and review
Authors: Roberts-Thomson P J , Onitiri A C , Venables G S , Lewis B
Published: December 2008

A patient is described who had myeloma of the polymeric IgA variety, together with a striking hyperlipidaemia and xanthomatosis. Investigations into the protein and lipid abnormality failed to demonstrate any mechanism for the hyperlipidaemia. A review of the literature, however, validates this clinical entity and some of the suggested explanations are discussed.
Methoxy-9-ellipticine lactate in refractory acute myeloid leukaemia
Authors: Ansari B M , Thompson E N
Published: December 2008

Two cases of refractory acute myeloid leukaemia were treated with methoxy-9-ellipticine lactate alone and in combination with other chemotherapeutic agents. In the first patient a successful complete second and third remission was achieved lasting 2 and 3 months respectively. However, a partial remission was obtained in the second patient as treatment with methoxy-9-ellipticine was only started in the terminal phase of the illness. In view of the resistance of this form of leukaemia to present chemotherapeutic drugs both initally and at the time of relapse, the response of these two cases to methoxy-9-ellipticine is worth reporting.
Intravenous trimethoprim/sulphadimidine in the treatment of Bacteroides septicaemia
Authors: Hanson Gillian C , Woods R L
Published: December 2008

The name Bacteroides is used to describe a group of Gram-negative bacilli which are non-sporing obligate anaerobes (Wilson and Miles, 1964). Their natural habitat is the large intestine, mouth, and vagina.

Bacteroides septicaemia is becoming increasingly well recognized as a complication of gastrointestinal and gynaecological surgery. Patients with underlying malignancy or prior antibiotic therapy are predisposed to this condition (Bodner, Koenig and Goodman, 1970). In a survey by Okubadejo, Green and Payne (1973), twenty-nine strains of B. fragilis were tested against co-trimoxazole—all were found to be sensitive. One of the disadvantages of co-trimoxazole has been the absence of a parenteral form for use in seriously ill patients in whom oral administration is not practicable. We report the use of intravenous trimethoprim/sulphadimidine in two cases of septicaemia due to Bacteroides infection.
Intramural intestinal haemorrhage: a complication of anticoagulant therapy
Authors: Hale J E
Published: December 2008

The history is presented of a patient on long term anticoagulant therapy who developed signs of intestinal obstruction due to haematoma in the small bowel. The difficulties of diagnosis and management are considered, and relevant publications reviewed.
The association of syphilis with cirrhosis: the role of alcohol and serum hepatitis
Authors: Sadikali F
Published: December 2008

The role of syphilis and alcohol was investigated in a prospective study of patients with cirrhosis of liver in Uganda, and results were correlated with the histological type of cirrhosis, and serological tests for hepatitis B antigen (HB Ag). Eighteen out of eighty (22·5%) patients with histologically-proven cirrhosis had positive serology for syphilis (VDRL and TPI). A high incidence of alcoholism (80%) and syphilis (60%) was found in patients with micronodular cirrhosis who were all negative for HB Ag. By contrast, HB Ag was detected in 37% of patients with macronodular cirrhosis who had a much smaller incidence of syphilis and alcoholism. Although chronic infection with hepatitis B virus related to HB Ag appears to be an important factor in the pathogenesis of cirrhosis in at least 30% of cases, infection acquired during past treatment for syphilis is not an important cause of the association of syphilis with cirrhosis in this population. Subdivision of patients with cirrhosis into those with and those without a history of severe alcohol abuse showed that the difference between the incidence of syphilis in the two groups is significant statistically. However, evidence of syphilis in association with non-alcoholic as well as alcoholic cirrhosis in this and other previously reported series suggests that the association between the two diseases cannot be entirely explained through the common factor of alcoholism, and other factors may also be responsible.
Neonatal listeriosis
Authors: Variend S , Blumenthal I
Published: December 2008

