bluuebunny/crossref_metadata_2025 huggingface dataset:
Coagulation problems in human pregnancy
Authors: Redman C W
Published: December 2008

Coagulation problems in pregnancy are primarily associated with overactivity of the intrinsic clotting system. This accounts for the increased incidence of thrombo-embolism during pregnancy. Where specific obstetric complications cause clotting problems the common underlying feature is usually placental pathology as in abruptio placentae, pre-eclampsia or hydatidiform mole.

Abnormal activation of the clotting system is an early, and occasionally the first detectable feature of pre-eclampsia, but there is no evidence that this is a primary change. Therefore the role of anticoagulant treatment in the management of pre-eclampsia remains questionable. A new test for estimating factor VIII consumption is proving to be a sensitive index of early activation of the clotting system and can be used for the diagnosis of early pre-eclampsia.
Exercise and hormonal secretion
Authors: Gawel M J , Park D M , Alaghband-Zadeh J , Rose F C
Published: December 2008

The effect of graded exercise on the secretion of cortisol, testosterone, prolactin, growth hormone, thyroid stimulating hormone (TSH), luteinizing hormone and follicle stimulating hormone (FSH) is reported. While cortisol, prolactin, growth hormone and testosterone rise during the period of exercise, a rise in luteinizing hormone becomes evident only after rest. Levels of FSH and TSH remained unchanged.
Cholelithiasis and biliary tract disease in sickle-cell disease in Nigerians
Authors: Akinyanju O , Ladapo F
Published: December 2008

The incidence of biliary tract disease was investigated by oral cholecystography and/or intravenous cholangiography in 77 unselected Nigerians with homozygous sickle-cell disease (SCD). They included 32 males and 45 females with ages ranging from 8 to 31 years. The prevalence of cholelithiasis was 9% with equal sex incidence. The stones were always multiple and 71.4% of them were radio opaque. Visualization and contractility of all gall bladders examined were normal. The only patient with symptoms and signs which suggested biliary tract disease had no radiographic evidence of cholelithiasis and it was impossible to predict the presence of cholelithiasis from the incidence of abdominal crises in the patients.

The prevalence of cholelithiasis is significantly less than that reported in American patients with SCD (35%) and different dietary habits are probably responsible for this.
Fulminating hyperlipidaemia
Authors: Bateson M C
Published: December 2008

A case is described of severe recurrent ischaemic heart disease associated with rapidly increasing and ultimately massive hyperlipidaemia.

The case is discussed, with suggestions for management of similar problems.
Bilateral sixth cranial nerve palsy in infectious mononucleosis
Authors: Neuberger J , Bone I
Published: December 2008

A 15-year-old girl who presented with a bilateral sixth nerve palsy caused by infectious mononucleosis is described. The neurological presentation of infectious mononucleosis is discussed.
Introductory address: lessons to be learned from high altitude
Authors: Houston C S
Published: December 2008

A historical account of the important landmarks in man's experience with the high altitude environment is followed by comments on the important stages in the understanding of its physiological effects. The work of The Mount Logan High Altitude Physiology Study on acute mountain sickness is reviewed from its inception in 1967 until the present.
Acid-base changes associated with respiratory acclimatization to altitude
Authors: Milledge J S
Published: December 2008

The respiratory changes associated with chronic hypoxia are described. The possible biochemical mechanisms which are responsible for the changes in control of ventilation are discussed and relevant experimental evidence assessed.
Birmingham Medical Research Expeditionary Society 1977 Expedition: the diuresis and related changes during a trek to high altitude
Authors: Howell A , Cove D H
Published: December 2008

Continuous 24-hr urine collections were made by 17 subjects during a trek to 5400 m. Fluid intake was recorded by diary. Weight and fat folds were measured daily. The results were compared with daily measurements of packed cell volume (PCV) and reticulocyte count. Early fluid retention was matched by a fall in PCV. There was a diuresis with negative fluid balance towards the end of the ascent and again early in descent. There was a slight trend for fluid retention to occur in those most affected by acute mountain sickness but the effect was not marked.
Exercise and altitude
Authors: Williams E S
Published: December 2008

In studies concerned with the performance at high altitude it is often not possible to separate the effects which are due to hypoxia from those associated with the stress of ascent. Some of the basic observations concerning exercise at high altitude are reviewed and a study is described which was designed to simulate the physical exertion of high altitude mountaineering but performed at altitudes below 1000 m. Some of the changes observed including peripheral oedema might under other circumstances have been ascribed to altitude.
The morbid anatomy of high altitude
Authors: Heath Donald
Published: December 2008

The morbid anatomical changes which take place in man and animals exposed to the chronic hypoxia of residence at high altitude are briefly reviewed.
Terminal care: evaluation of in-patient service at St Christopher's Hospice. Part II. Self assessments of effects of the service on surviving spouses
Authors: Parkes C M
Published: December 2008

Self-assessments of 34 spouses of patients who had died from cancer at St Christopher's Hospice were compared with self-assessments of a matched group of spouses of patients who had died in other hospitals in the vicinity.