Three cases of neonatal listeriosis are reported. This local incidence in a busy neonatal unit over a 10-year period would agree with other reports that the condition is rare in the United Kingdom. Two cases had septicaemia and one developed septicaemia and meningitis, contrasting with the previous view that the commonest presentation is with meningitis, and could be due to the greater use of blood cultures in babies suspected of having infection. The mode of delivery differed in each case which allowed certain conclusions to be made regarding pathogenesis of the condition. Thus evidence is presented against fetal infection through an ascending route or while passing through an infected birth canal. Maternal bacteraemia with a transplacental spread of infection would seem more likely. The possible use of Gentamicin in the treatment of this condition is discussed and the better prognosis with septicaemia, compared with meningitis, is emphasized.
Review of general surgery 1974
Authors: Ellis Harold
Published: December 2008

Introduction

In this year’s review, the author, once again, has selected those subjects which he has found of personal interest and appeal during the year. Cholecystectomy is one of the commonest major general surgical operations and, therefore, its post-operative complications are extremely important in the hospital community. Acute pancreatitis continues to be a somewhat mysterious condition which remains a clinical, diagnostic, and therapeutic challenge. There is evidence that renal calculi are being seen with ever increasing frequency in the Western World and there is naturally considerable interest in their diagnosis and management. New methods of investigation continue to make the study of deep vein thrombosis and pulmonary embolism an important and exciting topic. Realizing his surgical limitations, the surgeon is anxious to learn about new concepts of prophylaxis, early diagnosis and treatment in malignant disease; a number of interesting papers are discussed in this area. Surgeons are paying increasing attention to the local and systemic factors which are of importance in the healing of their gastro-intestinal anastomoses and much work of interest has been reported in this field. We report new studies in the management of patients with extensive burns and we conclude with one or two eye-catching papers which have been published during the year.
Thioridazine-induced diarrhoea
Authors: Mitchell A B S
Published: December 2008

Treatment for hypertension in a 68-year-old woman led to anxiety and depression which, in their turn, were successfully treated with thioridazine. Subsequent diarrhoea was shown to have been a side effect of this tranquillizer.
Introduction
Authors: Jacobs H S , Thomson Harron
Published: December 2008

Research in reproduction has been expanding at such a tremendous rate over the last decade that it has become a desperate problem even for workers in the field to keep up to date with the literature. In this respect the problem faced by the clinician is immense. It is made worse by the tendency of the modern conference to forgo any educative role and to concentrate on reporting original data. Consequently, such conferences tend to appeal mainly to the ‘super-specialist’. It was for these reasons that the Symposium on Recent Advances in Reproductive Medicine, whose proceedings are reported here, was organized. What follows is an attempt by specialists actively working in the field to summarize their own and the published experience in a way which is of practical help to the clinician, whether he be physician, surgeon or obstetrician.
Hormonal mechanisms in the onset of puberty
Authors: Swerdloff Ronald S , Odell William D
Published: December 2008

Sexual maturation is associated with increasing levels of sex steroids. These steroidal events are the result of complex changes that occur at several functional levels including the hypothalamus, pituitary, gonad and adrenal gland. These changes, as outlined in Table 3, are often interrelated.

While considerable progress has been made in our understanding of the hormonal events associated with sexual maturation, many important questions remain unanswered. Further intensive investigation will be required before we have a lucid understanding of the physiological basis of the sequence of hormonal events which occur during the pubertal process.
Endocrine aspects of anovulation
Authors: Jacobs H S
Published: December 2008

Endocrine features of anovulation are reviewed, with particular emphasis on methods of investigation. The value of, and indications for, measurements of serum gonadotrophin concentrations are discussed: it appears that FSH measurements allow better discrimination than LH measurements in diagnosing patients with primary ovarian failure. The results of stimulation tests with the synthetic form of gonadotrophin-releasing hormone are described and the relationship of tests with exogenous progestogens and clomiphene is discussed.
Monitoring the fetoplacental unit—the fetus
Authors: Klopper Arnold
Published: December 2008

Information concerning the value of steroid assays in monitoring the fetoplacental unit is reviewed. The emphasis is placed on urine and plasma oestriol concentrations, their relationships to one another and to abnormal gestation.
Excavating pulmonary metastases in carcinoma of the cervix
Authors: Kirubakaran M G , Pulimood B M , Ray D
Published: December 2008

A case of excavating pulmonary metastases from carcinoma of the cervix is described. The secondary tumour had appeared nearly 4 years after apparent ‘cure’ of the primary lesion by radiotherapy. The diagnosis is discussed.
Malignant gonadal tumour formation in intersexual states
Authors: Pigott H W S
Published: December 2008

Two cases of malignant tumour are reported in phenotypically male hermaphrodites. The importance of establishing the presence of persistent Müllerian duct structures in pseudo-hermaphrodites is discussed in relation to prophylactic castration in anticipation of malignant change.
Introduction
Authors: Oakley  , Somerville Walter
Published: December 2008

The first session demonstrated how little useful information has been obtained from cardiac biopsy, open or otherwise, when the conventional techniques are used. We discussed whether cardiac biopsy is useful in diagnosis. At the moment it is useful only when there is an exceptional cause such as amyloid. In the majority of cases, a biopsy which is subjected to light microscopy, ultrastructural studies, histochemistry and so on, will show only non-specific changes. In HOCM the changes are more specific and it seems to be a homogeneous entity. So let us concentrate on congestive cardiomyopathy, which is probably an aetiologically heterogeneous condition in which alcohol, viruses or immunological events following some still unknown antigenic stimulus may all play a part in different patients. When the International Society of Cardiology Council on Cardiomyopathies met a year ago in Singapore, we proposed that an onslaught on cardiac biopsy should be launched, not for diagnosis, but to find out more about causal mechanisms. We suggested that the council might co-ordinate research so that centres could offer their local expertise and pool their resources for most rapid advancement of knowledge. We are fortunate at the Royal Postgraduate Medical School in having Tim Peters to split up cells and look at the biochemistry of the subcellular fractions, the enzyme markers of the different organelles. Maybe that is our main line of progress here, while in New Orleans George Burch has virological know-how. New ways of looking at the biopsy material will emerge, but no one will have the technology to do everything in one place. We would like to suggest a centrally co-ordinated scheme to speed up progress.
The significance of Escherichia coli in the upper respiratory tract of children under 2 years of age
Authors: Barrie John D , Gallacher James B
Published: December 2008

Colonization of the upper respiratory tract of neonates by Gram-negative bacilli (especially Escherichia coli) is not rare, and the incidence declines after 1 year of age. It is believed that the likelihood of colonization increases with the length of stay in hospital at the time of birth, and that such colonization does not reflect any pathological process. Evidence has not been found to support the view that the use of antibiotics is the reason for colonization in neonates (the situation in adults or children over 2 years of age is not considered here). The authors believe that the birth canal is not an important source of Gram-negative bacillary flora but that perineal contact at birth and maternal handling after birth more probably are, especially in the hospital environment where Gram-positive organisms have been suppressed by hexachlorophane.

With the limited range of E. coli typing sera available, a relatively high proportion of non-typeable strains was found. Among those which did type, the incidence of various strains corresponded fairly closely to those which are known to occur in the normal bowel and to cause urinary infections. No evidence for type-specific respiratory pathogenic strains was found.
Cytomegalovirus mononucleosis with urticaria
Authors: Humphreys Daphne M , Myers Allan
Published: December 2008

A case of cytomegalovirus mononucleosis presenting with urticaria is described and so far as the authors know it is the first record of such an occurrence.
Autoimmune haemolytic anaemia and ulcerative colitis
Authors: Gorst D W , Leyland M J , Delamore I W
Published: December 2008