The spouses of St Christopher's patients differed significantly from the comparison group in spending more time at the hospital, talking to more members of staff, other patients and visitors, reporting less anxiety and psychosomatic accompaniments of anxiety before (but not after) the patient's death and being less worried about pain, others hurting or harming the patient or about revealing their own fears to the patient.

The institutional ideals of the Hospice were characterized as: 'The hospital is like a family', ‘Nothing is too much trouble’ and ‘Don't worry’.
Prevention of amino acid losses during peritoneal dialysis
Authors: Jackson M A , Talbot S , Thomas D W , Lee H A
Published: December 2008

The addition of amino acid supplements to peritoneal dialysis fluid has been studied in 8 patients with compromised renal function requiring peritoneal dialysis. By the addition of 10 ml of Vamin-glucose solution to each one litre of peritoneal dialysate, amino acid losses were curtailed, no significant alterations occurred in the plasma amino acid concentrations, there were no local complications and no infections were seen. This procedure is recommended as a safe, simple way of keeping a patient in positive amino acid balance during peritoneal dialysis.
Pre-operative intravenous feeding—a controlled trial
Authors: Heatley R V , Williams R H P , Lewis M H
Published: December 2008

Seventy-four patients with a pre-operative diagnosis of stomach or oesophageal cancer were entered into a randomized, controlled clinical trial to assess the value of a short course of pre-operative intravenous nutrition. The effectiveness of this treatment was assessed by the clinical course and monitored by means of immune and biochemical profiles.

Pre-operative parenteral nutrition given over a 7–10-day period resulted in a significant reduction in the incidence of postoperative wound infections. Clinical benefit was confined to those patients who had a low serum albumin on admission to hospital. It is doubtful whether this limited benefit justifies the routine use of intravenous feeding, with its attendant hazards, in the pre-operative preparation of patients with upper gastrointestinal cancer.
Chromophobe adenoma of the pituitary with Cushing's syndrome and skin pigmentation
Authors: Sterling N , Hall M R P
Published: December 2008

A 76-year-old man with pigmentation and Cushing's disease is described, who was found to have a large chromophobe adenoma of the pituitary. Despite normal skull X-rays the presence of bitemporal hemianopia led to the diagnosis which was later confirmed at post-mortem. Adrenalectomy performed in the treatment of Cushing's disease may be followed by skin pigmentation and an enlarging pituitary tumour (Nelson's syndrome), changes which are commonly attributed to the removal of the negative feed-back mechanism. The spontaneous occurrence of these changes in this patient who did not undergo adrenalectomy supports the view that a pituitary tumour pre-exists in cases of Nelson's syndrome and emphasizes the importance of directing initial treatment to the pituitary.
Adverse reaction to disopyramide
Authors: Dibble J B , Webster N R
Published: December 2008

A case is reported where the use of i.v. disopyramide for a supraventricular tachycardia resulted in a more serious ventricular dysrhythmia giving hypotension and this probably contributed to the development of a myocardial infarction. Attention is drawn to the possible risk.
Antifungal therapy, 1978
Authors: Baum G L
Published: December 2008

The past 40 years have brought great advances in the knowledge of morphology, immunology and epidemiology of fungal infections in man. Each general advance in the science of medicine has had its counterpart in man's improved facility to deal with these infections therapeutically. Although satisfactory control of fungal infections of man is still lacking, productive paths of investigation seem to have been found and the continued application of rigorous discipline to research efforts should provide even more efficient treatment in the future.
Imported mycoses: some diagnostic problems
Authors: Symmers W St C
Published: December 2008

Infections by actinomycetes or by true fungi may cause diagnostic difficulties in countries where they are not familiar. Illustrative cases from a series of 353 instances are given together with rare indigenous examples of the same infections. Early, accurate diagnosis is essential for rational and effective treatment.
Chronic mucocutaneous candidiasis
Authors: Rosman N
Published: December 2008

The pathogenesis of chronic mucocutaneous candidiasis is surveyed. Treatment comprises topical antifungal treatment which is insufficient, systemic antifungal treatment which is often followed by a rapid relapse, and specific immunotherapy with live tissue or transfer factor. Combination of systemic antifungal therapy and immunotherapy seems to be the most promising approach. However, no permanent cure has so far been achieved.
Aspergillus sinusitis
Authors: Grigoriu D , Bambule J , Delacretaz J
Published: December 2008

Since 1969, 79 cases of fungal maxillary sinusitis have been diagnosed. Forty-nine were due to Aspergillus fumigatus. There were no underlying diseases which depressed cellular immunity and no patient was receiving immunosuppressive drugs or corticosteroids. Most patients had received antibacterial therapy before the appearance of FMS. Treatment was by surgery, nystatin and econazole.
The role of chemotherapy in the management of fungal endocaridits following homograft valve replacement
Authors: Wain W , Ahmed M , Thompson R , Yacoub M
Published: December 2008

Initial intensive combined chemotherapy, with late re-operation when indicated, appears to give better results than immediate excision of the infected valve. The combination chemotherapy used in this series was amphotericin B (up to 100 mg/patient/day) and flucytosine (up to 12 g/patient/day). Serious side effects attributed to this chemotherapy were extremely rare. Candida infections were the most common and the Aspergillus infections were uniformly fatal. Embolectomies and excisions of large mycotic aneurysms were generally successful. Re-operation for late valve malfunction was common and yielded satisfactory results.
The effect of flucytosine on the germination of Candida albicans
Authors: Wain W H , Polak A
Published: December 2008

The effect of flucytosine on the germination of 3 strains of Candida albicans in serum was tested. No inhibition of germination was observed and it was concluded that germination did not require the synthesis of DNA.
Problems in the laboratory assessment of antifungal activity
Authors: Odds F C
Published: December 2008

The end points of tube dilution tests for minimal inhibitory concentrations of miconazole and flucytosine against Candida albicans were difficult to evaluate because partial inhibition was noted over a wide range of antifungal concentrations. This problem was not encountered with amphotericin B. Partial inhibition of Candida arose because of reductions in yeast growth rate and of cell yield. Different sizes of yeast inocula were differentially inhibited by the same concentration of antifungal agent.

An in vitro apparatus was described in which miconazole formulated as commercial creams, pessaries and medicated tampons for intravaginal application could be assessed for its inhibitory action in vitro.
Acute spinal epidural abscess. Observations from fourteen cases
Authors: Phillips G E , Jefferson A
Published: December 2008

Fourteen cases of acute spinal epidural abscess are analysed. Postoperatively 6 recovered completely, 4 patients recovered enough to allow unaided walking, 2 died and 2 who were paraplegic pre-operatively remained so.

The purpose of this paper is to remind readers of the existence of this condition and to plead for early diagnosis and prompt surgical treatment.
Prolonged survival with adrenal cortical carcinoma
Authors: Shaw K M , Fisher C , Peters J L , Ross E J
Published: December 2008

Recurrence of adrenal cortical carcinoma 22 years after first presentation is reported in a 54-year-old woman with Cushing's syndrome. This tumour is normally associated with poor prognosis and prolonged survival is rare. Although the patient had remained well with apparent ‘cure’ in the intervening years, it is suggested that hormonal changes related to the menopause and the development of primary hypoadrenalism stimulated recurrence of malignant activity and return of Cushingoid features.
The electrocardiographic diagnosis of apical infarction
Authors: Talbot Stephen , Kilpatrick David , Weeks Barbara
Published: December 2008

Dyskinetic areas of the left ventriculograms of 151 patients were related to electrocardiographic signs of infarction. Apical dyskinesia alone or in combination with anterior or inferior dyskinesia could be associated with inferior and/or anterior infarction patterns. Appreciation of this fact prevents over-estimation of the severity of coronary artery disease from a resting electrocardiogram, showing both ‘anterior and inferior infarction’.
Aetiological factors in infection following open retrograde intramedullary nailing of the femur
Authors: Eid Abulfotooh M
Published: December 2008

Thirty-three patients with chronic osteomyelitis of the femur following open retrograde Küntscher intramedullary nailing of the femur were studied to determine possible reasons for the development of infection. In 32 patients the indication for the operation was a closed fracture of the shaft of the femur (recent or malunited) and in one it was to shorten the femur. In 6 patients (18·2%) there was evidence of skin, urinary and upper respiratory tract infection. In 14 patients (42·4%) it was felt that potential infection was present in poor skin overlying the fracture and unhealed laparotomy wounds. Four patients were under the age of 15 years. The operating theatres lacked facilities for room-air exchange, for provision of filtered air or for modern body-exhaust systems. Twenty-two (66·7%) operations were performed by surgeons under training.
Focal fits during chlorambucil therapy
Authors: Naysmith A , Robson R H
Published: December 2008

An elderly man receiving chlorambucil for chronic lymphatic leukaemia developed focal fits. The onset and frequency were dose related. There was no evidence of metabolic disturbance or of meningeal leukaemia. Although reported in children and well recognized in animals, chlorambucil-induced fits in an adult have not been previously recorded.
Ruptured middle colic artery aneurysm
Authors: Whitehead Stephen
Published: December 2008

A case of rupture of an aneurysm of the middle colic artery treated successfully by colectomy is described. The diagnosis and management of mesenteric artery branch aneurysm are discussed.
Choreo-athetosis with severe thyrotoxicosis
Authors: Marks Peter , Anderson John , Vincent Richard
Published: December 2008

Two cases of severe thyrotoxicosis are described. They both exhibited choreo-athetoid movements which were abolished by successful treatment of the thyrotoxicosis. It is suggested that the tremor of mild thyrotoxicosis is one end of a spectrum at which choreo-athetosis is at the most severe end. A tentative explanation of this hypothesis is given in the discussion.
Extensive alimentary and genital ulceration, mesenteric cysts, malabsorption, T-lymphocyte depletion and subsequent anaplastic bladder carcinoma
Authors: Bateson M C , Beck J S , Clark J , Baxby K , Bouchier Ian A D
Published: December 2008

The occurrence of several unusual disorders in a single patient prompted the question as to whether these may all have been part of a single syndrome, and the possible differential diagnosis is discussed in detail.