Two cases of ulcerative colitis are described in which there was associated severe auto-immune haemolytic anaemia. The colitis in both patients responded to conventional therapy and one patient underwent splenectomy for her anaemia. Possible aetiological links are discussed.
Gastric carcinoma and Turner’s syndrome
Authors: Siegler D
Published: December 2008

The case is described of a gastric carcinoma developing in a 34-year-old female with Turner’s syndrome. The association has not been previously reported. The literature on the appearance of malignant disease in disorders of the sex chromosomes is reviewed.
Periodic migrainous neuralgia associated with an arteriovenous malformation
Authors: Thomas A L
Published: December 2008

A patient with periodic migrainous neuralgia is reported. An arteriovenous malformation was found on the affected side. This association has not previously been recorded.
Introduction
Authors: Wilkinson S P , Williams Roger
Published: December 2008

Abnormalities of renal function and electrolyte metabolism are almost invariable in advanced liver disease. These may play an important part of the clinical illness and, in one series, renal failure was considered to be the direct cause of death in 11 % of cirrhotic patients. Abnormal plasma electrolyte concentrations may develop independent of renal failure and both hyponatraemia and hypokalaemia may contribute towards encephalopathy. Central to the problem of how ascites develops in cirrhosis is the renal retention of sodium, and increasing evidence suggests that this may be the initiating factor in fluid retention, rather than the consequence of a loss of ‘effective’ extracellular fluid to the peritoneal compartment. Although the treatment of ascites by dietary sodium restriction and diuretics is often successful, the effects of the diuretics may introduce further electrolyte disorders. The recent commercial development by Rhône-Poulenc of a dialysis apparatus for the treatment of ascites in which ascitic fluid is concentrated two to threefold and the concentrate reinfused intravenously has aroused considerable interest. Large quantities of sodium and water can be removed from the patient without loss of the protein contained in the ascites. It was with the aim of establishing the place of this technique within the overall management of ascites that this Symposium was planned, and we are grateful to May & Baker Ltd who market the apparatus in this country and Rhône-Poulenc Ltd who made it possible and who both generously sponsored the meeting. Investigators throughout Europe were invited to present and discuss their experience. Opportunity was also taken to include sessions on the related problems of renal failure and electrolyte metabolism in liver disease.
Consequences of acute renal failure relevant to hepatic failure
Authors: Weston M J , Wilkinson S P
Published: December 2008

The onset of renal failure in patients with liver failure complicates an already deranged metabolic picture and may increase the retention of many potentially toxic substances. The risk to the patient of haemorrhage and infection is aggravated. Dialysis may correct the features of uraemia and, in acute liver failure at least, provide time for kidney as well as liver regeneration.
Functional renal failure (FRF) in cirrhosis of the liver and liver carcinoma
Authors: Vesin P , Traverso H
Published: December 2008

The term ‘functional renal failure’ has been used to describe the renal failure developing in advanced cirrhosis in which tubular function and structure remain intact. It may develop spontaneously, in which case prognosis is poor, but may be secondary to gastro-intestinal haemorrhage or excessive use of diuretics, in which case correction of the precipitating factor leads to improvement in renal function. It is suggested that the renal failure is due to a reduction in effective circulating plasma volume.
The role of renin in renal failure associated with hepatic failure
Authors: Smith I K
Published: December 2008

A review of the literature has shown that the role of renin in renal failure is not resolved. It has been invoked as an aggravating factor: decreased renal perfusion releasing large quantities of renin sufficient to cause further renal vasoconstriction. If so, then angiotensin generation and action must occur entirely intrarenally since the vasoconstriction appears to be confined entirely to this vascular bed. It may prove necessary to evaluate the renin-angiotensin system within the kidney rather than peripherally. Elevated renin levels in peripheral plasma are at least as likely to be a consequence of reduced renal perfusion as a cause of it.