The case was thought to be an instance of acquired T-lymphocyte depletion leading to the development of premature malignant disease.
Testicular feminization syndrome: a report of three Ethiopian patients and a brief review
Authors: Tsega E , Damtew B
Published: December 2008

The clinical features of 3 Ethiopian patients presenting with the complete syndrome of testicular feminization are described. All 3 were seen because of primary amenorrhoea. At laparotomy, one patient had testes located intra-abdominally, a second lodged in the inguinal canals and a third as masses in the labia majora. Also, one of these patients had bilateral inguinal herniae, a usual feature of this syndrome. Since the incidence of malignancy is high among individuals with undescended testes, they were removed in 2 patients. In the third patient, however, the testes were not removed because of delay in development of secondary sex characteristics. The literature on testicular feminization is also briefly reviewed.
Low salt diet and frusemide in the treatment of hypertension
Authors: George C R P , Burke A M
Published: December 2008

The BPs of 86 of 100 severely hypertensive patients were controlled by measures designed to reduce total body sodium, namely a low salt diet plus the addition of incrementally increased frusemide treatment if diet alone was inadequate. Control of hypertension was maintained over prolonged periods of time in 70 of the patients. Among the 14 who failed to respond adequately, mean plasma renin level was higher (when tested) than in those who did respond adequately, and renal artery stenosis was discovered in 2. Supplementary propranolol controlled the hypertension in 8 of the inadequate responders.
Galactorrhoea following surgical procedures to the chest wall: the role of prolactin
Authors: MacFarlane I A , Rosin M D
Published: December 2008

Normal prolactin levels were found in two cases of galactorrhoea following surgical procedures to the chest wall and one was treated successfully with bromocriptine. Studies were then carried out to test the claim that chest-wall injury is one of the common causes of hyperprolactinaemia. Serum prolactin levels were measured before and after thoracotomy in 7 patients, following traumatic rib fractures in 8 patients and after burns to the chest in one patient. No evidence was found to suggest that sustained hyperprolactinaemia follows chest wall surgery or injury, and the role of prolactin in the condition ‘chest wall injury’ galactorrhoea is discussed.
Haemorrhoids--objective measurement of proctoscopic appearances
Authors: Mosley J G , Galland R B , Saunders J H , Spencer J
Published: December 2008

The proctoscopic diagnosis of haemorrhoids may be influenced by the surgeon’s knowledge of the presence or absence of associated symptoms. In this study, an observer with no knowledge of the history, was used to check the surgeon’s proctoscopic findings in 12 asymptomatic controls, and 24 symptomatic patients on 2 occasions, the latter group undergoing McGivney rubber band ligation.

There was very good correlation between the findings of the surgeon and the observer, indicating a lack of ‘historical bias’. The documentation method designed to allow this comparison proved sufficiently accurate and reproducible to enable a correlation between haemorrhoidal mass and symptoms. Relief of symptoms after treatment correlated well with an objective reduction in haemorrhoidal mass.
Hypercalcaemia in malignant lymphoma
Authors: Greaves M , Hancock B W
Published: December 2008

Three patients with malignant lymphoma complicated by hypercalaemia without radiological bone abnormality are described. The medical literature has been reviewed and the possible underlying mechansims discussed. The early diagnosis of this potentially fatal complication is important since this may respond (together with the underlying disease) to appropriate chemotherapy.
Recurrent insulin resistance
Authors: Leatherdale B A , Ingram D A , Dixon K
Published: December 2008

The patient described developed 2 separate episodes of insulin resistance and on each occassion daily administration of soluble insulin in a daily dose of 980 units failed to achieve satisfactory control. Both episodes responded to steroid therapy. The maximum binding capacity of the serum for insulin was measured on each occasion; in the first episode it was grossly elevated whereas the second time the level was unremarkable. She is currently free of diabetic complications and satisfactorily controlled on a sulphonylurea and diet.
Primary hyperparathyroidism in a patient with Conn’s syndrome
Authors: Fertig A , Webley M , Lynn J A
Published: December 2008

A 61-year-old patient with treated Conn’s syndrome due to multiple bilateral adrenocortical adenomata developed primary hyperparathyroidism. At operation, a parathyroid adenoma and a thyroid colloid nodule were found. Although adrenocortical adenomata and hyperplasia are common findings in multiple endocrine adenopathy type I, they are only rarely functional. Hypertension is often associated with primary hyperparathyroidism, but the relationship is usually unexplained.
Recurrent oculomotor palsy due to haemorrhage in pituitary adenoma
Authors: Mohanty S
Published: December 2008

Haemorrhage in pituitary adenoma is an unusual cause of recurrent oculomotor palsy. Three episodes of right oculomotor palsy are reported from a patient having haemorrhage in pituitary adenoma. Early operation and decompression of haemorrhagic pituitary adenoma should be performed so that vision may be preserved and recovery of oculomotor palsy be assured.
Clostridium difficile isolated from the stool of a patient with pseudomembranous colits following ampicillin plus flucloxacillin (Magnapen) therapy
Authors: Morgan R J , Gemmell C G , Lee F D , Lang W , Russell R I
Published: December 2008

A case is reported of the isolation of Clostridium difficile from the stool of a patient with antibiotic-related pseudomembranous colitis.
Abdominal aortic aneurysm--the forgotten diagnosis?
Authors: Contini S , McMaster P
Published: December 2008

A review of all cases of abdominal aortic aneurysm presenting to Addenbrooke’s Hospital, Cambridge, in a 4-year period revealed that there were 118 such patients and confirmed the relatively low operative mortality for elective aneurysmal surgery (6.6%) compared with the high mortality (66.6%) for ruptured or leaking abdominal aneurysm. In only 50% of the cases was the correct diagnosis made during the lifetime of the patient; nor was the correct diagnosis always made after admission to hospital.

The need for an early and accurate diagnosis of abdominal aneurysms is stressed and an increased awareness of this condition, based on well established clinical features, would undoubtedly reduce the overall mortality.
Pseudohypertrophy of muscles of thenar eminence in X-linked muscular dystrophy (Becker type)
Authors: Boddie H G , Wade J
Published: December 2008

A case of benign X-linked muscular dystrophy is described in which the distribution of pseudohypertrophy is unusual.
A common source outbreak of Acinetobacter pulmonary infections traced to Wright respirometers
Authors: Cunha B A , Klimek J J , Gracewski J , McLaughlin J C , Quintiliani R
Published: December 2008

Over a 30-day period, Acinetobacter calcoaceticus var. antiratus was the responsible pathogen for hospital-acquired pneumonia in 10 patients, and resulted in the colonization of the upper respiratory tract in an additional 9 patients. Wright respirometers contaminated by this organism were shown to be the common source for the outbreak as indicated by the recovery of a single serotype (8J), the inability to recover Acinetobacter from any other environmental source, and the demonstration that moisturized Wright respirometers are capable of "aerosolizing" fluids containing Acinetobacter.
Fatal dependence on kaolin and morphine mixture
Authors: Barragry J M , Morris D V
Published: December 2008

A patient is described who had a long history of abuse of kaolin and morphine mixture which ultimately proved fatal.
Prolonged dystonic reaction to chlorpromazine in myxoedema coma
Authors: Wood G M , Waters A K
Published: December 2008

A case of myxoedema coma is reported where the administration of chlorpromazine resulted in a prolonged dystonic reaction. A similar challenge with a butyrophenone when the patient was on thyroxine caused a similar but much abbreviated response.
Alveolar hydatid disease of the liver with Budd-Chiari syndrome
Authors: Khuroo M S , Datta D V , Khoshy A , Mitra S K , Chhuttani P N
Published: December 2008

Alveolar hydatid disease in man is the intermediate stage in the life cycle of the tapeworm Echinococcus multilocularis. This is a rare disease restricted to very few areas of the world. The occurrence of this disease in India is now described for (so far as the authors are aware) the first time. Some unusual features of the disease are highlighted in this patient. The hepatic lesion had infiltrated into the right atrial wall resembling an atrial tumour. The ostium of the inferior vena cava was occluded, causing Budd-Chiari syndrome. The radiological and haemodynamic study of the hepatic outflow tract in this disease are documented.
The use of cross-sectional echocardiography in a general hospital
Authors: Brown A K , Anderson V
Published: December 2008

Three hundred and five patients routinely referred to a general hospital were surveyed to assess the advantages of cross-sectional echocardiography (CSE) over the conventional M mode method. CSE provided a dynamic display of the movement of the heart, particularly left ventricular function, and facilitated the location of cardiac structures. It was valuable in assessing the degree of mitral stenosis and the type of left ventricular outflow obstruction. Mitral valve prolapse, pericardial effusion, intracardiac tumours and congential heart disease were more easily diagnosed than by M mode techniques, but the origin of the basal systolic murmur still remained a problem. It was concluded that the 2 systems were complementary, and that CSE provided important additional information which improved the diagnostic capability of echocardiography.
Survial from acute renal failure with and without multiple organ dysfunction
Authors: Routh G S , Briggs J D , Mone J G , Ledingham I McA
Published: December 2008

A 10-year retrospective analysis has been carried out of 114 patients dialysed for acute renal failure. Fifty-eight patients, predominantly suffering from multiple organ failure, required treatment in an Intensive Therapy Unit (ITU); 56 less severely ill patients were treated in a Renal Unit. Overall survival in the former group was 36% and in the latter group 63%.

In the first 5 years of the study, survival in the ITU patients was 31% and in the second 5 years, was 38% in spite of a trend towards increased severity of illness. These results challenge the view that haemodialysis is rarely worth-while in patients with multiple organ failure, and suggest that current management techniques have improved prognosis. The most important adverse factors continue to be old age, sepsis and gastrointestinal disease.
Transient severe hypertension following alcohol withdrawal convulsions
Authors: Kennedy P G E , Moxham J
Published: December 2008

A case of transient severe hypertension following alcohol withdrawal convulsions is described. In the absence of other recognized causes of hypertension it was concluded that the hypertension was caused directly by the convulsions themselves.
Acute leukaemia in siblings
Authors: Harrison J F , Lilleyman J S
Published: December 2008

Unequivocal lymphoblastic leukaemia in a 4-year-old boy was followed 3 years later by equally unequivocal myeloblastic leukaemia in his 20-year-old brother. The boy achieved complete remission and remains well more than 6 years later whereas his brother failed to respond to treatment and died after 5 months. The parents and 3 remaining siblings showed no recognized features suggesting a constitutional predisposition to leukaemia despite thorough investigation.
Idiopathic granulomatous hepatitis and abdominal pain
Authors: Shee C D , Creamer B
Published: December 2008