The few studies so far undertaken of the renin-angiotensin system in renal failure associated with liver disease are inconclusive. If further studies should ascribe a role to renin in the pathology of renal failure, then it may be possible to treat the condition by pharmacological manipulation of the renin-angiotensin system and thereby prevent some of the more serious consequences of renal failure.
Use of dialysis in the treatment of renal failure in liver disease
Authors: Parsons Victor , Wilkinson S P , Weston M J
Published: December 2008

Early and thorough peritoneal and haemodialysis has a part to play in the management of selected patients with hepato-renal failure. Patients with advanced irreversible hepatic damage due to cirrhosis, however, may have their prognosis shortened by dialysis, but there are many problems in these techniques in patients with multiple organ failure which still require investigation and solution.
Potassium metabolism and diuretics administration in liver cirrhosis
Authors: Vesin P
Published: December 2008

The author first reviews, on the basis of personal and literature data, the main changes in three major parameters of potassium metabolism: serum potassium; daily urinary output of potassium; exchangeable potassium (Ke) at the three stages of the course of liver cirrhosis. The action of K-sparing diuretics (spironolactone, triamterene, amiloride) on these parameters is analysed. Although the introduction of these diuretics in our therapeutic armamentarium has resulted in a major advance, i.e. the quasi-total elimination of iatrogenic hypokalaemia and hypokalaemia-induced portacaval encephalopathy in the cirrhotic, the limits of their action on K metabolism are underlined: they may moderately enhance urinary K output; following cessation of their administration, a ‘rebound’ in urinary K output may be noted. Finally, Ke may still continue to decrease during their administration, indicating an aggravation of the underlying disease. It was also found that a rise in serum K and/or Ke during amiloride administration did not prevent the elevation of plasma renin activity usually induced by volume and/or Na depletion.
Discussion
Authors: de Wardener H E
Published: December 2008

Dr N. Jones (London): Two questions. Firstly, do you have any immunofluorescence studies on your renal biopsies? Secondly, I am sure you are aware that when talking about incomplete RTA it is necessary to pay attention to total hydrogen ion excretion—did you measure this?
Clinical experience with the Rhône-Poulenc ascites reinfusion apparatus
Authors: Arroyo V , Mas A , Vilardell F
Published: December 2008

Ascites reinfusion is not free from complications. The Rhône-Poulenc ascites reinfusion apparatus could be of value in those patients with cirrhosis and ascites who cannot be managed by diuretic therapy.
Experiences and problems in the management of ascites with the Rhodiascit machine
Authors: Thaler H , Fous G
Published: December 2008

The ascites reinfusion technique is an excellent therapeutic aid to patients with cirrhosis who are otherwise in good general condition.

The loss of weight often exceeds the amount of filtrate considerably.

The ratio between filtrate and concentrate may be increased by applying a filtration pressure of between 140 and 180 mmHg. This modification could result in shortening the procedure, if the machine were fitted with wider tubes and a more efficient pump.

The treatment in three of our cases was unsuccessful.
The role of luteinizing hormone-releasing hormone in the diagnosis of constitutional delayed puberty
Authors: Sagel Julius , Distiller Larry A , Joffe Barry I
Published: December 2008

The presumptive diagnosis of constitutional delayed adolescence is difficult to substantiate. Clinical examination and routine biochemical testing are not sufficient to exclude isolated gonadotrophin deficiency. Seven males are reported who presented with delayed puberty. These patients were given 100 μg luteinizing hormone-releasing hormone (LH-RH) intravenously, and the luteinizing hormone (LH) and follicle stimulating hormone (FSH) responses were measured.

Three of four males who were completely prepubertal (Stage 1) had a normal adult male response. These three patients have progressed further into puberty several months after this diagnostic test. The fourth patient in stage 1 puberty had a prepubertal LH response. A year later the response became adult in type, and 3 months thereafter stage 2 puberty was evident.