Granulomatous hepatitis may present with abdominal pain. Four patients are described who had longstanding severe abdominal pain associated with this condition.
Acute renal failure due to gold
Authors: Robbins G , McIllmurray M B
Published: December 2008

A patient with rheumatoid arthritis is described who developed acute renal failure whilst receiving gold. This occurred despite the normal precautions of patient monitoring before each dose was given. The clinical picture suggests this was a hypersensitivity reaction to chrysotherapy.
LSD ‘flashback’ as a cause of diagnostic error
Authors: Smith J A , Walters G , Johnston D
Published: December 2008

An emaciated, but otherwise physically normal young man presented with an acute psychosis resembling hallucinogenic drug abuse. His behaviour was so strange that the underlying pathology of severe pyloric stenosis was only detected when a chance measurement of urea and electrolytes was made, revealing gross biochemical abnormalities. His abnormal mental state persisted for more than one week and an LSD ‘flashback’ was postulated as the cause of the prolonged psychosis
Angioneurotic oedema and urticaria following hydrocortisone--a further case
Authors: Ashford R F , Bailey A
Published: December 2008

It is still not commonly realized that immediate hypersensitivity reactions to hydrocortisone can occur. A rare case is reported which illustrates the need for caution when using this drug in atopic subjects. Ideally, parenteral hydrocortisone should only be used where facilities for resuscitation are available.
Double-blind crossover trial of oral meptazinol, pentazocine and placebo in the treatment of pain in the elderly
Authors: Pearce V , Robson P J
Published: December 2008

In a randomized, double-blind crossover trial in 30 elderly patients suffering from moderate to severe pain, the analgesic efficacy, tendency to produce mental confusion and side effect profile of meptazinol 100 mg orally were compared with those of pentazocine 25 mg orally were compared with those of pentazocine 25 mg orally and placebo. Both the active drugs produced significantly better analgesia than placebo but meptazinol also provided significantly better pain relief than pentazocine, whilst at the same time causing less mental confusion. Side effects were unremarkable. Meptazinol appears to be a better general purpose oral analgesic in this group of patients than pentazocine.
Leucocyte alkaline phosphatase in neonatal infections
Authors: Sharma S C
Published: December 2008

The leucocyte alkaline phosphatase (LAP) score was estimated in healthy and infected neonates. A leucocyte band count was also done simultaneously. The infected group showed a significant (P < 0.001) decrease in the LAP score and a significant (P < 0.001) increase in the band count. These findings are discussed.
Papaverine and hepatotoxicity
Authors: Pathy M S , Reynolds A J
Published: December 2008

Six of 14 patients receiving a sustained release papaverine preparation developed abnormal liver function tests. One patient had jaundice and another abnormal liver histology on a biopsy specimen. This is only the third report of impaired liver function following the administration of papaverine--a drug which has been used in clinical medicine for over 100 years.
Epidemiology of coronary heart disease. Lessons from North and South Belgium
Authors: Joossens J V
Published: December 2008

Differences in food intake, smoking and drinking habits in the North and the South of Belgium have been studied with the aid of household data gathered by the National Institute of Statistics, Brussels, 1973-74. Consumption of sugar, vegetables, fruits, crude fibre and meat was almost identical between the regions. Consumption of bread, fish and salt intake were slightly higher in the North and alcohol consumption higher in the South. The major differences were located in fat consumption. Saturated fat as a percentage of dietary energy amounted to 15·8% in the North v. 18·5% in the South; polyunsaturated fat was, respectively for the North and South, 7·9% and 5·5%. Dietary cholesterol intake was 320 mg/day in the North against 400 mg/day in the South. The difference in serum cholesterol, calculated with the Keys formula, was 11·9 mg%, a value totally consistent with the observed values.

The difference in saturated fat intake between the regions was almost entirely due to the difference of butter intake, thereby explaining why butter correlated so perfectly with mortality in different parts of Belgium. Similar correlations were found in France and Western Europe.

The mortality trends in both regions were compared with the available data on fat consumption over the last 15 years. Again a decreasing intake of saturated fat (less butter and less common (hard) margarine) was associated with a decreasing coronary, cardiovascular and total mortality in both the North and the South. The time-related decrease discussed in the second part was quantitatively similar to one obtained in the first part from geographical differences, making a spurious association extremely unlikely.

Similar dietary changes with identical results in terms of mortality have also been observed in the U.S.A. and Finland.
The role of essential fatty acids and prostaglandins
Authors: Crawford M A
Published: December 2008

The FAO/WHO Rome Report recommended an increase in the consumption of fat in countries where malnutrition is endemic; for maintenance, 3% of the dietary energy as essential fatty acids (EFA) may be adequate; in pregnancy and lactation an additional 1.5 to 2.4% energy as EFA is needed. For population at high risk for atherosclerosis and coronary heart disease (CHD) the recommendations were to decrease saturated fat in particular and increase EFA intake in the diet, reduce sugar, alcohol and cholesterol. These recommendations were similar to those of the Royal College of Physicians but the report went further by saying that EFA loss through industrial hydrogenation should be minimized and associated nutrients such as vitamin E and carotene should be restored if lost in processing. In terms of production, they asked for an increase in edible plant oils in developing countries and requested that intensive animal feeding and breeding should be corrected to avoid the excess accumulation of saturated fats. In addition, the Rome Report requested meaningful labelling of amounts and quality of fat in foods containing added fats. The basic aims of the Report were to state the position of lipid nutrition. The issue of the nutrient correction in terms of CHD cannot properly be discussed without taking into account the essential components which are needed for the integrity and development of the vascular system.
Dietary prevention of coronary heart disease. Effect of dietary fats on arterial thrombosis
Authors: Hornstra G
Published: December 2008

Epidemiological studies indicate that dietary saturated fats are implicated in coronary heart disease (CHD). Human prospective studies have shown that diets low in long chain saturated fatty acids and enriched in linoleic acid are beneficial in CHD-prevention. Experiments in animals have shown that such diets diminish atherosclerosis and the tendency to arterial thrombosis; they also lower the ability of platelets to aggregate in animals and in man. The mechanisms by which these diets produce these effects are not yet completely understood. Platelets and vascular prostaglandin-like substances may be involved as well as platelet membrane fluidity and platelet coagulant activities. On the basis of the available evidence, measures to decrease the intake of long chain saturated fatty acids (concomitant with an enhanced consumption of linoleic acid-rich products) are justified. Although certain marine oils may also have anti-thrombotic properties the possibility of undesirable side effects compels extensive investigation before their wide-spread use can be recommended.
Is diet an essential risk factor for coronary heart disease?
Authors: Ball K P
Published: December 2008

Cigarette smoking, hypertension and diet each play a major role in the development of coronary heart attacks in most industrialized nations. In some countries where cigarette smoking and hypertension are prevalent there is a low risk of coronary heart disease (CHD). Hyperlipidaemia resulting from national food habits appears to be the essential factor in the high rates of CHD in developed countries.
School catering: the place for change
Authors: Collins S C
Published: December 2008

The 1944 Education Act marked the foundation of the modern School Catering Service. A statutory duty is imposed on Local Education Authorities (LEAs) to provide a ‘mid-day dinner...suitable in all respects as the main meal of the day’. LEAs are free to provide meals consistent with broad nutritional guidelines of the Department of Education and Science but financial pressures have a large bearing on this. The traditional 2-course meal is still the norm, although there is a multi-choice menu for the majority of secondary schoolchildren. But a wide choice of food is incompatible with closely prescribed nutritional standards and pupils need to be aware of the implications for their health in the choice of food. The adoption of dietary recommendations for prevention of coronary heart disease would not generate serious practical difficulties for the professional caterer. The technical problems arising from minor adaptations in catering practice would be minimal in comparison to those of cost, education and hence modification of consumer demand. The move away from nutritional standards is likely to accelerate if, owing to financial constraints, the Government withdraws nutritional guidelines or removes the obligation on LEAs to provide a catering service. The danger is that financial considerations will override those of nutrition and a unique opportunity for health education by guidance and example in the schools may be lost.
The clinical features of migraine as a manifestation of allergic disease
Authors: Wilson C W , Kirker J G , Warnes H , O’Malley M
Published: December 2008

Patients with a clinical history of migraine were evaluated psychiatrically, and by electroencephalography. They were challenged with food antigens by skin-prick test, and abdominal symptoms were evaluated following oral ingestion of food allergens. A significant correlation was found between challenge with specific food allergens and the development of migraine headaches, the appearance of abdominal symptoms and the occurrence of positive skin reactions. Psychiatric abnormalities and EEG alterations were associated with the occurrence of headaches and allergic clinical features. It is suggested that the clinical features of migraine can be explained as a result of release of chemical mediators following antigen-antibody reactions in the brain and other tissues where specific antibodies are localized. The continuous ingestion of the responsible food allergens would account for the raised tissue concentrations of noradrenaline, histamine and other mediators to which the clinical features of migraine are attributed.
Efficacy of nifedipine in the treatment of angina pectoris and chronic airways obstruction
Authors: Jaiprakash S S , Sahay J N , Chatterjee S S , MacDonald G
Published: December 2008

Twenty patients suffering from angina pectoris with co-existing fixed or labile airways obstruction, were administered fortnightly treatment periods of nifedipine or matching placebo over an 8-week period. Maintenance treatment for their airways obstruction continued throughout this period. Nifedipine was found to be an effective drug in controlling their angina, and did not have an adverse effect on the airways obstruction. Both systolic and diastolic BP was reduced over a 90-min period after administration of a single dose of nifedipine.
Clinical distinction of cerebral haemorrhage and cerebral infarction
Authors: Harrison M J
Published: December 2008

The clinical features of 62 cases of computerized axial tomography scan-proved cerebral haemorrhage and 81 cases of cerebral infarction in the carotid territory have been compared in a retrospective case note survey. The clinical features which can help in making the distinction between haemorrhage and infarction at the bedside are discussed and compared with those of classical teaching which referred only to post-mortem proved cases.
Serum theophylline concentrations during multiple dosing with two sustained release methylxanthine preparations in normal subjects
Authors: Prior J G , Berry D , Cochrane G M
Published: December 2008