The LH response to LH-RH thus appears to have some prognostic value in the assessment of males presenting with delayed puberty.
A double-blind trial of salmefamol, a new bronchodilator
Authors: Bainbridge D , Hoare Margaret V , McHardy G J R , Dash C H
Published: December 2008

Salmefamol is a new sympathomimetic drug with predominantly β2 actions. In a double-blind trial in a group of twenty-four patients with airway obstruction, we have compared the effect of 100 μg of salmefamol given by metered aerosol with that of a placebo aerosol. In the same patients we have also compared the aerosols with subcutaneous adrenaline and subcutaneous atropine, the sequence of treatments being determined by a latin square design.

At all times salmefamol had a significantly greater bronchodilator effect than the placebo. Although the effects of atropine and adrenaline were greater at the earlier times of measurement, that of salmefamol was greater at 4 hr.
Computer-aided analyses in diagnostic histopathology
Authors: Kramer Ivor R H
Published: December 2008

Almost every branch of pathology has derived benefit from greater objectivity and greater quantitation. However, diagnostic histopathology remains obstinately subjective and non-quantitative. Although a well developed art, it is heavily dependent on experience acquired over a long period of time. Even so, experienced pathologists will sometimes reach confident but differing diagnoses on the same set of sections.
The role of histochemistry in increasing objectivity in histopathology
Authors: Pearse A G E
Published: December 2008

The techniques of microscopic histochemistry, successfully applied to problems in histopathology, necessarily result in increased objectivity.

Combined with procedures for quantification the increase may be such as to remove subjective judgment altogether.

Extended to the ultrastructural level the quality of the information derived is greatly enhanced in terms of localization but there is usually no increase in objectivity.

Of all branches of technology capable of conferring on histopathology an increase in objectivity, histochemistry must take first place.
The phonocardiogram in a partially detached mitral (Starr-Edwards) prosthesis
Authors: Raj M V Jeeva , Clarke C R A , Fleming H A
Published: December 2008

Phonocardiographic evidence of extreme variability of the time interval between the aortic sound (A2) and the opening click (OC) with intermittent absence of the OC of a partially detached mitral prosthesis of the Starr-Edwards type has not hitherto been reported. This case illustrates the diagnostic use of phonocardiography in a malfunctioning mitral Starr-Edwards prosthesis.
Ketotic hypoglycaemia of childhood
Authors: Pierides A M , Anderson J , Stansfeld J M
Published: December 2008

A patient with recurrent convulsions in childhood and associated ketotic hypoglycaemia is described. Hypoglycaemic attacks started at the age of 3 years and 4 months and continued until 9. At present (aged 15) the patient is mentally retarded, has epilepsy, high tone deafness and a major behaviour disturbance. Prednisone therapy failed to prevent hypoglycaemic convulsions and eventually irreversible brain damage. Intramuscular glucagon and adrenaline were ineffective in raising the blood glucose during acute hypoglycaemic attacks.

Investigations at 3 years and 7 months and at 14 years showed a persistent and markedly abnormal sensitivity to a small dose of exogenous insulin with severe hypoglycaemia with convulsions, absence of clinical hyperadrenalism during hypoglycaemia, and a metabolic block in gluconeogenesis. The demonstration of a persistent biochemical abnormality of glucose metabolism at the age of 14 strongly suggests that ketotic hypoglycaemia of childhood is not another aspect of nutritional deprivation, as recently suggested (Buist, 1974), but the result of a defect in glucose homeostasis.
Correspondence
Authors: Engelhardt A
Published: December 2008

Sir—Because of an error on the part of the organizers, I was not informed about the presentation of my data at the Clotrimazole symposium and did not see the manuscript of the paper that appeared under my name (Postgraduate Medical Journal (1974), 50 (Suppl. 1), 61).
The current lead pollution problem
Authors: Barry P S I
Published: December 2008

In the past few years, pollution of the environment by lead has received considerable attention and evoked a variety of responses the more extreme of which have been readily accepted for publication in the National Press.