In normal subjects, receiving multiple dosing regimens with Slophyllin and Phyllocontin in does calculated to give either 4 mg/kg or 6mg/kg theophylline free acid twice daily, serum theophylline concentrations were frequently less than 8 mg/l. Accumulation of the serum theophylline trough concentration occurred during the first 3 days of multiple dosing, and was followed by subsequent stabilization or even decline in serum theophylline trough concentrations. Side effects were noted with both Slophyllin and Phyllocontin, but only on the higher dosage regimens; they occurred within 24--48 hr of starting the drug, and tended to diminish if dosing was continued. The accumulation effect of serum theophylline concentrations may explain the timing of adverse effects, and should be avoided by starting methylxanthine therapy at a low dose. This may be increased after a few days. Further dosage adjustment may be necessary in some patients and should be facilitated by measurement of serum theophylline trough concentrations.
Staphylococcal septicaemia, endocarditis, and osteomyelitis in dialysis and renal transplant patients
Authors: Nicholls A , Edward N , Catto G R
Published: December 2008

Septicaemia is a common and potentially lethal hazard of haemodialysis and renal transplantation; it is usually caused by Staphylococcus pyogenes. In 6 patients with S. pyogenes septicaemia, fatal endocarditis and spinal osteomyelitis have each occurred once, and 3 patients have had recurrent episodes of septicaemia. The management of septicaemia in these patients must include a search for metastatic infection, and prolonged therapy with 2 antistaphylococcal agents is necessary to ensure eradication of infection. Access site infection in dialysis patients must be treated vigorously, and recognized as potentially hazardous by patients. The risk of sepsis in dialysis and transplant patients cannot be excluded, but devastating consequences may be avoided by simple measures.
Tuberculous peritonitis: a review of thirty-five cases
Authors: Vyravanathan S , Jeyarajah R
Published: December 2008

The clinical course of 35 patients with tuberculous peritonitis notified in Kandy (Sri Lanka) over a 6-year period has been reviewed. The maximum incidence occurred in the age group 21 to 40 years and the female/male ratio was 3:2. Clinical features were non-specific and the main presenting features were fever (68.5%), abdominal pain (65.7%), abdominal distension (54.2%), abdominal mass (54.2%) and ascites (45.7%). The symptoms were of insidious onset and 85% had symptoms for more than one month. Chest X-ray revealed abnormality suggestive of tuberculosis in 47%. Intra-abdominal tuberculosis was suspected in 43% of 26 patients before laparotomy. Four of the 32 patients given anti-tuberculous drugs died. Overall mortality was 20%.
The effect of varying amounts of intravenous glucose on the metabolic changes after surgery
Authors: Swaminathan R , Bradley J A , Hill G H , Morgan D B
Published: December 2008

The metabolic effects of saline, 30 of glucose a day and 129 g of glucose a day were studied in patients after either cholecystectomy or highly selective vagotomy. In the saline group the blood ketone concentration increased to 3.3 mmol/l on the 5th day after surgery, but this increase was completely abolished by a daily intake of 129 g of glucose and almost completely so by 30 g of glucose. Urine nitrogen excretion expressed as nitrogen to creatinine ratio in the saline group increased from 42.5 to 66.2 by the third day after surgery, and there was a similar increase in the group given 30 g a day of glucose. However, 129 g/day of glucose completely prevented the increase in urine nitrogen, an effect which is similar to that reported in starving subjects given similar amounts of glucose. It is suggested that 129 g of glucose only prevents that part of the increase in nitrogen excretion which is due to starvation and that it has no effect on the increase in nitrogen excretion which happens as part of the metabolic response to surgery.
Treatment of tardive dyskinesia with choline and tetrabenazine
Authors: Snell A P , Cleary M , Sambrook M
Published: December 2008

A patient with severe tardive dyskinesia due to long-term neuroleptic medication is described. The 2 factors immediately precipitating the onset of the disorder appeared to be the administration of benzhexol hydrochloride and the sudden termination of neuroleptic therapy. the disorder was satisfactorily controlled with choline chloride and a small dose of tetrabenazine. The suggested mechanism of tardive dyskinesia is discussed.
Agranulocytosis associated with carbamazepine, and a positive reaction with anti-lymphoid leukaemia antiserum during recovery
Authors: Owens C W , Parker N E , Nunn P P , Davies J
Published: December 2008

Carbamazepine is a valuable drug in the treatment of trigeminal neuralgia and temporal lobe epilepsy. Rarely agranulocytosis has been described associated with its use but in this further non-fatal case a new finding of a positive reaction with anti-lymphoid leukaemia anti-serum was seen during the recovery phase.

A brief review of 18 cases in the literature is provided and it is noted that 94% of reported cases are over the age of 45 years. The significance of the haematological finding is discussed.
Unilateral pulmonary oedema and Pseudomonas pneumonia
Authors: Uppington J , Penney M D
Published: December 2008

A case presented clinically as unilateral pulmonary oedema; this was subsequently revealed to be due to unilateral Pseudomonas pneumonia.